Tag Archives: Laos

GNU Health: Helping Laos Heal from UXO physical and emotional trauma.

25 Saturday Jul 2020

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Luis Falcon with the Lao CMR staff in charge at the 2 year anniversary of the implementation
GNU Health implementation anniversary at Laos Center of Medical Rehabilitation

Laos is one of the most heavily bombed countries in the world. During the period from 1964-1973, over 2 million tons of bombs were dropped by B-52 aircrafts across the 2/3 of the country during the “Secret War”. This nine-year period bombing caused thousands of deaths and a unprecedented human displacement that exceeded a hundred thousand civilians from the poorest areas of the country.

The tragic legacy of that period remains today. Thirty percent (30%) of those bombs remains active (Unexploded Ordnances – UXOs – ), causing over 300 victims every year until 2008, and now down to 50 / year. Nearly 60% of the UXOs accidents result in death, and 40% of the victims are children[1].

If the explosion does not kill the person, it causes severe traumatic injuries resulting in the amputation of limbs in many of the victims. Physical and emotional trauma that takes many years to heal. In addition, many UXO victims suffer from Post-traumatic stress disorder (PTSD), a serious condition that can be devastating for the victim and their families[2].

But there is hope. The wonderful people from Laos are resilient, and they are willing to cope and move forward. I have been in Laos several times in the last few years, in the context of GNU Health implementations both in Mahosot Hospital and the Center for Medical Rehabilitation – CMR – .

The Center for Medical Rehabilitation (CMR), located in Vientiane, is a specialized institution that helps people with disabilities and victims survivors of UXOs. The CMR, formerly known as the National Rehabilitation Center initially provided prosthetic limbs for victims of war. Today they have extended the services to provide services to children with disabilities across the country. Some of the services include medical and community based rehabilitation, special education for the deaf and the blind and vocational school for people with disabilities.

At the moment I had the meeting with the hospital directors, I knew that we had to focus both in short term surgery as well as in the long term psychological, physiotherapy and occupational therapy that would allow the person to be fully functional in the society. Again, I was facing a project in need of Social Medicine.

We trained a local multidisciplinary team of nurses, doctors, physiotherapists, social workers, computer scientists, psychologists, administrative personnel, pharmacists and accountants.

CMR nurses. The heart of the institution

It was during that period that I created the package “functioning and disability“.

General patient information and Functioning & Disability tab. Red boxes on these two sections denote UXO related information

Some of the GNU Health functional modules that CMR decided to use included surgery, socio-economics, ICD-10, nursing, physical therapy, stock, accounting, lifestyle, reporting, health services and diagnostic imaging, among others. In addition to those, we included the “functioning and disability” package.

The GNU Health “Functioning and Disability” package integrates the ideas of WHO Health Organization International Classification of Functioning, Disability and Health. This functionality complements the ICD-10 classification of diseases, with the concept of functionality. For example, after a person has been diagnosed with diabetes, we must go beyond the biology and molecular bases of the disease, and evaluate how diabetes impacts of on her daily activities and integration in the society and environment.

GNU Health contextualizes the health condition in the particular individual, key for personalized medicine. In the UXOs example, the related ICD10 codes are visible from the main chart:

  • S88 : Traumatic amputation of lower limb
  • F43.1: Post-traumatic stress disorder

This diagnostic information is relevant and key for epidemiology and statistics, but if we want to practice medicine, we must take into account the social aspect of these conditions, and how they affect the person in her particular environment.

The GNU Health Functioning and disability assessment has two sections. The first section is a summary of impairments related to the Cognitive, Visual, Hearing, Speech, Hand, Mobility and Activities and Participation .

The second section is a detailed assessment of Body functions, Body structures, Activities and Participation and Environmental factors and barriers. Each of these groups has its own set of qualifiers and components that will provide the health professionals where to put the focus to the time and the context of that person, as well as to evaluate the progression of the conditions.

We can now study, with a multi-disciplinary team, how the body structure and body functioning impairments relate to the person capacities and engagements in social activities; daily household tasks; using the current public transportation system or the level of access to Labor and employment services.

This is my concept of medicine, the assessment of the bio, psycho, social determinants of health and disease. Medicine is, first and foremost, a social science, and GNU Health is first and foremost, a social project.

Example of GNU Health person functioning and disability assessment

Celebrating the success of cooperation: During a two-year period of using GNU Health, they have provided over 67,000 medical services, automated their finances, prescriptions, stock management, medical appointments and evaluations, diagnostic imaging, and the demographics tracking for the thousands of patients they assist.

CMR Cope team helping people in Lao rural areas

Local capacity building: CMR trained its own local group of professionals who customize and maintain GNU Health, in their own Lao language. This creates a local and ethical business model, very important for the long-term sustainability of the project.

A well-deserved award. The work that CMR has been doing in Laos for the rehabilitation of their people has been magnificent. Their multidisciplinary approach to trauma, from the acute care and surgery, to the physical therapy and the work in the field is an example for many of us. CMR has helped thousands of people every year healing from the UXO physical and emotional scars, moving forward and being able to get re-inserted in society, and we are so proud to have been part of it.

A delegation of the Laos Ministry of Health presented at GNU Health Con 2016 the implementation in the Lao Center for Medical Rehabilitation – CMR – and in Mahosot hospital. We are so proud that they are part of the GNU Health community.

CMR received the GNU Health Social Medicine Award in 2016 for best Institution.

  1. – Somnuk Vorasarn, Chansaly Phommavong, Khonephet Sely. GNU Health in Mahosot Hospital – GNU Health Con 2016
  2. A cross-sectional community study of post-traumatic stress disorder and social support in Lao People’s Democratic Republic

GNU Health, the "Dok Champa" blooming in Lao

06 Friday Sep 2013

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National flower in Lao, the Dok Champa is a symbol of sincerity and the beauty of life. Likewise, the Center of Medical Rehabilitation (CMR) in Vientiane, capital city of Lao, is a pillar of pure honesty and compassion, dedicating their efforts and knowledge to promoting the best services for deaf, blind or otherwise disabled people. This week a team at CMR announced they will be incorporating GNU Health to their healthcare center. For the first stage of the project, the hospital will be implementing key modules such as Administration, Patient Registration, Accounting/Finances and Billing. 
Heading this enterprise will be the Director of the Center, Khamphet Manivong, along with Bounmy Sihaphom, Sisouvanh Sangbouaboulom and Anousak Souphavanh,
IT consultants from Calat.

 

This healthcare facility, formerly known as the National Rehabilitation Center, was established in 1964, comprised of the following departments:
  • Orthopedic workshop
  • Wheelchair workshop
  • Medical Rehabilitation
  • Community-based Rehabilitation
  • Special education for the deaf and the blind
  • Vocational school system for the disabled
However, it was not until March 29th, 1968, that the CMR officially opened its doors, providing physiotherapeutical treatment through an extended service across the country. It was originally the orthopedic workshop where prosthetic limbs for veterans and war victims were produced.

Nowadays, this center is rather renowned for its unique services for the unexploded ordenance (UXO) victims after the Vietnam War. The Hospital manages a total of 100 beds in different buildings and specializes in physical medicine, orthopedic surgery, prosthetic and orthotic fitting, as well as in physiotherapy and special education for blind and/or deaf children. Not only are they committed to the improvement of health conditions, but the center aims at changing the quality of life of every person they can reach. When it comes to their educational programs, this is what the hospital stated: “This is a significant step towards fulfilling the obligations of providing the fundamental rights of all our kids with disabilities to have equal access to mainstream education”.
 

It’s not over yet: the silent murderers attacking Lao

“The war is simply an obscenity, a depraved act by weak and miserable men, including all of us who have allowed it to go on and on with endless fury and destruction – all of us who would have remained silent had stability and order been secured. It is not pleasant to say such words, but candor permits no less”.

 

Noam Chomsky, in American Power and the New Mandarins (1969)

 

More than 30 years after Saigon’s fall, tipping point that ended the Vietnam War in 1975, the government of Lao is still asking the international community to sign a new agreement that forbids the use of cluster bombs.

During the Vietnam War, American airplanes dropped millions of bombs, many of which failed to explode when they hit the ground, but are yet still active today in the jungle. It is a war of the past that keeps murdering generations of the present.
 

5 things you should know about Lao

  • Capital city: Vientiane
  • Population: 6.5 mio (2012)
  • Government: Marxist-Leninist single-party state.
    • President: Choummaly Sayasone
    • Prime Minister: Thongsing Thammayong
  • Area: 236, 800 km2
  • Currency: Kip (LAK)
  • Official language: Lao
 


Laos Regions Map
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National Anthem of the Lao People’s Democratic Republic: “Pheng Xat Lao”

 
  1. Lao appoints 4.5% of its GDP to healthcare (2013)–more than Monaco, Saudi Arabia and India, for example. However,  there is one physician every 3000 people and one bed every 1000 people. Interestingly enough, one in every 10.9 jobs belongs to the tourism sector (2010).

     

  2. During the bellicose period from 1964 to 1973, 260 million bombs fell on Lao, making the country (on a per capita basis) the most heavily bombed civilian population ever. Of these, around 80 million cluster bombs failed to explode, so most villages have unexploded ordnance (UXO) on display salvaged from the forest and rice fields. Alas, thousands of Laotians die every year because of this unwanted war veteran.

     

  3. The internet domain for Lao is .la; there are 1,532 internet hosts (2012) and 300 thousand internet users. Moreover, there are 5.481 million mobile cellulars (2012) for a 6.5 million population
  4. Most of the basic words of Lao have only one syllable. Multi-syllable words are usually higher level and used in religion, academics or government. They were taken mainly from Sanskrit, the classical language of India, and are often the same as or similar to high-level vocabulary in Thai.
  5. The Mekong River runs like a major artery for the length of the country and its vast network of tributaries allow both locals and visitors to reach the remote interior. The WWF organization affirms that a new species is registered every two days in the Mekong area.