4ms minutes on april 30, 2009

MEDiCAM successfully conducted its Membership Monthly Meeting (4Ms) on April 30,
2009 at Chamkarmon Referral Hospital, No. 130, at the corner of street 294 and Norodom
Boulevard. The meeting took place from 2:00-5:00 pm with the following topics: 1)
MEDiCAM short announcement and swine flu update, 2) Cambodia MCH Handbook and 3)
the Secondary prevention of disability.

1. MEDiCAM 4Ms Swine Flu Update
MEDiCAM presented a swine flu update to its members in the meeting. Swine Flu is a highlycontagious respiratory disease. It is caused by one of several swine influenza A viruses(A/H1N1). The virus normally infects pigs, but has the ability to be transmitted to humans. It wasreported that the virus has changed its structures and developed the capacity to pass fromhuman to human rapidly when the infected patient has contact with non-infected persons.
It was reported that the disease, initially occurred in Mexico and rapidly spread to the US, Canadaand it has now been transmitted globally. This caused WHO to alert all countries all over theworld to the potential of a pandemic. “It is pretty miserable”, Dr. David Bulter-Jones, Canada’sChief Public Health Officer said. The death tolls hit 159 globally. Of these, 149 cases werereported in Mexico. The suspected cases in Mexico have reached 1,614 up from 1,324 aspreviously reported by the media.
Symptoms of the swine flu are very similar to those of seasonal influenza. If people feel ill, theyare advised to stay home from work and school because an infected person can spread the virus24 hours before symptoms actually start. If symptoms are experienced and the believe is that theperson has swine flu, the advice is to call a physician before making a trip to see them and tothen follow the advice on how to proceed.
It was imperative to note that the Ministry of Health (MoH) has issued temporary advice toenhance surveillance, April 27, 2009. The medical clinics were asked to report any unusualrespiratory illness in hospitals, HCs and airports. The MoH has prepared stockpiles of variousresources, medication and treatment for intervention and in addition, has worked closely with theWHO to prevent the rapid spread of swine flu in Cambodia. However, no vaccines are currentlyavailable for SF treatment. As an interim measure, Tamiflu can be used to treat the disease untilnew vaccines are developed that are effective against the virus.
Ms. Kyoko KOTO asked about the availability of vaccines for treatment when the patients getinfected. Mr. Ham Hak replied: “Cambodia has only 15, 000 doses of Tamiflu in its stockpiles”.
More significantly, no case has been reported in the country.
Global actions have been highlighted and are being undertaken. The U.S. government declared apublic emergency. World Bank has lent Mexico $205 millions to deal with the outbreak. Russia,China and Thailand have banned the import of pork from the U.S. Mexico and Canada. Inaddition, “International travels should not be restricted, but actions to prevent the fearful spread ofSF need to be undertaken”, WHO said in its statement. “WHO will facilitate the process needed todevelop a vaccine effective against A/ (H1N1) virus”, the statement read.
2. Cambodian Maternal and Child Health (MCH) Handbook
Dr. Hang Vuthy said that the perinea period is the most difficult time for intervention. Manywomen in the rural areas deliver babies at home. The perineal period stands as a black box tohealth professionals when information is least available. Therefore, the health professionalswould not be able to intervene on time. “This happens throughout the country”, he added.
Compared with CDHS 2000 and 2005, the mortality rate of child under 5 years had decreasedsignificantly—124 per 1000 live births in 2000 and 83 in 2005. The infant mortality rate decreased95 and 65 respectively. “Although the infant mortality rate have decreased remarkably, it is sad tothe see that the maternal mortality rate was reported to have been increased from 437 to 472 perlive births”, CDHS 2005 read. The high level of maternal deaths may indicate that the stillbirthsand neonatal deaths had not been properly reported.
Most life-threatening episodes for mothers and babies occur around the delivery periods. “It isnecessary to have continuous monitoring system throughout pregnancy period in order to getaccurate information in which the MCH Handbook is a tool for establishing such a system”, Dr.
Hang Vuthy said.
The Cambodian MCH Handbook was introduced in December 2007 in Ponhea Krek, Dambe andMemut operational districts, Kampong Cham province and its interventions are in Chong Cheahand Da health centers. The MCH Handbook was distributed to all pregnant women in theintervention areas. The pregnant women live outside the intervention areas can also receive theMCH Handbook. However, it was not recorded in the study. “The pregnant women who give birthwith twin babies will receive two handbooks, Dr. Hang Vuthy said.
The MCH Handbook has covered 89.3% in Ponhea Krek-Dambe operational district, whilst theMCH Handbook covered only 77.4% in Memut operational district. “70 to 85% of pregnant womenhave completed the book properly; others have missed completing parts of the book or completedparts inaccurately for example, recording husband’s education background, last menstruation,child identity and number of miscarriage”, Dr. Vuthy said.
Obviously, the MCH Handbook has increased mother health awareness and it is thereforepromoted the conversation between couples on maternal and child health.
Although the advantages have been clearly identified, accurate and complete recording in thebook is still to be achieved. Child records are difficult to find and the columns for the antenatalgrowth chart are too small to fill in. The midwives take more time to properly complete the record.
In addition, the quality of the cover page needs to be improved in order to write on it legibly.
All in all, the mothers have shown their satisfaction with the MCH Handbook because it givesthem health education and a reminder for when they need to have their routine medical checkup.
Carrying her MCH Handbook with her, Ms. Kun Tha is 19 years old. She is 6 month pregnant.
She has 3 antenatal visits. Two days after her last visit, she came back to the health center againfor her antenatal checkup, for she has a severe abnormal abdominal pain.
Despite the increase of time required with filling-in the book, the health workers welcomed theMCH Handbook. However, the MCH Handbook needs to be revised before it is used to train thehealth professionals.
3. Happy Child Project Cambodia (2009 Update)
It was reported that the rate of persons with disabilities is 4.7% of the total population inCambodia. Almost half of the disabled people are under 20 years of age. No preventive care atbirth makes them disabled. The children are the most marginalized groups in society.
“In addition, the child mortality rate is sky-high compared within the region”, World Bank reportedin 2006.
The study on the cause of children with disabilities was conducted in Takeo and Siem Reapwhere the major findings were found. The study focused on the demographic information, theweakness and difficulties in action, history of disability and the knowledge-based implementationof activities relating to their healthcare attention.
Evidence shows that 71% of the respondents were housewives, in which their children arechildren with disabilities. Of the 500 respondents, each family has 4-9 persons with disabilities.
47% of respondents said that they had never attended school at all.
One fourth of the children with disabilities have seeing and hearing difficulties. However, none ofthem has contact lens or hearing assistive devices to wear. But half of children with movementdisabilities are provided with assistive devices. In addition, 53% of children with disabilities havemovement difficulty due to psychological problem. 42% others are painful. 55% of them reach theschooling age. Sadly, they are only able to attend school at grade 1 and grade 2.
It was reported that 40% of the respondents said their children had been disabled at birth. Othersare disabled through disease.
The study shows that 3/4s of the communities understand that they can be easily affected bydisease due to inadequate sanitation, poverty and malnutrition. They only have access toinformation on health through the mass media and from meetings in the villages. Every familyalways sends a family member to attend the meetings in the villages. However, financial barriersprevent them from attending the meetings regularly.
Mr. Prum Rithy, HIB Project Officer, however, said: “It is difficult to teach the families of childrenwith disabilities to have access to health services when the diseases are not clearly identified”.
Also, it is hard to strengthen the referral system, for the experts on hearing and seeing difficultyare under-staffed. “The communication between the national level and the provincial level andbetween the operational districts is still a major concern. In addition to this, discrimination of thechildren with disabilities in the rural community continues to happen.
Responding to these said concerns, HIB will work closely with the relevant stakeholders anddisability organizations and the Maternal and Child Health Program to design the program tomeet them. It was said a committee to strengthen and promote awareness raising is to beestablished and the network’s meeting should be regularly conducted. “HIB will work closely withthe existing institutions of the Ministry of Health and the Ministry of Education to disseminate theconcerned information”, Mr. Prum Rith added.

Source: http://www.medicam-cambodia.org/activities/info/4ms/source/2009/4/Apr_09.pdf

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