Background

SFE has been working in Laos and inAttapeusince 1998. Four projects have been signed with the authorities. Each time, SFE has diversified, returning those accomplished to the authorities and continuing to follow those still in need. The first phase concerned the provincial hospital (construction and staff training), the second extended the activities to district hospitals. In the third phase, SFE developed an activity in villages with cases of Tuberculosis.

The current phase (the fourth) aims to develop the training of health supervisors and a community development activity in the villages. This last phase, signed by the Lao authorities in 2010*(almost a year after the expected date) will end in July 2013.

Since 2010, SFE has been gradually withdrawing from hospital construction and the purchase of medical equipment. The Vietnamese government will build a new hospital inAttapeu, and equip that hospital with new equipment, thus taking over from SFE in that area.

* Note: Projects signed with the authorities have always been for a period of 3 years. Each begins the day the official document is signed. Nevertheless there is always a delay between the end of a project and the signing of the continuation. When a NGO is known and a signature can be taken for granted, it continues working and advancing the program of the next project. In our situation the end of Project 3 was in September 2009. We were hoping a renewal signature in January 2010: it took place in July 2010.

An initial application to PPPAttapeuwas made for the period 2009-2011. This new application is for the period 2012-2013, to cover the whole of phase IV signed with the government.

Objectives

To improve overall health care in our area, multi-level, sustainable and for all.

The specific aims, considering the progress of work, have been readapted

1. to improve the health and living conditions in 10 target villages (cf., the community development project article).
2. to develop health supervisor training of trainers to reach an autonomous and dynamic training program
3. to improve management and support and to develop new income generating activities.
4. to improve the mother and child staff facilities in the provincial hospital.

1. Community development.

See the Attapeu Community Development project

2. Training of health supervisors:

SFE participation has already helped the Government in its efforts to build sustainable health facilities in the province. The long-term commitment of expatriate doctors and nurses who have learned the Lao language improves both cultural integration and creates a closer relationship of trust with the authorities. Recently young doctors with better training were sent to theAttapeuprovincial hospital. For the first time, these young doctors have the necessary skills to become trainers able to assure a training program for their dynamic and autonomous hospital. It is now essential to continue trainer training to create a pool of Laotian autonomous trainers. Previous phases have focused on training of trainers but the level of training of these trainers only enabled them to pass on knowledge gained from training provided by expatriate organizations. The trainers that we plan to train will have the ability to study independently, to keep updating their knowledge, to read scientific papers critically and to present clinical cases to an expert network (via internet).

SFE presence in the daily work has developed an appropriate improvement in the health service. ‘Companionship’ help identifies the needs and adapts to them in a specific way. Since 2008, two Lao doctors (two ladies: a pediatrician and internal medicine) have been appointed to become trainers at provincial and district levels. This training is done in coordination with other agencies: Health Frontier and the Swiss Institute of Tropical Medicine. Paramedical trainers have also been appointed. This training program requires long term support because these subjects are vast and the necessary skills are important.

A parallel partnership with the Department of Ambulatory Care and Community Medicine, University Outpatient Clinic, Lausanne, Switzerland (Policlinique médicale universitaire, PMU) is being developed. This partnership, being less dependent on fundraising and authorization renewal every three years with the authorities has the advantage of being easier in the long term. This should continue to develop training for Lao doctors, with internet and physical exchanges with Swiss experts.with the Polyclinic Medical University (PMU) is being developed. This partnership, being less dependent on fundraising and authorization renewal every three years with the authorities has the advantage of being easier in the long term. This should continue to develop training for Lao doctors, with internet and physical exchanges with Swiss experts.

3. Governance:

From the beginning of its work SFE has always provided advice and support in running and managing its hospital through the implementation of WHO recommendations concerning a provincial hospital and also at the request of the hospital: improving statistics, work monitoring in each service, inventory, maintenance, etc.. Finally, SFE is also involved in providing help to poor patients through a fundraising program of its own, and allowing the hospital to produce and sell spiruline.

4. Mother-child problem.

In a previous project, we wanted to create a day care center to enable mothers working in the hospital to leave their children rather than keeping them with them during their work time as staff in the hospital. During the planning phase this project received a very positive response from the mothers concerned. The practical and financial aspects of this project were finalized but it has had to be suspended following the announcement of the construction of a new hospital by the Vietnamese government.