Evolution of the Lao-Luxembourg Heart Institute towards functional independence.

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Dr. Richard Schneider

discours-photo2In 2013 we celebrate 10 years of heart surgery in Laos as well as the 15th anniversary of the foundation of our NGO. Laos, a small country with 6.4 million inhabitants, is one of the poorest according to the United Nations World Report on Human Development. ADS has decided to help the development of the country in the cardio-vascular area. In the prevailing situation, it is mostly the poorest and underprivileged part of the population that has no access to medical care. ADS has chosen to concentrate its efforts on rheumatic as well as congenital heart diseases as they affect young patients, children and even infants. An appropriate and timely treatment can quickly change the course of their lives. ADS believes it is a rational way to make its contribution to the fight against poverty and for the improvement of the lives and the prospects of a very large number of young patients.

ADS began working in Laos in 2002. In the intervening years, a lot of progress has been made. Medical and surgical teams had to be created from scratch. Training took time; it entailed specialized training placements in European and Asian countries as well as long and well-planned training throughout Laos. The aim was to endow all the personnel involved with a high level of knowledge about the disease and a deep understanding of it, as well as train them to a high-level performance in medical techniques. This has been achieved: open-heart surgery is performed on cardiac patients in the country by a well-trained Laotian team; the Laotian doctors have taken charge of the entire process of treatment. To this day 1,200 patients have been operated on in a dedicated structure, the Lao-Luxembourg Heart Institute. The results are excellent, with extremely low mortality and morbidity rates similar to those in western countries.

After 10 years of training the Laotian surgeons are now able to operate on all the adult cardiac pathologies on their own without outside help, but ADS will certainly remain indispensible to take responsibility for the poorest patients and the most complex cases such as congenital cardiopathies.

The next step is to consolidate the project by reinforcing knowledge, by the development of screening for congenital and rheumatoid cardiopathies, by increasing the involvement of the Laotians themselves in taking charge of therapy and, crucially, of management.

A course for training specialists in cardiology has been created at the Medical Science Faculty of Vientiane University, leading to a real specalist diploma. After three years (2008-2011), this has produced the first 10 specialist cardiologists in the country.

In the region of Champassak, one of the poorest and most populated, ADS has run a public health programme to determine the incidence of ARF among the infant population, together with a prevention programme. The results of the ultrasound pilot project (2008-2011) covering 20,000 children in schools will be used for public health purposes.

It is now a well-known fact that the doctors of the Institute have acquired an expertise in recruiting patients who now come from all over the country.

To improve the medical cover even further, ADS engages in decentralised screening campaigns and, during its missions, organises specialized consultations in the principal provincial cities, notably Paksé, Savannaketh and Luang Prabang. To allow cardiac patients to be cared for in better conditions in the provinces, and to enable the immediate selection of those patients who will have to have surgery in Vientiane, we inaugurated two cardiac intensive care units in February and June. In parallel we have continued with in-service training for the medical and paramedical staff in the provinces and in Vientiane. We have also installed a telemedicine network connected to the Institute which will lessen the medical isolation of the doctors working in remote areas by allowing them to contact specialist reference teams. Telemedicine is also an important tool for training health professionals as it obviates long and costly travel and ensures continued medical activity on the spot.

Another aspect has become increasingly important since ADS started work in Laos, i.e. the problem of hospital management and health economics. A lot remains to be done in this area as the idea of a high-performance, efficient, modern management is only in its infancy. Courses have been organized, and their implementation on the ground gives rise to high expectations. A positive outcome would turn the Institute into a pilot institution which would form the basis for a major restructuring of the hospitals in the country. It is imperative that the development of the means and objectives of hospital management should run in parallel with the determination to establish financial and economic autonomy. ADS is strongly committed in this area, but also remains dependent on the local administrative and political determination. ADS still has several years to go to approach this goal and win its challenge. The organigram published by the Laotian Ministry of Health and the Ministry of the Interior gives rise to some hope for the development of hospital management.

The objective is now to assist the Laotians with organizing their management in such a way that they become able to run the Institute on their own and to become gradually independent for a large part of paediatric cardiac surgery treatment.

Despite the enthusiasm shown by the ADS team, these results could certainly not have been achieved without the support of

  • the numerous, often unknown donors. May they here receive the thanks and the gratitude of all the children treated with their support;
  • the Luxembourg government which, through its policy of international cooperation aimed at developing countries, has provided substantial financial resources without which a project of this magnitude could not be undertaken;
  • the Laotian government which, through its confidence and its commitment, has been the indispensible driving force behind the success of the improvement to the health and thus the wellbeing of Laos;
  • all the Laotian participants, whether they be doctors, nurses or engineers who committed themselves body and soul to this project.

The ultimate objective remains the provision of high-quality health care to every person in Laos; the results achieved and the commitment of the Laotian participants oblige us to continue our human and financial support with a view to provide a long-lasting assistance for the benefit of the cardiac children.