Database Development in Laos

I have read your report and I congratulate you on a comprehensive yet succinct and very clear presentation. I enjoyed reading the document, which is something that I could not have said I expected in anticipation of it! We have also found it very helpful, in terms of the range of recording devices that it has pulled together, in the ongoing job of constructing our database. More of that later.

A little background first. POWER entered the victim assistance arena (P&O division) in 1994, after I had experience working with mine victims in Cambodia for two or three years. Our whole focus was on mine victims and the job of providing prostheses, mainly, to those victims. The experience of Cambodia was that all amputees were mine victims. I was taken aback on my first visit to our project in Mozambique to interview seven amputees awaiting treatment in our Nampula facility, to find that not one of them was a mine victim, nor even a war victim! We were funded by the Leahy War Victims Fund and I was going to have to explain to them that we were using their money to fit legs to people who had been bitten by snakes, attacked by crocodiles or stood in the way of railway goods wagons in shunting yards. Over the years, I have come to understand that our job is not to look after mine victims (well, yes, it is, but only as a part of a bigger scene) since there is no case for setting up parallel services and there is no virtue in mine victims as opposed to any other type of victim!

All of that is a very long-winded introduction to what our recording is all about. What we are concerned with is patient management. We want to establish a system that is capable of recording sufficient details of the patient for those purposes. Now, that is not something that your survey anticipated - the nearest that you come in terms of your categories is number 5 'The information is used as part of needs assessment for rehabilitation services.' Whether what we record is a satisfactory contribution to a special-interest group is another matter. Certainly, we record some of the details that you list from the various forms you have analyzed, and it is possible that our information is capable of being amalgamated with whatever you determine is the best outcome. Once our database is functioning well, we will share our information with UXO Laos who will be able to interview relevant patients in greater detail. We may agree to notify UXO Lao as soon as a new patient presents so that they can interview them immediately, or to adopt a system in which we carry out the necessary interviews in the clinics.

The thing is that we are serving a population of people with a disability, some of whom are mine or UXO victims. We are certainly interested in many of the same variables as are being listed in your forms, but I am not sure how relevant to our objectives are the questions on such things as the precise location of the incident, and the activity of the victim at the time of the accident/incident. I believe that this emphasis on a special-interest group, such as mine victims, will be ephemeral and will eventually go away because a significant relevance that it has is to those who are putting pressure on governments to ban landmines or, nearer to home, feel that the job of securing funds for the assistance of disabled people, benefits from being attached to some cause such as this. When it goes away, we are left with a patient management database! Is what we have good at that job?

The system that we are currently in the late stages of developing here in Laos, with the help of external consultants, is designed:

(a) To allow data to be recorded for the management of P&O services mainly to mobility-      disabled patients
(b) To be simple to operate and use in a country where literacy rates are low and familiarity      with computer skills not necessarily high
(c) To allow simple transfer of data, by modem, from the provincial centres to the HQ
(d) To allow cross tabulation of aggregated data
(e) To represent patient data on a map to permit tracking and contact plans to be facilitated

To conform to these sorts of requirements, the system (based in Access) relies substantially on multiple-choice with pull-down menus, so that the answer to, e.g., the cause of the disability will almost always be found in one of the responses on the pull-down. In this way, too, the address can be located by a fairly rapid process of interrogating a system in which Province leads to District, leads to sub-District, leads to village, doing away with the opportunities for spelling errors in entry etc. and utilizing the list of villages employed by the census. Looking at the map on the system, we can locate pockets of patients and rapidly home in on the locations and, thence, the names. And this eases the job of monitoring and evaluation.

I am attaching some files containing Word format forms that we have developed, showing the data that we collect. These are what we have converted to an Access database - which is rather too big to get on a diskette so I do not have it on the computer that I am working from. The yellow highlighted parts are data that may be of interest to your work. You will see the Activity at Time of Accident form that contains the type of information that goes on the pull-down menu. The hieroglyphics that you receive are what started out as Lao but cannot be printed out without a Lao script facility - and would not be understandable in that form, either, unless you are a Lao speaker/reader! [view forms]

We also have a programme here to assist and strengthen the (effectively new) Lao Disabled Peoples Association. This is a membership organization and, of course, represents all classes of disability: it is intended to operate through provincial branches. There are 18 provinces in Laos, so we shall end up with a major logistics problem unless we are careful. We are hoping, right from the beginning, to establish the membership data on the same database that we use for the P&O patients, slightly modified to allow information about other forms of disability to be recorded. Many of the same considerations will apply, with the remote recording of member details and the ability to locate where the membership is based. Since the membership management system is expected to operate on a cell system, the mapping facility will be of enormous importance.

In this case, you will see, we want to move outwards from our patient recording system to a wider audience, rather than inwards to a narrower audience. Having said all of that, I see no reason why the database that we are constructing here should not serve the needs of the IMSMA/GICHD etc community. We very much believe that all of our data collecting activities, in different countries and for different purposes, should be coordinated to provide helpful, agreeable statistics on a global basis. We think that there should be a single information collection form, so that victims/patients can be clearly identified, we can avoid duplication, and information can easily be shared within countries and compared between countries.

I do hope that this has been helpful in some way. Certainly, your report has been immeasurably helpful to us in putting together our system and I repeat my admiration for the job that you have done.

With best wishes,
Mike