Sjukvårdsprojekt i samarbete med det kristna sjukhuset Aide Yiyuan i Yiyang, Henan-provinsen, Kina.

Sammanfattning av projektet:

Insatsen innebär att stöjda uppbyggnaden av ett rehabiliteringscenter. Rehabilitering är ett eftersatt område i den kinesiska sjukvården och sjukvårdspersonalen har ofta dålig utbildning i ämnet. Många patienter förstår inte heller vikten av träning. I området kring Yiyang pågår bergssprängning och gruvarbete. Olyckor är inte ovanliga. På rehabiliterings- avdelningen får patienterna, ofta unga män, undervisning och hjälp att komma tillbaka efter olyckor. Sjukhuset i Yiyang har också en sjukhemsavdelning. Stroke till exempel, är en vanlig diagnos. Även dessa patienter får stor nytta av rehabiliteringsavdelningens utökade resurser.

EÖMs projekt fokuserar på utbildning för sjukvårdspersonalen och inköp av rehabiliteringsutrustning.

Ansökan till Svenska Missionsrådet, SMR, en ekumenisk sammanslutning som bland annat ansöker om medel från Sida åt sina medlemsorganisationer:

To the Swedish Mission Committee

Our hospital, Aide Hospital , from Yiyang county, hereby applies for the support of Your Honourable Committee to develop our rehabilitation ward into a rehabilitation centre for disabled people.

The project needs the following resources: six treatment rooms, 300 square meters for activity and training, 18 patient's rooms, 30 beds, bedclothes, wardrobes, bedstands, lamps etc, altogether a start-up capital to the amount of 210 000 RMB. We would need a medical staff of 24 people and other service personnel of 12 people. Everything listed above would be provided by the hospital. The following: 20 000 RMB for the training of physicians, 40 000 RMB for the training of nurses, 40 000 RMB for indoors rehabilitation equipment, 60 000 RMB for outdoors equipment and 100 000 RMB for rehabilitation courses for patients - in total, a sum of 260 000 RMB - would depend on contributions from the Swedish Mission Committee. We therefor apply for 260 000 RMB for the first year of this project.

For the second year we apply for another 100 000 RMB. 60 000 of these will be used for further education of the medical staff. 40 000 will be used for purchasing additional medical and rehabilitation equipment.

For the third year we apply for another 50 000 RMB. During the third year of the project we hope to further develop our rehabilitation center and our home for the elderly to be able to receive more patients. This means we will need to hire more staff, give them them further education in rehabilitative care and purchase more equipment. The 50 000 will be used for this purpose.

1. Background

• Aide Hospital is situated in the province of Henan and is a county belonging to the city of Luoyang. The size of the county is 1651 km2 consisting of 374 administrative units. The population of Yiyang is 644 500. Swedish missionaries from the Swedish Mission to China (EÖM) established a church in the city of Luoyang around 1905. Shortly after they started work in Yiyang which became an outstation to the Luoyang church.
• Our country is a country under development. The population is aging. A vast majority of the old people has a very low educational background. Their knowledge in hygiene and health care is very limited. The living standards are low, which causes high rates of geriatric illnesses, especially with hemiplegia (stroke), spinal neck problems etc. These illnesses require much rehabilitation but there is no rehabilitation centre run by the government in the area. The government does not have the financial resources to open one. But more importantly such a centre does not seem to have high priority.
• Our hospital serves as a church hospital. It has a rehabilitation ward and special housing for the elderly. The rehabilitation ward is small. We do not have the capacity to receive all the patients who come to us. We would like to be able to help people with very low living standards who need rehabilitation, in our county and in the surrounding counties; to give them better access to medical care and rehabilitating training. The medical staff at our hospital has the technical skills and the spirit needed for this project.
• Since our hospital is a church hospital, most of the people working there are Christians. Besides treating the patients' illnesses they can also evangelise. In their medical work they can show the love of Christ and spread the gospel. Their care will help the patient to a state of peace in the midst of their medical treatment.
• Pastor Jan-Endy Johannesson from the Swedish Evangelical East Asia Mission showed an interest in the project when visiting us in April 2004. The Mission founded the church in Luoyang in the beginning of the last century and shortly afterwards Yiyang became an outstation to the Luoyang church.

2. Problem analysis

• The basic establishment of the rehabilitation ward is poor. It lacks equipment and the existing facilities are old. There is a shortage of medical staff and the knowledge in rehabilitative care is under-developed. The reason for this is that the hospital lacks financial strength. We can not up-date the equipment when needed. We can not regularly send the staff to participate in training courses. We hope to be able to solve the problems mentioned above with financial support, enabling us to renew our equipment and train the medical staff, so that we can give the best medical care possible and also spread information on prevention.
• The project has already been approved and validated by the County Government's Office of Civil Administration, the Bureau of Religious Affairs and the County Board of Health. The Christian church of the county leads and supports it wholeheartedly.
• Since our hospital is run by the church and is a non-governmental institution, the state does not, at present, give any financial aid to this kind of project.
• The County Government and the County Committee presently show an active interest in our rehabilitation ward and the special housing for the elderly. Their policy towards us is favourable. The County Government official has been to the hospital on several occasions to inspect the work. He has, through the Luoyang Board of Health, given the hospital, a non-profiting medical institution, authorization to open a ward for the elderly and a ward for rehabilitation.

3. Local organisation

• Our hospital stands under the direct leadership of the church. The church itself is under the supervision and support of The Three Self Movement and China Christian Council on a county level. The Hospital is firmly supported by the church. It is also supervised and guided by the Bureau of Religious Affairs and by the Board of Health. At our hospital there is a group of strong believers, devoted to the medical profession, who are willing to offer a whole life's service in working with health care. Our contact with our Swedish partner will be mainly through the hospital staff and if needed also with the church leadership.
• Our hospital often organizes the medical staff to come to the church to give free consultations to patients and to participate in the church's studies and training courses for service to the church. We often organize medical groups to go to the countryside and offer free consultations and spread information about hygiene and health care. During the work we continuously listen to the patients' suggestions and requests to improve the hospital's facilities. At the hospital there is a clerical department with a hospital pastor. The department organizes the Christians at the hospital to pray for the development of the hospital and for the recovery of the patients.
• Through the Christian Two Committees in Luoyang (Three Self Committee and China Christian Council), we have come in contact with the Nanjing Amity Foundation . The cooperation with them will focus on the basic conditions of the hospital buildings. They will also invest partly in the medical instruments. Our cooperation with Amity Foundation does not only mean that we receive financial aid from them. For instance, the hospital chief has attended courses held by Amity Foundation. These include courses in hospital management and in how to start educational programs (for example art or caligraphy courses) for disabled people as a part of their rehabilitative care. Our hospital also has regular contact with Amity. We report our work achievments to them and they give us advice and guidance. We will also consult them on how to make this project develop further, to other clinics, run by churches in the surrounding neighbourhood.
• Our hospital came in contact with the Hong Kong Tianlin foundation when the foundation was working with medical projects in Henan. The cooperation with them will focus on improving the buildings for medical treatment. They will also invest partly in the medical equipment.
• At present our county does not have any organisation receiving contributions from the Swedish partner.
• We do not have any other cooperation partners.
• Our hospital is a health care institution. Its worldly role is to saving lives and treating the sick. Before God we are bearers of the Gospel.
• Since our hospital has always held the love of God in high esteem, it has gained a good reputation among the patients. In our work we do not only cure the body of it's pain but also share the love of God with the patients while helping them, bringing life back to crippled bodies. At the same time we constantly strive to improve ourselves.

4. Organisational development

• We should train our staff to reach a good medical skill and through projects see to it that the staff's medical skills increase continuously. We should continuously spread information and teach patients about medical treatment and rehabilitation. It should be pointed out that a loving and dedicated theological ideology is not enough. We also need advanced scientific skills. We need to value theology as well as pay attention to science and confront the actual situation.
• After the first year's courses we will make an evaluation of the content of the courses and investigate how well we have been able to incorporate our new knowledge in our daily work. We will try to identify problem areas and focus the second year's courses on these areas.
• If a rehabilitation centre, that can provide a good medical service, is established, it will help more people become rehabilitated. More disabled people will be able to break away from their handicap and regain strength and health. It will relieve many families of their burdens and contribute to society and make it possible for these people to make their own living.
• The responsibility for the development of the organisation lies upon the rehabilitation centre after it has been established. In a near future we hope to be able to encourage and support other churches and clinics to start similar projects working with the handicapped and the elderly. As our staff is educated in this special medical care, they will be able to help and guide medical staff at smaller hospitals in the sourrounding villages.
• The hospital is small. We already work with educational campaigns but the range of our work is limited. As the center developes it can serve as a base for future projects. Some of the equipment purchased (for example a VCD-player for showing educational videos) can be used in future projects. We are already working with a campaign on HIV/AIDS-prevention and we welcome the policy on AIDS that our Swedish partner has translated into Chinese (the PMU-policy) and will study it closely hoping to adapt it in our country.

5. Target group

• The target groups for this project are:
  

  1.	the physicians and nurses at our hospital who will undergo special training for rehabilitative care.
  2.	patients (with very poor financial situations) who will receive treatment for free and be compensated for their cooperation in the training program.
  3.	patients who will have access to rehabilitative care at the centre for a low fee or for free (depending on their financial situations) after the training courses for the staff are finished.
  4.	the family of the patient is an indirect target group whose life will be greatly affected by the project. They (and especially the women) will have more freedom when the patient is admitted at the hospital and in the future when the patient needs less care or even recovers enough to be independent.
  5.	people not directly connected to the patients or the hospital who sees or hears about our work learns about the church as an institution of love and and compassion for our fellow man. Through our work we want to show people the love of Christ.

• Our goal is to provide service to people of the poorer social classes with congenital or acquired handicaps, or people who has been disabled because of illness. To let the patient come to the rehabilitation ward to receive training under the guidance of the physician for a minimum expense. This will ease the burden on the patient's family and make it easier for them to work.
• In the more undeveloped rural parts of this area there is no equality between men and women. The idea of men being more worth than woman is still predominant and handicapped men are more accepted by society than handicapped women. Men with handicaps more often get some kind of transportation that makes it possible for them to move around whilst handicapped women often are hidden in their homes and seldom get out. Also in families with a handicapped family member it is always the mother/wife who stays at home and takes care of the patient. Our rehabilitation ward accepts women as well as men. This means many women, both patients and family members, benefit greatly from our care.
• Since we are a non-profiting hospital we can offer treatment for a very low fee or free of charge in those cases where the patient does not have the ability to pay at all. Because of this we can reach patients who would not be able to get treatment or rehabilitation at any other institution.
• The patients in the target group need to actively participate in the program. Only if they fully cooperate with the medical staff can they be well rehabilitated. The staff will, during the course of treatment continuously and according to the patients' ideas and suggestions summarize their experiences and improve their care. They will make every effort to see to it that the patient receives the best care for his/her recovery.

6. Main goals

• Our main goals are to further educate physicians and nurses and develop the rehabilitation ward into a rehabilitation centre so that it can offer the best medical care to the patients. The rehabilitation centre for the disabled will be able to offer information on how to prevent handicaps. It will treat patients with existing disabilities and also give psychological guidance and spread the Gospel to them. It will not only help them to recover their health but also give them comfort and rescue to the soul.
• We think that the number of people becoming disabled will be reduced in this area as the centre develops. And that the already disabled will be rehabilitated or gradually get better. Our goal is for the patients to be able to support themselves. This will also ease the burden on the patient's family.
• As the center develops it can serve as the basis for future projects and as we learn from this project we want to encourage and support other churches and clinics to similar projects.
• On how to evaluate our main goals see "13. Evaluation"
• There is a governmental organization for the disabled. This organization gives them support and enforces favourable policies, like tax-reduction in trades or reduced tax for business administrations etc. It is of first priority to arrange employment for the disabled person according to his/her actual circumstances. Our rehabilitative care acts in accordance with the governmental organizations main goals.

7. Sub goals

• The goal can be divided into three parts: 1) Inviting specialists to our rehabilitation centre to conduct training courses for the staff 2) Purchasing the rehabilitation equipment needed 3) Receiving patients for treatment and rehabilitation. These three parts can be carried out at the same time.
• An investment in this project would greatly strengthen the rehabilitation centre's personnel and financial power; it would improve the technology, and make treatment accessible to more people. It would give these impoverished people a chance of recovery.

8. Project activities

• The content of the courses in rehabilitative care for physicians and nurses has already been established. We have decided to invite specialists in this field from Luoyang First People's Hospital, Luoyang Second Central Hospital and Zhengzhou Central Hospital. These hospitals provide a very good rehabilitative care. We have also decided on the teaching material for these courses. The sums applied for the courses 60 000 RMB in all, may not cover all the expenses for the courses. If so we will find a way to contribute to parts of it ourselves.
• The courses will be held at our hospital and the duration of the course will be six months. The courses will not only have a theoretical part but an extensive practical part where the specialists demonstrate on patients. These will be the poorest patients with the most urgent need of care. Their hospital stay will be free of charge (including treatment, medicines and food) and they will also receive a small sum of compensation for participating in the training course. Four physicians will participate at time so that by the end of the first year all eight physicians have taken the course. The nurses will also be divided into groups of four. The nursing staff consists of 16 nurses. Although they are all registered nurses we want all of them to undergo the special training for rehabilitative care.
• The second year the couses will be based on the first year's courses. The third year we hope to develop the rehabilitation ward, to employ more doctors and nurses. The new staff will need the same training as the original staff.
• Rehabilitation equipment will be purchased. A list of what equipment will be of best use has already been made. Specific machines have been chosen and we have a list with their names and serial numbers. The exact prices are not yet determined. The list includes training machines for walking and balance, machines to train specific muscle groups, a DVD/VCD-player for showing instruction and educational videos etc.
• The medical staff of the hospital and the service personnel will actively participate in suggesting ways and means to help and assist the poor and disabled.
• The training of the staff and purchasing of equipment will be under the supervision of the church and the Bureau of Civil Administration. At the same time the centre will start receiving patients for training. The project will be analysed every month and evaluated once a week. The homes of the patients will be visited on a regular basis and the results of the treatment confirmed by family members. In cases where the recovery is unsatisfactory the patient can return to the hospital and receive further training.
• Six months after the project has started running, qualified personnel (physicians, nurses or physical therapists) will visit the hospital to evaluate the project so far. Together with all cooperation parties we will sit down to discuss the projects future direction. The Swedish personnel will give a presentation of the Swedish rehabilitation care. Swedish models (not only concerning the direct medical issues but also for example patients' associations and support groups for patients) will be discussed with the medical staff at Yiyang hospital.

9. The project's resources

The project needs the following resources: six treatment rooms, 300 square meters for activity and training, 18 patient's rooms, 30 beds, bedclothes, wardrobes, bedstands, lamps etc, altogether a start-up capital to the amount of 210 000 RMB. We would need a medical staff of 24 people and other service personnel of 12 people. Everything listed above would be provided by the centre. The following; 20 000 RMB for the training of physicians, 40 000 RMB for the training of nurses, 40 000 RMB for indoorsrehabilitation equipment, 60 000 RMB for outdoors equipment and 100 000 RMB for rehabilitation courses for patients - in total, a sum of 260 000 RMB - would depend on contributions from the Swedish Mission Committee.

For the second year we apply for another 100 000 RMB. 60 000 of these will be used for further education of the medical staff. 40 000 will be used for purchasing additional medical and rehabilitation equipment.

For the third year we apply for another 50 000 RMB. During the third year of the project we hope to further develop our rehabilitation center to be able to receive more patients. This means we will need to hire more staff, give them them further education in rehabilitative care and and purchase more equipment. The 50 000 will be used for this purpose.

10. Conditions and risks

• The crucial factors for the project are: the technical skill of the staff, the medical equipment and the patients' active participation and determination.
• The staff members, are very enthusiastic and positive. The internal factors that affect the project are: shortage of specialised and qualified people and the inadequate medical equipment. At present there are no external factors. We believe that with the efforts of the whole staff and with the support of the Swedish Mission, any obstacles can be overcome and the project will surely be a success.
• The project will not cause any negative side effects.
• After conducting an environmental analysis, we believe that the project will have no negative effects on the environment.
• Concerning this particular project: before the rehabilitation ward opened, there were arguments and conflicts concerning everyday life, occupation, marriage, economical issues etc in many families because of a disabled family member. There were disputes between households and the community. Families needed the community's help to ease some of their burden, but the community didn't have the resources to help them. With the development of the rehabilitation ward the disabled can be rehabilitated or improve their health conditions. In this way the problems described above can be solved.

11. Responsibility and sustainability

• The hospital has a committee consisting of the hospital chief, the vice hospital chief, the chief physicians of the medical wards, the chief nurses, the hospital pastor, the head of the office and the treasurer. The committee will lead the realization of the project. The hospital also has an accountant named Song Xuanzhao (???) who will be responsible for the internal auditing. For external audit we will employ an authorized company.
• The church has a committee for the running of the hospital. This committee consists of the pastor (chairman of the committee), two vice chairmen, a secretary and a treasurer. This group of five people will supervise the project. The church will participate in the management and the church committee will call for a meeting once a month.
• The project's treatment rooms, activity and training rooms, patient's rooms, beds, bedclothes, wardrobes, bedstands, lamps, electrical fans can be ready by July-August 2004. The 260 000 RMB contributed by the Swedish Mission will give you the right to supervise how the funds are used. It will give you the right to participate in the leading of the project. The rehabilitation centre will report to a representative of the Swedish Mission, on a monthly basis, on how the money is used. The local Bureau of Religious Affairs has the right to supervise the project.
• The rehabilitation ward has no benefactors at present.
• As the rehabilitation centre gradually develops, we hope for financial help to the sum of 100 000 RMB for the second year and 50 000 RMB for the third year. The money will be used in similar ways as the first year - for further education for the staff, some new equipment and for receiving very poor patients free of charge. Depending on how many patients we receive we may also need to recruit more staff. The fourth year we should be independent. By then we should also be an institution that can support other poor areas and individuals.
• When the project is established, there will be a maintenance cost to the total sum of 5-10%. This cost will be paid by the centre. We do not require any financial help from the Swedish Mission for this.
• Already our hospital works with different educational campaigns. Right now we are working with an information campaign on prevention of HIV/AIDS. We have printed pamflets and posters and started small classes. As the rehabilitation center develops we want to be able to hold more classes on different issues, not only on rehabilitation and geriatric care but also on other topics such as basic hygiene and prevention. The center with its qualified medical staff will serve as a base for other, future, medical projects.

12. Government endorsement

• The project is developed under the direct guidance of the Province Government, which is subordinated to the Bureau of Religious Affairs, and the Bureau of Civil Administration. There is no contract between the parties.
• A certificate from the Board of Health in Luoyang confirming that the hospital is a non-profiting health care institution, and documents with approval from the Bureau of Religious Affairs and the Bureau of Civil Administration, are enclosed.
• Our hospital is very well considered by the state administrators. Several officials show great interest in our work. The chief of the Bureau of Religious Affairs, Yang Liukun is engaged in our work with courses in caligraphy for disabled and the chief of the local Bureau of Civil Administration shows his consern for our work by sending greetings and gifts to the disabled. We also have a close cooperation with The Bureau for Work, which helps us find suitable work for patient who have been rehabilitated.

13. Evaluation

• To make it possible for the Swedish partner to follow the proceedings of the project, our hospital will provide you with a financial report every month, and a name list of the patients receiving medical care and a report of their recovery.
• During the courses in rehabilitative care for physicians and nurses the participants will have to pass practical examinations. The courses will also end with a written examination. Those who pass will get a certificate.
• For evaluating the care of the patients we use a grading system with five levels (1: the patient can live independently, does not need any care, 2: the patient can, with difficulty, get dressed and go to the lavatory but needs supervision, 3: the patient can not dress on his own, wash himself or go to the lavatory but needs help, 4: the patient needs help with everything in his daily life, 5: the patient can not fully communicate and express himself or has a mental handicap). The treatment is aimed at gradually making the patients independent. The patients are also taught a professional skill so that, when they leave home, they can make their own living. For example Wei Libo, who was treated at our hospital, can use his left hand to paint pictures. Or Wang Zhecheng from Yanzhenxiang, who had lost both his arms. He was interested in calligraphy and today he can use his feet to write characters.
• Beside the five-level grading system described above, we also use machines to measure the patient's muscle strength and other equipment to evaluate the treatment. This is done once a week. The evaluation results in one of the five remarks: no effect, some effect, good effect, towards recovery and fully recovered.
• Concerning the evaluation, apart from the internal evaluation plans described above, we also plan to invite independent personnel to conduct evaluations of the patients. Independent personnel can be invited at any stage of the project to conduct evaluations, to give instructions and to help improve the running of the operation.
• For observation and evaluation, a special form with advanced evaluation guidelines will be printed. Detailed documentation should be made at the daily round at the hospital. When the patient is discharged from the hospital a summative evaluation of the patient's condition, based on the daily records, should be made.
• The patients' families will be visited some time after the patient has been discharged. An interview with the patient and his relatives will show what impact the treatment has had on the patient and on the whole family.
• Evangelical East Asia Mission will send qualified personnel to the Yiyang Hospital to evaluate the program when it is running. Experiences from rehabilitative care programs in Sweden will be taught during the evaluation process. Any problems with the program should be identified and presented at this meeting and a strategy to meet these problems should be decided. As soon as possible the course of direction should then be changed accordingly.

14. Signing of the document

This document must be signed by both the Swedish side and the local organisation in China. Please note that the date of the signing and the position of the person signing the contract must be included.