Child health care in Cambodia

Before the rise of the Khmer Rouge (KR) in 1975 there were ~950 doctors in Cambodia, afterwards just 53. Now in Cambodia there are a group of five hospitals (Kantha Bopha in Phnom Penh and Jayavarmann in Siem Reap) which with the support of the King were set up by a couple of Swiss doctors, starting 1991. These hospitals provide 100% free health-care for mothers and children, treating disease and ensuring TB and HIV infections are not passed on during childbirth. Though founded with western staff, after years of training they are now staffed by 2060 Cambodian doctors and nurses, with just two Swiss remaining.

One of these men, Dr Beat Richner worked in Cambodia before the KR and came back on the explicit request of the King to become hospital director. Each week he holds a fund raising concert in Siem Reap during which he plays the Cello and talks about the the catastrophe of child health in Cambodia. Last week we went and this is what we learned.

During the KR regime there was the biggest explosion of TB in the 20th century, leaving 65% of the population infected. The infection is carried for as long as it remains untreated and is also passed to babies during birth. Lying dormant in the stomach it weakens the immune system and exacerbates subsequent infections by Japenese Encephalitis (JE), Malaria, Meningitis and particularly Dengue Fever (DF). In the case of DF, there are annual outbreaks in Cambodia and once a child is infected five times it leads to severe bleeding, requiring transfusions to save their life. Each day several children are admitted to these hospitals in shock fom DF. At the height of an outbreak in 2003, 150 a day, or 1 every 10 minutes arrived in Phnom Penh alone. Treatments can require up to 14 pints of blood, oxygen to prevent brain and kidney damage and expensive drugs.

The hospitals statistics are amazing. In the last 15 years they have treated 7.5 million children, with 75,000 hospitalised each year, and 40,000 would die were it not for the treatment administered. Annual costs are around $24m of which 90% comes from private donations (mostly Swiss) with another 5% each from the Swiss and Cambodian governments. Half this money is spent on importing drugs, since 80% of medicines are fake in Cambodia and 20% of these are toxic! Another $2m is spent on obtaining and administering safe blood, that has to be screened to protect against the 7.5% HIV and 25% Hepatitis B national infection levels. Finally $6m pays the staff, wages of $200-300 a month for nurses and $600-$700 a month for doctors.

Compared to the average national of $20 a month these wages are sufficient to eradicate corruption, systemic in Cambodian society. Dr Richner claims that his hospitals are the only corruption free infrastructure in the country (excluding some NGOs such as the Angkor Hospital for Children, which also operates in Siem Reap but are much smaller outfits).

Despite all this work Dr Beat Richner is criticised by the WHO and Save the Children who claim that the standard of care offered is inconsistent with the economic status of the country. For instance...

Despite the necessity for CAT scanners to diagnose possible brain damage caused by TB inflamed JE, the WHO claim they are excessive.

Were donated blood not screened first, then they would stand to infect 1 in 12 of their patients with HIV and 1 in 4 with Hepatitis B. The blood lab they have built is of western standard but again deemed overkill for a 3rd world country.

Meningitis treatments with modern drugs are 20x more expensive than the WHO endorsed Chloramphenicol treatment, but the later has been banned in the west due to life threatening side effects.

Dr Richner claims that the unique situation of the Cambodians demand this care. The TB infected children are particularly susceptible to DF and despite reporting the address of each infection to the government, nothing is done to stem the outbreaks (as in other countries of the region). He claims Cambodian lives are simply not valued enough. In 2003 there were 24,000 cases of DF in Cambodia and no international aid given or press coverage received. The same year one case of bird flu in the north resulted in 100s of WHO officials arriving in under 24 hours and international network wide coverage.

Whilst DF was of threat to the Cambodians only, bird flu threatened westerners too, so was dealt with no expense spared.

Indeed the consultants officials who regularly visit his hospitals and advise him to follow the cheaper WHO line of treatment for 3rd world countries, stay next door at the Sofitel hotel, at a cost of $320 a night. The cost of the average five night admittance and treatment for a child at his hospitals is just $170!

After all, the situation of Cambodian health is one of our creation. The KR only came to power because of the secret bombing campaign of the US during the Vietnam war. Cambodia was decimated with a loss of 600,000 lives (although at the time it was claimed that the US were helping the Cambodians) and the subsequent civil war was inevitable. Dr Beat Richner claims it is therefore a moral obligation to help out and do so in a manner which values Cambodian life. Ignoring the situation, or offering lesser care, amounts to a “passive genocide”.

We were very impressed with his work and saddened by his story. To find out more (or even donate as we did) you can do so here...

http://www.beat-richner.ch/

If you want to donate blood (like us) you'll need to book yourself a flight to Siem Reap (don't spend too long at the temples of Angkor Wat!).

- Peter (Cambodia - April 08)