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South China Morning Post story on AHC

south_china_post_storyThe Healing Fields

Despite struggling with meagre funding, a hospital in Cambodia is working miracles with poor children.
Lisa Genasci ([email protected])
Updated on May 13, 2012

In a medical facility that could be in any affluent, modern city, Srey Touch lies in a coma. Her young father, his skin darkened from farm labour, sits anxiously beside her bed, watching the swell of his daughter’s chest and the
monitor that registers her vital signs. Doctors regularly check Srey Touch’s breathing and pulse, and exchange words of comfort with her father.

This is Angkor Hospital for Children in Siem Reap, Cambodia, which offers free treatment to families who cannot pay and otherwise would not have access to anything like the top-notch medical care found in Hong Kong. Last year, the hospital treated 157,000 children for illnesses ranging from diarrhoea to tuberculosis. Its sole operating theatre
performed surgeries ranging from hernias to heart repair. It has also become northern Cambodia’s premier paediatric teaching facility and one of only two in the country.

AHC, as it is known, not only trains its own doctors via a three-year residency programme and ongoing medical education, it also works with government facilities to improve their quality of care, working with doctors and nurses nationwide.

“Our mandate is to see the poor, and we want to provide them with the same level of care found in the West,” says Dr William Housworth, the hospital’s executive director, who is American. “We also want to play a role in health care in Cambodia. What we are developing is to be shared.”

Srey Touch had fallen into a coma a day earlier and was brought 35 kilometres to the hospital’s intensive care unit by ambulance from a small government hospital where the paediatric ward is also run by AHC. Her father had managed to borrow the US$20 needed to get his 3-1/2-year-old daughter, who had a cough and high fever, the 30 kilometres by taxi from their home to the rural hospital, where doctors diagnosed meningitis, began treatment and watched as she got betterthen quickly worse. The doctors said she had a 50-50 chance of recovery.

Three days later, however, Srey Touch has pulled through. She is breathing and sleeping normally again in the inpatient ward. Her doctors expect her to make a full recovery.

Apart from borrowing the money, at 10 per cent monthly interest, to get his daughter to the hospital, this would be no different to a normal Western medical experience. But doctors working in the country say it is
much different from what an impoverished Cambodian usually experiences: unstaffed local health centres, public hospitals with limited and untrained personnel, no life-saving equipment and fees that are unaffordable.

Without AHC and its rural satellite clinic, Srey Touch probably would not have received the needed high-dose antibiotics and other careful treatment in time to save her.

Although public hospitals are not free, about 30 per cent of the rural population has what is known as a Health Equity Card, which establishes that they are poor and reimburses at least some of the medical and travel costs associated with a hospital visit. Even so, observers say it is not uncommon for doctors and hospital administrators to ask patients for payment on the side before they do their jobs. Emergency health care costs, which land families in a spiral of debt, are the most common reason Cambodians become impoverished. When a child contracts a chronic disease, the costs can be devastating.

Siem Reap province, better known for its Angkor Wat temple complexes and lavish hotels, has the third-highest poverty rate among Cambodia’s provinces.

“Without AHC, we couldn’t provide paediatric support in Siem Reap,” says Dr Sarath Kros, public health director in the province. “They offer better quality than the public services, and better staff motivation. We cannot work effectively with the resources we have.” For a province of one million people, the total health care budget this year is about US$2.8 million, Kros says, and almost two-thirds of that comes from large or foreign government donors. Indeed, the entire country receives roughly US$600 million a year in aid from Western governments and aid agencies. Last year’s total budget was US$2.4 billion.
Part of the problem is the low pay health workers receive, Kros says.

Thus doctors, who might earn as little as US$100 a month, often supplement their incomes by working at private clinics at the expense of the government hospitals.

“To be effective, we would need a carrot and a stick,” Kros says. “We have only a small carrot and no stick.”

AHC, which functions as the paediatric ward of the Siem Reap provincial government hospital, was established in 1999 by Japanese photographer Kenro Izu, who founded Friends Without Borders, a charity dedicated to raising funds for children’s hospitals in Cambodia.

Despite its success, the hospital struggles to raise the funds to support its current US$4.5 million annual budget. This includes not just the hospital care, but medical education, work in the communities to educate people on nutrition, disease, hygiene and sanitation, the satellite clinic and an extensive home-care programme for children with chronic diseases, including HIV/Aids.

The first person Housworth, the executive director, turns to at the weekly staff meeting is not the medical director but his accountant: “How much do we have in the bank?” he asks. “Have we paid staff this month?” Relief is evident on his face as he hears the hospital has a balance of US$256,000 in its account and, yes, the staff have been paid.

With a team of 46 doctors, 149 nurses and additional support staff of 130, the hospital feels like a family with a mission to be good medical workers and educators, and to work towards improving Cambodia’s health care system.

Apart from Housworth, there is only one other foreign doctor and two foreign nurses at the hospital. The remaining medical staff are Cambodian and fiercely proud.

“We are here as a young generation of Cambodians,” says AHC chief paediatrician Dr Ngeth Pises. “We respect one another, we have education and we have our common goal, which is to treat patients as our own child. We educate doctors from the moment they arrive here.”

Dr Varun Kumar, a senior paediatrician who has worked at the hospital since 2005, says that when he first arrived from the US, he worked to improve the quality of medical care and establish the protocols to guide treatment. Now, he says, doctors rarely need him, and most of his time is spent in medical oversight and guiding hospital research and training.

Part of the problem is the legacy of destruction from the 1975-79 rule of the Khmer Rouge, when medical professionals and other educated people were singled out for slaughter. By the time the Vietnamese ousted the Khmer Rouge from power, there were only an estimated 40 doctors left in the country.

Decades of war and isolation followed, leaving the medical infrastructure in shambles. In the 1990s, NGOs simply took over the health care system without trying to build anything indigenous, and change began in earnest only after the civil war ended in 1998,observers say.

Angkor Hospital is one of the few institutions trying to improve the situation, says Dr Christophe Grundmann, chief of party for University Research Co, an American-based health care NGO that has worked in Cambodia for more than two decades.

He says many of the nursing and other medical protocols at the hospital are being shared, not only with other hospitals to try to help them establish clear treatment and ethical plans, but also with the Health Ministry in Phnom Penh, the capital.

“Angkor Hospital is very influential at a critical moment in the development of Cambodian health care,” Grundmann says.

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