11:50 PM ICT
Jayavarmann VII (Kantha Bopha) Children's Hospital
Siem Reap, Siem Reap Province, Cambodia
I guess there is one thing that I’ve ‘done’ that I can report on – I mean tourist-y thing. But it’s still political and poverty-realted.
Specifically, I went to a cello concept. More specifically, I went to a cello concert held at a private hospital called Kantha Bopha Children’s Hospital in Siem Reap, with the head doctor and founder of Kantha Bopha, one Dr. Beat Richner (who calls himself Beatocello'), playing Bach music and discussing the politics of medicine in Cambodia.
Dr. Richner is certainly one of the more enigmatic figures in Cambodia. He’s a Swiss-born doctor, who worked with the Red Cross in Cambodia, then got kicked out when the Khmer Rouge came to power. In 1992, when things were starting to stabilize again, he came back to Cambodia and founded a children’s hospital. There are now 4 of them – 3 in Phnom Penh and 1 in Siem Reap – and every Saturday evening he gives a cello concert at the Siem Reap hospital.
Now to me a Swiss doctor holding free concerts in a Cambodian hospital that combine Bach and lectures about politics, would be odd enough. But it continues to get odder. First off, the hospitals are fucking beautiful. Like nicer than most Western hospitals. (For those who live in Peterborough, so so so much nicer than the new hospital.) And did I mention it’s in Cambodia? Do you know what Lonely Planet’s advice is about getting decent medical care in Cambodia is? Go to Bangkok. And this is a top-notch Western facility, in the middle of abject poverty, offering free care to anyone who needs anything ever. They’re also teaching hospitals. Between the four hospitals, there’s a total of 2 non-Cambodian doctors – the rest are locally-trained.
The hospital's lobby (actual lobby is less blurry).They provide a level of care that literally the WHO claims is too high (this is where politics comes in). The WHO says that imposing Western standards of medicine (levels of sterilization, expertise, etc) on third world countries is ridiculous. The countries simply do not have the resources to pay for such care. In other words, the level of medical care must be economically viable. Now 90% of Kantha Bopha’s funding is private donations (the main reason for hosting the concerts is to fundraise from wealthy tourists, and apparently it works… he claims $5 million comes in every year from those who see the concert). But still, he is providing, free of charge, Western standards of medicine. So basically, even though he’s literally saving tens of thousands of lives (maybe more) every year, the WHO, the UN, and the Cambodian government don’t like him.
Likely because of the criticism leveled against him, combined with the numerous international awards he’s won, he has become a recluse with a cult-like following. Outside the concert hall (a lecture room for the teaching hospital) is a gift shop selling books and DVDs about him (and CDs of him playing Bach – and it is almost exclusively Bach), and displaying in glass cases his awards and commendations. Then at the concert, he comes out, an odd hush falls over the crowd, then he switches back and forth between interesting (if slightly one-sided and lacking in fact-checking) lecture, and good (not amazing, but good) cello playing. This continues for 20-30 minutes, then he plays a half hour glowing documentary about how great he is. Then he makes a short plea for donations, and leaves without talking to anyone.
Indeed, his doctors are forbidden from discussing what goes on in the hospital – no academic papers are put out based on their extensive experience with dengue fever or TB, no statistical reports are released discussing their patient load – only a few scant statistics posted on the wall of the ‘gift shop’ and in his lectures. SiRCHESI has actually tried for years to get data from his hospital about HIV/AIDS, and more recently, Fetal Alcohol Syndrome – generally to no avail. (By comparison, every other hospital has provided SiRCHESI with all the data they can, generally as quickly as they can.)
An intriguing evening.
The L. Ron Hubbard of obscenely well-funded humanitarian aid to Cambodia.
7 comments:
Swiss pediatrician Dr.Beat Richner has headed three hospitals in Cambodia — Jayavarman VII Hospital with its maternity annex in Siem Reap and Kantha Bopha Hospitals I and II in Phnom Penh since 1992. His hospitals are renowned as the only world-class hospitals in Cambodia that offer first-world health care free of charge to all children. Everything is free of charge (outpatient consultations, hospitalization, surgical operations, deliveries, transportation to the hospital, and all medicine) because 95% of Cambodian families are too poor to pay. During the last 13 years, Dr. Richner has achieved what no international aid organization has been able to do in Cambodia. He has set up three corruption-free hospitals giving first-world health care, including cutting-edge diagnostic equipment, CAT scans and ultrasounds. With an annual budget of $17.5 million Annually for the three hospitals combined, , here are the results:
• 750,000 parents receive basic health and hygiene education.
• 750,000 children receive outpatient treatment.
• 100,000 healthy children are vaccinated.
• 60,000 critically ill children are hospitalized. (85% of all hospitalized Cambodian children are hospitalized in Dr. Richner’s hospitals. Lacking hospitalization, 75% of these children would die.) 50% of all in-patients have tuberculosis. The biggest killers are tuberculosis, malaria and AIDS. The 4. 5 day average hospital stay costs only $170.
• 16,000 children receive life-saving surgery.
• 11,000 babies are delivered, thereby preventing AIDS & tuberculosis transmission during birth.
In 1992, only 52 doctors survived in Cambodia. Since then, Dr. Richner has realized one of his most important goals: He has overseen the training of over 5000 Cambodian doctors and nurses in cutting-edge western medicine at his hospitals. Today, all 1540 hospital professionals are Cambodian, except for Dr. Richner and a French microbiologist. These three hospitals have become the nation’s university hospitals and training centers for physicians, medical students, physiotherapists and nurses. Today, Kantha Bopha has become the highly respected model for the entire Southeast Asian region of how efficient corruption-free medical and humanitarian aid can be delivered in the areas of preventive and curative medicine as well as in long-term staff training and research.
Dr. Richner’s hospitals run almost entirely on donations. Of the $17.5 million total annual budget for the three hospitals, 92% comes from private donations by the Swiss people, many of them Swiss children. The Swiss government pays 2%. The Cambodian government provides 1%. No funds currently come from U.S. citizens nor from the U.S. government. Administrative costs of the foundation are held to 6.3%
Today, Dr. Richner faces two huge challenges. The Asian tsunami diverted donations so that Kantha Bopha has a $1.5 million shortfall. In 2005, termite-ridden Kantha Bopha II Hospital has to be replaced. The new 450 bed hospital is stalled, half-completed, lacking $10 million yet for completion. Dr. Richner pleads for immediate tax-free donations of any amount. Ear-mark your checks for Kantha Bopha and send them to the Cambodian-American National Council. What your donation buys:
• $1.66 pays for the outpatient treatment of one child.
• $ 17 pays for one child to receive his six necessary childhood vaccinations.
• $ 100 cures one child of tuberculosis during year-long treatment.
• $133 covers the C-section of one TB and/or HIV+ mothers.
• $170 pays the total cost to hospitalize one critically ill child.
Kantha Bopha Children’s Hospitals Fight Tuberculosis:
The Number One Killer of Cambodia’s Children
The various faces of the principal cause of death in the children of Cambodia
Kantha Bopha’s successsful fight against the number one killer bypasses mainstream world health policy for poor countries and excludes corruption.
Tuberculosis and the Battle to Cure It in the Children of Cambodia
Most people believe that tuberculosis (TB) is an old people’s disease affecting the lungs. The fact that tuberculosis is a killer of children often goes unrecognized.
In Cambodia, tuberculosis is the principal cause of mortality in children and adults. With adequate medical intervention we can eradicate this disease, but we need help.
This monograph presents:
• How and why tuberculosis attacks and devastates Cambodia’s children
• The devastating multiple faces of tuberculosis in children;
• The ability to save these children, when appropriate medical knowledge, equipment, facilities and correct drugs are made available in a 100% corruption free environment.
• The profound loss of human potential and life at a young age.
Background
Tuberculosis became entrenched and rampant in Cambodia beginning in the 1970s when Cambodians were forced into overcrowded refugee camps during Pol Pot’s reign and subsequent Vietnamese occupation of Cambodia following the Vietnam War. Prior to that, tuberculosis was unreported in the country.
Kantha Bopha Children’s Hospitals are the only hospitals today in Cambodia where paediatric tuberculosis is diagnosed and treated. Our work in Kantha Bopha Children’s Hospitals demonstrates that with the proper facilities and medicine problems of tuberculosis can be solved. And if we can do it under the very difficult conditions in the developing country of Cambodia, it is also very possible to solve the global problem of tuberculosis. This disease acts directly as a severe and aggressive disease. Indirectly, it weakens the immunity and resistance of children, making them more vulnerable to simple viral diseases, all the tropical diseases (e.g., dengue, malaria), suppurative diseases, and kidney problems (nephrotic syndrome), while making pregnant mothers susceptible to eclampsia and other problems.
In children, 70% of tuberculosis cases affect the lymph nodes. In 5% of cases, tuberculosis, by way of the blood stream, attacks the bones, joints, nervous system, and other organs. These cases are the hardest to detect and the most quickly fatal.
Simple X-rays of military tubercular cases (also called disseminated tuberculosis because it spreads throughout the body) readily show thousands of small tuberculomas of the lungs. This monograph concentrates on these latter 5% of cases these are the most aggressive. These forms of tuberculosis kill the child if not detected and correctly treated immediately
Thousands of our children are infected with dormant tuberculosis although they are not yet critically ill.
Only the ”primary complex” -- the calcification of a bronchopulmonary (hilar) lymph node –is visible to radiologists. However, this primary complex is often not visible on an X-ray, especially when it is smaller than 3 mm. Only a CAT scan can detect it. Much of the calcified primary complex in the immune system potential is bound up, imprisoning and neutralizing the dormant tuberculosis germs. Because of this, only a part of the immune system potential remains available. Thus, thousands of our children have weakened immune systems.
CAT scans to detect these difficult-to-diagnose forms of tuberculosis are available at our four, state-of-the-art Kantha Bopha Children’s Hospitals. But we need much more screening and treatment through outreach to effectively eradicate this needless disease in Cambodia.
The challenges and faces of tuberculosis in children
Although most tuberculosis in children affects the lungs (70%), it is the 5% of cases that go beyond the lungs that is the most challenging for many reasons.
• First, the World Health Organization (WHO) does not mention this aggressive form of tuberculosis in its clinical protocols for acute respiratory infectious diseases of children among the world’s poor.
• Second, protocols of the WHO for developing countries continue to state that tuberculosis is only confirmed by sputum containing TB germs. It is imperative to realize that young children cannot produce sputum.
• Third, because of this lack of recognition of protocols to address these deadly forms of the disease, except for our hospitals in Cambodia, there is no adequate screening for these most deadly forms of tuberculosis and there is no consistent and reliable access to medication.
• Fourth, tuberculosis in infants and children younger than four years of age is more likely to spread throughout the body via the bloodstream.
• Fifth, one in ten latent infections will progress to active TB disease which, if left untreated, will kill more than half of its victims.
• Sixth, children do not usually contract tuberculosis from other children or transmit it themselves because they cannot produce sputum. It is usually passed from an adult. So it is imperative to test and treat the family members of tubercular children.
• Seventh, there is no effective vaccine against tuberculosis. The Bacillus Calmette-Guerin (BCG) vaccination against tuberculosis does not work in Cambodia. Our experience indicates that BCG vaccinated children develop stronger and more aggressive tuberculoses.
• Eighth, the broadly accepted requirement that families contribute financially to the care of TB patients means most Cambodians will receive no care because they cannot afford it. (All treatments at all Kantha Bopha Children’s Hospitals are free to all patients.)
• Ninth, because of corruption requiring payment under the table in Cambodian hospitals, many diagnosed cases are not properly treated. Because of corruption, the compliance rate is only five percent for patients treated at The National Center for Tuberculosis and Leprosy Control for adults in Phnom Penh.
About Kantha Bopha Children’s Hospitals
Kantha Bopha Children’s Hospitals treat 85% of all Cambodian children. All treatment is free to all. The treatment mortality rate has dropped over the past 14 years to 1.1 percent. Over the last 14 years we have treated over 5 million patients.
We have four hospitals in Cambodia.
In Phnom Penh, the capital city of The Kingdom of Cambodia:
• Kantha Bopha I Children’s Hospital opened in 1992.
• Kantha Bopha II Children’s Hospital opened in 1996.
• Kantha Bopha IV Children’s Hospital opened in 2006.
In Siem Reap, Angkor Province of Cambodia:
• Kantha Bopha III (also called Jayavarman VII) Children’s Hospital opened in 1999.
Kantha Bopha IV Children’s Hospital in Phnom Penh and Kantha Bopha III Children’s Hospital in Siem Reap are university teaching hospitals where students for the whole country rotate during their nursing and medical training and internships. When Kantha Bopha I Children’s Hospital began in 1992, it opened with a staff of 16 foreigners and 60 Cambodians. Today, there are only two permanent foreigners and over 1650 Cambodians staffing the hospitals.
Here are the annual results that we achieved for 2006 alone (all four hospitals combined):
• 800000 parents received basic health and hygiene education.
• 800000 children received outpatient treatment.
• 100000 healthy children were vaccinated.
• 60000 critically ill children were hospitalized. (The 4. 5 day average hospital stay costs only $170.)
• 16000 children received life-saving surgery.
• 11000 babies were delivered via Caesarian-section, thereby preventing AIDS & tuberculosis transmission during birth.
Our annual operating budget is US$18 million for the four hospitals combined. Ten percent of the budget comes from the government of Cambodia. The Swiss government also contributes ten percent of the budget. Almost all of remaining 80 percent of the budget comes from private donations from the Swiss people.
In direct and indirect ways, the four Kantha Bopha Children’s Hospitals contribute to the national economy of Cambodia. Salaries paid to our 1650 Cambodian staff support their families. And the families of our 800000 patients are not bankrupted by medical costs.
In contrast, medical care costs in other Cambodian hospitals are the largest contributing factor leading to the destruction of their family livelihoods. Families sell their animals and land to pay for exorbitant and incorrect care in very bad and corrupt private hospitals.
Cases demonstrated in this monograph
In this monograph, we show liver tuberculosis, intestinal TB, TB peritonitis, kidney TB, TB osteitis, tubercular bone infection and others, such as cases of abdominal TB and abdominal muscle and psoas abscesses.
We present 72 brain tuberculomas that we treated between 2000 and 2005 in Kantha Bopha Children’s Hospitals. These brain tuberculomas, the most tragic and severe form of tuberculosis in children, are only the tiniest peak of a huge iceberg.
Comparing our 72 known cases of brain tuberculomas identified during this five year period with descriptive medical epidemiological rate of distribution of paediatric tuberculosis in populations, we infer that there must have been at the same time and in the same age group in Cambodia, about 150,000 children infected with tuberculosis, with some 95,000 tubercular pneumonias during that same time period.
Because we have diagnosed and treated only some of Cambodia’s children who have brain tuberculomas, our numbers can represent only a sample of the total number of children we estimate to have tuberculosis.
Between 2000 and 2005, we treated 230 cases of Pott’s disease, which is spinal destruction by tuberculosis. During these 5 years, we also show 100 diagnosed cases of military TB, disseminated tuberculosis that has spread throughout the body.
In this monograph, we do not show all of the cases of tubercular meningitis that we diagnosed between 2000 and 2006; however we have diagnosed many hundreds of these cases. These children endure horrible pain that is too difficult to imagine.
We present 230 cases -- every severe case of brain tuberculoma, Pott’s disease and miliary tuberculosis that we saw between 2000-2006 in this monograph. We show every case because it is imperative that we always remember that each « case » presented here is the life of a child.
At Kantha Bopha Children’s Hospitals, we are able to treat and save most of the children we see, thanks to international standard facilities, equipment, and drugs--all of which must be imported into Cambodia.
In this monograph, we show some cases before and after treatment to document just a few of the many impressive successes we have had.
Why we do not follow the mainstream of world health policy
We are able to diagnose and treat the cases of tuberculosis presented in this monograph at Kantha Bopha Children’s Hospitals only because we do not follow the mainstream thinking of world health politicians. These are the two requirements that make their policies fatally wrong:
• First, that facilities and treatments must correspond to the current economical reality of each country; and
• Secondly, that patients must pay something in order to take responsibility for their health.
Those who adhere to these two requirements of current world health policy can only completely miss the diagnosis of tuberculosis in children.
Reasons for our success
First, the facilities of Kantha Bopha Children’s Hospitals do not correspond to the economic realities that exist today in The Kingdom of Cambodia. Today’s economic reality in Cambodia is almost nil for 95% of the population who live on less than one US dollar per day. As tuberculosis in infants and children is quite different from tuberculosis in adults and difficult to diagnose, it is not possible to diagnose paediatric tuberculosis without high-tech equipment. The same technical standards in facilities, equipment, and medicines are needed in rich and poor countries alike.
Thus, if facilities can only correspond to the economic reality of the country, physicians there will totally miss the diagnosis of tuberculosis in children. The same technical standards in facilities, equipment, and medicines are needed in rich and poor countries alike. The facilities of Kantha Bopha Children’s Hospitals are of the same standard found in all hospitals in western countries.
The second reason is that all treatments at all Kantha Bopha Children’s Hospitals are free to all patients. Our patients are poor. If their parents had to pay anything, our hospitals would be empty. Most other government hospitals in Cambodia have been ravaged by corruption, usually requiring a payment under the table. There is no corruption at Kantha Bopha Children’s Hospitals, because we pay our staff —-from cleaners to physicians —- realistic living wages.
It follows that those who adhere to the above two requirements of current world health policy dictates will completely miss the diagnosis of tuberculosis in children.
Resistance, compliance and corruption
Fortunately, tuberculosis germs sometimes show no resistance to treatment with Rifater (isonizid, rifampin, and pyrazinamide). We must often treat tuberculosis patients for six to twelve months. Otherwise, there is the risk of creating drug resistance. Therefore, we do follow-up care on all TB patients. They return after two months for examination, follow-up treatment and for new drugs. We have a compliance rate of 90% until final dismissal from care. Parents receive education about the disease and their children’s treatment. They get all drugs free of charge. They also receive money for transportation to and from the hospital, as many of them must travel great distances, which they could otherwise not afford.
No vaccine for tuberculosis
A major world health policy credo is that prevention is the priority. Curative medicine is a luxury. This is believed and practiced by most health workers and experts in the developing world.
To break the epidemic of tuberculosis, all TB foci, both active and dormant, must be neutralized and the chain of transmission must be broken. All patients with TB and their contacts must be identified and then treated. All must be treated with correct, curative medicine.
All tuberculosis treatment must be provided free of charge. When adults have only asymptomatic latent TB infection (LTBI), they often do not feel symptoms, so they do not feel ill. Thus, it follows that poverty-stricken adults will not pay for a regimen of treatment for six to 12 months when they do not feel sick.
Tuberculosis -- A consequence of war
Tuberculosis is the principal case of death in Cambodia today. This is a consequence of prolonged war in Cambodia that began in the 1970s and provoked civil war.
This author worked as a young paediatrician at the original Kantha Bopha Children’s Hospital during 1974 and 1975, until the Khmer Rouge entered Phnom Penh. At that time, there were already many serious TB cases among children living in overcrowded refugee camps. Overcrowded conditions are always breeding grounds for tuberculosis. But prior to 1970, there had been no refugee camps and there were no reported cases of TB.
During the Pol Pot regime from 1975 – 1979, there was no medical care in Cambodia. Tuberculosis then spread in a way never before seen in Cambodia in the 20th century. During the occupation of Cambodia by 400,000 Vietnamese troops from 1979-1987, medical care for the average Cambodian barely improved.
Tuberculosis continues to spread today in Cambodia. The prevalence of tuberculosis remains so high in Cambodia because of corruption, lack of modern facilities and equipment, and lack of correct drugs and medicines of the same quality used in the “civilized” world.
We dedicate this monograph to all people with common sense and humane hearts
We dedicate this medical review to all who have common sense and humane hearts. Too often, so-called local and foreign « experts » —- physicians, health officials, politicians and opinion leaders in the health sector in Cambodia and in other poor countries -- ignore and hide the impact of tuberculosis in children.
Some of these governmental and non-governmental officials think that treating paediatric tuberculosis is unnecessary partly because the transmission rate of paediatric tuberculosis is lower than the contagious rate of adult tuberculosis. But we know that children usually get TB from adults living in close proximity. Because children cannot produce sputum, it is also true that paediatric diagnosis is far more difficult than adult diagnosis. The conclusion of the « experts » not to treat pediatric TB is absurd because it constitutes a severe violation of children’s right to health and to correct treatment. It violates the United Nation’s Declaration of the Rights of the Child. We ask all people with common sense and humane hearts to bring pressure to bear on these “experts” to act in effective and ethical ways.
We remember that every case presented in this monograph is the case of a child — a person with a name and only one chance to live. We list the patient’s name on each picture in this monograph. We do not indicate that the patient is a girl or a boy. Instead, we respectfully title each patient as “Mr.” or “Ms.” The purpose of this respectful titling is to make it clear to the international community and their experts that it is not acceptable to discount the value of these patients’ lives by rationalizing that these are just little children among all the global poor of the developing world. Every person’s life in the world has the same value as the lives of Their Excellencies, VIPs, so-called “opinion leaders”, experts, etc.
We ask that everyone heed the motto of educator Heim Ginott: “Treat a child as though he already is the person he is capable of becoming.” We implore the world to follow Albert Schweitzer’s universal principle underlying all ethical practice: “A thinking man feels compelled to approach all life with the same reverence he has for his own.” We ask all who have common sense and humane hearts to bring pressure to bear on « experts » to act in correct, effective and ethical ways when treating all of our globe’s children.
The research project on tuberculosis together with the Infectious Diseases department of the University
of Berne (Prof. Kurt Schopfer) has continued. In March 2007, an international symposium
took place in Siem Reap about paediatric tuberculosis. It was made clear that the BCD-vaccination
is not only useless but also dangerous, namely, that vaccinated children suffer much more seriously
from tuberculosis than those not vaccinated. It is incomprehensible that the WHO and UNICEF
continue to recommend the BCD-vaccination in developing countries. Participants at this conference
were (et al) Prof. R. Zinkernagel from Zurich and Prof. H.E. Kaufmann from Berlin, who
dedicated a chapter of his book on global epidemics and poverty to the Kantha Bopha hospitals in
Cambodia.
Annual Report of the Kantha Bopha Children’s Hospitals Foundation, Dr. med. Beat Richner
Annual Report 2007
1. Challenges, efficiency and recognition of the Kantha Bopha Children’s
Hospitals in Cambodia
2007 has been the year of the huge and terrible Dengue fever epidemic in Cambodia. At the same
time the epidemic was able to be contained in Singapore through suitable preventive measures.
Unfortunately and incomprehensibly, the authorities and the WHO in Cambodia were too late and,
due to corruption, almost ineffective in applying any action, despite the warnings from the Kantha
Bopha hospitals, so that 23 250 most seriously ill children with Dengue fever had to be hospitalised
in our hospitals.
Mainly due to the Dengue epidemic, the total number of hospitalisations increased by about 10%
to 112 865. The hospitals’ mortality rate has been reduced from 5.4% in the years 1992/93 to now
just 0.75%. In the surgical departments, 15 873 operations were carried out. In addition, there
were 744 102 paediatric outpatient consultations, to high degree in the service of tuberculosis
treatment control. Additionally about 421 000 examinations and consultations were carried out at
the maternity clinic in Siem Reap, where 14 300 births took place. In total, 251 000 vaccinations
were given, of which 200 000 against Japanese encephalitis.
The work at the Kantha Bopha I-IV hospitals
The five statistics in the appendices (Global Admission, Global Consultation, Operated surgical
cases, Dengue Haemorrhagic Fever, Global Immunization) give an impressive overview of the development
of medical services in the past few years.
In 2007, 112 865 seriously ill children were hospitalised (1993: 5367). In the polyclinics 744 102
consultations took place (1993: 124 962). Because of the extreme Dengue fever epidemic in 2007,
23 500 childen were admitted (1995: 2681). 15 873 surgical operations were carried out (2000:
4635) and 251 520 vaccinations were performed (1999: 93 887).
At Siem Reap maternity clinic, built to prevent the transfer of HIV from mothers to their children,
there were 14 300 births (10% increase to 2006). Only 7.5% of all births were by caesarean section,
carried out as part of the AIDS prophylaxis. Only 3% of newborns needed to be hospitalised
in the neonatal department of Siem Reap hospital. The Phnom Penh (Kantha Bopha IV) neonatal
department, on the other hand, is always overflowing with serious cases (100-120 sick newborns),
as the obstetrics in the regional hospitals and the corrupt private clinics in Phnom Penh are not run
according to proper medical guidelines and these clinics have no neonatal departments attached
to them, either.
The transfer to local medical training has led to the 2000 Cambodian staff being perfectly competent
in running the hospitals. The University Children’s Hospital Zurich under Prof. Felix Sennhauser
provides excellent service for us, being prepared to regularly put lecturers for defined training
modules at our disposal. This cooperation is an effective model for development aid with great
humanitarian value, in our opinion, since the Cambodians receive the necessary know-how from
the University Children’s Hospital Zurich and the Swiss lecturers are able to experience and gauge
the precise problems and possible chances in developing countries on a personal level.
The research project on tuberculosis together with the Infectious Diseases department of the University
of Berne (Prof. Kurt Schopfer) has continued. In March 2007, an international symposium
took place in Siem Reap about paediatric tuberculosis. It was made clear that the BCD-vaccination
is not only useless but also dangerous, namely, that vaccinated children suffer much more seriously
from tuberculosis than those not vaccinated. It is incomprehensible that the WHO and UNICEF
continue to recommend the BCD-vaccination in developing countries. Participants at this conference
were (et al) Prof. R. Zinkernagel from Zurich and Prof. H.E. Kaufmann from Berlin, who
dedicated a chapter of his book on global epidemics and poverty to the Kantha Bopha hospitals in
Cambodia.
Annual Report of the Kantha Bopha Children’s Hospitals Foundation, Dr. med. Beat Richner
Annual Report 2007
1. Challenges, efficiency and recognition of the Kantha Bopha Children’s
Hospitals in Cambodia
2007 has been the year of the huge and terrible Dengue fever epidemic in Cambodia. At the same
time the epidemic was able to be contained in Singapore through suitable preventive measures.
Unfortunately and incomprehensibly, the authorities and the WHO in Cambodia were too late and,
due to corruption, almost ineffective in applying any action, despite the warnings from the Kantha
Bopha hospitals, so that 23 250 most seriously ill children with Dengue fever had to be hospitalised
in our hospitals.
Mainly due to the Dengue epidemic, the total number of hospitalisations increased by about 10%
to 112 865. The hospitals’ mortality rate has been reduced from 5.4% in the years 1992/93 to now
just 0.75%. In the surgical departments, 15 873 operations were carried out. In addition, there
were 744 102 paediatric outpatient consultations, to high degree in the service of tuberculosis
treatment control. Additionally about 421 000 examinations and consultations were carried out at
the maternity clinic in Siem Reap, where 14 300 births took place. In total, 251 000 vaccinations
were given, of which 200 000 against Japanese encephalitis.
The work at the Kantha Bopha I-IV hospitals
The five statistics in the appendices (Global Admission, Global Consultation, Operated surgical
cases, Dengue Haemorrhagic Fever, Global Immunization) give an impressive overview of the development
of medical services in the past few years.
In 2007, 112 865 seriously ill children were hospitalised (1993: 5367). In the polyclinics 744 102
consultations took place (1993: 124 962). Because of the extreme Dengue fever epidemic in 2007,
23 500 childen were admitted (1995: 2681). 15 873 surgical operations were carried out (2000:
4635) and 251 520 vaccinations were performed (1999: 93 887).
At Siem Reap maternity clinic, built to prevent the transfer of HIV from mothers to their children,
there were 14 300 births (10% increase to 2006). Only 7.5% of all births were by caesarean section,
carried out as part of the AIDS prophylaxis. Only 3% of newborns needed to be hospitalised
in the neonatal department of Siem Reap hospital. The Phnom Penh (Kantha Bopha IV) neonatal
department, on the other hand, is always overflowing with serious cases (100-120 sick newborns),
as the obstetrics in the regional hospitals and the corrupt private clinics in Phnom Penh are not run
according to proper medical guidelines and these clinics have no neonatal departments attached
to them, either.
The transfer to local medical training has led to the 2000 Cambodian staff being perfectly competent
in running the hospitals. The University Children’s Hospital Zurich under Prof. Felix Sennhauser
provides excellent service for us, being prepared to regularly put lecturers for defined training
modules at our disposal. This cooperation is an effective model for development aid with great
humanitarian value, in our opinion, since the Cambodians receive the necessary know-how from
the University Children’s Hospital Zurich and the Swiss lecturers are able to experience and gauge
the precise problems and possible chances in developing countries on a personal level.
The research project on tuberculosis together with the Infectious Diseases department of the University
of Berne (Prof. Kurt Schopfer) has continued. In March 2007, an international symposium
took place in Siem Reap about paediatric tuberculosis. It was made clear that the BCD-vaccination
is not only useless but also dangerous, namely, that vaccinated children suffer much more seriously
from tuberculosis than those not vaccinated. It is incomprehensible that the WHO and UNICEF
continue to recommend the BCD-vaccination in developing countries. Participants at this conference
were (et al) Prof. R. Zinkernagel from Zurich and Prof. H.E. Kaufmann from Berlin, who
dedicated a chapter of his book on global epidemics and poverty to the Kantha Bopha hospitals in
Cambodia.
Preventing vertical transmission of the HIV virus in Jayavarman VII maternity.
Laurent D, Richner B; International Conference on AIDS (15th : 2004 : Bangkok, Thailand).
Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. ThPeB7015.
Foundation Kantha Bopha, Phnom Penh, Cambodia
Background: Since November 1995, 3.45% (4452/128722) of children hospitalized in Kantha Bopha pediatric hospitals in Phnom Penh show HIV positive serology, mainly caused by vertical transmission. In Cambodia, the most effective way to reduce this high HIV-infection rate among children is to prevent the vertical transmission of the HIV virus at the time of delivery. Methods: In October 2001, a new maternity ward was opened within the Jayavarman VII pediatric hospital in Siem Reap. Systematic HIV screening is carried out for pregnant women. Nevirapine (200 mg) is administered to all HIV-infected mothers just before delivery by caesarian, and Nevirapine (10-15 mg) is then given to the baby 48 hours after birth. Artificial milk is substituted to breastfeeding. A monthly follow-up of both mother and child allows monitoring of CD4 count and ultra-sensitive p24 antigenemia. Results: 14684 pregnant women were tested during the period from October 2001 to October 2003. While 323 of them tested HIV positive (2.20%), only one of them had been aware that she carried the virus. 225 mothers gave birth under our protocol and 75% of them had a CD4 rate above 200 at the time of delivery. Up to now, 145 children over 6 months born from the HIV-positive mothers under our protocol have been tested for ultra-sensitive p24 antigenemia and only 7 (4.8%) show to be positive and definitively infected Conclusions: Actions carried out at Jayavarman VII maternity hospital, Siem Reap, show that Cambodian pregnant women readily collaborate with us and are willing to comply with the protocol. With regards to HIV-positive mothers, the Nevirapine protocol associated with delivery by caesarian and bottle-feeding significantly diminishes the vertical transmission rate, from 35% to 4.8%. This is the most effective procedure to reduce the number of HIV-infected children in Cambodia in the years to come.
Spread of HIV-1 To Children in Cambodia
Lancet (05/17/97) Vol. 349, No. 9063, P. 1451
Richner, Beat; Laurent, Dennis; Sunnart, Yit; et al.
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Abstract: The first clinical study of the infant HIV-1 epidemic in Cambodia was conducted at Phnom Penh's Kantha Bopha Children's Hospitals I and II. Children age 5 or younger who were suspected of having tuberculosis were admitted to the study and tested for HIV-1 antibodies. Of the 9,026 children tested, 290 tested positive. Moreover, because all but three of the mothers of 173 HIV-1 seropositive children tested positive as well, the findings suggest that the primary mode of transmission to children in Cambodia is vertical. The researchers note that none of the 369 children over the age of 5 tested seropositive for HIV-1. According to the researchers, this indicates that infection is spreading quite rapidly in Cambodia, having only recently been introduced. Because antiretroviral drugs have yet to be made available to Cambodia, the authors note that their management of HIV-1 infected children has been confined to such preventative measures as advising mothers to bottle-feed infants and providing children with cotrimoxazole for the prevention of Pneumocystis carinii pneumonia.
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