Six-year-old Ieap Leap has been hospitalised for a week.
``She came in looking very pale and anaemic,'' explains Dr
Samuthea, the head of station CII at Jayavarman Hospital in
Siem Reap. ``She had a high fever and was shaking.'' The
cause? Malaria. But a routine X-ray revealed additional
symptoms associated with tuberculosis. A CT scan ordered to
examine the child's lungs later confirmed the presence of a
lung calcification, a surefire sign of TB, her doctor says.
After seven days of treatment, Leap has tested negative for
malaria. Outwardly she shows few signs of illness. A bit
lethargic from fighting off the tuberculosis, she sits in
bed and surveys the room with large, inquisitive eyes. Her
two-year-old sister, Ieap Lang, climbs around her while
their mother watches on with a weary but contented smile.
Leap has been released and can now return to her village _
though she will need to come back to the hospital every
eight weeks for the next nine months to receive the
remainder of her tuberculosis treatments.
Despite the cost of the rough two-hour journey from Leap's
village to the city, this is the fourth visit her mother, Bo
Reap, has made to Jayavarman, each time with a different one
of her children.
Like Leap, most of the children at Jayavarman live in
poverty and come from distant towns or provinces. The
hospital tries to ease the burden placed on their health by
providing free treatment and subsidising the price of
transportation to Siem Reap. Before discovering this, Leap's
mother sought care for her children locally. But at 10,000
riel (103 baht) for one vial of medicine, the costs began to
mount. Bo Reap was eventually forced to sell the family's
modest home and their cattle to pay off the debt resulting
from these treatments.
With no home Leap's father and two oldest brothers took up
residence near a rice field where the family is cultivating
a small crop. Her mother, sister Lang and 12-year-old
brother moved into her grandmother's hut in a neighbouring
This is the place to which she returns. The village is
composed mostly of her relatives _ aunts, uncles and
cousins; families with five, seven, even 10 children _ many
of who gather outside as Leap arrives.
It's only been a week, but she shyly scoots about before
warming up to her surroundings. The homecoming is happy, but
Bo Reap worries it may be premature. This is malaria country
and access to clean water is scarce. Despite her best
efforts and those of the doctors at Jayavarman, diseases
like tuberculosis are still prevalent here.
``Money or blood?''
That's a question Dr Beat Richner has grown accustomed to
asking. As founder and director of the three Kantha Bopha
Paediatric Hospitals in Cambodia, he holds solo cello
concerts every Saturday to generate the money needed to keep
the hospitals up and running _ a task that has become
At exactly 7:15pm, Dr Richner enters Jayavarman's polished
hospital auditorium with crisp, clacking steps, takes up his
cello and with a brisk nod of the head _ an acknowledgement
of his welcoming applause _ he begins.
``So now, not so many tourists, not so many guests,'' he
says. ``But two years ago, maybe you remember, there were no
That was during the Sars scare. Not long after 10,000
children were hospitalised in Cambodia due to dengue fever.
The country is still fighting that epidemic, along with a
host of other diseases, such as malaria, encephalitis and
tuberculosis _ an infection that, according to Dr Richner,
affects 65 per cent of Khmers.
A long-time entertainer, Dr Richner began performing for
children at the beginning of his medical career, creating a
musical clown character he dubbed ``Beatocello'' in the
early 1980s. He has since hung up his costume but continues
to use the character to draw attention to, and support for
His passion for what he's doing is evident in the gusto and
verve with which he flavours each performance. Given the
weight of the topic and the starkness of the situation he
faces, Dr Richner is surprisingly good humoured.
``We ask young people for blood, older people for money and
people in between for both,'' he explains, drawing laughter
from the crowd.
The newest of the three Kantha Bopha centres, Jayavarman
Hospital, sees an average of 900 outpatients each day, with
up to 170 hospitalised as a result. That number has doubled
since last year, a fact Dr Richner attributes to road
improvements that allow children from far away provinces
such as Anlong Veng _ the former Khmer Rouge stronghold _ to
make the trip to Siem Reap. The peak of the dengue season
usually occurs in July and this year was no exception. In
that month alone Jayavarman saw a record-setting 28,967
people, 4,528 of whom were hospitalised.
Between the two hospitals in Phnom Penh and Jayavarman,
Kantha Bopha can accommodate around 1,000 patients at one
time, and a new wing will be opened in the capital at the
end of December, providing the hospital system with an
additional 600 beds. While that is a positive step, it still
may not entirely reduce overcrowding that at times is so
acute that children are often forced to share mattresses.
Jayavarman is by far the largest, most high-tech hospital in
town, but other smaller operations are also going to great
lengths to care for local Cambodians. Angkor Hospital for
Children (AHC), operated by Friends Without a Border, sees
anywhere from 200 to 400 children per day and offers free
treatment to all children up to the age of 16.
Some say its size makes it more intimate, appealing and
accessible to Khmers intimidated by the formalities at
Jayavarman. AHC welcomes all a child's immediate family
members and allows them to bring their own food for cooking.
It also has an outreach programme through which volunteers
go out into the community to deliver food and medicine,
conduct basic check-ups and provide education.
Jayavarman offers education as well, but Dr Richner is
adamant that curative medicine, the type of treatment Kantha
Bopha offers, is the only way to curb infectious illnesses.
Despite its successes, however, such treatment can be
costly, and the hospital system faces problems when it comes
Annual operating costs amount to $17 million (701 million
baht), most of which is funded through donations. ``That's
why I talk about the money,'' Dr Richner says, ``because
it's a brutal reality without it.''
Until 2005 the Swiss government was the only authority
providing Kantha Bopha with funds, $2 million (82.6 million
baht) per year. Dr Richner's Saturday evening concerts
currently bring in around $4 million (165 million baht) and
donations still make up the bulk of the hospital's financial
support. But on January 1 of this year the Cambodian
government agreed to provide the hospital with $1.6 million
(66 million baht) annually and Prime Minister Hun Sen has
called the hospital system a model for the country.
Cambodians feel safe here, Dr Richner says, and that feeling
of confidence is very important for the healing process.
With that as his focus, Dr Richer is trying to awaken the
sensitivity of a new demographic: Wealthy Cambodians. In
late June, Dr Richner implemented a programme called the
Kantha Bopha Club. Members must contribute $100 (4,100 baht)
a year to the hospital, and they must be Khmer. There are
already more than 200 members, including the prime minister,
and Dr Richner aims for an eventual 12,000.
His hope is that Cambodians will take a greater role in
supporting their own health-care system. He already takes
pride in the fact that Jayavarman is what he calls a
Cambodian hospital, with 1,600 Khmer staff and only two
Of course, there are still many miles of rough and rocky
road to go. Improvements in infrastructure are needed in
order to provide safe drinking water to the 70 per cent of
the population without it. The work of NGOs and grassroots
organisations like AHC is equally important.
While Jayavarman aims to create a global impact through its
services, smaller facilities that provide home-care
programmes and medical education are also doing their best
to improve the health-care situation in Cambodia. Apart from
infectious diseases, many children are afflicted by
preventable illnesses such as diarrhoea and acute
respiratory infections. Thus, long-term improvements in
child health cannot be achieved through hospital-based work
``It's a success that it works,'' explains Dr Richner when
talking about the Kantha Bopha centres. In the early 1960s
the health-care system in Cambodia was on a par with that in
Singapore, he says. Yet the long civil war and years spent
under the Khmer Rouge regime destroyed the country's
infrastructure and depleted the number of trained
physicians. His efforts and those of NGOs and personal
donors have gone far, but still more needs to be done.
``I never thought the needs would be so strong. Day by day
you must fight again.
'' Despite the difficulties at hand, Dr Richner remains
positive. In his mind, the solution lies in making people
aware that change is possible.
``It's very important that people can see change exists,
because it does.''
Funds for Kantha Bopha and Angkor Hospital for Children are
raised through grants, annual events and the generosity of
donors. For further information, visit www.beatocello.com