Dr Beat Richner of the Kantha Bopha Childrens' Hospital, asks his

political hero to help the West atone for mistakes made past and present in

Cambodia.

Dear President; since you are the only leader of the Western

world during my lifetime whom I have admired and respected with all my heart, I

would like to ask you to solve a problem which is a consequence of the Indochina

wars.

It is one you could not have foreseen before you were so cruelly

taken from us prematurely.

You and your courageous and brave brother

Robert wanted to call a halt to the fighting which would have prevented this

problem which is now the scourge of the young in Cambodia. Tragically they

killed Robert too.

I am sure you know that in 1970 Nixon and Kissinger

started a secret war in Cambodia by bombing the Ho Chi Minh trail which

stretched into the eastern edge of the country. When this crime became public

the students demonstrated against it in the University of Kent. Three of them

were shot down too. This war in Cambodia, started by the Western world 25 years

ago, is still going on.

Cambodian people are living in degrading conditions largely because of the

war and its consequences and these conditions are a fertile breeding ground for

tuberculosis.

Thousands of people are killed by it every year, hundreds

of thousands of people are weak and sick. They carry the burden of the disease

around for years before finally succumbing to it. I believe that one in three

Cambodians are suffering from tuberculosis. This pernicious disorder, which had

been all but eliminated in the West, can attack not only the lungs but every

organ in the body. It also forms deadly teams with other diseases such as

meningitis.

I will later explain why the epidemic is much bigger than

large aid organizations like Unicef have realized.

The war, caused and

brought by the Western world has here created what has quietly become in

percentage terms the world's greatest epidemic of tuberculosis.

Dear

President, even worse, the Western strategy to manage this catastrophe, has

actually caused the situation to deteriorate in a terrible and shocking way. Let

me explain it, dear President.

The World Health Organization (WHO) has

made recommendations to all governments and NGOs about how to manage health care

in the "third world". Their principal maxim is to conduct simple medical care in

third world countries. I would term it poor medical care in poor countries.

WHO's philosophy is to concentrate on prevention first at the expense of

treating existing victims. They are putting their resources into areas like

health education.

Quite simply from my professional point of view this

is a huge and tragic mistake which has cost thousands of lives. To stop an

epidemic of tuberculosis you have to neutralize all contagious foci, that is

treat all existing victims to stop them spreading the disease.

Before you

can treat victims you have to diagnose them but tuberculosis is a notoriously

difficult disease to pinpoint, especially in children. In order to diagnose it a

high level of medical professional skills and professional technical facilities

are needed. But the message from WHO is that such things are too sophisticated

for countries like Cambodia. They do not believe in training doctors and nurses

to a high level because these skills cannot be matched by the medical facilities

that are available. This causes a vicious cycle which forever mires Cambodia in

a healthcare quagmire.

We take a very different approach at Kantha Bopha

Children's Hospital despite criticism from WHO, other eminent public health

experts and even my own Swiss government. In one Swiss newspaper our hospital

was described in a headline as giving "Rolls Royce" treatment. This description

caught on in criticisms of us by third world health care experts.

In

Kantha Bopha we have the skills and the facilities which nearly match those in a

Western country.

Due to our more sophisticated diagnostic equipment and

skills we uncovered the hidden killer of tuberculosis lurking in so many

Cambodian children, which other aid agencies had not been able to find.

When children come to us they have a wide variety of infections such as

meningitis, pneumonia bone infections, skin infections or diarrhea. But in so

many cases a proper examination of these poor little children reveals that the

root cause of all these ailments is tuberculosis which has undermined their

body's immunity system. Even more tragically the most likely persons to have

given the children tuberculosis are their parents. In fact if a child is

diagnosed as having the disease there is an 80 percent chance his or her parents

will have it too.

Sadly every day, seven days a week, we diagnose

between five and 12 more children as having tuberculosis. Thankfully we can save

95 percent of these children by treating them with Rifater over six to nine

months.

But thousands more are dying needlessly because they are not

being properly diagnosed. The big health care aid agencies such as WHO and

Unicef with their poor medical care for poor people were blind to what was

really happening.

Unicef figures put the yearly number of deaths in

Cambodia from tuberculosis at 13,000, with 22,000 new cases. However until we

began our "Rolls Royce" work at Kantha Bopha children were rarely diagnosed as

having the disease. Not forgetting that 45 percent of the population are

children under 16, I am therefore inevitably led to the conclusion that the real

figures are far higher, perhaps even by a factor of four.

Dear President

permit me to tell you of an example of the tragic consequences of WHO's policy

of which I term poor medical care for poor people. WHO-trained medical staff in

Cambodia are told to diagnose children with chronic fever and breathing

difficulties as having severe pneumonia. The treatment for this, the staff are

told, is a course of the antibiotic Chloramphenicol. This approach in my view is

not only a mistake but a crime.

Firstly I have found that 60 percent of

the children showing these symptoms are not suffering from pneumonia but

tuberculosis. Secondly Chloramphenicol should never be used with children. In US

and Europe it has been banned for both children and adults since 1970 because of

its terrible side effects. The drug can stop bone marrow producing new blood

cells. In Cambodia it is not only used to treat pneumonia symptoms but also

typhus and meningitis and is freely available at all pharmacies.

At the

Kantha Bopha Hospital we use instead of Chloram-phenicol the drug Rocephin,

which does not have any side effects but is sixteen times more expensive at $8 a

gram. We are the only medical institution in Cambodia to use it and Western

experts told us it is too expensive for an impoverished country such as

Cambodia. But I have to ask them why shouldn't poor children have the same

rights to proper medical care as children in the West?

Dear President,

this crime is compounded by the fact that children in Cambodia are more at risk

from Chloramphenicol's side effects because many are also suffering

simultaneously from Hepatitis B. In fact because of this Cambodian children are

between 100 and 1,000 times more at risk from the drug's side effect than those

in the West.

A lot of children arrive at Kantha Bopha suffering and some

later dying from malfunctioning bone marrow caused by Chloramphenicol

administered elsewhere.

Dear President let me summarize. Two strategies

dictated by the Western world have caused the immense problem of tuberculosis,

which is growing all the time and could, I fear, destroy the Cambodian people:

These two strategies are the war in 1970 and the approach to public health now.

It is now up to the West to recompense their mistakes and crimes without

any condition. Dear President please talk in the forthright terms of your 1961

inauguration speech to the mighty and rich in West when they sleep at night.

Please get this message over: "Don't ask the Cambodia government what it should

do for its people, ask yourself, what you can do for the poor Cambodia nation...

and do it, now, before it is too late."

Dear President, I can confirm

with the attitude it is possible to do anything in Cambodia. Kantha Bopha is one

example. The hospital is clean, there is no corruption, no child has to pay for

anything, all 300 Cambodians working in the hospital are doing a very good job,

they are motivated. Since November 1992 we have treated as in- patients 15,000

children and as out-patients 220,000. Since August 1993 we have been performing

four to eight surgical operations every day and since this February we are

vaccinating up to 150 children daily.

These things are possible! Please

spread the word far and wide dear President. Just six more centers like Kantha

Bopha around Cambodia could provide health care for nearly every Cambodian

child. There is money enough in the Western world. With the money Untac has

spent for the salaries and cars for its expat employees you could create 350

more Kantha Bophas and run them for 30 years!

I think funds for six more

centers is not a lot to ask in compensation for the past and present mistakes of

others dear President, and I think people will hear your voice.

-

Yours, Dr Beat Richner, Kantha Bopha Children's Hospital, Phnom Penh