ABOUT one-third of the government's national pharmaceutical budget has been put on

hold, victim of Germany's decision to suspend all official development aid to Cambodia.

Ministry of Health officials said the suspension may jeopardize progress in treating

diseases such as malaria and tuberculosis in recent years, as well as HIV-AIDS prevention

programs.

"If they reduce the medicines, we will have a very big problem. It would be

very difficult for us to treat people who have tuberculosis or malaria," said

the director of Siem Reap provincial hospital, Chhay Tich.

"Plus, the majority of our patients are very poor and it would be difficult

for them to buy drugs privately in the markets. Also, the markets sell medicines

which are not kept in one hundred per cent good quality; some of them are kept past

the sell-by date."

Many of the 340 beds at Siem Reap hospital are occupied by children with malaria

or dengue fever. The hospital, like others in the provinces, receives its medicines

from the Ministry of Health's central procurement unit in Phnom Penh. About 200 medicines

feature on the ministry's essential drugs list.

While some other nations are restarting aid projects suspended following the July

5-6 ouster of Prince Norodom Ranariddh, Germany is sticking to its decision to indefinitely

suspend all aid.

That includes an agreement with Cambodia's Ministry of Health to give 16 million

deutsche marks - about $10 million - over the next three years. The bulk of it was

earmarked for essential drugs - the rest to be spent on contraceptives, as part of

the national anti-AIDS program, and a smaller amount on technical support, mainly

in the provinces.

On top of Germany's decision to suspend its aid, health officials are facing financial

difficulty on a second front. The Cambodian government, because of reductions by

international donors and other economic effects of the July overthrow of Ranariddh,

is now looking at making serious budget cuts.

Dr Chroeng Sokhan, deputy director of the ministry's department of drugs and food,

said that could mean his department would have to operate on half its annual budget.

"This will be a crisis, because it's a lot of money that we need for buying

drugs. Tuberculosis and malaria are the two main diseases in Cambodia - and we spend

about three million dollars on treatment each year. Now, we don't have enough in

the budget to cover all of the need. Even for these main programs we have to reduce

our work by 50 percent."

Dr Sokhan feared a "serious health epidemic", particularly of tuberculosis,

could be the result.

One problem with tuberculosis was that any break in the two-month treatment and six-month

follow-up programs could result in drug resistance, according to Guilloeume Schmidt,

a pharmacist with the NGO Medicins Sans Frontiers.

"We can see a lot of diseases emerging which have been here a long time which

are really difficult to treat, like TB, like malaria, sexually-transmitted diseases

or AIDS," Schmidt said. "And because many Khmer people practice self-medication,

with the drugs which are available in Cambodia, that you can find everywhere in the

markets, with bad quality, and no guarantee of the right dosage... that is helping

to create diseases which have resistance to the most important drugs."

"That's why this crisis is coming at a really bad situation because... the Ministry

of Health is requesting on the essential drug list more sophisticated drugs like

antibiotics, anti-tuberculosis, anti-malaria... and also more expensive drugs. So

next year it will be more difficult to control these diseases."

Dr Sokhan, at the Ministry of Health, urged donors to think carefully before cutting

aid: "We are health people, we are independent from the political problem. What

we would like to appeal is that when people decide to cut donations or aid to one

country, it's not the government who will suffer from that - only the poor people

will suffer."