Phillipe Guyant is a doctor with Médicins du Monde at its office in Mondolkiri

province, one of the poorest areas in Cambodia. He has brought two patients with

heart problems to a state-of-the-art cardiology facility in Phnom

Penh.

Surgeons perform a mitral regurgitation, a procedure to repair damaged heart valves. Cardiologist Dr Hak Sok Hay says: "In the US they usually replace [damaged valves] with a mechanical valve whereas in Cambodia we repair it." This removes the need for follow-up medicines and tests.

One is an adult with a valve problem, the other a child with a

congenital heart condition. Both will receive free treatment at the Centre de

Cardiologie de Phnom Penh.

"Most people in Mondolkiri are very poor,"

says Guyant. "Previously we couldn't do anything [for patients with heart

problems]. We could send them to Calmette Hospital for a cardiogram which would

tell us what the problem was, and we could prescribe some drugs to help, but

that was all."

Cambodia's high level of poverty means the country's

children suffer a much higher rate of heart problems than children in the West.

Lack of education and access to simple medicines means more than half of heart

problems are caused by rheumatic valve disease.

"If a child has

tonsillitis, the streptococcal bacteria can travel to the heart, where it

creates a toxin which kills the heart valves within three or four years. If the

child has penicillin just once it can prevent this," explains Jean-Claude

Prandi, director of the center.

Prandi says 20,000 children are on the

waiting list and that number is growing each year. One new arrival is Senghort,

the two-year-old son of Chap Chhat, who has come from Pursat. The Kantha Bopha

Hospital in Siem Reap diagnosed a hole in her son's heart and suggested she take

him to Phnom Penh for treatment.

She says her son contracted heart

disease after she saw a man killed by a harvesting machine when she was pregnant

with him. She called out for people to help the man and felt immediately

overwhelmed with tiredness. Two weeks later her son was born. He is always

tired, she says, convinced the traumatic death she witnessed before his birth is

the reason.

With its policy of free operations for poor children, the

hospital has no shortage of patients. Prandi says three-quarters of patients at

the hospital are treated for free. Twenty percent pay a partial charge

- anything from $200 to $1,000 - while only 5 percent pay the full price. The

difference is paid for by donors, although by 2006 that funding will be

cut.

Above, surgeons operate on the heart of an unidentified patient.

To make the center self-sustaining, says Prandi, the hospital is

trying to attract wealthy Cambodians, many of whom currently fly to Bangkok or

Singapore for treatment. Open heart surgery costs around $15,000 in Bangkok,

compared with only $2,500 at his center. Costs in Singapore are twice those of

Bangkok, he says.

"They would be paying much less for the same quality

[by coming here]," says Prandi. "We went to Bangkok and it's no better than

here."

The good news for Cambodia's adults is that they have a lower rate

of heart problems than their counterparts in the West. One reason, says Prandi,

is the fact that heart problems usually start at about 55 years of

age.

"And in Cambodia there is a percentage [of the population] who

should be 55 and aren't here because of Pol Pot," he says. However, he says,

this situation will likely change in the future.

"Heart problems in

adults are generally the result of 'living rich'," he concludes. "The more you

eat, drink and smoke, the higher the risk, and of course stress is also a

factor. In Cambodia the food is healthy, although the number of smokers is

steadily increasing so it will change."