T HE government-managed part of Calmette Hospital gets about $2000 a year in

official funding, according to hospital director Dr Heng Tay Kry.

Faced

with a chronic money shortfall, he said the hospital had no choice but to charge

patients as it tried to meet yearly operating costs of more than $1

million.

The hospital got five million riels ($2000) a year from the

government, which last gave medicine supplies to it in 1989.

"If we did

not charge patients, our hospital would have shut down a long time ago." he

said.

Current charges varied from $30-100 per day, depending on the

condition of the room, and $120-200 for operations. Foreigners are charged

more.

Dr Kry maintained that hospital staff treat emergency patients

without concern for whether they had money.

He said poor people were not

charged for rooms, but acknowledged that they were often asked to buy their own

medicine and bandages. Some, he said, borrowed money or sold property to do

so.

The hospital tried to pay for the medicine and treatment for

patients, and later seek reimbursement from them.

But patients who

promised to repay the money often did not, or paid less than they had agreed

to.

Dr Kry said half of the revenue from patient charges went toward

buying hospital materials, 40 per cent was spent on staff bonuses and 10 per

cent was given to the government.

Conditions at Calmette - or at least

the "A-building" and other wards funded by the government - have long been the

subject of criticism.

One Westerner who recently visited the hospital

with her maid, who had a tumor, was shocked at the conditions there, with little

attention to the most basic hygiene standards.

"I was outraged at the

medical conditions, which were unacceptable even for a country like Cambodia,"

the woman said.

She said she went to great pains to decide whether to

have her maid's tumor checked at Calmette, or go overseas, but was assured by a

French doctor there that the procedure was easy.

The doctor told her the

operation to remove the tumor for a biopsy would cost $200, which she

paid.

The operation was conducted - and the tumor left in a bottle on the

patient's bed. The woman said she eventually found out a biopsy could be

conducted at the School of Medicine, which reported that the tumor was

malignant.

She took her maid to Bangkok for surgery - where it was found

that the tumor was in fact not cancerous.

Of Calmette Hospital, she said:

"I was misled into believing I could get some semblance of quality medical care

there by the Western doctor. I wonder how any Khmer with little idea of

acceptable medical care could survive in the Cambodian medical system without

money, to say the very least."

Referring to the privately-funded Kantha

Bopha children's hospital, she said: "I'm also outraged when I hear criticisms,

particularly among Westerners, of the one medical facility which is providing

top quality, free medical care to more than 1000 patients per day. The price tag

is high but the results speak for themselves and I see no reason why Cambodian

and international organizations involved in medical care should not be aspiring

to the same.

"I think that in a country where multi-million dollar deals

are being signed for casinos and other businesses, there should be some way of

finding funds to meet more basic needs.

"In my experience, Calmette seems

to be neither providing care for the masses, nor quality care for the

few."

Others tell similar tales of inadequate treatment at

Calmette.

One Khmer medical student said he waited for almost an hour at

the hospital's emergency room for treatment, before deciding it was simpler to

go and buy bandages and antiseptic and treat himself.

Dr Kry, the

hospital director, said staff should always respond to emergencies. He defended

hygiene at the hospital, suggesting that any dirt was from patients or their

relatives who did not clean up after themselves.

To combat this, he had

issued instructions limiting the times that relatives - who others say are often

called upon to look after patients - can be in the hospital.