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