By seven o'clock any weekday morning at Kantha Bopha pediatric hospital in Phnom
Penh the courtyard is full of hundreds of parents clutching crying sick children,
waiting anxiously for a consultation with one of the six physicians on duty.
On an average day, in addition to the 120 or so in-patients in the hospital, 300
children will be seen as outpatients; on Monday, after the weekend holiday, the average
is more like 500 to 600. Kantha Bopha is an anomaly in Cambodia, a clean, well-equipped
and fully staffed pediatric hospital that treats and provides medicines free of charge
to all its patients.
Re-opened in November last year after extensive renovation and installation of new
equipment, the modernly outfitted hospital is the brainchild and work of Beat Richner,
a 45-year-old Swiss pediatrician who first came to Cambodia in 1974 to work at Kantha
Bopha. On exchange from his university hospital and the Swiss Red Cross, Richner's
work at the hospital was cut short after less than a year by the arrival of the Khmer
Rouge in Phnom Penh and the ensuing forced evacuation of the city.
Richner returned to Cambodia as a tourist in 1991 and visited Phnom Penh's hospitals.
He was shocked at the devastation. "I saw the actual medical situation - it
was a catastrophe. I walked around the hospitals in Phnom Penh, and talked to the
Cambodian doctors, and they asked me to do anything I could," Richner explained.
Richner did not immediately visit Kantha Bopha, which had been abandoned and fallen
into disrepair since the Khmer Rouge forced his departure 16 years earlier, because
he was afraid of what he might find.
Urged on by the doctors he talked to, Richner went to see officials at the Ministry
of Health. "I recognized two doctors I had worked with before (in 1975), one
of them was working in the ministries, and I was asked to re-install this pediatric
hospital where I had worked before," he said.
Richner accepted the challenge, having been led to believe that he would receive
funding from the Swiss government to re-build the hospital. He signed a contract
with the Cambodian Health Ministry in February 1992, only to discover the Swiss government
would not provide funding for the reconstruction.
"So I started to collect the money myself," Richner said. "In Switzerland
I am quite well-known as an entertainer (a concert cellist, his stage name is Beatocello),
so it was possible for me to raise money." In conjunction with a Swiss magazine
Beatocello launched a fund-raising campaign and held benefit concerts in Switzerland.
As of the end of 1992 he had raised 5.2 million Swiss francs (U.S. $3.46 million),
which he estimated is enough to operate the hospital until the end of 1994.
Construction began in April last year and in September the newly renovated hospital,
complete with a modern, well-equipped laboratory and pathology and X-ray facilities,
was inaugurated at a ceremony presided over by Prince Sihanouk and Special Representative
And Richner has not finished yet. Construction is nearly completed on a building
housing a new pediatric surgery, the first such children's surgery in Cambodia, which
is due to open by the end of this month. In addition, plans are in the works to begin
building a maternity ward next, and later a vaccination center as well.
All of the renovation and re-outfitting of the hospital, as well as its monthly operating
expenses of approximately $45,000, have been paid for entirely through small private
Richner returns to Europe frequently to raise money, and articles about his work
with the hospital in European and American publications generate contributions as
well. A recent benefit concert in conjunction with the Swiss Circus Knie raised another
half-million Swiss francs - enough to keep the hospital running for three months.
"With 2.7 million Swiss francs - that's about US $ 1.8 million - we could construct
and install a whole hospital and run it for two months," Richner said.
Richner had not originally intended to move to Cambodia to direct the entire reconstruction
himself, which meant giving up his busy musical career and private practice in Switzerland.
But he felt he had no choice.
"I realized that I will not get any money unless I come do it myself, because
people have no more confidence in all these big organizations because they lose so
much money in administration," Richner explained. "If an international
organization had to do a project like this it would cost twice as much because of
all the administrative costs - planning and discussion, all this humanitarian long-distance
travel. These $150,000 project manager salaries, that's a problem," he said
While Richner has a cooperative working arrangement with the State of Cambodia, he
receives no financial support from it. "They are bankrupt," he explained
simply. Nor has he received any funding from other governments or international agencies.
Richner said angrily, "It's the silliest thing, you know, all the governments
are waiting until after the elections, that was the slogan, 'wait until after the
elections' - even in the humanitarian sector. But that's a very sad example, because
children don't wait until after the election to get sick, they are already sick.
And after the elections everybody knows the situation is not any safer, not any better
Richner himself intends to stay five years - long enough to get the hospital up and
running self-sufficiently, and to train a new generation of pediatricians. "It
takes five years of training," Richner said, "so our contract is for five
years. Two years to install the whole hospital, two years to solidify it, and one
year to prepare to depart."
A medical training program for doctors and nurses is already in place, with medical
professors and nurses from Switzerland and elsewhere coming to Cambodia on rotation
to train the Cambodian staff and help with the installation of new equipment.
Currently there are five Swiss and Canadian nurses, and a Swiss lab technician training
the Cambodian staff. Cambodian doctors from the provinces also come to Kantha Bopha
for six weeks for medical courses. "We have a very good Cambodian crew now,
and we are teaching as many doctors as possible," explained Richner.
"Now the hospital is running very well, and from the professional medical point
of view, the hospital will work after four or five years without our assistance,
of that I am sure," Richner said confidently.
The problem after that, as always, will be money. Richner is working on ways to provide
on-going sources of revenue for the hospital after he departs, so that it will ultimately
be independent of donations. "Medicines cost a lot, you know, and the money
you spend for medicines goes back to Europe, it's profit for Europe, not for Cambodia,"
Richner said. One of his ideas is to set up some kind of factory, perhaps a subsidiary
of a Swiss manufacturer, the proceeds of which would go to the hospital. Another
is to garner a large donation from the pharmaceutical industry to set up an endowment,
and pay the hospital's operating costs from the interest on the endowment.
In addition to normal operating expenses like medicine, water and electricity, Richner
also pays his staff a salary to supplement the $20 monthly government salary that
doctors, as civil service employees, normally receive. "It was not even a question
for me that I should pay salaries," Richner said. "The salary given by
the government is too small, and I wanted to prevent doctors and nurses taking money
from the parents to treat children [treatment is free at Kantha Bopha, as in theory
it should be at all government hospitals], and to prevent losing medicines. Normally
hospitals lose 45 percent of their medicines [stolen and resold by the staff] and
we do not lose any medicines, we have a very good control system. It's not necessary
for them to steal because they receive a salary," he said.
Understandably, Kantha Bopha is a desirable place for Cambodians to get a job. According
to his contract with the Health Ministry, Richner hires all the ex-patriot staff,
and the Ministry is responsible for the Cambodian staff. Richner acknowledges that
paying salaries causes some problems with the ministry and other hospitals, who are
already jealous of his well-outfitted facilities. But he feels all hospitals, especially
those with well-paid foreign staff, should pay salaries, both as a sign of respect
to the local staff and in order to motivate them. Richner stressed the importance
of motivating his staff, both by paying a small salary and providing suitable working
conditions and materials to do their job properly.
As Pauline Soucy, a Canadian nurse in charge of the new surgery, said, "It's
hard to work if you don't have the equipment or material to do the work. For the
doctors it's very rewarding to work in a place where they can treat the patient.
These doctors have their five years of medical training, they see a patient, they
can diagnose the patient - if they know the sickness and they know how to treat the
sickness but don't have the possibility to do so, it's very frustrating. Here at
Kantha Bopha we have all the lab machines that we need, the medications."
Asserting that Kantha Bopha is the best-equipped and staffed hospital in Cambodia,
Richner insisted that all hospitals should be renovated and have the same equipment.
"I get angry because some people in Europe say this hospital is too sophisticated
- it's this idea of cheap medical care for the Third World. People forget that in
1975 this hospital had the same level of care as Bangkok Children's hospital. Without
the proper laboratory equipment or facilities, you cannot treat in a responsible
manner; it's not a luxury."