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

Yasushi Akashi.

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

donations.

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

disdainfully.

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

to invest."

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."