The director of the National Anti-Tuberculosis Institute is uncompromising in his
view of the TB problem in Cambodia: "If this was the West it would be considered
But it is not and Dr Kong Sim San has been doing the best he can for 13 years through
the institute, known as the TB Center, which is part of the Ministry of Health.
He has had to fight social prejudice as well as disease. Many Khmers believe TB is
hereditary and Dr San is hoping health education will shatter this myth.
He says many people hide themselves because of the shame.
Another problem is ensuring drugs end up with patients.
Some low-paid medical staff are known to sell drugs as do some patients.
Dr San is also forced to find an alternative income to supplement his 50,000 riel
salary (approx $25) and runs a private clinic in his own time.
Money appears to be the root of many possible solutions.
Dr San estimates he received about half the money he needed to run the previous national
"We already have the plan, but where do we get the money?" he asked.
Dr San launched an urgent appeal at a recent conference on tuberculosis and lung
disease in the Asia-Pacific region, held in Bangkok from Nov. 1-4.
Germany has donated $1 million worth of medicine for the first year, but Dr San says
another $500,000 is needed to set up next year's program. From 1995 $1m will be needed
The National Tuberculosis Program (NTP) aims to increase the diagnosis rate to 70
percent and the cure rate to 85 percent. It is being supported by the World Health
The previous program, supported by the French Red Cross, only cured 44 percent and
diagnosed 28 percent.
Any improvement in treatment cannot, however, change the problems of detecting the
disease which comes in many forms and can affect any area of the body.
Most at risk are the lungs, skin, intestines and the membrane around the heart. TB
also shows itself in meningitis and septicemia.
Dr San outlined the TB Center's method of detecting the disease. If a patient has
coughed more than 21 days in a row, then TB is suspected.
"The first task," he said, "is to examine the [patient's] spittle
to check for TB bacillus."
If positive, a patient undergoes treatment using up to five different drugs. If negative,
penicillin and antibiotics are prescribed until a patient is cured.
Out of patients that cough for more than 21 days and do not receive treatment, 50
percent die within two years, 25 percent cure themselves, the remainder tend to develop
chronic coughs and thus help spread the disease.
Dr San said the Center sees 2,000 new cases a year of which 180 are hospitalized.
Between 60-80 people seek treatment every morning.