IV Journees de Medecine et de Pharmacie
7.8.2000 , Phnom Penh
 
REFLECTIONS ON THE HEALTH SYSTEM
Dr. Beat Richner, Kantha Bopha Children`s Hospitals, Cambodia
  
WHO is wrong and WHAT is wrong
Asked by His Majesty the King Norodom Sihanouk and the Cambodian government we restored 1992 the empty and destroyed Kantha Bopha Children's Hospital, where we were working in 1974/75 until the Khmer Rouge entered the town. 1995/6 we built a second , 1998 a third Hospital. So in the meantime we are running three Hospitals: Kantha Bopha I and II in Phnom Penh, Jayavarman VII, annexe of Kantha Bopha in Siem Reap Angkor. The running costs per year (without investments) are 9 Million USD. Most money beeing fundraised by myself in my beloved country Switzerland. Per year these three Hospitals are hospitalising 32 000 severely sick children, are managing 450 000 consultations, are doing 4200 surgical operations and 100 000 vaccinations.
2400 children more would pass away per month without the facilities of Kantha Bopha.
 
There are working 890 Cambodians and only 4 expatriates. There is no corruption.
All is free of charge for all families. 85% of the families are too poor to pay any treatment. And 99 % are too poor to pay a correct medical treatment. There is a tremendous poverty. So Kantha Bopha is their last and only chance. Our policy, giving all treatments free of charge and never taking money from patients, is not only the vital question for the Individuum, the single case, but it is important for the whole society: If they should have to pay, they would stay at home with their Infectious Disease. The days, the weeks or in case of Tuberculosis the years before they will pass away ,they would pass the germs on all people around.
 
Kantha Bopha , having saved and going on saving so many children, preventing so many children from lifelong handicaps, Kantha Bopha is a social and economic factor for the future of Cambodia.
Kantha Bopha is a working system with an efficiency rarely seen on the world.
 
How comes WHO is telling the medias and the Cambodian government 1995, that Kantha Bopha is undermining the Health System of Cambodia. How comes WHO and other International Organisations are telling the medias 1997, that Kantha Bopha is wrong in its approach and in its conception. How comes International Health Experts and the WHO again are saying 1998, that Kantha Bopha is nothing else than subversion of the Health System. Tell me, subversion of which Health System? Subversion of which System?
 
In 1998, just around the time, when these crazy criticisme and blames in public were done again, blames which endangered the vital donations , that means the existence of the Kantha Bopha Hospitals, 10 000 cases of the haemorrhagic Dengue Fever were hospitalised in Kantha Bopha. The Ministry of Health has registrated 12 000 hospitalised cases in whole Cambodia. So Kantha Bopha is covering 80 % of the really sick children. 60% of the 10 000 Dengue-children arrived in shock. If you do not treat the shock in a correct way the child will dye. Our mortality was only 1,5%.
 
So let me ask : WHO is wrong and WHAT is wrong? WHO is undermining which System? WHO's approach is wrong? There is only one way to treat a child in shock or preshock. A correct one. That´s exactely what we are doing.
 
In connection with the mentioned Dengue epidemy let me ask, why WHO is still sending today , the year 2000, Experts to simplify the monitoring and treatment of Dengue cases. Experts who have much less experience and knockledge as my Cambodian colleagues, but much higher salaries? There is never a simple treatment of the shock, never a simple monitoring of the shock: there is only a correct one.
 
Mr Peterson , the Representative of WHO in Cambodia from 1995 up to 1999, was telling me and the medias: In Cambodia there are simple diseases , that's why a simple medical care is needed in Cambodia. A cheap one. But, ladies and gentlemen, there is only a correct one.
 
Why Unicef is telling 1998 the Medias that Jayavarman VII Hospital (at this time in construction) is not necessary? Why the International Experts think, that the nine health centers and district Hospitals runned by Unicef since 7 years are covering the needs? Their statistic of Tuberculosis of the year 1998 in Siem Reap shows 26 cases. The first month, the Jayavarman VII Hospital was in function, we found already 240 children suffering from Tuberculosis.
So let me ask: WHO is wrong and WHAT is wrong?
 
In June 2000 alone, in the Jayavarman VII 860 severely sick children were hospitalised. Today, there are 177. So the needs are not covered by all these centers. And again and again we get children being holded back by these very district centers for days, arriving in desastrous states and too late. Often not sent by the doctors or responsibles of these centers, but by the parents themselves in despair, having lost there all their money, farmers having lost their cows, having lost their economic existence for nothing. Even worse: There their children were misstreated or not treated. There are no facilities to do a correct diagnosis and afterwards a correct treatment. It does not make sense to pay salaries for expatriates working in such desastrous and not efficient conditions as it is done by NGOs following the protocolls of WHO. Meningitis is not recognised, Malaria is interpreted as Typhus or Typhus as Malaria. The Diagnosis of Tuberculosis is missed. It would really be better for these children there would not be such centers.Then these children would directly arrive in Jayavarman VII for a correct treatment in time. In Europe police would close these centers. The justice would be involved.
 
Even the immunizations were and are not done by these centers created and run by Unicef the last 7 years.Unicef , who has told the medias, that they are covering the needs. At the beginning of 2000 we had a huge Measles epidemy. Even in Phnom Penh we hospitalise today, the day of this conference in this luxuary Hotel, 9 cases of Newborn Tetanus. Can you immagine the suffering and the pains of these children? Unique in this world, the rate of Tetanus in Cambodia ! The vaccinations of the children`s mothers were not done. The expensiv programms of Unicef obviously not realised. Why?
 
In Siem Reap 2/3 of the hospitalised children are suffering from Tuberculosis. This is not a simple disease , as WHO is thinking. The diagnosis of Tuberculosis of the child is one of the most difficult diagnosis in pediatrics.
WHO told medias and the Cambodian government 4 years ago, that there is no Tuberculosis among children. And if there would be a case of a child Tuberculosis, it would not be of any importance: the child is not contagious. A grave mistake: thousands of children were found the last 8 years in Kantha Bopha with contagious Tuberculosis (Cavernes, Fistulisations etc.). Kantha Bopha is still the only place in Cambodia where the diagnosis of Child-Tuberculosis can be made and where a correct treatment is applicated.
 
Still Tuberculosis is not yet in the Respiratory Infectious Disease Protocol by WHO. Why?
 
At times we have more than 6000 ambulant cases of Tuberculosis under treatment.
 
Still there are today International Experts telling you, that by these 3 Kantha Bopha Hospitals needs were created ,that did not exist before. But the Tuberculosis does not exist because we found it, we find it because it is existing. But you need the means and the facilities inorder to find it. And these very International Experts tell you these means are too expensive and too luxuary for a poor country as it is Cambodia.
 
The preexisting Tuberculosis is weakening the child, so infectious diseases as Typhus, Malaria, Dengue, Measles , Japanese Encephalitis, or common banal virus infectious diseases, are much more aggressive. On the other hand the Tuberculosis may explose by these additional infectious diseases. In cases of acute Measles( where we know, that the general immunity of the child is rapidely going down ) we can observe Miliaris Tuberculosis or Menigitis Tuberculosis emerging within hours. The synergies of these diseases , the complications caused by these frequent synergies are complicated and important to be understood, if there is any will and interest to save the sick child. By the Idea of the Representative of WHO in Cambodia Mr.Peterson, that there are simple diseases in Cambodia which are needing a simple medical System only, a cheap one, by this idea you will fail saving all these children. And in these simple centers they are failing to do so.
 
And most important : The Tuberculosis is weakening the child in case of HIV too.
 
In 1993/94 there were no HIV cases in Kantha Bopha . The first seven months of this year 2000 we have already hospitalised 518 new cases!!! Most of these cases among children younger than 5 years. As you may know: UNTAC has brought this disease and in defiance of warnings and outcries by professionals at this time, the UNTAC-soldiers have spread out the mess and were going on spreading out the disease. Since then there is the biggest HIV increasing rate ever seen in Asia. WHO and UN did nothing against . We were here at this time.
So WHAT went wrong and WHAT goes wrong?
 
 
In Durban there was recentely an International Conference on AIDS. The question was asked: Why HIV is so agressiv among children in South Africa? Is there Tuberculosis? No, there is no Tuberculosis, at least there is not known , if there is Tuberculosis among children. Four years ago you could hear by WHO in Cambodia the same answer. But as I told you: As we found it in Kantha Bopha: Tuberculosis in Cambodia is the Problem Number One of the children and the future of the country.
 
In Durban International Experts were critisising and blaming President Mandela having cried out about AIDS too late , only in 1998, much too late. This is a shameful, cynical and hypocrit critisisme. Don't forget that the WHO´s General Director said 1992, that Malaria is more important as AIDS in the southern Africa. There we fight, Malaria is the priority, he said. Some doctors beeing oposed to this decision told the General Director of WHO: The Increasing rate of AIDS will be enormous , the rate of Malaria will be more or less stable. But these people were told by the General Director of WHO : At least, Africa is overpopulated.!!!! And remember, ladies and gentlemen :The HIV-rate among the black population is much higher as the HIV rate of the white population.
 
Mandela was suffering in the prison from Tuberculosis. By chance a Doctor, sent by an UK delegation to the South Africa`s prisons, discovered it observing from far a not symetrically breathing Mandela. There was a serofibrinouse pleuresy. The regime was forced by UK to confirm the Diagnosis and to do a correct medical treatment. Otherwise there would no more be a Mandela, since 20 years. And no free South Africa….. The Germs can be used as silent weapons. The Idea, that Mandela now should be responsible on the AIDS and Tubercolusis Crisis in South Africa is a shameful act and a perfidious act of Propaganda by International Experts, who have lost their shorttime and longtime Memory , inorder to hide their failure . They try to transfer their own responsibility on their desastrous attitude and inefficient work to the governments.
 
Similar things can be observed in Cambodia. International Health Experts now are more and more critisising the Government because of the Health desaster in Cambodia. After having worked here 9 years , beeing frustrated by their penible results, they transfer all the responsibility of this catastrophy to the government.
 
But remember: The high rate of Tuberculosis is a direct consequence of the war. And the war in Cambodia was brought by the western and rich world 1970. The High Rate of AIDS is caused by UNTAC (1992 /93).
 
I have mentioned South Africa because sometimes I think, what is the black African
in the southern Africa for rich and mighty instances , that is the Cambodian in southeastern Asia.
 
Why WHO and Affirms (a US military-medical agiency) are against the mass vaccination of Japanese Encephalitis in Cambodia? In Kantha Bopha we found thousands of children distroyed and killed by JEV. In Thailand the vaccination is done. In Thailand it is obligatory. In southern China it is done. In southern China it is obligatory. Of course the children of the International Experts living in Cambodia will get the vaccinations, the children of some rich people too. But who can pay 60 USD for a complete Immmunization in the Institut Pasteur.
 
In Kantha Bopha we are now doing the vaccinations free of charge since 3 years. It is very expensiv for us. So again, let me ask again , WHAT is wrong and WHO is wrong?
 
The use of the Antibiotic Chloramphenicol for children is forbidden in the western world since 1970 because of its dangerous side effects. Still it is on the essentiel drug list of the WHO and still stored in the central Pharmacy of Unicef. By WHO it is still recommended to be used in cases of severe infectious diseases. Because it is cheap…... Week by week we find children bleeding and bleeding and passing away by the side effects of this drug, still even used by International Organisations.
 
In addition to this we find that Chloramphenicol is not efficient. The germs are resistent up to 100%. So Chloramphenicol is killing children actively and passively. We went to the International Court of Justice in The Heague against WHO and other International Organisations concerning the handling of Tuberculosis, HIV, JEV and the use of Chloramphenicol in Cambodia. All this is causing a passive genocide. We did not get an answer . It seems, that the Internationals are out of law. The International Experts "intouchables".
 
The policy and strategy of WHO applicated to the third world can be described as poor medical care for poor people in poor countries. It has to be simple and cheap ,so it reaches all the masses of the poor. That is a Leninist Marxist Idea . Let us say a Leninist Marxist Illusion. Let us be honest and say: That is a lye. Nothing is reaching the poor masses. The International Experts may be compared with the Nomenclatura of the gone Empire of Sowiet-Russia, the Nomenclatura being highly privileged. For their children are different standards as they are for the children they are working for. They have all interests to sustain this system because they have a super life. So huge amounts of money (Millions of Dollars) are spent for Propaganda (Television PR, Medias PR, International Conferences , International workshops, Regional seminars, Plannifications , books , bulletins ,Conferences again , follow up Conferences and so on), Propaganda ,inorder to sustain this inefficient system ,that means to make believe the western and rich world, the rich part of the global village ,which is paying all this, that things are well done.
 
If the powerful governments of rich and mighty nations are aware of this gap between the Propaganda by the global International Nomenclatura and the reality , that means the efficiency and results of their work?….. that is the question! If the mighty governments are not only aware of this gap , but agree, great doubt on apartheid arises. Apartheid which causes passive genocide.
 
Let me compare this situation again with Russia: Secretary General M. Gorbatschew was aware of the gap between the Propaganda done by the nomenclatura and the desesparate reality. First he tried to manage improvements within the system, fighting against " schlendrian" , the old rut and corruption. Only 1988 he recognised, that whole the System is wrong.
 
So the worldwide global Nomenclatura of International Experts and at the same time the mighty governments should understand: the System is wrong. It should be replaced by a System of correct medical treatment accessable for everybody, because everybody has the same right, the human right of getting a correct medical treatment, which is not killing but saving. A free system for everybody, so everybody has access to it. All the money spent for the Propaganda and the worldwide more or less ineffective International Nomenclatura should be used for centers working on the spot in a correct way. Propaganda of programms for poor people in poor countries by the Nomenclatura are not only not necessary but dangerous , harmful and paralysing, as we showed above. It is causing a passive genocide. Most parts and sections of WHO and other Organisations are not necessary. By the money the rich world is spending for WHO alone , you could install 400 centers Kantha Bopha and operate there for ever. By 400 centers working in a correct way without corruption you can save all the children of Southeast Asia and whole Africa. And last but not least: only in such centers professional and efficient teaching, training and education are possible.
 
You do not need this Nomenclatura of International Experts bringing rules for poors. Rules their own children are excluded from, because for them there are other standards. All countries have their Medical Faculties. All Medical Faculties can communicate by internet. All countries have their excellent doctors and nurses. What you have to do is to implement the facilities and adequate salaries, that an efficient work can be done. And it will be done, as it is shown in the three Kantha Bopha Hospitals.
 
I thank you

Present

History

Foundation

Academy

Concerts & Events

Publications

Info Material

Home

Donations - Spenden

contact: Email