Dr. Beat Richner, Kantha Bopha Children's Hospitals
Phnom Penh / Siem Reap Angkor, 27. Oktober 2004
Mrs Carol Bellamy
Executive Director, UNICEF
Copy to HE Secretary General Kofi Annan,
to the Minister of the Swiss foreign affairs, HE Madame Micheline Calmy Rey
in your recent Child Survival Report Card (Vol 1 2004, published early October 2004) Cambodia is told to be a country where under - five mortality rate has increased since 1990.
Excellency , be assured of my high respect to the worldwide activity by UNICEF for the benefit of our world's children.
Excellency , let me explain why this information on increasing child mortality by UNICEF is wrong, why the strategy by UNICEF in Cambodia in the Health sector is not only not efficient but dangerous. These alarming statements are due to Cambodia only, not to other countries where I do not know the situation. And only due to UNICEF's
health sector. Not to other important sectors as Protection, Education and others.
As a pediatrician, working since 13 years in Cambodia (first time I was here 1974/75), having created three Children's Hospitals and a Maternity , hospitalizing 85% of all Cambodian Children being hospitalized in Cambodia, I know the Health situation of Cambodia's children. I know the situation of Cambodia's Public Health System. As medical doctor I have the duty to tell you the truth.
The Child mortality in Cambodia has not increased since 1990
Excellency, who can tell you the figures of the Child Mortality in Cambodia in 1990 or 1980 or 1975 ? At this time the access to many regions was not possible for different reasons. So nobody can tell you these figures.
So nobody can compare any actual figures with figures of 1990.
The figures in a recent report which nobody has the chance and the privilege to see and nobody has the chance to know the methods used to figure out these strange figures...., these very figures were told to the medias in Phnom Penh on June 2nd 2004. But this so called report is based on mere estimations of the years 1998/1999.
At this time the children in the north of Cambodia had really no chance to get a correct and efficient medical treatment.
1999 we opened in Angkor, the north of Cambodia, our third Hospital, the Jayavarman VII Hospital. The last 12 months 25 000 severely sick children were there hospitalized. 80 % among these children would pass away without this Hospital, which is free of charge for all. (People here are very poor. If they should pay, they would not have any access to.)
Since 1998 the rate of Hospitalizations in Phnom Penh (Kantha Bopha I and II) has increased by 35%. The last 12 months we hospitalized in Phnom Penh 45 000 severely sick children. 80 % of these children could not survive without this Hospitalization.
The children arrive from all over the country. The roads are now much better. The security situation too.
So the mortality of children in Cambodia has not increased.
The alarming and strange attitude of UNICEF
Excellency, in 1998 the representative of UNICEF in the province Siem Reap told people in Swiss Television (Swiss people are the main donators of the Kantha Bopha Hospitals), that the Hospital Jayavarman VII at this time under construction is not necessary. The needs are covered by the 10 Health Centers managed by UNICEF the Swiss people were told....Other Health Experts told the same nonsense in the medias. The figures above tell us: The last 12 months 22 000 children more would have died in Cambodia without this Hospital opened in Siem Reap 1999, and UNICEF thinks this hospital is not necessary. This error was never corrected or excused by UNICEF. In contrary UNICEF thinks that the way we are doing the job together with 1500 Cambodian now well trained employees is wrong: Not adequate to the economical reality of the country. Most childhood death occurs for simple reasons, they are telling you. That is why you have to do a simple medicine, which is not expensive. This philosophy by UNICEF and WHO is wrong and a reason why the health situation in Cambodia is still so bad. UNICEF and WHO have their permanent offices in the Ministry of Health and they dictate its policy.
All this above mentioned 10 Health Centers by UNICEF in Siem Reap province are not working. The model project, the Hospital Sotnikum (under the so called New Deal contract between Ministry, Unicef and MSF) does not work too.
Fatal and frequent stories about pregnant mothers, not being operated because no power, because the money for the generators' Diesel is stolen, about mothers or sick children not beeing transferred to our center until there is money for the Diesel of the ambulance the families have to borrow . If with convulsions (Eklampsia) or if bleeding, first they ask for money poor people cannot pay. Corruption and the lack of facilities are fatal. The Laboratory is empty. A correct diagnosis can not be done. And without correct diagnosis no correct treatment is possible.
The future strategy of UNICEF
On June 2nd UNICEF has told the medias in Phnom Penh that you must " refocus on simple , low-tech and doable interventions". This is exactly what UNICEF is doing here since 13 years without any efficiency. The Public Health system is zero.
And this strategy is dangerous. They use cheap and dangerous drugs and medicines forbidden for children in the so called civilized world, where they are still produced for the poor world and stocked in the central pharmacy of UNICEF in Kopenhagen, they use drugs which do not work because of the germ's resistances. They implement simplified medical protocols neglecting the main killer of Cambodia's children, the Tuberculosis, and so on.
The success of the Kantha Bopha Hospitals (Kantha Bopha I and II in Phnom Penh and Jayavarman VII in Angkor) with its low mortality rate of 1,2 % is firstly explained by the transfer of the technology and by the transfer of correct drugs and medicines allowing a correct diagnosis and treatment, and secondly by the exclusion of the deadly corruption. All families have access. All is free of charge. We give the money to the families for their travel costs too, the families arrive from all over Cambodia. The compliance of the follow up of TB patients is 90 %. Cambodians are cooperating if there is no corruption and correct information. The compliance of the folow up of the HIV positiv mothers with their children is 100 %! But they cannot pay. And the UNICEF and WHO, dictating the policy of Health, are thinking patients must pay by themselves.
Excellency, let me send "The Angkor Declaration" , now signed by 200 000 Cambodians, by the victims themselves , not by ambassadors , stars and VIPs of the so called civilized world, asking for correct medicine for all sick children. Free of charge for the poor. I think that should be the idea of UNICEF too, but it is not corresponding to the way UNICEF is working in reality in Cambodia.
We have the idea that most functionaries not only of UNICEF , but of WHO and others too, are accomplices of local officials. Wrong figures are not disputed and blindly accepted in order to sustain a bad virtual situation to keep their status as lords of poverty in the poor countries. (85% of the International Organizations' money is for the salaries of their functionaries). This spirit of intellectual corruption with its severe consequences, Excellency, must be changed in Cambodia in the Health sector. I do not hope there is the same problem in other countries.
By a budget of 15 Millions USD per year the three Kantha Bopha Hospitals are saving 60 000 or more lives per year. And by the 700 000 consultations per year thousands of sick children are prevented from being severely sick. And thousands of healthy children are vaccinated.
By 15 Millions this all can be done. The Budget by the Ministry of Health is 58 Millions USD (excluded all the money pouring in Cambodia by UNICEF, WHO, USAID, JAICA , the British, the German, the French cooperation, Safe The Children, Care , and so on). On June 2nd 2004 it was told that 64 000 children under 5 are passing away per year. Why these lives, if the figure should really be true, can not be saved by the Ministry's Budget and the Ministry's policy directed by UNICEF and WHO?
Excellency, allow us to invite you to see our Hospitals and some other Health Centers to show you this alarming and not tolerable situation.
Sincerely Yours, Dr. Beat Richner
NB: the Angkor Declaration can be found in the last chapter of the book enclosed :Hope for the children of Kantha Bopha





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