If you are interested in Cambodia then you definitely need to know about this guy, whose real name is Dr Beat Richner. He is a Swiss paediatrician who first travelled to Cambodia as a young graduate in 1974 with the Red Cross. He left when the Khmer Rouge seized power in 1975. In 1991 he returned and was asked by the Cambodian government to rebuild Kantha Bopha Children’s Hospital in Phnom Penh. Since then he has established a total of five hospitals in the country, four of them in Phnom Penh and one in Siem Reap. All are named Kantha Bopha (and numbered to distinguish them from each other), after a daughter of King Norodom Sihanouk, who was born in 1948 and died of Leukaemia in 1952.
Cambodian Ministry of Health hospitals operate a fee-heavy system, leaving a significant proportion of Cambodians in debt. Many basic interventions will not be performed without a private cash fee being paid to the individual doctor, nurse or other health staff first. This can be crippling for people who barely have enough to keep themselves nourished, which is the cause of much ill health here in the first place. Most Ministry of Health staff have their own private clinic or work in a private setting outside their government job. They often leave the hospital grounds during shift hours to attend to their private paid work, which is unofficially accepted practice, largely due to the appallingly low pay received in government employment. From my observations, Cambodians have learned to have very low expectations of health care, gravitating towards NGO or private services wherever possible on the usually correct assumption that resources and care will be of a higher standard. People with enough income will travel to neighbouring Thailand or other Asian countries to receive treatment, but this option is unavailable to most.
A total of 2500 Cambodian staff are employed at the Kantha Bopha hospitals, providing treatment free of charge. No payment is required from patients and no staff work outside of their hospital employment. This makes for a corruption-free system in a country where corruption is normalised in many government departments. The standard of care is also closer to western standards than in government hospitals which provide a horrifically low level of care in an equally horrific environment. During my time based in a collaborative position as Medecins Sans Frontieres staff working alongside the Ministry of Health I blogged about some of these appalling standards. For example sewerage seeping out of the ground and hospital waste being burned adjacent to patient care areas, or cardboard boxes overflowing with potentially infective sharps and children playing amongst infectious waste including sharps. On a daily basis my tolerance levels were confronted in ways which were abhorrent to my “first world brain” but accepted as normal by my colleagues. This is the case even outside a hospital setting. For example, sitting at an outdoor cafe having a meeting the other day, a skeletal father and son scavenging team walked past us, dressed in rags with sacks on their backs. I stopped in my tracks while my Cambodian friends discussed how easily shocked the likes of me can be about things which they have spent their lives becoming sensitised to. They still care, and in fact dedicate a lot of their livelihood to helping others. But there is no shock for them to such sights.
A good example of the difference in standards of care at Kantha Bopha is the shock lesson I had recently when my ex-colleague’s cerebral palsy affected infant was afflicted with a mystery illness causing very high fevers of unknown origin. He really seemed to be on death’s door and the family travelled with him to Siem Reap so that he could be admitted at a place they trusted he would receive good care. During a previous illness his grandmother had taken him to a health centre and been refused treatment for him as the clinic staff deemed it unnecessary to treat a disabled baby! Requiring admission to Intensive Care, his mother shared an agonising photograph to friends on Facebook of her son, unconscious and intubated. Initially happy to see that he was receiving a level of care which is usually unavailable here, I was then shocked when a European paediatrician with experience in Cambodian ICUs instructed her to make sure that someone continued to manually ventilate the bag! He was intubated but he was NOT ventilated and the tubes could actually increase his respiratory distress and risk of respiratory arrest, unless someone was manually pushing air through the breathing bag and connected tubes into his lungs, at the correct pressure and rate. This is a skill that medical and nursing staff in wealthy countries learn thoroughly before being trusted to perform manual ventilation, which is usually only required in emergency situations, due to the many associated life threatening risks. Anyone requiring ventilation in a wealthy country will be hooked up to a sophisticated, computerised ventilator with a highly skilled nurse/technician providing 1:1 care. In this higher standard Cambodian facility, untrained family members put themselves on rotating shifts to keep their baby breathing! So while the level of care at these hospitals is far better than elsewhere in the country, it remains incomparably inferior to standards considered normal in western hospitals.
The Kantha Bopha hospitals treat 85% of Cambodia’s seriously ill children, and 92% of all paediatric cases of Dengue Haemorrhagic Fever, an endemic and potentially lethal mosquito-borne virus which infects thousands of Cambodians each year and occurs at higher rates in children under the age of seven. Each day across these five hospitals, 3,000 children attend Outpatient departments, 400 severely sick children are hospitalised, 75 surgical procedures are performed, 500 pregnant women are seen and 60 babies are born. Without this essential service, many of these people would die or be maimed for life, in a country where premature death and disability are all-too-common.
The reason that Dr Richner is known as Beatocello, is that he is also a cellist. He has developed a cello-playing clown persona who entertains crowds using comedy and has also published a number of books based on the Beatocello character. Since beginning his work with the Kantha Bopha hospitals in 1991, he has held many cello concerts in Switzerland and Siem Reap, for the purpose of raising funds for the hospitals. 85% of the annual budget of all five hospitals relies on private donations. It is reported that since 1991 upwards of $370 million has been raised by private donation in order to keep the hospitals operational.
Dr Richner is now 68 years old and has begun expressing his concerns about how the hospitals will remain viable once he is too old to participate. He expects that much of the private funding will dry up once he is no longer involved. This week he wrote a letter to the European Union, who are allegedly planning a political boycott against the Cambodian Government in the region of US$700 million. Dr Beat requests that the EU pledge to donate half of this boycotted money to the Kantha Bopha hospitals over the following ten years, in order to keep them operational at the same standard as they are able to function now.
Will the European Union consider maintaining support of the Cambodian people while boycotting their government? Beatocello seems to have given them a very realistic option to do so. I watch with an anxious heart.