Miracles From Tragedy

It’s a tragedy or a miracle, depending on how you look at the health sector’s development over the past 15 years, with The Cambodia Daily’s coverage dominated by superstitions, renegade “physicians” and epidemics of HIV/AIDS, malaria and dengue fever. 

In 2007, Cambodia experienced its worst outbreak of dengue fever, with 40,000 people struck by the mosquito-born disease that caused 407 deaths. In 1998, the year of the last dengue fever epidemic, 474 people died in a year with 16,200 infections.

Dr Beat Richner, who said his five Kantha Bopha children’s hospitals treated more than half of all dengue fever cases in 2007, sees Cambodia’s health sector as a 15-year tragedy.

Richner, who founded his first children’s hospital in 1992, said that improved roads and security have increased access to medical care. However, due to corruption and under-funding, the public healthcare system treats fewer people today than in 1993, Richner claims, pushing more and more Cambodians into his hospitals.

“From my point of view, nothing has im­proved…. A lot of these [public] hospitals are phantom hospitals, and a lot of these medicines outside are fakes. And a lot of these fakes are toxic,” he said in a recent interview.

While Richner sees tragedy, Dr Tia Phalla sees a miracle.

“I think we have done a lot so far,” said the secretary-general for the National AIDS Authority from 1999 to 2005, who was assigned until mid-2007 to the UN regional HIV/AIDS taskforce.

About 21,000 Cambodians today live with HIV/AIDS, he said. But the rate of 15-to-49 year-old Cambodians affected has dropped by more than half over the last seven years, going from 2.1 percent in 2000 to 0.9 percent at last count in November 2007.

In 1996, Tia Phalla said, about one sex worker out of three was infected with HIV/AIDS. The rate dropped to 21.4 percent in 2003, and is now estimated at 13 percent of the 17,000 to 20,000 sex workers in the country, he said.

“This is an incredible achievement,” Tia Phalla said.

The 1990s saw HIV/AIDS fast approaching epidemic proportions as the Daily’s headlines reflected: ”AIDS on the Rise” (1993), “AIDS Spreading Faster Than Earlier Estimates” (1995), “Prime Minister Decries Carnage of AIDS” (1999).

A September 1995 report of the World Health Organization attributed the spread of HIV/AIDS to the thriving commercial sex trade due to the “influx of foreign businesses, tourism, relief and development personnel,” and Untac personnel, the Daily quoted.

In 1995, WHO estimated 30,000 HIV/AIDS cases in the country. Two years later, WHO revised its estimate to 210,000 cases.

The National Center for HIV/AIDS was established in 1999; by 2001, WHO had measured a decline to 169,000 cases, although the infection rate of 2.8 percent in 2001 remained the highest known in Asia. By 2004, fewer new cases were appearing but more Cambodians were dying from the disease than ever before.

“[A]n estimated 50 people succumb to AIDS every day, about 25 percent more than in past years,” the Daily wrote Sept 21, 2004.

Hampering efforts to curb the spread of HIV/AIDS were local healers and unlicensed pharmacists hawking scam drugs, according to the story.

Already in the mid-1990s, unlicensed pharmacies were in full swing despite curtailing efforts from the Health Ministry. A Daily story in August 1995 reported that at least two-thirds of the private drugstores were unlicensed. While the Health Ministry planned as far back as 1996 to set up a committee to investigate healers claiming to cure HIV/AIDS, the legislation, making it a crime to knowingly spread HIV/AIDS or advertise cures for the disease, was not adopted until 2002, the story said.

Fake or obsolete malaria medicines also impeded malaria-control programs. A 2003 study in Western provinces revealed that one out of four customers at retail outlets had received a different medicine from what they had requested.

“Besides having wasted money, this customer could die if the individual’s malaria gets worse and he or she only has useless drugs to treat it,” the Daily reported, finding that there were an estimated 2,400 illegal drug outlets throughout the country selling counterfeit medicine.

Overall, malaria control was a rousing success story for the health sector. By 2002, Cam­bodia had managed to become a world leader in malaria control due to the National Malaria Center’s prepackaged drug regimen, malaria-monitoring village volunteers and bed-net and education programs (“EC Hands Malaria Project Over to Government,” Dec 10, 2002).

A tragic note in Cambodia’s battle against disease is the nation’s susceptibility to tuberculosis. In 2002, TB was claiming nearly 10,000 lives annually, as reported in “A Common Death” (Oct 12, 2002). The disease is curable but poverty and HIV/AIDS, which makes people especially susceptible to tuberculosis, hampered efforts to fight the disease, TB advisor Dr Ikushi Onozaki was quoted saying.

Lack of basic knowledge on hygiene and some traditional beliefs and practices have also been major factors affecting health.

Every year, an estimated 11,000 deaths and 9.5 million cases of diarrhea result from poor hygiene and sanitation, the Daily reported Feb 14, 2008.

“About 10 million people are estimated to still defecate in open areas, and the [World Bank] report states that about $37.5 million could be saved if people didn’t have to take time out of their work say to walk 10 minutes trying to find a quiet place to go to the bathroom,” the story said.

An increasing number of abortions and a decreasing number of breastfeeding mothers also proved hurdles for the Health Ministry over the past 15 years.

The Daily reported in 2002 that 10 out of 100 children were dying before their first birthday, one of the highest infant mortality rates in Asia, and that keeping mothers breastfeeding was one way to fight this.

In a direct challenge to foreign baby-food manufacturers marketing their infant milk formula directly in the country’s hospitals and healthcare centers, the Health Ministry in 2002 launched its Baby Friendly Hospital Initiative to train medical staffers to encourage mothers to breast feed (“Mothers Duped by Milk Products, Officials Say,” Aug 5, 2002).

Still, the Health Ministry admitted in 2007 that the maternal mortality rate had actually increased over the last seven years, going from 437 deaths of mothers per 100,000 births in 2000 to 472 last year (“Maternal Mortality Rate Remains High, Report Finds,” March 29, 2007).

Another risk to women is a method of abortion “as old as it is dangerous,” as reported in “Unregulated Abortions Popular, Dan­gerous” (Feb 6, 2001).

Expensive hospital abortions send women to traditional midwives, as large families, once seen fortuitous, become a burden on the poor, the story said. While the Health Ministry stipulated that only qualified doctors, nurses, and midwives authorized by the ministry could perform abort­­ions, and illegal abortions could mean up to 10 years in jail, nobody had ever been prosecuted.

The article ended on a note commonly tragic, or perhaps miraculous, in The Cambodia Daily’s heath coverage.

Abortion tablets, “which cost $10 for a packet of six, can be used up to the 49th day of pregnancy, though some women have used them as late as two months, a staff member at a Chinese medicine store on Kampu­chea Krom Boulevard said.

“The tablets, taken on an empty stomach, cause the body to reject and expel the fetus. ‘It’s very safe,’ said the staff member. ‘Many people use it. They never have problems.’”


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