For now, the stretch of land west of the road that leads from Siem Reap town to Angkor Wat is undeveloped and set off by fences.
If all goes according to plan, Dr Beat Richner, director of two private children’s hospitals in Phnom Penh, will build the $3 million Siem Reap Regional Children’s Hospital there by the end of the year. The new hospital will comprise an outpatient vaccination clinic, laboratories and inpatient infectious-disease wards.
Meanwhile, Friends Without Borders, a Japanese NGO with its head office in New York, will erect an outpatient clinic and a 30-bed inpatient facility nearby as part of the $1.2 million Angkor Hospital for Children by December.
The second and third phases, including a surgical ward, laboratory and x-ray facilities, are projected to be completed by 2000.
But the prospect of two expensive, private pediatric hospitals built side-by-side in a country whose hospital system is stretched thin has the medical community in Cambodia scratching its collective head.
“It’s a very difficult problem,” said Yasuyuki Furuyama, head of the Phnom Penh office for Friends Without Borders.
“We [have been] planning this construction since 1995 and we got permission from the Ministry [of Health] and the governor.
“So why did the government give permission to have another children’s hospital in Siem Reap? I think in Siem Reap we don’t need two children’s hospitals.”
Rob Overtoom, the UN Children’s Fund health adviser to Siem Reap province, said stuffing two specialized hospitals into one corner of the country goes against common sense.
“It is going to be a fight for the sick children of Siem Reap,” he said.
Siem Reap Provincial Hospital, which has been the beneficiary of help from Medecins Sans Frontieres in the past, also features a pediatric ward. But it could suffer from the new private hospitals, which don’t plan to charge any fees. “Nobody will go to the local system because there they have foreigners and very good medical equipment,” Overtoom said of the two private hospitals.
For his part, Richner believes the work of the two new hospitals will dovetail. The surgical ward planned for the Angkor Hospital would allow his proposed 180-bed regional hospital to concentrate on treating infectious diseases instead of performing surgeries, he said.
“If they have surgery wards and we can work together, then we work together,” Richner said. “For the same amount of money, I can save many more children through medicine.”
Ninety percent of the 430,000 children who come to his Phnom Penh hospitals every year are treated for infectious diseases, Richner noted.
Richner said “it makes sense” to put a hospital in a place where poverty is rampant and children have no access to medical facilities.
Richner, who lives in Phnom Penh and started Kantha Bopha I in 1992 and Kantha Bopha II in 1996, said the new hospital was suggested by the Ministry of Health last year. Senior Ministry of Health officials, however, did not know if Richner’s proposed hospital had been approved and they could not produce a project agreement between the two sides.
Furuyama said the idea for the Friends Without Borders hospital originated from Kenro Izu, a photographer and one of the group’s directors.
“In Cambodia there are many land mines and many children so he thought maybe in Siem Reap, he wanted to construct a hospital for the children,” Furuyama explained.
A contract with the Ministry of Health was signed in 1997.
Dr Hong Rathavuth, director of hospitals for the Ministry of Health, summed up the dilemma. “In Cambodia, when we think about hospitals, we think about multi-functional hospitals that treat everybody,” he sighed. “What about the others? A woman? A surgery patient?”
The ministry for the last three years has concentrated on building a sweeping health system of 70 general hospitals each supported by an average of 14 health centers.
Experts have said only 20 of the hospitals have the facilities and staff to safely perform emergency surgery and only a handful can offer the services and staff that a general hospital should provide.
Dr Henk Bekedam, the World Health Organization’s chief technical adviser to the Ministry of Health, expressed concern about whether three pediatric hospitals in the same area are out of step with the ministry’s health facility network.
“I’m not against any hospital,” Bekedam said. “But I’m not really sure if it is the first priority for this country. There are a lot of areas which might need a hospital earlier.”
And while there may soon be more than enough hospital beds in Siem Reap to go around, there may not be enough trained hospital staff.
Dr Dy Bun Chhem, Siem Reap’s provincial health director, expressed concern over losing his most valuable staff members to the higher-paying jobs being offered by private hospitals.
Health officials warned that a staff exodus will be a serious province-wide problem.
“All the people we have slowly been training and have in place and are very delicately getting off their feet, they will be sucked away,” the UN’s Overtoom said. “Everybody’s asking, where can we apply? Where can we apply? People who function well will be taken.”
Dy Bun Chhem said he has volunteered six public health workers from his facilities for the projected 60-bed Angkor Hospital.
Richner—who pays his doctors up to $500 per month—has not approached Dy Bun Chhem about hiring staff.
Regardless, he expects 120,000 children to seek the services of his hospital the first year it is open.
Medecins Sans Frontieres Country Director Maurits van Pelt said the local patient load and international donors eventually will not support three separate pediatric wards in the same area.
“Let the best quality pediatric hospital prevail,” he said, “and let the donors be aware that there are three hospitals out there.” (Additional reporting by Touch Rotha)