Angkor Hospital for Children, From the Field

As we entered the Angkor Hospital for Children’s open air courtyard, located between the outpatient department and the surgical ward, we were greeted by the smells of Khmer cooking. Mothers, grandmothers, and other relatives of sick or injured boys and girls were busy making lunch. Patients’ relatives are responsible for preparing meals for family members, and are provided with a variety of high-protein, nutrient-rich foods by the hospital.

The cost of the fish, meat, and vegetables, purchased daily at the market, is currently covered through a Direct Relief-supported nutrition education and support program. This facility-designed, comprehensive nutrition program is being funded by Abbott, one of our most active and generous corporate partners.

Under the ruling of the Khmer Rouge in Cambodia, health facilities were destroyed and most of Cambodia’s medical professionals were killed or escaped (in 1979, at the end of the regime, all but 40 of Cambodia’s doctors had either perished or fled the country). Today, after decades of conflict, Cambodia is struggling to rebuild the infrastructure of its health system as well as that of its work force.

During a series of photographic trips to Cambodia’s Angkor monuments, international acclaimed photographer Kenro Izu had numerous encounters with children disfigured by landmines and in desperate need of medical care. He decided to dedicate himself to establishing a pediatric hospital in the region, and as a result of his efforts and determination, the Angkor Hospital for Children (AHC) was founded in 1999. Located in Siem Reap, the city closest to Angkor Wat, the facility was established to provide both quality health care for the children of Siem Reap and neighboring provinces, and to provide training for healthcare providers countrywide.

AHC provides outpatient (average of 300 to 500 patients per day) and inpatient services, basic surgery, 24-hour emergency service, and dental care. The hospital’s acute care unit includes three emergency room beds and three intensive care beds. Each month the hospital serves 600 to 700 emergency patients and 25 to 35 intensive care patients, with the majority of cases involving acute respiratory distress/failure or trauma. Other common illnesses seen at the facility include dengue fever, dysentery, tuberculosis, HIV/AIDS, malaria, and intestinal parasites. Malnutrition and dehydration is clinically evident in 66 percent of children admitted to the hospital, and 10 percent of admissions are due primarily to severe malnutrition.

Due to the extreme shortage of trained medical professionals in the country, AHC was initially staffed by an international team of healthcare providers and administrators. The facility immediately began to provide intensive training to Cambodian doctors, nurses, dentists, and other hospital personnel, and has since handed over most of the medical, nursing, management, and other positions to an extremely motivated and enthusiastic local staff. In 2003, AHC was recognized by the World Health organization as the only pediatric medical training facility in Northern Cambodia. The hospital also participates as a training site for the Ministry of Health (MoH), WHO-led Integrated Management of Childhood Illnesses (IMCI), playing a key role in improving the quality of pediatric care for the entire country.

Direct Relief has supported AHC with shipments of medical and nutritional products since 2003. The Family Nutrition Education and Support Program had just been launched on September 1, 2006, and I was visiting the facility with Thomas Tighe, CEO and President of Direct Relief, and Reeta Roy, Vice President of Abbott Citizenship and Policy. While visiting, we observed nutrition trainings, cooking classes, the care and utilization of demonstration gardens, and the distribution and use of donated nutritional products – all essential components of the program.

We watched as the family members of malnourished children learned about the importance of serving balanced meals containing a source of protein such as fish, meat, eggs, or beans, as well as fruits and vegetables that can be easily grown or inexpensively purchased. Nutrition education staff members discussed the health effects of the different foods, and demonstrated the best manner to prepare them in order to preserve essential vitamins and minerals. One-on-one bedside nutritional counseling is also provided for parents of severely malnourished children, and provides specific advice and guidance on how to care for the acute and on-going needs of their particular child.

We also accompanied the outreach team on one of their home visits to check on a two-year old boy who had recently been admitted to the hospital with severe malnutrition and dehydration. The team was expected by the boy’s family and other community members had been encouraged to meet at their home. Over 50 adults and children were waiting for us when we arrived, and the outreach team took advantage of the gathering to provide nutrition and hygiene education, as well as to distribute Direct Relief-donated albendazole, or de-worming tablets, to the children. Eliminating, or reducing the worm load in children can significantly improve their nutritional status and overall health. Boys and girls, ages one year and up, now receive the medication twice yearly – an easy and very effective intervention.

Over the past four years, seven shipments of Direct Relief-donated medical goods have been provided to AHC. The most recent shipment consisted of an ocean freight container of Abbott-donated nutritional and medical products. The new partnership between Direct Relief and Abbott, to provide critically needed products and fund the facility’s expanded nutrition program, will allow the hospital to more effectively address the high incidence of pediatric malnutrition, and improve the health of thousands of Cambodian children and their families.

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