Cambodia - Gov’t Warns of Rainy Season Diseases

The director of the Communicable Disease Control (CDC) Department at the Ministry of Health has urged the public to protect themselves from diseases that are easily spread in the upcoming rainy season, including dengue fever, malaria, acute watery diarrhea and influenza.

Dr. Ly Sovann said people should take a wide range of precautionary measures to prevent communicable diseases from spreading, including eating a balanced and nutritious diet to washing their hands as often as possible.

“During the rainy season, all people should drink hot water, eat hot soup and/or hot milk,” he said.

“They also should make sure that their body is clean and their hands washed often with soap. Their water should be clean from larvae and mosquitos must be eradicated from their house and places around their house.”

Seang Nath, the chief of Mesor Chrey commune’s healthcare center in Kampong Cham province’s Stoeng Triang district, said he plans to travel to villages in the area to speak to resident representatives to pass on the CDC’s recommendations. 

He said officials from the provincial health department occasionally visited to share the CDC’s recommendations to residents.

“They come in ambulances with a big speaker on the roof. The villagers can hear the recommendations of the CDC from far away,” he said.

Dr. Nath said diseases such as malaria, diarrhea and influenza were common occurrences in the commune thanks to the wet conditions of the aptly named season.

According to the Ministry of Health, diarrhea and foodborne disease outbreaks are common in Cambodia, with officials saying the most effective way to prevent the spread of diseases was to only consume bottled water.

Dengue is endemic throughout Cambodia, with the majority of infections occurring during the rainy season. Health officials advise residents and tourists to protect themselves from mosquito bites during the night and even in the day.

Last year the World Health Organization (WHO) and the Ministry of Health alerted travelers and citizens to the possibility of catching the Middle East Respiratory virus (MERS) in Cambodia after it was detected in South Korea.

Vicky Houssiere, a communications officer with the WHO, said the government has been preparing for the virus since 2012 by sending doctors to receive training on how to prevent it.

Ms. Housiere also said the WHO has been cooperating with the Ministry of Health to improve and strengthen the Kingdom’s capacity to deal with emerging diseases such as SARS and MERS. “They focus on improving the healthcare system such as laboratories and surveillance,”she said.

According to the CDC, the government has received a second Greater Mekong Sub-region grant of $10 million for the cost of a Regional Communicable Disease Control Project, with the additional funding for malaria program activities getting a grant of $4 million.

The main goal is to improve the health of the population in the region, in particular for ethnic groups, women and children in border districts.

The CDC added that the project aims to control communicable diseases in the region that are likely to have a major impact on public health and economic growth through “enhanced regional communicable diseases control systems, improved surveillance along borders and economic corridors and integrated project management.”

Tin Sokhavuth

Khmer Times

Cambodia - Cambodia tough on smokers

PHNOM PENH, 30 May 2016: Cambodia will ramp up effort to end smoking in public places by imposing fines on both individuals and businesses, effective this September.

Phnom Penh Post reported that the Ministry of Health will run a campaign to explain  recent legislation that bans smoking in public places. 

Once the campaign ends the law will be strictly enforced against smokers and establishments, mainly restaurants and hotels.  Fines will be imposed from 16 September.

Under the sub-decree, approved in March, establishments will face a USD12.50 fine if they fail to put up no smoking signs, or they provide ashtrays for customers. Smokers will be fined USD5.

The ministry issued a statement, last week, requiring managers and owners of establishments to display signs in clear view to their customers.

The signs must be written in Khmer, or English and must specify the fines.

The decree is based on the law on tobacco control, which was passed by the National Assembly in March. It bans the consumption of tobacco products at the workplace and public areas, such as restaurants, hotels and on public transport. It includes smoking and chewing tobacco.

According to the latest WHO statistics, there are close to 2 million tobacco users in Cambodia, of which 1.5 million smoke cigarettes, while the balance chew tobacco. The latter are guilty of spitting the residue into ashtrays ,on street pavements, on the floor of buses  and even out  of the open windows of cars and taxis.

WHO technical officer, Dr Yel Daravuth, who helped draft the ban, said: “We don’t want to punish people… but we need to protect non-smokers for second-hand smoke and accompanying health risks.”

Last year, the kingdom welcomed 4.77 million international tourists up 6.1% from 4.50 million visits in 2014.

The top 10 supply markets were Vietnam, China, Laos, South Korea, Thailand, the United States, Japan, the United Kingdom, Malaysia and France.

Wanwisa Ngamsangchaikit 

ttrweekly

Cambodia - Organ Transplant, Donation Draft Law Approved

The Council of Ministers approved a draft law last week regulating and controlling organ donations and transplants in response to a World Health Organization (WHO) report which revealed that the lives of patients with non-communicable diseases like hypertension and diabetes could be further endangered following kidney transplants, if done improperly.

The draft law also attempts to curb the illegal and brutal organ trade, especially in kidneys.

According to a statement released after a Council of Ministers meeting on Friday, the announcement was made as a result of finding a high incidence of non-communicable diseases such as high blood pressure and diabetes after kidney transplants, especially in countries that have average to high incomes.

“In order to respond to the needed treatment of non-communicable diseases, the medical field has studied research to successfully save the lives of patients. The most common organ that is transplanted is kidneys,” said the statement.

The four main complications which can occur following a kidney transplant are infections, high blood pressure, diabetes and rejection of the donated organ. Most complications occur in the first few months after a transplant, but can develop after many years.

The Ministry of Health press statement added that the imbalance of kidney demand versus the number of kidneys donated has caused rampant trafficking of the organ both domestically and internationally.

“Organ trafficking is globally condemned and curbed by creating laws to manage the donation and transplant of these organs,” it read.

The six chapters and 34 articles of the draft law on regulating and controlling organ donations and transplants was written by the Ministry of Health with the aim of improving the quality, effectiveness and transparency among donors and recipients and to improve the wellbeing of citizens who have received donated organs. The draft law also attempts to prevent organ trafficking.

Health Minister Mam Bunheng said poverty was one of the main factors to the illegal trade, with impoverished people donating their internal organs, especially kidneys.

“At some point, poverty forces people to sell their own organs for money. The broker makes quite a lot of money from such an organ trade while the organ seller struggles to live,” he said.

Prime Minister Hun Sen told the cabinet in the meeting that authorities should pay greater attention and be extra cautious when scrutinizing child adoption cases. The prime minister added children could be sold to criminal gangs and their organs harvested and sold in the brutal trade.

“We do not want our parentless children to be victimized by organ smugglers,” he said.

The draft law was sent to the National Assembly for debate after the Council of Minister’s approval.

Mom Kunthear

Khmer Times

Cambodia - Untrained & Unlicensed: A look At Cambodia’s Public Health System

When the Cambodia National Assembly passed the 2016 national budget last December Cambodia’s public health system was not high on the list for additional resources, receiving a meager 8 per cent increase from the year prior, or $275 million. Admirably education received a boost of 28 per cent of the $4.3 billion budget, or $502 million, while the defence budget rose 17.3 per cent to $382 million.

With Cambodia healthcare spending amounting to about $18 per person, per year, Cambodians feel hopeless when dealing with Cambodia’s public health system. The service delivery is viewed bad by both rich and poor in the country, with only 8,502 licenced health-service providers, and more than 3,900 illegal healthcare practitioners.

As a consequence, when people face health problems most rich people turn to private rather than public hospitals in the hope of better service, despite having to spend more. Some even cross the border to find better service and doctors for treatment; Vietnam and Thailand being the two most popular.

However, for poor people unable to access private hospital they have no choice but to seek treatment through Cambodia’s public health system. Others in remote areas such as Battambang Province’s Roka commune even turn to unlicenced doctors instead for treatment due to the lack of confidence in local Cambodia public health services.

Roka Villager Mao Sophan said: “The health centre is no good. They give paracetamol for everything. If you want something else, they say ‘No’.”

The poor standard of healthcare available to Cambodians was highlighted globally in 2014 when a sole unlicenced ‘doctor’ in the commune infected 300 villagers ranging from infants to the elderly with HIV through the re-use of needles. This malpractice left 14 villagers dead and the rest of the community in fear.

In response the Cambodian government announced a ban on unlicensed doctors throughout the country and ongoing raids by the Cambodia Ministry of Health (MoH) have seen many closed down.

However, with just one qualified doctor for every 5,000 people unlicenced medical practitioners continue to play a vital role in filling the gaps in the under-funded and resource stretched Cambodia public health services system.

In this documentary by Aljazeera English 101 East, Steve Chao examines the role of unlicenced medical practitioners in propping up Cambodia’s public health services system.

Vat Vin 

Cambodia - Cambodia's health care system struggles to cope with mentally ill patients

PHNOM PENH: As soon as the clock struck seven in the morning, a commotion broke out in front of an old, yellow building inside the Khmer-Soviet Friendship Hospital.

More than 40 people flocked to the main metal door separating them from the waiting area and consultation rooms. Some craned their neck to look for a sign of staff inside the building, while others searched for empty spots on the dusty ground to give their feet a rest.

Coming from various parts across Cambodia, they all shared one thing in common; everyone seemed stressed and weary, as they waited to enter the busiest psychiatric clinic in Phnom Penh.

“We’ll open at 9 o’clock today,” a member of the medical staff told the patients as she squeezed through the main entrance. “We have a meeting,” she quickly explained and continued on a dusty path linking the busy outpatient department with another building.

For mental health patients in Cambodia, long waits are far from uncommon at the state-run clinic. Although its outpatient department is the biggest in the country, the facility has 13 registered psychiatrists and 12 nurses to treat hundreds of patients per day. For those with serious conditions that require continual specialised care, there are ten beds available.

“One doctor treats about 50 patients each day,” said one of the psychiatrists at the clinic, Sou Sarifin. The limited resources mean that not every patient can be seen, consultations last minutes, and treatment is often limited to prescription drugs.

Mental health problems are widespread in Cambodia. Some patients are often locked up at home or chained to trees, as their family members do not know how to deal with the symptoms. Health care services exist but are hard to access, particularly in rural areas. And some patients are dropped off at the clinic with their hands and legs tied, Sarifin said.

Anxiety, depression, bipolar disorder and schizophrenia are the most common forms of mental illness diagnosed at the clinic. And a number of patients are survivors of the Khmer Rouge regime, whose legacy has left them with deep mental scars.

"They still have bad memories; some of their family members were killed during the Khmer Rouge regime," Sarifin added.

Under the Communist Party of Kampuchea (CPK), Cambodia was radically transformed into an agrarian society with no social classes. Its citizens were stripped of their basic rights and driven into forced labour in the countryside, while religions, education and financial system were abolished. Between 1975 and 1979, prisons and execution sites popped up across the country, as starvation, diseases, exhaustion and capital punishment killed nearly two million people.

And for those who have survived, many find it hard to deal with the psychological scars.

“I FELL UNCONSCIOUS WHEN THEY STARTED TO RAPE ME”

Some of the Khmer Rouge survivors with mental health problems are old people who still have fresh memories of the past.

One of them is Leang Korn. Her husband was killed in 1975, she said, 20 days before their baby was born. Both were accused of conspiring with the Central Intelligence Agency (CIA) against the Khmer Rouge.

“I couldn’t see my husband but heard his voice through the air. How scared and painful he was. We all couldn’t do anything but only whisper,” the 57-year-old widow said.

After giving birth to her child, Korn joined other Cambodians who were sent to work in the fields.

“One evening, several men came to me and said Angkar (the Khmer Rouge’s ruling body) wanted information about my work. There were about 10-12 men there. I fell unconscious when they started to rape me. They were like animals, not human beings,” Korn said.

Over the past 37 years, the old widow has been trying to live a normal life and forget her past. “But I can’t forget. My feeling is attached with something, something unclear, like a shadow.”

Mental health issues in Cambodia, however, affect more people besides Khmer Rouge survivors such as Korn. A number of mental health patients at the Khmer-Soviet Friendship Hospital have a long history of alcohol and drug use. Social factors such as poverty and gender-based violence also play a key role.

Of the over 15 million population, an estimated 40 per cent suffer from mental health and psychological problems, according to Transcultural Psychosocial Organization Cambodia (TPO) – a non-profit group that promotes mental well-being among Cambodians.

But despite high incidence of mental disorder, Cambodia's public health care is still lacking. It is estimated that only 0.02 per cent of the country's health budget goes to mental health, based on a report by the Leitner Center for International Law and Justice.

"Public mental health care in Cambodia is a little bit better now but there are still a lot of issues. Services provided are poor and to access them is difficult. There is only one hospital in Phnom Penh that provides mental health care," said Sek Sisokhom, Head of the Psychology Department at Royal University of Phnom Penh.

"People don't know about psychology because the concept is very new in Cambodia. When they encounter mental health problems, they often seek help from monks at the temple or spiritual healers," Sek added.

A 'VERY CHALLENGING' SITUATION

The mental health situation in Cambodia is "very challenging", according to Sek. The sector is only allocated a small amount of funds from the national budget and "there is no quota for recruitment of psychologists into the public sector," he said.

New graduates often face difficulties finding jobs in the mental health industry. In the entire nation, there are only a few state-run psychiatric clinics. One of them is located in the capital city and five more in Banteay Meanchey, Ratanakiri, Kampong Cham, Kampot and Battambang. "Mental health is not the government's first priority," Sek added.

Moreover, mentally ill patients at state-run facilities often receive bio-medical treatment rather than psychological or psychosocial treatment. "And this means the government services mainly lack counselling, psycho-education and community-based intervention that addresses the issue through a holistic approach," said Dr Sotheara Chhim, senior consultant psychiatrist and TPO executive director.

"There are huge needs for mental health care."

In a bid to improve mental well-being among Cambodians, many NGOs have set up their own mental health care facilities in response to the limited resources.

In 2015 alone, TPO’s treatment centre provided more than 6,500 consultations. But the group also aims to promote non-medical treatment through its several programmes targetting different groups of mentally ill patients, including the likes of Korn.

For several years, the Khmer Rouge survivor has been receiving mental health support from the NGO, which provides her with counselling every two months. Her conditions continue to improve over the years. Korn is now more open to discuss her past and fully aware of the problems she is facing.

Still, many mentally ill patients in Cambodia are struggling to live a normal life. “They’ve never received support from the government,” Sarifin said before rushing back into his office, as more patients streamed into the mental health clinic.

But soon, the door would be closed, and those who did not make it to the psychiatrists would have to come back again the following day.

Pichayada Promchertchoo

channelnewsasia

Cambodia - WHO eyes new TB test regime for Kingdom

A quicker diagnosis and a shorter and cheaper course of treatment for multidrug-resistant TB patients in Cambodia could soon be on the horizon.

The World Health Organization recommends countries with high incidences of TB, including Cambodia, begin implementing the new treatment regimen based on studies in 10 countries.

“Cambodia, as a WHO member state, is of course expected to take note of this recommendation and adapt it, according to its local epidemical context,” said Ernesto Jaramillo, a TB expert with the WHO.

Health officials in Cambodia will develop a plan to implement the new regimen by late 2017 or early 2018, said Dr Mao Tan Eang, director of the National Centre for Tuberculosis and Leprosy Control.

The new treatment, which costs less than $1,000 per patient, could be completed in nine to 12 months, compared to the current period of 18 to 24 months, said Tan Eang. Officials would phase out the existing regimen.

“We hope to be more efficient and cost-effective,” he said.

Although TB is a leading cause of death in Cambodia, a 2015 Yale Global Heath Review study found that multi-drug resistant TB hasn’t been a significant problem, but rates are rising.

In 2015, 70 multidrug-resistant TB cases were identified in the Kingdom, and officials expect to identify 145 this year, Tan Eang said. It’s too early to estimate funding levels needed, he said.

US Embassy spokesman Courtney Woods said that once the WHO releases the guidelines in June, USAID will discuss with the national centre how it can “support the roll-out of the new recommendations at the country level”.

Yesenia Amaro

phnompenhpost

Cambodia - Overwhelmed by cervical cancer

More often than not, on Tuesday and Thursday mornings, a line of women wraps around the building of the women’s health clinic at the Sihanouk Hospital Center for HOPE seeking free cervical cancer screening.

On a recent Tuesday, a 36-year-old from Kampong Speu, who asked to remain anonymous, was one of them. She had been enduring abdominal pain for the past three months, with severe pain up to three times a week.

“I want to find out what the problem is,” the woman said.

Cervical cancer is not only the most common kind of cancer among Cambodian women, it’s the most prevalent cancer in the Kingdom. Cambodia’s cervical cancer rate is also among the highest, if not the highest, among Southeast Asian countries, doctors say.

However, research on the topic remains sparse, and the availability of prevention services, screenings and adequate treatment remains severely limited, creating a high burden on the country, causing hundreds of preventable deaths every year and making younger-than-usual women more susceptible to the deadly disease, medical experts say.

Data from February show that the country’s cervical cancer rate stands at 20.5 for every 100,000 women, according to the HPV Information Centre in Spain, which compiles, processes and disseminates country-specific information on HPV and cervical cancer.

Rates in neighbouring Vietnam, meanwhile, are just over half that, at 11.3 for every 100,000 women, while Laos’s rate is just 9.8 for every 100,000, data show.

The Kingdom has a population of about 5.56 million women, aged 15 and older, who are at risk of developing cervical cancer, according to the data, and the country sees about 1,512 new cervical cancer cases and about 795 deaths every year.

Cervical cancer, however, is preventable, doctors say, and with more preventive resources – such as those provided by the women’s health clinic – the country could one day reverse those dismal statistics.

Screenings key

Screening makes an important difference by detecting cancer at an early stage, when it can still be cured, said Dr Thay Sovannara. Sovannara’s research, recently presented in Australia, found that out of 1,000 women, there was an estimated 11 per cent prevalence of cervical abnormalities that can be indicative of cancer, most of which were in the early stages.

Although several medical professionals are helping train their counterparts in the provinces and informing the public about the deadly disease, as Sovannara notes, “Education is still low.”

What’s more, in Cambodia, detecting cervical cancer at an early stage is not always a victory in itself. Even with a diagnosis, many women lack the financial means to pursue treatment options, Sovannara said.

“They decide to take the traditional medicine,” she said.Most women with diagnoses, she added, “are from the provinces”. Currently, however, both primary national hospitals in the country offering oncology treatment – Calmette Hospital and Khmer-Soviet Friendship Hospital – are located in Phnom Penh.

Why the high rates?

Dr Eav Sokha, head of the Onco-Hematology department at Calmette Hospital, said there are several factors contributing to the high rate of cervical cancer in the Kingdom.

For starters, there’s no HPV vaccine in the national immunisation program; pap smear screening, which has drastically curbed cervical cancer in developed countries, is not well established in Cambodia; and cultural norms often prevent women from speaking up or seeking treatment if they don’t have any symptoms, Sokha explained.

According to Sokha, Cambodian women are also often unfamiliar with preventative measures, such as not smoking, using protection when sexually active, limiting the number of sexual partners and practising proper hygiene.

For example, he added, he once met women in Kampong Chhnang who, during menstruation, used dirty pieces of fabric as a substitute for sanitary pads. “The young girls are now being educated, but there’s still the traditional ways,” Sokha said.

One notable difference in Cambodia is that women suffering from cervical cancer are younger compared to patients in other countries, said professor Kouy Samnang, chief of oncology services at the Khmer-Soviet Friendship Hospital. While the culprit behind the phenomenon remains unknown, Samnang suggested early marriage could be a factor.

“We need to do a research study,” he said. “It’s in the vision of the hospital and the department to do the study.”

Alternative options

While there are several screening methods for cervical cancer, medical professionals have come to learn that a visual inspection with acetic acid, known as VIA, is both affordable and effective, said Dr Khin Sam Ath, with WHO Cambodia.

There are currently pilot projects for screening and treating cervical cancer in the provinces, Sam Ath said, but treatment remains concentrated at the district hospital level.

Under the pilot programs, women get a VIA screening at local health centres, but must be referred to a district hospital for cryotherapy treatment, Ath said.

While cryotherapy, which destroys abnormal tissue by freezing it, is performed in some countries by nurses, Cambodian nurses and midwifes at the health-centre level are not trained in the use of the equipment.

According to Sam Ath, local treatment would be ideal, as those referred to district hospitals might not follow up.

WHO Cambodia is supporting the development of the national action plan for prevention and control of cervical cancer, which would include primary prevention – such as the HPV vaccination for girls 9 to 13 years old – and secondary prevention – such as the VIA. Officials hope to have a draft completed this year.

HPV vaccination can help prevent 70 per cent of cervical cancer cases, Ath said, while VIA screenings can theoretically catch the other 30 per cent.

“If the country starts providing primary prevention and secondary prevention today, we will see the results in the next 20 years, almost 100 per cent of women can be prevented from [having] cervical cancer,” Sam Ath said.

Rob Kelly, spokesman for pro-vaccine non-profit GAVI, said the organisation will provide just over $500,000 to support Cambodia’s two-year HPV pilot program. During that period, the country will receive more than 60,000 doses of HPV vaccine for use in two selected provinces – Kampong Thom and Svay Rieng.

Dr Chhun Loun of the Ministry of Health confirmed that the ministry would be cooperating with GAVI to roll out the program. Other ministry officials did not return numerous calls seeking comment for this story.

A plan of attack

The availability of treatment options for those already diagnosed with cervical cancer remains limited, though may soon start to change.

Sokha, Calmette’s head of onco-hematology, said by next year, Cambodia’s first national cancer centre will be operational. It will offer sophisticated treatment and medical procedures, such as nuclear medicine and bone marrow transplants.

“These are new technologies for Cambodia,” he said. “The government in Cambodia is still very poor. Investment for health is still very low, compared to our neighbours, but for this project, they made a great effort.”

The International Atomic Energy Agency, Sokha said, will help with fellowships, scholarships and training in hopes of developing the cancer centre into a teaching facility. Cambodia needs “[to] produce our own oncologists,” he said.

Two more regional cancer centres are planned to be built by 2025, Sokha said, with the centre in Phnom Penh to cover about 60 per cent of the population, another in Siem Reap to cover 30 per cent, and a third in Kratie to cover 10 per cent.

“The aim is to create a triangle for a national cancer centre network,” he said, adding, however, that he wasn’t sure if the plan could be completed by 2025.

Khmer-Soviet Friendship Hospital alone gets about 350 cervical cancer cases a year, said Samnang, the oncology chief, and 60 per cent of those are already at an advanced stage.

On Wednesday afternoon, Phoung Sokhom, 38, from Kandal, was waiting in Khmer-Soviet’s radiation department.

Sokhom was diagnosed with stage-2 cervical cancer in February of 2015, and was scheduled yesterday to go in for her 28th day of radiation and chemotherapy, the last of her treatment.

Seated in the waiting room, Sokhom closed her eyes and slowly reopened them. “I don’t have much hope,” she said. Sokhom, who had already paid more than $1,000 for her 28 days of radiation, said that her condition may require surgery or more treatment, but she doesn’t have the money to pay for it.

“I’m not sure yet,” she said of what might happen next.

Yesenia Amaro

phnompenhpost