Defendant ‘impaired’

FORMER Khmer Rouge Social Action Minister Ieng Thirith “most likely” suffers from Alzheimer’s disease, according to a physician who examined her, as new details emerged in hearings yesterday about her fitness to be tried for charges including crimes against humanity and genocide.

John Campbell, a geriatrician from New Zealand who examined the 79-year-old Khmer Rouge “First Lady”, testified yesterday that the she had “significant cognitive impairment”, compromising her ability to participate in the trial against her.

“My conclusions were that Ieng Thirith did have significant cognitive impairment and there were a number of possible causes for that including an underlying dementing illness, which may have been due to either Alzheimer’s or vascular dementia, but most likely a component of Alzheimer’s disease,” Campbell said during public hearings at the Khmer Rouge tribunal.

Alzheimer’s is an irreversible brain disease that slowly destroys the ability to create new memories, think and carry out routine tasks.

Campbell said  other factors might have influenced Ieng Thirith’s cognitive ability, including medications she had been taking, stress and her “social circumstances”, including detention.

Ieng Thirith, one of four defendants in the Khmer Rouge tribunal’s Case 002,  faces charges for her alleged role in the deaths of an estimated 1.7 million people between 1975 and 1979.

The court’s Trial Chamber has said that Ieng Thirith requires further assessment of her mental health, and will schedule additional hearings to consider the pending exams.

Campbell also revealed in testimony that Ieng Thirith had been taking three medications that might have influenced her cognitive abilities.

He said she had been taking two psychotropic drugs – bromazepam and clonazepam – “for a considerable time” and recommended a reduction in both, as the original justification for them was “no longer evident”. Ieng Thirith has been off both drugs for a week and began a reduction in the third.

In one cognitive test, Ieng Thirith was asked to draw the face of a clock with hands indicating a specific time, and Campbell said she was “able to draw a clock face using her own watch as a guide, but wasn’t able to put the hands to indicate a particular time”.

Ieng Thirith appeared attentive during the beginning of the hearing, but spent most of the day in the court’s holding cell.

Khmer Rouge Brother No 2 Nuon Chea has also contested his fitness to stand trial, but his claim was rejected in Campbell’s evaluation. Nil Nonn, president of the Trial Chamber, said at the outset of the hearing that Campbell had concluded “the accused Nuon Chea is not presently unfit to stand trial”.

Nuon Chea told the court before leaving at 10:30am that his health was “deteriorating”, demanding further assessment of his claim that he was unable to concentrate or sit for longer than 90 minutes.

“Even if I try my best to concentrate or remain seated more than that period of time, I cannot do that. And I will have problems understanding or reading any material after this period of time,” he said.

Campbell said during testimony that Nuon Chea’s ability to concentrate for 90 minutes “seems very reasonable”.

Campbell’s divergent assessments of the two accused created a point of tension for the defence teams.

Ieng Thirith defence lawyer Diana Ellis sought to bolster Campbell’s credibility, at one point noting his previous position as dean of the faculty at the school of medicine at the University of Otago in New Zealand. “Not to embarrass you,” Ellis asked, “that, in fact, is a position showing a measure of both seniority and the respect with which you are held by your other professional colleagues?” Campbell replied: “That is correct.”

Nuon Chea legal consultant Jasper Pauw, meanwhile, posed sceptical questions and emphasised the fact that Campbell had never conducted a fitness exam for a criminal trial.

Michiel Pestman, co-defence lawyer for Nuon Chea, said that his team planned to raise “a lot of questions” for Campbell.

“He has never done a fitness to stand trial test before,” Pestman said. “And it’s not a bicycle theft … it’s the biggest case since Nuremberg.”

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HIV treatment saves lives and dollars

Photo by: Mai Vireak

Heng Sambath (left), who is HIV-positive, speaks to reporters from the Post yesterday at a restaurant in Phnom Penh.

As moves to undermine the production of cheap generic HIV/AIDS drugs continue in Europe, a study released today by the National Aids Authority reveals the medicines have helped save thousands of Cambodian lives and prevented hundreds of millions of dollars in GDP losses.

The study examining the socio-economic impacts of HIV/AIDS was conducted for the NAA by the United Nations Development Programme. It estimates that 21,497 deaths in the labour force were averted through the government’s antiretroviral drug strategy between 2003 and 2009.

Antiretrovirals fight the progression of HIV/AIDS and have been provided free in Cambodia through government and civil society groups since 2001, after Indian companies began producing generic copies of the patented medicines. Heated protest have been launched in recent months by HIV/AIDS groups here and around the world to oppose the European Union’s attempt to prohibit production of the generic drugs through free trade agreements with India. The price of the life-saving medicines will surge if the EU succeeds in prohibiting the production of generic versions by Indian firms, the groups have warned.

But James Cercone, lead author of the NAA report, said that pressure from major international organisations, such as the Clinton Foundation, would likely ensure prices remain affordable for Cambodia’s “surprisingly” effective ARV programme to remain well supplied. “I never would have expected such a huge impact,” he said.

Cambodia’s ARV programme had saved the country more than US$600 million in the six-year period by reducing strains on GDP caused by decreased labour efficiency and lost taxes from death, the report said. Cercone said that though Cambodia surpassed some other countries in the region, such as China and Vietnam, in access to medical care for people with HIV/AIDS, significant problems remained. He pointed to the poverty that HIV/AIDS-affected families faced.

More than 30 percent of people who had contracted HIV subsequently lost their jobs and those who hadn’t saw their income drop by 50 percent, the report found.  Families with one member with HIV/Aids experienced discrimination within their communities and saw lower rates of school attendance among children because they had to work to contribute to household income. It also found that affected families had higher rates of asset sales to pay living expenses.

Heng Sambath, a former employee at the Cambodia People Living with HIV/AIDS Network, experienced discrimination firsthand. He recalls being so overwhelmed by despair after learning he had tested positive for HIV that he abandoned his fiancée and fled to a temple.

She tracked him down and convinced him to marry her, but Heng Sambath said this did not prevent the virus from tainting all of his personal relationships. He recalls arguing with neighbours on a daily basis “because of the way they treated me”.  “They belittled me, they looked down on my family,” he said. He was also forced to quit a high-paying job at a construction company and was ostracised in his community. Sambath eventually accepted his wife’s request for a divorce and left their village in 2003. According to ppp

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Pressure on for acid victims

Photo by: Will Baxter

Marie Doolan (left) examines recently made pressure garments with Mop Ngieb at the Cambodian Acid Survivors Charity yesterday.

Kandal province
As 24-year-old Mop Ngieb sewed together pieces of fabric yesterday to create a custom-made pressure garment to treat the scars of acid attack victims, her mentor Australian nun Marie Doolan monitored her progress.

Originally from Takeo province, Mop Ngieb began working at the Cambodian Acid Survivors Charity after suffering burns to her face, body, arms and legs after a petrol explosion last year.

Next week, she is set to become one of the first two people ­– along with colleague 31-year-old Yim Chheng Leang – certified in Cambodia to train people in designing and producing the garments, which help to reduce scarring in burn victims by moving fluid under the skin.

“I know about the pain of scars,” she said yesterday. Mop Ngieb was trained in how to sew the garments by 73-year-old Catholic nun Sister Marie Doolan.

Doolan, who is now on her third trip to Cambodia in order to help train the two women, believes that enabling them to make the medical dressings will help to ensure that future victims receive treatment.

“They hopefully will then be able to train other people because it’s so important,” Marie Doolan said. “They know exactly what to do.”

Photo by: Will Baxter

Yim Chheng Leang stitches a pressure garment at the Cambodian Acid Survivors Charity.

A former designer and dressmaker from Melbourne, Doolan has been making the pressure garments using her own method for the past 25 years. “I have a dysfunctional lymphatic system ... so I thought I would try it on myself,” she said. “I hated [having the medical condition] all my life but it has allowed me to work out this method which is very successful.”

Her invention has taken her across Asia. She received funding from charity Interplast Australia to train people to make pressure garments in Bangladesh last year, before being funded to travel to Cambodia in 2010.

“Somebody is presented to us with horrific burns, terrible scarring, and we have to come up with a design to try and put pressure on that particular area to get the fluid out of there and to soften the scarring,” she added.

Acid attack survivor Khov Srey Neang has seen the positive effects of the project. She arrived at CASC three months ago with her five-year-old daughter, after a neighbour doused her in acid following an argument, burning her face, arms and legs.

Though the 24-year-old said that “her scars will be there forever”, the tailor-made garment lessens her pain and covers her scars.

Photo by: Will Baxter

Srey Neang (right), 24, puts on a new pressure garment with the help of Mop Ngieb.

“When I do not wear them, my scars are stiff and hurt so much,” she said.

Horng Lairapo, chief of the medical and legal unit at CASC, said yesterday that the pressure garments were most effective on scars stemming from recent acid attacks.

He added that medical staff used both surgery and pressure garments to treat acid burn scars.

“The most effective use of the pressure garment treatment is usually after the wound has been healing for about three weeks. Usually, we see at around three months that the scar disappears,” he said.

In the first six months of this year, 127 pressure garments were tailor-made at CASC for 51 acid survivors. Last year, 136 garments were made at the organisation. According to figures recorded by CASC, 20 people have been injured in acid attacks so far this year. 

A long-awaited acid draft law was submitted to the Council of Ministers in March, which rights organisations hope will reduce the frequency of attacks and punish the perpetrators of such crimes more severely. According to PPP

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Free clinic aids snakebite victims

Photo by: JIM KEENAN

An Indochinese spitting cobra, which are a danger to local rice farmers.

Rice farmer Khong Phat will never forget the day he nearly died – an Indochinese spitting cobra bit him as he was pumping water into his paddy fields near Kampot.

“When it first bit me, it didn’t hurt at first but half an hour later I couldn’t breathe and could hardly walk,” recalls the 42-year-old.

Luckily he was working in the field with his brother when he was bitten above his right knee. His brother promptly killed the snake and took it home to cook for dinner, while Khong Phat was sent for first aid to Kampong Trach district health centre near his home.

The clinic gave him an injection and sent him home, although when the wounds failed to heal, the family took him to a traditional healer.

“After the traditional doctor spat the traditional medicine from his mouth on my wound, I felt relief from the pain, but that only lasted about an hour so he had to do the same thing every hour,” recalls Khong Phat.

“Two days later, my family decided to bring me to the Hand of Help hospital in Sihanoukville.” This is run by an NGO dedicated to treating victims of snake bite for free with anti-venin and educating people about poisonous and non-venomous snakes in Cambodia.

The cobra’s poison had infected Khong Phat’s wound, but treatment at Hand of Help saved his leg from amputation or further infection. After staying at the hospital for one month, he was finally allowed home to the farm to see his family.

That was two months ago – he’s one of the few snake victims to survive, as most Cambodians are bitten by the more common Malayan pit vipers.

Teth Sovath, a 45-year- old palm oil worker, was bitten by a viper last month when he was collecting palm fruits while working barefoot in Preah Sihanouk’s Prey Nob district.

“I could feel the pain immediately it bit me, but after I walked about 100 metres, I collapsed and the pain grew really bad as the blood flowed out of the bite.”

After a 12-day course of anti-venin treatment at Hand of Help clinic, he recovered – but says he definitely won’t be going to work without his boots in future.

Photo by: GLOBAL WILDLIFE

Malayan pit vipers also carry a nasty bite that can cause tissue to die.

About 30 or 40 victims of snake attack are treated by the clinic at Hand of Help every month, according to nurse Lok Kiry, 22.

Most are bitten by Malayan pit vipers because these snakes, with their attractive banded markings, live around farms and their camouflage makes it easy for them to hide undetected in piles of leaves or undergrowth.

It generally doesn’t attack people but most bites happen when people accidentally step on the snakes, he says, especially if they aren’t wearing enclosed footwear.

“Their bite can make people’s flesh swell up and rot, and can cause disability or even death,” Lok Kiry warns.

However, their toxin is not as strong as that produced by the cobra family, which in Cambodia include king cobras, monocellate cobras or the Indochinese spitting cobra, which attacked rice farmer Khong Phat.

Delaying treatment or stopping first at traditional doctors can seriously hinder the victims’ recovery from a snake bite, says the nurse.

By the time victims arrive at his clinic, some suffer from swelling and dead tissue around the wounds after seeing traditional healers.

“People who are attacked by a snake shouldn’t panic, should not drink alcohol, and should not tie a tourniquet around the wound the block the toxins,” advises Lok Kiry.

“They should lie down on a flat surface, drink plenty of water, and get to our hospital as soon as possible.”

Advice on snakebite and identifying poisonous snakes is also available from Hand of Help by telephone, 034 934 331. according to ppp

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Girl becomes Kingdom's 14th bird flu victim

A seven-year-old girl from Prey Veng province died on Tuesday of respiratory complications resulting from bird flu, according to a joint statement released by the Ministry of Health and the World Health Organisation last week.

According to the statement, the girl, from Prasat village in Kampong Trabek district’s Prasat commune, fell sick on May 24 before being sent to a hospital in Phnom Penh on May 31. She died at the facility on Tuesday. The girl is the sixteenth recorded person to become infected with human avian influenza virus H5N1, commonly known as bird flu,  in Cambodia since 2005.

She is also the fourteenth person in the Kingdom to die of complications resulting from the virus.

Philippe Buchy, head of virology at the Pasteur Institute in Phnom Penh, said yesterday that samples had tested positive for bird flu on Wednesday.

“Usually, by the end of April, the virus stops circulating among poultry stock.But this year, for an unknown reason, the virus is still circulating,” he said.

Before the girl fell sick, her family had cooked and eaten two chickens that had become sick and died, Kampong Trabek district governor Chan Rann said yesterday.

“The girl’s mother sold dead chickens to another family and she cooked two sick chickens for food for her family, but they did not know the chickens had H5N1,” Chan Rann said.

According to the joint statement, the Health Ministry plans to train clinicians in “high-risk provinces” to detect bird flu in the early stages of infection.

Ly Sovann, deputy director of the communicable diseases department at the Ministry of Health, said yesterday that clinicians must be trained to identify potential cases when patients presented with flu-like symptoms.

“[Clinicians must] be more attentive by asking the history of the [patient’s] contact with sick poultry, or even healthy poultry,” Ly Sovann said.

He added that provincial health officials had so far collected samples from 65 people in the girl’s village, all of whom had tested negative for the virus.

Avian influenza does not easily transmit from human to human, but “if the virus changes, it could easily be spread like seasonal influenza”, the joint statement said.

It was “practically impossible” to predict if bird flu would begin to transmit from human to human, Nima Asgari, public health specialist at the WHO, said yesterday.

 “It is a worst-case scenario,” he said. according to ppp, June 13, 2011

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HIV/AIDS groups gather in the capital

As delegates met for a second day of the United Nations high level conference on HIV/AIDS in New York yesterday, groups representing Cambodians living with the illness gathered to voice concerns that they were inadequately represented at the talks.

At a meeting in Phnom Penh yesterday, representatives of Cambodian health organisat-ions expressed frustration that the political language of the high-level meeting was oblique and noncommittal.

The groups are seeking firm assurances that parties attending the UN conference will not bow to pressure from the European Union and developed countries to tighten controls on the production of affordable generic HIV/AIDS treatments through a “draft zero” declaration and proposed free trade agreements with India.

Heng Phin, monitoring and evaluation manager at the Cambodian People Living with HIV/AIDS Network, told the meeting that research showed the price of treatments had skyrocketed by 854,000 per cent in Jordan after it signed a free trade agreement with the United States that tightened controls on generic drugs.

“We are against Europe  making a free trade agreement with India so that India cannot produce HIV/AIDS drugs for Cambodia.”

Experts estimate 85 to 90 per cent of the HIV/AIDS treatments in Cambodia, which are provided free through the Global Fund to Fight AIDS, Malaria and Tuberculosis, are cheap, generic copies of patented drugs developed in wealthier countries.

Pen Mony, national co-ordinator of the Cambodian Community of Women Living With HIV/AIDS, said at the meeting she  hoped that the leader of Cambodia’s delegation to the talks, first lady Bun Rany, would be able to forcefully articulate local concerns. “I hope she is aware of our concerns, and she is  involved a lot in HIV response, so she knows what are the needs [of Cambodia] and what the challenge is for this country,” Pen Mony said.
“I don’t think she will use the language that the community wants her to. “She may use her diplomatic language, but I hope that she raises our concerns and shares our concerns with those people.” Rafael Dochao Moreno, charge d’affaires of the Eur-opean Union delegation to Cambodia, could not be reached for comment, nor could representatives of the National AIDS Authority. according to ppp

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CAMBODIAN CSO CALL FOR GLOBAL MORATORIUM ON FREE TRADE AGREEMENTS & TRIPS-PLUS MEASURES

The Cambodian People Living with HIV Network (CPN+) will host a press conference at 2pm today to call for immediate Global Moratorium on Free Trade Agreements & TRIPS-plus measures.

As the global community meets in New York for the United Nations General Assembly High Level Meeting on HIV and AIDS from 8 to 10 June 2011, networks of People living with HIV, health groups and treatment activists from around the world are calling for an immediate moratorium on all Free Trade Agreements (FTAs) and TRIPS-plus measures. 

The ‘Bangkok Declaration on Free Trade Agreements and Access to Medicines’ endorsed by groups and individuals from Asia, Africa and Latin America declares opposition to the increasingly rapid spread of FTAs that put the profits of multinational pharmaceutical companies ahead of people’s right to health around the world. The Declaration states that these “agreements are threatening to fundamentally and permanently undermine access to affordable medicines for millions of people. New HIV/AIDS medicines, Hepatitis C treatments, cancer drugs and life saving medicines for chronic diseases are all under threat.” 

The current Declaration states that trade agreements should not undermine access to medicines, however civil society groups say this language is too weak and allows the European Union and the United States to continue to ask for TRIPS-plus provisions in all the FTA negotiations.

Civil society and those supporters are encouraged to attend the press conference at the CPN+ offices: #99, Street 608, Sangkat Beoung Kork I, Khan Toul Kork

For more information please contact Mr Heng Phin hengphin@cpnplus.org from CPN+

Read the Phnom Penh Post coverage on Cambodian lobbying activities last week here

Download the Bangkok Declaration here

FHI SEEKS EXPRESSIONS OF INTEREST FOR A NATIONAL MSM ROAD SHOW CAMPAIGN

FHI is soliciting expressions of interest from qualified and experienced agencies for the management and execution of a national Men who have Sex with Men (MSM) road show campaign.

The campaign seeks to design and produce messages, materials and events to support this national MStyle road show.  The road show will travel to six locations across the country and special events will take place in MStyle clubs, MSM drop-in centers, private homes and/or other entertainment establishments that serve primarily MSM clients. Proposals must be submitted by 24th June 2011 at 2:00 pm.

Go to HACC’s website for more details and to download the criteria for application.

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UN to meet on HIV drugs

A Cambodian delegation headed by Bun Rany, the wife of the prime minister, will arrive at the United Nations General Assembly in New York today to negotiate a draft declaration on HIV/AIDS policy that has drawn sharp criticisms from NGOs in Cambodia.

NGOs fear the European Union will use the high-level UN meeting to advocate stronger intellectual property controls on the manufacture of generic copies of patented antiretroviral drugs, both through the UN’s ‘draft zero’ declaration and the its Free Trade Agreement negotiations with India.

The generic copies, 90 percent of which are estimated by experts to be manufactured in India, cost significantly less than the near identical branded originals, allowing some 40,000 people in the Kingdom living with HIV to access cheap, safe treatment.

Such treatment is subsidised by the Global Fund to Fight AIDS, Malaria and Tuberculosis – a scheme which NGOs have said the EU, the United States, Japan and Switzerland are tying to avoid financing past 2012 by deleting a provision of the draft zero declaration.

Heng Phin, an evaluation manager at Cambodian People Living with HIV/AIDS Network, said yesterday that a letter circulated by 10 Cambodian NGOs to the Ambassador for the EU and dozens of embassies last week over the issues had received little response at first.

“I tried anyway to go to the office of United Nations Office of the High Commissioner for Human Rights to see [Surya] Subedi and also the secretariat of the German embassy and also Raphael [Dochao Moreno], the representative of the EU delegation,” he said.

Moreno, who yesterday said he was too busy to comment, agreed to raise concerns expressed in the letter at the UN General Assembly, Heng Phin said, as had Subedi.

Pen Mony, national coordinator of the Cambodian Community of Women Living with HIV, said yesterday she had also raised concerns about the EU’s negotiations with India with Bun Rany through Cambodia’s National Aids Authority. “We just do our best to make sure India does not sign the agreement with the EU,” she said.

Last week’s letter also attacked Japan, the US and Switzerland for allegedly pushing for weakened protections for generic ARVs. Mark Wenig, public affairs officer of the US embassy in Phnom Penh, said last week the US would negotiate at the UN meeting to “ensure we save as many lives as possible”. according to ppp

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First Lady to champion the elimination of mother to child transmission of HIV in Cambodia at the 2011 UN General Assembly High Level Meeting on AIDS

Cambodia’s First Lady, Her Excellency Dr. Bun Rany Hun Sen, will join First Ladies from around the world to explore the barriers and opportunities to reaching the global community’s commitment to ensuring no infants are born with HIV at the 2011 UN General Assembly High Level Meeting on AIDS next week.

Held from 8 – 10 June in New York, the UN General Assembly High Level Meeting will review progress and chart the future course of the global AIDS response.

Her Excellency will join the forum for First Ladies to discuss the issue of virtual elimination of mother-to-child transmission and meet with UN Secretary-General Ban Ki Moon to discuss Cambodia’s progress in addressing maternal mortality and newborn health.

In Cambodia, only 50 per cent of HIV-exposed infants are able to access life saving interventions. However, with interventions being taken to scale, combining antenatal care and education with HIV testing for women and their families, these figures could dramatically improve.

The effective integration of prevention of mother-to-child transmission activities into maternal and child health services, through what is called the “Linked Response” approach, is already putting Cambodia well on track to ending the HIV epidemic in children. Read Full Story of HACC's website

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Reproductive Health Report: Whatever the result; woman can have a positive future

More consensual sex among teenagers in Cambodia, not to mention a the alarming rise in rape of teenage females in the Kingdom, has made teen pregnancy an increasingly common reality. There are a number of organizations ready with resources to help, so why are so many young woman still resigned to accepting an unwanted future. Sitting on a sofa in a living room of Marie Stopes clinic based in Chi Phou district of Svay Rieng province, Meas Soa Charkrya, 19, is waiting for a midwife while her friend sits by her side. It was about half past eleven Charkrya is hugging her friend with a look of worry on her face. 

Charkrya got married when she was 16 years old and is now a little over a month pregnant.

“I’ve come here to get an abortion,” says Charkrya.

Teenage pregnancy in Cambodia is still a social problem as teenaged girls with unwanted pregnancies often seek abortions from unqualified clinics. This can cause very negative consequences such as sterilization or even death.

Before coming to Marie Stopes, Charkrya had tried to have an abortion at a private clinic in Bavet city, Svay Rieng province, but it did not turn out well.

“A doctor gave me abortion pills and then he asked me to take them by myself,” she said. “After taking it, I thought it was working well. However, a few days ago I felt unwell. I had a fever, and pain in womb, so I went back to see the doctor again,” she said.

She said the doctor told her that she had a big problem because some blood had remained in her womb for many days and she could face womb cancer if she didn’t cure it quickly.

“He could not help me and he asked me to go to the Marie Stopes clinic instead because they provide safe abortion services and the doctors are skillful,” she said.

The reason that forced Charkrya to have an abortion, she said, was an argument with her husband that broke out when she found out that he was with another woman.

“I was very afraid, but I had no choice because I wouldn’t be able to feed my baby once it was born,” she said.

The Marie Stopes clinic, in Chi Phou district, Svay Rieng province, has been established for over six months and it provides many services such as counseling, safe abortion, family planning and outreach education for reproductive health.

Marie Stopes is an international organization that has been working closely with health care services in Cambodia since 1998. Now, there are seven clinics in the Kingdom.

In 2009, the organisations work contributed to the prevention of 51,963 un-planned pregnancies in Cambodia. Assuming these children followed national averages,  2,217 infant deaths and 2,871 deaths of children under 5 were prevented. Marie Stopes’s work on safe abortion averted 4,705 unsafe abortions and prevented 171 maternal deaths.

Prum Thorn, a midwife for Marie Stopes in Chi Phou district, said that on average there are seven customers per day coming to her clinic, which also facilitates 19 abortions per month.

Because patients occasionally lie about their age out of embarrassment, she said specific figures on how many of them were underage would be difficult to say.

There cost depends on the stage of the pregnancy: from 0 to 7 weeks costs 60,000 riel and seven to twelve weeks costs 80,000 riel. If customers bring a referral client card, Marie Stopes will give them a discount of 2,000 riel. 

However, before having an abortion, the young women must meet with a midwife, such as Prum Thorn.

“I do counseling with clients because abortions can be damaging to a mother’s health”, she said.

Chip Hou health centre is one of Marie Stopes’s partners in providing family planning and health care services to Cambodian women.

Brak Sambath, president of the Chi Phou health centre, said that his team focuses on always facilitating a safe abortion, and always has doctors consult with patients first, as is the law in Cambodia.

“I tell my customers about how to take care of themselves during and after the abortion,” he said,” adding that the procedure costs between 30,000 and 50,000 riel at his clinic.

He added that going to unlicensed private clinics can be dangerous for the woman because of conditions of the operation and because they are often willing to do an abortion after 9 weeks of pregnancy.

“Doing unsafe abortions can cause vaginal discharge, pelvic inflammation, bleeding, or even womb cancer which can cause a woman to die,” he said.

Leap Sovann, 44, a doctor of the clinic Arun Rah, which has been established for 10 months, said that people come to his clinic for quality  service and safe abortions. He noted that many of the women who come to his clinic are around 19 or 20 years old.

Paou Linar, head of child and maternal care of Phnom Penh, said that the Ministry of Health  is now focused on reducing the risk to both mothers and babies during abortions and pregnancies in cooperation with NGOs and private clinics.

“The ministry of health always checks private clinics to make sure they have a license and are providing safe abortions,” he said. “We want to enforce the ban on unsafe abortion services,” he said.

He added that people who most often have unsafe abortions are young teenagers in secondary school, high school and university students, who are shy and afraid of going to well-known and well-run clinics. Now, “the reproductive health for youth programme educates them,” he said.  

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Early treatment prevents stroke

Sroke can be debilitating,  often devastating. Potentially reversible in some cases, it’s completely preventable in many more. Hypertension, or high blood pressure, has long been known as a major cause of vascular disease including stroke. Indeed, dietary modification for treatment began early last century. In the 1980s, more Westerners became aware of the role of salt in hypertension. I remember vividly when the ‘Golden Arches’ fast food chain announced they were removing salt from their fries. I also remember they didn’t taste nearly as good! A few years later, salt was quietly reintroduced – now there’s a lesson in health marketing.

We need no reminding that hypertension costs billions of dollars globally and millions of lives are lost each year as a consequence of high blood pressure. Cambodia is no exception. A 2005 study estimated 12 percent of the population of Siem Reap and 25 percent of those in Kampong Cham had hypertension. Ninety-five percent of people with the condition have no identifiable disease process causing the rise in blood pressure. In this group high salt intake and being overweight are the two most common risk factors. It may be that a high-salt diet is the most common cause of hypertension in rural Cambodia. More work needs to be done, but these are alarming statistics.

Hypertension has an insidious course. In general, one’s blood pressure is related to one’s height and body mass. An extreme example is the giraffe, where the normal blood pressure is 240/160mmHg*. It takes a lot of pressure to maintain blood flow to a giraffe’s brain. On the other hand, small hibernating mammals maintain an average blood pressure of around 50mmHg. Humans are somewhere in between.

The number you’ll hear is 120/80. If you are a young small female, then no doubt your blood pressure will be 100/60 or perhaps lower, whereas a tall burly male would register much higher. Ideal blood pressure is less than 120/80. Treatment starts above 140/90 although if you are diabetic, the upper limit is 130/90.

Ideal blood pressure gives the optimum amount of blood flow to our organs so they are fully functional. Any more than this and the system gets stressed. The walls of our smaller arteries start to get sheared, damaged and eventually scarred. As they scar, they harden, further increasing blood pressure. The damage and scarring can lead to greater fragility. The small arteries supplying the kidney filtering system, the back of the eye and small brain vessels are the most vulnerable to permanent damage. Certainly mild kidney damage, poorer eyesight and mild cognitive decline are common in those with hypertension.

A recent study showed that for every 10mmHg increase in diastolic (but not systolic) blood pressure, the risk of cognitive impairment increased by 7 percent. Higher blood pressure can cause impairment of brain function at all ages, although older people are more at risk. Tiny little breakdowns in the walls of the smallest brain vessels eventually deprive brain cells of vital blood and oxygen and they die more rapidly. Early on, the effect of these tiny strokes isn’t noticed, but incrementally it adds up.

Although there is some evidence that treatment can reverse this impairment, study results are disappointingly mixed, so prevention remains the best cure for the brain.

The most unfortunate consequence of hypertension is a stroke. In many ways it is a matter of magnitude. A tiny stroke won’t be noticed, but if a larger vessel is affected, everything changes. The body is amazing good at regulating itself. On detection of a lack of oxygen to part of the brain, the body increases the blood pressure further to increase blood flow to the area. This can make the situation worse.

Depending on which part of the brain is affected, the effect will be different. A stroke on the left side means language is lost; on the right means being unable to perform tasks or movements despite understanding; the back of the brain affects eyesight. There are examples of stroke victims being unable to recognise faces, despite being able to see that it is a face. Oliver Sacks’ well-known 1985 book The Man Who Mistook His Wife for a Hat and Other Clinical Tales describes some of these weird and tragic stories. The most devastating strokes affect the brain stem (the centres of consciousness). Few survive such a devastating injury.

With some key excepptions, modern medicine has no effective treatment for stroke. In many cases watching, waiting, even hoping and praying are the only options. As a doctor it’s a tragic and often helpless situation. I often wish I had met the patient years before, perhaps warned them – but then I might see another younger patient who is blissfully ignorant of the debilitating consequences of not treating their high blood pressure.

Which brings us back to reality in Cambodia. How to explain these facts (and treatment) to a rural villager in Kampong Cham, let alone emphasise the risks to an exuberant expat immersed (or enmeshed) in the throngs of life in Phnom Penh? Eat less salt perhaps, but there’s no access to effective hypertensive treatment that can readily reverse this process. Ultimately greater development will bring better medical care, though accompanied by more medical problems, no doubt. For the rest of us, check your blood pressure regularly and if it’s too high then take the next step before it’s too late. according to ppp

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Fears of a dengue epidemic

As Cambodia enters its dengue season, with outbreaks in four out of 24 provinces, the National Dengue Control Programme is warning that a repeat of the 2007 epidemic – when about 40,000 people were hospitalised, more than 10,000 in one week – may be imminent. “Based on my experience, I see the same pattern as 2007 emerging now,” said To Setha, a vector control specialist at the NDCP, pointing to the higher number of cases than usual during the final months of last year and the first two months of this year. Rekul Huy, chief of epidemiology at the NDCP, is also alarmed by the high number of cases during months when dengue is usually rare.  A change in the serotype of the virus, which has four, from DEN2 to DEN1 detected in the middle of last year also concerns him, as does the increase in the percentage of patients with dengue haemorrhagic fever in the first four months of this year: from about 50 percent last year to two-thirds this year. An increase in DHF patients signals the possible presence of a new serotype, he said. In Cambodia, where dengue is endemic, the number of cases spikes in June and July – a period NDCP director Ngan Chantha refers to as the “nightmare season” – with major outbreaks occurring in three- to five-year intervals. Ngan Chantha said the number of cases at the beginning of this year had reached the “alert” level, signalling a possible nationwide outbreak during the rainy season. This year, however, his department faces severe financial constraints to implement the swift interventions necessary to contain local outbreaks before they spiral out of control as in 2007.  The Asian Development Bank, which contributes about three-fifths of the NDCP’s less than US$500,000 annual budget, has yet to disburse the funds, while the decentralisation of health services that began in 2008 has left the NDCP’s 12 staff unclear about what many of their provincial counterparts are doing.  Furthermore, there has been only one test so far this year to detect the prevalent serotype, according to Rekul Huy. Testing is not conducted at the hospitals where most dengue patients are treated, which are run by a Swiss foundation that offers free treatment for children and a high level of service but operates outside the state-run system.  National officials do not know where or when the larvicide Abate, their primary preventative tool, is being distributed because it is now held by provincial officials, Rekul Huy said.  Steven Bjorges, team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia, explained that the high turnover of officials at the provincial level meant that in some provinces they lacked experience in preventing or containing outbreaks. “Everyone likes decentralisation, but the adverse consequences can perversely result in less optimal public health outcomes,” he said.  He is, however, less alarmed than officials at the NDCP that a repeat of the 2007 epidemic is imminent because there have been fewer cases reported nationwide this year than last. “But that could change next week,” he added. Bjorges agreed that the chronic lack of funding undermined the NDCP’s efforts to prevent or contain outbreaks. “We’re begging for funds year after year. If the dengue programme could get sustained, even limited funding, for a long period, it could accomplish so much more,” he said. “Foreign funding of public health in Cambodia is often not directed at the primary health needs of Cambodians, and it sometimes distorts the delivery of services,” Ngan Chantha said. “What is more alarming than a dengue outbreak is the lack of funding to deal with it.”  The NDCP has been trying to expand its most successful project for preventing dengue for the past four years, using guppy fish to get rid of the larvae of the mosquito that transmits dengue from water storage containers. In the 16 villages where this project has been operating since 2004, there have been no outbreaks, To Setha said.  The small amount of funding to expand the project, which costs about $1 per person a year to maintain, has been restricted to either one- or one-and-a-half-year grants, which have been insufficient to allow for its sustainability in other villages, he said.  It takes about four years for a health centre and its surrounding villages to develop the physical and social infrastructure needed to sustain it, he said. according to ppp

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An introduction to Lift’s sexual health issue from senior writer Kounila Keo

After working as a journalist for several years and consuming news media for many more, I have discovered that the coverage of politics has received more importance than that of reproductive health in Cambodia.

I have observed that many Cambodian journalists have heard or written relatively little about the issue of reproductive health. Therefore, it makes the issue almost unheard of in Cambodian society.

The basic function of the press is to inform, entertain and above all else, educate the society we live in. In this matter, while it is a powerful tool that can change public opinion, the media can play an important role in reinforcing long-term prospect of sustainable growth by providing enough coverage or disseminating information related to reproductive health which our people need to be informed about.

Reproductive health, is considered a by the media at large to be a superficial topic according to female journalist participants from Asia and Africa who spoke at a seminar in Washington DC last year. Articles about mother and child, youth, environment, domestic violence, early marriage and population control, are still considered ‘soft news’ and when written are often tossed to ‘unimportant’ sections of newspapers.  While I think this is unfair, there are a lot of things which I believe Cambodian media both in English and Khmer can do to improve the well-being of Cambodians. It is hugely important for our society to be educated in the basics of reproductive health.  The statistics for a woman’s risk of death from pregnancy or child birth in the underdeveloped world are shocking. In developed countries, 1 in 7,300 pregnancies end in maternal death, while in developing countries the ratio is an appalling 1 in 75. Laos has one of the highest maternal mortality rates in Southeast Asia at 1 in every 152. With 540 maternal deaths per 100,000 live births, according to the World Health Organization (WHO), Cambodia has the second highest maternal mortality rate in the region after Laos, with 660. As part of the UN Millennium Development Goals to be achieved by 2015, Cambodia has committed to reducing maternal deaths to 540 per 100,000. Beyond this problem, what Cambodia is confronting is complacency regarding the decreasing number HIV infection prevalence. In Cambodia, the number of new HIV infections has dropped from an estimated 15,500 per year during the peak of the epidemic in the early 1990s to about 2,100 last year, according to a report written by Cambodian experts working closely with the United States-based Result for Development Institute. The media taking an interest in reproductive health is of the utmost importance for Cambodia. Issues such as early arranged marriage, unsafe abortions, sexual abuse, contraception and safe sexual practices need to be discussed and examined to ensure the well-being of our evolving culture.  There has been a healthy shift in the rural areas surrounding the issue of domestic violence. This is a good start, and I can only hope that with the media giving more attention to these other issues there will be good news to report on these subjects very soon.  The programme I attended in late 2010 is a new approach from the Population Reference Bureau which has targeted female journalists to make the concerns heard by policy makers of the respective countries and encouraged them to pay more attention to the issue. On the global level, we can ask why it takes so long for these problems to be resolved in some parts of the world. It goes without saying that it depends on the commitment of each government and those who are involved in disseminating information such as the media to educate the people.  During the seminar I took, we agreed on one answer: corruption, poverty, and politics will were real constraints that kicked reproductive health aside, but it would not take long for us to find out how much impact reporting on reproductive can help address issues the government and policy makers are working on.  Media, is a powerful tool that can be used to educate people and improve our country’s future. according to ppp

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Fears of a dengue epidemic

As Cambodia enters its dengue season, with outbreaks in four out of 24 provinces, the National Dengue Control Programme is warning that a repeat of the 2007 epidemic – when about 40,000 people were hospitalised, more than 10,000 in one week – may be imminent. “Based on my experience, I see the same pattern as 2007 emerging now,” said To Setha, a vector control specialist at the NDCP, pointing to the higher number of cases than usual during the final months of last year and the first two months of this year. Rekul Huy, chief of epidemiology at the NDCP, is also alarmed by the high number of cases during months when dengue is usually rare.  A change in the serotype of the virus, which has four, from DEN2 to DEN1 detected in the middle of last year also concerns him, as does the increase in the percentage of patients with dengue haemorrhagic fever in the first four months of this year: from about 50 percent last year to two-thirds this year. An increase in DHF patients signals the possible presence of a new serotype, he said. In Cambodia, where dengue is endemic, the number of cases spikes in June and July – a period NDCP director Ngan Chantha refers to as the “nightmare season” – with major outbreaks occurring in three- to five-year intervals. Ngan Chantha said the number of cases at the beginning of this year had reached the “alert” level, signalling a possible nationwide outbreak during the rainy season. This year, however, his department faces severe financial constraints to implement the swift interventions necessary to contain local outbreaks before they spiral out of control as in 2007.  The Asian Development Bank, which contributes about three-fifths of the NDCP’s less than US$500,000 annual budget, has yet to disburse the funds, while the decentralisation of health services that began in 2008 has left the NDCP’s 12 staff unclear about what many of their provincial counterparts are doing.  Furthermore, there has been only one test so far this year to detect the prevalent serotype, according to Rekul Huy. Testing is not conducted at the hospitals where most dengue patients are treated, which are run by a Swiss foundation that offers free treatment for children and a high level of service but operates outside the state-run system.  National officials do not know where or when the larvicide Abate, their primary preventative tool, is being distributed because it is now held by provincial officials, Rekul Huy said.  Steven Bjorges, team leader of the malaria and vector-borne diseases department of the World Health Organisation in Cambodia, explained that the high turnover of officials at the provincial level meant that in some provinces they lacked experience in preventing or containing outbreaks. “Everyone likes decentralisation, but the adverse consequences can perversely result in less optimal public health outcomes,” he said.  He is, however, less alarmed than officials at the NDCP that a repeat of the 2007 epidemic is imminent because there have been fewer cases reported nationwide this year than last. “But that could change next week,” he added. Bjorges agreed that the chronic lack of funding undermined the NDCP’s efforts to prevent or contain outbreaks. “We’re begging for funds year after year. If the dengue programme could get sustained, even limited funding, for a long period, it could accomplish so much more,” he said. “Foreign funding of public health in Cambodia is often not directed at the primary health needs of Cambodians, and it sometimes distorts the delivery of services,” Ngan Chantha said. “What is more alarming than a dengue outbreak is the lack of funding to deal with it.”  The NDCP has been trying to expand its most successful project for preventing dengue for the past four years, using guppy fish to get rid of the larvae of the mosquito that transmits dengue from water storage containers. In the 16 villages where this project has been operating since 2004, there have been no outbreaks, To Setha said.  The small amount of funding to expand the project, which costs about $1 per person a year to maintain, has been restricted to either one- or one-and-a-half-year grants, which have been insufficient to allow for its sustainability in other villages, he said.  It takes about four years for a health centre and its surrounding villages to develop the physical and social infrastructure needed to sustain it, he said. according to ppp

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CAMBODIA: Dengue officials brace for "nightmare season"

Photo: Swiss Radio,  Dengue is endemic in Cambodia
PHNOM PENH, 17 May 2011 (IRIN) - As Cambodia enters its dengue season, with outbreaks in four out of 24 provinces, the National Dengue Control Programme (NDCP) is warning that a repeat of the 2007 epidemic - when about 40,000 people were hospitalized, more than 10,000 in one week - may be imminent.
"Based on my experience, I see the same pattern as 2007 emerging now," said To Setha, a vector control specialist at the NDCP, pointing to the higher number of cases than usual during the final months of last year and the first two months of this year.
Rekul Huy, chief of epidemiology at the NDCP, is also alarmed by the high number of cases during months when dengue is usually rare.
A change in the serotype of the virus (which has four) from DEN2 to DEN1 detected in the middle of last year also concerns him, as does the increase in the percentage of patients with dengue hemorrhagic fever (DHF) in the first four months of this year: from about 50 percent last year to two-thirds this year.
An increase in DHF patients signals the possible presence of a new serotype, he said.
In Cambodia, where dengue is endemic, the number of cases spikes in June and July - a period NDCP director Ngan Chantha refers to as the "nightmare season" - with major outbreaks occurring in three- to five-year intervals.
Chantha said the number of cases at the beginning of this year had reached the "alert" level, signalling a possible nationwide outbreak during the rainy season.
This year, however, his department faces severe financial constraints to implement the swift interventions necessary to contain local outbreaks before they spiral out of control as in 2007.


Funding shortfalls and data gaps
The Asian Development Bank, which contributes about three-fifths of the NDCP's less than US$500,000 annual budget, has yet to disburse the funds, while the decentralization of health services that began in 2008 has left the NDCP's 12 staff unclear about what many of their provincial counterparts are doing.


Furthermore, there has been only one test so far this year to detect the prevalent serotype, according to Huy. Testing is not conducted at the hospitals where most dengue patients are treated, which are run by a Swiss foundation that offers free treatment for children and a high level of service but operates outside the state-run system.


National officials do not even know where or when the larvicide Abate, their primary preventative tool, is being distributed because it is now held by provincial officials, Huy said.


Steven Bjorges, team leader of the malaria and vector-borne diseases department of the World Health Organization (WHO) in Cambodia, explained that the high turnover of officials at the provincial level meant that in some provinces they lacked experience in preventing or containing outbreaks.


"Everyone likes decentralization, but the adverse consequences can perversely result in less optimal public health outcomes," he said.


He is, however, less alarmed than officials at the NDCP that a repeat of the 2007 epidemic is imminent because there have been fewer cases reported nationwide this year than last. "But that could change next week," he added.


Bjorges agreed that the chronic lack of funding undermined the NDCP's efforts to prevent or contain outbreaks.


"We're begging for funds year after year. If the dengue programme could get sustained, even limited funding, for a long period, it could accomplish so much more," he said.


"Foreign funding of public health in Cambodia is often not directed at the primary health needs of Cambodians, and it sometimes distorts the delivery of services," Chantha said. "What is more alarming than a dengue outbreak is the lack of funding to deal with it."


Prevention tools
The NDCP has been trying to expand its most successful project for preventing dengue for the past four years, using guppy fish to get rid of the larvae of the mosquito that transmits dengue from water storage containers. In the 16 villages where this project has been operating since 2004, there have been no outbreaks, Setha said.


The small amount of funding to expand the project, which costs about $1 per household a year to maintain, has been restricted to either one- or one-and-a-half-year grants, which have been insufficient to allow for its sustainability in other villages, he said.


It takes about four years for a health centre and its surrounding villages to develop the physical and social infrastructure needed to sustain it, he said. according to khmerization, May 17, 2011

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High school student scores medical internship in Cambodia

LAKE WORTH, Fla. - John Hanes is a young medical professional who is about to finish his junior year at Lake Worth Community High School. Rather than spending his summer break relaxing, he will be getting some real-life experience in Cambodia working for an organization called HOPE worldwide . "This will be a good experience for me and I think it will help a lot more in life that just going to the beach every day," said Hanes. He leaves for Cambodia on July 18th. The 17-year-old student will work closely with doctors in an intensive care unit observing surgical procedures and helping with patient care.


His exposure to volunteering began at an early age. John's parents took him on his first mission trip at the age of three.
John is already a certified medical assistant and an EKG assistant. He plans to spend more time helping meet the medical needs of those living in third-world countries. After high school John hopes to study at New York University or the University of Florida and eventually study medicine at Columbia. Hanes wants to be an orthopedic surgeon. John plans to blog about his Cambodia summer experience. according to wptv.com, May 16, 2011

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