Kantha Boptha – Children's Health is the Key for Cambodia's Future.

“Each child's life is a destiny, and this destiny becomes an absurdity when the death of a child is seen as having a different meaning for mothers in poor countries than in western countries.”

It's 1975, fighting continues as Dr Beat Richner attends to another child suffering from Dengue Fever. He's a newly qualified doctor and is working for the Swiss Red Cross in Kantha Bopha paediatric hospital, Phnom Penh. Everyday the Khmer Rouge soldiers dressed black advance upon the capital. It looks as though the capital will soon be under their control. Dr Richner knows that his time in Cambodia is limited and an evacuation order will soon be passed down from above. All he can do is continue with what he does best and help as many children he can until that point.

It wasn't long before Dr Richner received that message and had to leave the country and his extremely vulnerable children behind. On 17 April 1975, the Khmer Rouge soldiers seized control of the city, the country and meticulously and bureaucratically organised genocide began which saw 2 million victims. Among those killed were the intellectuals that could possible threaten the regime including doctors, nurses, teachers and professors. Believe it or not, prior to the Lon Nol government, Cambodia had a health care system that outranked Thailand and Malaysia. The Khmer Rouge's attempt to wipe Cambodia clean and return everybody to an equal place in society destroyed that system.

Following Cambodia's independence in 1991, His Majesty King Norodom Sihanouk and the government invited Dr Richner back to Cambodia to help rebuild Kantha Bopha children's hospital. It's now 2011 and Dr Beat Richner, also known to many Swiss as children's television star Beatacello, is still in Cambodia treating children from across Cambodia. In ten years an impressive five hospitals and a maternity ward for HIV-positive mothers have been built and a fully operational.

Government run healthcare in Cambodia is not free and is thriving with corruption, money simply disappears and it is believed that 80% of drugs used in these clinics are counterfeit, of which 10% of toxic. The Kantha Bopha children's hospitals provide free healthcare to children and mothers throughout Cambodia and are completely independent from the government. 85% of all children admitted into hospital for treatment come from families who are unable to pay the smallest fees. With 80% of Cambodian families earning a maximum of $0.5 per day, Kantha Bopha hospitals represent the only chance for their children to get the medical treatment they need. Every child has a right to proper medication unhampered by corruption. Without these hospitals, an estimated 3,200 additional children would die every month from treatable diseases. Despite this, the World Health Organisation insist that patient families must pay for the cost of treatment in order to take more responsibility for their health.

Dr Richner and his team of doctors

To beat corruption Kantha Bopha have employed 2,230 local Cambodian staff who are paid a decent wage that they can comfortably live on. Dr Richner claims that to this day there have been no thefts in any of the hospitals and no cases of vanishing medicines. Staff are also completely dedicated to their roles within the hospitals as they do not have to rely on second jobs to get by and this means the hospitals can run 24 hours a day. The hospitals provide on the job learning for 100 medical interns and nurses. This training is akin Artisans D'Angkor's goal and that is to regenerate the once great Cambodian healthcare system.

During 2010:

• 108,000 children were hospitalised in the five hospitals (Kantha Bopha I, II, IV and V in Phnom Penh and Jayavarman VII in Siem Reap Angkor,) The average length of hospitilisation was 5 days.
• 733,070 ill children received treatment in the outpatient departments.
• 580,000 healthy children were vaccinated.
• 16,100 surgical operations were carried out.
• 91,136 pregnancy control with 14,171 births in the maternity ward which has been designed to prevent mother-to-child AIDS and TB transmission
• 3,000 families received daily health care education
• The Kantha Bopha Hospitals cover 85-90% of the country's sick children.

The above statistics prove the great importance of the Kantha Bopha hospitals to Cambodian families. The annual budget for the running costs is US$30m which is sourced from donations the Cambodian and Swiss governments, but the majority of the funds are from private donations (approx US$22m per year).

In order for the hospitals to provide the healthcare that Cambodian children deserve and need, the assistance of modern and fully functioning equipment, proper and effective medicine and sufficient disposable medical equipment is required. The constant development of the hospitals is needed and at the moment, Siem Reap Angkor is being extended to accommodate 300 more beds and also house a new MRI scanner. The MRI scanner is indispensable when it comes to faster diagnosis of Tuberculosis and checking the subsequent bone and brain infections which is commonplace in northern Cambodia. Kantha Bopha's research on Tuberculosis in children is incredibly important in gaining further understanding on the affects of the disease and to improve the efficiency of treatment.

Unfortunately this is the sticking point. MRI scanners are incredibly expensive to purchase, run and maintain. Dr Beat Richner takes to the stage every Saturday evening as Beatacello and holds a cello recital and talk in order to raise funds for the hospitals. He starts off by stating what he wants. He says “From the young people, I want your blood. From the old people, I want your money. And from the people in between I want blood and money.”

Admitted children with their parents

The biggest threat to Cambodian children is Tuberculosis which also makes increases susceptability to HIV, Dengue Fever and Encephalitis. Should Encephalitis and Dengue Fever be diagnosed early enough, the effects on the brain are dramatically decreased and the chance of a full recovery is improved. The only way to gain this early diagnosis is through an MRI scan. The World Health Organisation (WHO) have become the bane of Dr Richner's life as they insist that he's doing too much in Cambodia and that he should take a step back. Their idea that medical care should be reflective of the countries economy is constantly grating on his mind. It is saying poor medicine for poor people. Dr Richner claims that it costs US$250 to save a child's life who is suffering from TB. How can the WHO stand by and say Cambodia are too poor to have medicine that's readily available in the richer western countries. Are western children lives worth more than that of a Cambodian? Does a Cambodian mother love her child less than a western mother? Should a Cambodian father accept that because his country's GDP is less than that of other countries, his child shouldn't deserve treatment that is there and available to western child? How can a person's life have a price on it? How can rich people who get rich peoples healthcare turn around and say, you're too poor to get proper contemporary treatment like I do?

When there is was a serious Dengue Fever outbreak, no one cared, but when there was an outbreak of Avian flu the WHO were there straight away to quarantine sites and take control of the situation because it is a global threat and can affect the richest western countries whereas Dengue Fever is localised to certain areas? Dr Richner dubs the WHO's health policy as passive genocide of Cambodian children and continuously urges them to revise their stance. It's not just the WHO or other 'charitable' organisations that refuse to offer assistance. A big grievance of Dr Richner's is with those countries that were implicit with bringing the war that reeked havoc in Cambodia.

In 1968 The United States of America were on the loosing end of the Vietnamese war and turned on the heat by raging a secret war against Cambodia in an effort to cut off supply lines and support for the Viet Cong. Cambodia was, at the time neutral, yet between 1968 and 1973 700,000 tonnes of bombs dropped on Cambodia and an estimated 500,000 innocent Cambodians were killed. In 1973 Cambodia fell victim to more bombs than Japan were during the entire second world war. Dr Richner believes that this secret war was clearly a huge factor in motivating broad swaths of the population allying themselves with the Khmer Rouge. At the same time, the Central Intelligence Agency of the USA financially, politically and strategically supported the 1970 military coup that successfully overthrew Prince Norodom Sihanouk as Head of State and thrust Lon Nol to power of Cambodia.

Dr Richner persistently approaches the USA for support, but they continue to refuse. The aid they do pay goes to governmental agencies and most of the funds simply disappear through the back doors and sticky hands of those in charge. Richner continues to be surprised with the attitude of the US superpower and their lack of responsibility for the part they played in the loss of 3.5 million lives during the war. Yet Washington insists that the money loaned to the Lon Nol government between 1970 and 1975 is paid back. Without officially declared war on Cambodia , the US bombarded the country for four months, killing hundreds of thousands of Cambodians, toppling Sihanouk through the CIA and replacing him with Lon Nol, and Cambodia are expected to pay back $300 million dollars to the US!

Another disgusting intervention of the US has been revealed. In 1979, Vietnamese troops marched into Cambodia and took control of the country as they had grown tired of constant encroachments of the Khmer Rouge along the Vietnamese border. 400,000 Vietnamese troops remained in Cambodia for nine years and President Regan took this opportunity to fund the Khmer Rouge $100 million to continue the fight against the Vietnamese. How can the US believe that they are within their rights to intervene in this way and fund a regime that had just wiped out nearly half of their population. What right do they have to insist on repayment of any monies that may have been loaned to Lon Nol. If it wasn't for their intervention in Cambodia, Prince Sihanouk would have never been deposed and the Khmer Rouge may have remained that small radical fraction with no power.

Beatacello in concert

Richner continues to approach agencies worldwide in an effort to secure long term funding for the hospitals. The model of these hospitals where they are run by the country's people for their fellow countrymen works well and it is believed more sustainable than that of voluntary organisations, such as the Red Cross that rely on western doctors, nurses and volunteers in the delivery of their service. Once the western volunteers leave, there are no experienced local people to continue treatment. By training locals up, paying them a decent wage, treating them with the respect they deserve and entrusting them with the honour of looking after their own people is the best way to ensure sustainability and development. These people continue to train up new doctors and nurses, and before you know it, a whole country will be filled with highly skilled professionals that have the ability to treat severely ill people.

I will never understand the principals of the US and organisations such as the WHO. The key to a countries success is through a healthy workforce. If you constantly hinder health services by either refusal or changing patients, then you will never have a healthy country. The work Dr Richner is doing in Cambodia is inspirational and I hope we will see other countries take up this highly efficient health care model. He has already stated that he wants to start a similar scheme in Burma but cannot attempt that until sustainable funding is sourced for Kantha Bopha.

During Richner's talks about his work, the hospitals and the problems of Cambodia, his split personality of Beatacello takes over and he plays his cello. It is a highly enjoyable, informative and shocking presentation given every Friday and I would recommend this to anyone that visits Siem Reap.

After leaving the hospital with my tuk-tuk driver who had waited for me for only $2(!), I felt deep sense of appreciation of the health service we receive in the United Kingdom, although the NHS may need a slight reorganisation, there is no reason for people to despise it and want private healthcare. If you care about your friends and your family, the NHS provides healthcare for them should they need it. I don't mind paying my taxes to ensure my friends and family health. So the next time you feel about complaining about the NHS, just think how lucky we are.

Please check out KanthaBopha's website to get a better understanding of Dr Beat Richner's work.

The Mysteries of Angkor - 20-23 April 2011

Violently woken from my sleep at 5am, I slam my hand down upon my mobile telephone to shut the alarm up. Scared to use the snooze function, I force myself to get out of bed and under a brief shower. Not that a shower is worth it, as within a few minutes outside and I'll be drenched with sweat once again. My whole theory that I would be used to the humid climate by this point was blown out of the window and I resigned myself to a few months of dripping. I stepped out side and walked down the stairs quietly, trying not to wake the night watchman whom was sleeping in reception. Nicky and Tom were already outside in the dark waiting for me and the adventure ahead of us. Our tuk-tuk driver and guide for the day silently pushed the machine from around the rear of the guesthouse. The gates were opened and we hopped in and were off to catch sunrise over the ancient Khmer ruins.

Early morning in a tuk-tuk

We were on a tight schedule, sunrise was at 5.45am and we had to pick up Kate from her hotel and her friend Shale from his. Once we had collected everyone we would have to travel a few kilometres out of Siem Reap, buy a ticket and travel a further kilometre to the main temple of Angkor Wat. The night before, I handed the driver a piece of paper with details of where we needed to collect the other two from and he assured me that it was OK and that he knew where the places were so everything 'should' be fine. The streets of Siem Reap were eerily quiet and not reminiscent of Asia at all. As we drove down the street towards Kate's place, the three of us savoured the peaceful atmosphere and cool breeze flowing past us. The driver's confident attitude began to diminish and his head started slapping from side to side desperately trying to find the intended address. He slammed his breaks on, changed his mind and applied the throttle over and over again. Our peaceful mood turned to concern, time was passing rapidly. I leant over and spoke to him in a loud clear voice so that he could hear me over his whining engine. I pointed to the map but he had no idea where he was going. Unfortunately, he had no telephone on him, neither did we, so we couldn't call Kate or the hotel in question. The tuk-tuk driver took the initiative to turn around and steam back to our hotel to seek assistance from the night watchman.

He ran into the reception area and was in there for a while. I had become impatient and followed him in to see what he was up to and when I got inside, I just saw him staring idly at the telephone. I'm not sure he knew what it was or how to use it. My impatience turned to frustration and I urged him to hurry up as we only had 25 minutes now to pick up the others and get into the complex for sunrise. Another minute passed by and the guide leaped energetically through the front door and moved briskly towards the tuk-tuk, said “OK!” and we were moving again but our hopefulness immediately disappeared when we reached the end of our road, we turned right onto the main road... The opposite direction to where we should have been going! My anxiety increased, I looked at the other two and we couldn't help but laugh through our pain.

The tuk-tuk stormed into the quiet streets of central Siem Reap and we arrived at Shale's hostel where he had been waiting for a while. He jumped on board with now only 15 minutes to pick Kate up, buy tickets and get into the site before that sun rose above the horizon. To our surprise, the tuk-tuk driver said “OK, Angkor Wat!”. “NO!!!!” we all screamed in disbelief, “We need to pick up Kate!”. My hands clasped together in a fit of stress, squeezing my guide book like it was an orange. I raised the book and to stop my teeth clenching together and shattering, I stuck the book in between my top and bottom deck and bit down hard. We laughed at the unbelievable situation. “Ah, I can't find this address to pick this person up so I'm going to just forget about her, they won't mind and everything will be fine.” How could he possibly think such a thing. Luckily Shale had a mobile and could contact Kate. Within a few minutes we were back the other side of the river and town with Kate climbing aboard. We now only had 10 minutes to get over to Angkor Wat for sunrise.

We now had five people squeezed in the back of this tuk-tuk and the engine was noticeably struggling to get above 50km/h. The sky was getting lighter by the second and we all knew in the bottom of our hearts that we wouldn't make it. We had a couple of kilometres to go, stop at the ticket office, travel a further kilometre or two to Angkor Wat and then walk into the site itself. We still urged the driver to go as fast as possible, but it became more light hearted and fun as we had come to terms with our late arrival. We finally arrived at the site around 5.50am, the sun had brightened the sky somewhat but was still not visible above the horizon. So we jumped off the tuk-tuk and walked with a hurried step into the temple site.

Suddenly all the memory of the past 45 minutes evaporated as we were presented with Angkor Wat's impressive entrance and our first taste of the mystery that lies within. Although the sky was light, the sun hadn't risen above the ruins so we had in fact got there in time for the sunrise show. The sky began to turn red over the surrounding jungle illuminating the ruins in a beautiful orange glow. Hundreds of people swarmed around the temple capturing as many photos as they possible could. The views were awe inspiring, unforgettable and certainly a highlight of Andy's Epic Voyage. We spent a couple of hours at the main site walking through the endless elaborately designed passageways. It is so easy to lose your bearings and sometimes you have to stop and retrace your steps. Especially as you get in towards the centre where it's all pretty much symmetrical. In the centre, you have the chance to climb up to the highest point of the temple and this is where I confirmed my choice of wearing flip-flops was not, I repeat NOT a good idea! Climbing uneven 800 year old steps in those was not the easiest or safest thing to do. 

My new young monk friend

After walking round for a while, I needed a break, so I headed out to one of the many exits of the central complex and sat down. I opened my bag up to retrieve my bottle of water but opened my front pocket instead and was extremely surprised when a huge cockroach scuttled out at speed up my arm. I instinctively shuddered and flicked the disgusting insect off me. I have no idea how long I had been carrying that around for! After taking several swigs of my water, which was now warm, I was joined by a few young monks who greeted me and took my photo. Such friendly people, yet I'm still not used to seeing them walk around with their digital SLRs and using mobile phones.

We all reconvened and decided that we should take this moment to leave and head towards another temple. The second temple was a small ruin just to the east of the main one and fairly unremarkable. We weren't there long before we headed back off to another more impressive temple. Perhaps even more impressive than the main Angkor Wat temple we visited first thing. This temple, I have Preah Khan is a perfect example of how powerful nature is and how it will consume us given the opportunity. With the downfall of the Khmer Empire, the Angkor region went into hiding for many years giving the surrounding jungle to move in until a French man rediscovered the complex 150 year ago. Seeing the trees twisting around the stone carvings and coming through walls is an inspiring sight. These temples are jaw droppingly amazing now, I can't imagine what they were like when they were built?

Flip-flops not ideal....

Time was moving on rapidly and hunger began affecting us, so before we visited any more of the temples, we stopped for dinner at this restaurant to give us all a break from the heat. The five of us went inside and got a meal and a nice cold drink whist the guide got into a hammock and fell asleep for a while. The restaurant owners were lovely and accommodating, they pulled over a couple of fans and pointed them directly at us.

After lunch we headed to another temple that sat quite isolated in the complex but was a tall pyramid with steep steps on all four sides that led to the top. We walked round the temple in a bid to find the side that was in the shade so we could climb up without the sun burning our backs. We finished our complete circle and failed to find shade. Only by looking at my watch did I see the reason why, it was midday.

Banyon Temple, our last temple of the day and one of the most popular due to the mysterious faces that are carved into the stones around the temple complex. The temples are certainly one of the wonders of the world and too amazing, mysterious, provoking and vast to justifiably describe with written word. You could spend days, weeks, even months wondering the countless passage ways through the dozens of ruins on this site. We only had one day and by the time we got to Banyon we were so hot and tired that we ordered our guide, who was eager to show us more, to take us back home. We had spent eight hours walking, exploring, climbing, haggling, drinking gallons of water and sweating it straight back out again. The ruins are in the midst of a jungle and thus the humidity, even as early as 7am is unbearable.

The Faces of Banyon

Once arriving back at our guesthouse I just got straight into the shower and I'm pretty sure there was steam rising off my body as the cold water sucked the heat from my body. After the shower, Nicky and I headed out to have our hair cut for the second time on my trip. This time I took along a photograph to show the barber instead of trying to explain what I wanted. Nicky had a dramatic change to his hair and had most of it chopped off.

Later that evening we went to unwind at a restaurant with Kate, as it was her last night and have a couple of drinks. I enjoyed the evening until it came to paying for the meal when I handed over $10 to the waiter and after a few moments of deep evaluation he returned it to me saying it was unacceptable. I was taken aback. I asked why he wouldn't take it and he pointed out the tiniest tear not even one millimetre long and asked whether I had another one. I didn't. Even if I did, I would have said no out of principle. I began to get frustrated at their refusal of my money. I would have accepted it if it was screwed up and ripped in half but it was a perfect bill apart from that tiny minuscule blemish. I stood up and spoke quietly to the waiter and asked him where his manager was as I wasn't prepared to take it out on an innocent waiter as it's not his fault. The manager came out and I again presented the bill, and with it an ultimatum that he either take the perfectly good money on offer or I walk out and don't pay for my meal as that is the only money I have. He began asking my friends for cash and unfortunately someone handed over another note on my behalf and I left the restaurant feeling defeated.

The evening finished up perfectly at a bar down some back alley where locals were celebrating the end to Khmer New Year with some locals. We only went for a couple of beers but as we sat quietly drinking and talking the revellers urged us to join them for a dance and so we did. These are the moments travelling is all about, being invited to celebrate and share a memory with the local people.

As there are so many photos, here's a slideshow!