Wednesday, February 17, 2010

The Passive Genocide of Children in Cambodia... (In Praise of Dr Beat Richner)

“Every year more than a million children receive first class medical care in one of the world’s poorest countries, and it’s all down to the work of a Swiss doctor and his cello”.

Dr Beat Richner is quite a performer – the founder, director and chief fundraiser of the Kantha Bopha group of children’s hospitals in Cambodia, he is passionate, eloquent – and a rather good cellist.

Every Saturday night Dr Richner attracts a large audience for his free ‘Beatocello’ concert at the Kantha Bopha 3 hospital in Siem Riep. The crowd, almost entirely tourists dropping in on the way to the nearby Angkor Wat, are treated to some lovely Bach, interspersed with an impassioned lecture in defence of his controversial approach to children’s healthcare in Cambodia.

He doesn’t pull any punches: the international community, through the World Health Organisation, is accused of accepting and even promoting a situation where countries have to match the quality of their healthcare to their wider economic situation.

But that seems fair enough doesn’t it? As I heard him speak, I couldn’t help thinking that it’s only reasonable that we live within our means - if you’re a poor country you can only afford to provide a certain level of care. It’s not nice, but it’s the way things work – isn’t it?

No, absolutely not said Dr Richner, anticipating the objection and swiping his cello bow dismissively. This may be how things are, but it is not how they have to be. In fact, accepting this situation, in his view, amounts to a policy of “poor medicine for poor people in poor countries”. If we tolerate this, we are complicit in nothing short of a “passive genocide of children”. Strong words.

But what is impressive about Dr Richner is that he backs up his words with actions. When both Cambodian and international authorities dismissed his approach as unworkable, he was unbowed. Through a mixture of charm, smart strategy and dogged determination, he went ahead anyway, and helped to re-open the first Kantha Bopha hospital in Phnom Penh in 1992, following its distribution by the Khmer Rouge regime. There are now 4 Kantha Bopha hospitals in Phnom Penh as well as the one in Siem Reap.

Dr Richner is no stranger to the challenging situation in Cambodia. Unlike me and many others he isn’t a recent, peacetime arrival in Cambodia, but in fact was here helping the most vulnerable people during the depths of its miserable recent history. Footage in the documentary which accompanies his performance shows a slimmer, fresher-faced but equally committed Beat treating children in 1975 as a Red Cross volunteer, even as soldiers fight and Pehom Penh falls to the Khmer Rouge right outside the hospital.

The Kantha Bopha hospitals themselves are impressive – they are big, modern, with well-trained staff, equipment including scanners, and supplies of reliable medicines (which he explains are all imported from Thailand, as - shockingly - 80% of drugs in Cambodia are potentially dangerous fakes). Most impressive of all is the approach: Kantha Bopha hospitals are completely free for all children in Cambodia – unlike state hospitals here, there are no (officially sanctioned) payments for treatment, or (unofficial) payments to staff for care or to grey market pharmacies for drugs.

And the result? Whereas many Cambodians are put off from accessing state hospitals early (or at all) partly due to these costs, there are no such issues at Kantha Bopha. As well as avoiding official fees, the staff are also paid decent wages, taking away the temptation to charge patients, to steal and resell drugs, or to moonlight in other jobs to supplement their wage, all of which seem to be major problems elsewhere in the country’s hospitals.

Dr Richner rattles off an impressive range of statistics to demonstrate the success of his hospitals: every day across the 5 hospitals they see over 3,000 children as outpatients, admit 300 inpatients and deliver 26 babies; the cost averages only $240 per patient; and the contribution is sustainable, including the ongoing training of 63 medical students.

I was impressed by Dr Richner, as a man and as a visionary. He is a smart operator - when he built his first children’s hospital in Siem Riep, he managed to secure land either side of the only road connecting the town’s 5 star hotels with the temple complex. Every day a stream of wealthy potential donors passes through his hospital – clever guy!

This approach is controversial, and the presence of such hospitals may even be embarrassing in a country whose state healthcare provision is otherwise still pretty basic and whose system suffers from endemic corruption. Personally I think good on him for having the vision and the guts to fight the good fight, but I’m sure he’s made a few enemies here along the way.

And he’s not sitting still either – only last week, believing that the Cambodian government are not responding properly to a recent cholera outbreak in the southern Mekong area, Dr Richner took out a full page advert in the Cambodia Daily newspaper calling for immediate action and the declaration of a state of emergency in the area. It won’t make him any friends in the government – but it might save the lives of children, which has to be more important.

If my contribution here – to health (or even to music!) - is a fraction of that of Dr Beat Richner then I’ll be a very happy man.


  1. Interesting article from Financial Times: "The impossible solo… or how a maverick doctor raised too much money and cured too many children".
    Maybe explains the critics' side a bit more than in my version?

  2. Good piece I totally agree with the good doctor but I am socialist so i would I think its our right honorable friends on the RIGHT that would have issues with it. God bless, there live and die die attitude to anyone that doesn't have money and power. (tongue firmly in cheek)