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Cambodia & Health : Kantha Bopha, "to upgrade and maintain an excellent quality of care"

Operating for 32 years in Phnom Penh and 25 years in Siem Reap, originally with 60 beds, Kantha Bopha now offers more than 2,000 beds. After 30 years of experience in these hospitals, Denis Laurent, Managing Director of the Kantha Bopha Children's Hospitals and representative of the Swiss Kantha Bopha Foundation, remains a key player in the development of these establishments alongside the Cambodian people.

During his long professional career, Denis Laurent has nevertheless had to face up to the doubts that arose about the smooth running of the hospital after the death of its founder, Dr Beat Richner. However, he never wavered, thanks in particular to the support of the Cambodian staff, but also with support from Switzerland.

Kantha Bopha, the hospital in search of excellence for Cambodia

Open on weekdays from 6.30am to 11.30am and from 2pm to 5pm, Kantha Bopha has a single consultation room in Phnom Penh, with a similar structure in Siem Reap. More than 1,000 consultations can be carried out every day. With nine medical wards and one surgical ward, all children undergoing consultations are examined by a doctor and, if the child needs to be hospitalised, he or she is referred directly to the Central Office, which will know exactly where to place the child for hospitalisation depending on the space available, the pathology and the initial diagnosis.

As Denis Laurent, Managing Director of Kantha Bopha, explains:

"It's more about 'screening' than a real consultation, because with 20 doctors, it's still complicated, but it allows us to make an initial diagnosis and as soon as we have any doubts, we prefer to hospitalise."

Consultations have been easier for three years now with the introduction of a computerised system. Thanks to the development of cards on which the medical history of each child is stored, the Kantha Bopha teams are able to keep track of the child's medical history, whether in terms of consultations, test results or hospital admissions.

Kantha Bopha also has 35 hospital wards, including six surgical wards, an oncology ward and three neonatal wards. The hospital has three operating theatres and five intensive care units in the various departments (post-surgical, premature, neonatal, etc.).

Hospitalisation is often preceded by various sampling and analyses to determine whether or not hospitalisation is necessary. This can be done thanks to the various analysis laboratories at Kantha Bopha, which Denis Laurent, a biologist by training, knows well.

Within these different laboratories, several machines are used to detect kidney problems, diabetes, anaemia and infections, such as during the dengue fever period, when the hospital had to take up to 1,000 samples a day. Cancer and thyroid check-ups are also carried out, as are serological tests.

This organisation reflects the desire to respond precisely to the Kingdom's health needs, with the development of new services and the introduction of precision medical equipment. Kantha Bopha acquired its first scanner in 1996, and today new models allow direct screening for intracerebral haemorrhage and tuberculosis.

Then there's the radiology department - with up to 150 x-rays a day - and the MRI department, as Denis Laurent explains: "The problem with a CT scan is the bone, because of the radiation. MRI allows us to see all the soft tissues (brain, encephalitis, tumour, etc.). It's the best detection method, but it's not invasive, it's magnetic resonance, and there's no radiation.

A more efficient organisation for Kantha Bopha, where the services are being modernised and extended in order to respond to the most worrying medical and surgical situations. What's more, in addition to the departments, there are essential areas such as pharmacy and hygiene.

Neonatology, a vital service for Cambodia

Neonatology is one of Kantha Bopha's major services, given the high birth rate in Cambodia. In Phnom Penh, this department has three wards with "normal" beds, as well as incubators for children who need more care.

Denis Laurent explains: "For the past six months, we have been working more closely with the Ministry of Health, particularly on neonatal and perinatal issues. We don't have a maternity unit in Phnom Penh, so all the newborn babies we treat come from elsewhere, and this time lag and lack of information between the maternity unit of origin and Kantha Bopha is problematic".

A problem that doesn't exist in Siem Reap thanks to the presence of an in-house maternity unit.

Oncology department, the latest addition to Kantha Bopha

The oncology department at Kantha Bopha has been open since September 2023, and to date has treated around forty children. It has two conventional surgical wards, one of which is on the top floor, away from other patients to avoid infections, and where children undergoing cancer treatment have longer hospital stays.

"Thanks to the laboratory, we can determine the right treatment. So, for long hospital stays, we use chemotherapy and surgery. If the child needs radiotherapy, we transfer them to Calmette, with whom we have a very good working relationship. Cancer treatment in Cambodia costs between $10,000 and $30,000, and at Kantha Bopha it's free. We work on the basis of the child and his or her pathology. Our hospitals operate without racial, religious or social discrimination.

He adds: "We are in contact with professors from Switzerland every day and it is also with them that we decide whether or not to treat and what treatments to provide".

Strong cooperation, support from Cambodia and Switzerland for Kantha Bopha

As Director of Kantha Bopha, but also as a representative of the Swiss Kantha Bopha Foundation, Denis Laurent manages an annual budget of 42 million dollars, which is supplemented by state aid in the form of equipment.

Until a few years ago, 70% of the financial support came from Switzerland and 30% from Cambodia. This is now beginning to balance out, with this year's investment provisionally expected to be 55-60% from Switzerland and 45-40% from the Cambodian Foundation.

A result that demonstrates Cambodia's willingness to invest more in the Kingdom's health sector. On the Swiss side, there is still a great deal of support for Kantha Bopha, as the legacy of Dr Richner is still very much alive.

Kantha Bopha, a medical sentinel, between sharing knowledge and new specialisations

As a children's hospital, Kantha Bopha receives on average 80% of serious cases in Cambodia, so it is important for them to share their data and statistics.

"We are trying to have more exchanges with the Ministry of Health so that we can be a 'little sentinel'. Especially as the situation in Phnom Penh is not the same as in Siem Reap, so the fact that we have two very distinct centres, but with the same configuration, means we can learn a lot", says Denis Laurent.

Indeed, Kantha Bopha also aims to promote the knowledge of Cambodian professionals. With a total of 2,683 employees (100% Cambodian) between Phnom Penh and Siem Reap (around 1,280 in Phnom Penh and around 1,400 in Siem Reap), Kantha Bopha also provides training courses.

The senior staff present are real mentors for the new Cambodian interns for six months to a year. Thanks to these trained and experienced Cambodian teams, Kantha Bopha is able to take on new young doctors who have time to train and prepare for the start of their professional careers. This transfer is also taking place internally between the two sites, in Phnom Penh and Siem Reap, where the cardiac surgery medical team in the capital has been fully trained by the Siem Reap team.

At present, doctors from other Cambodian hospitals also come to Kantha Bopha for specialisation training, as well as professionals from France and Switzerland for technical missions at the rate of around twenty per year lasting two weeks in different specialities (cardiac surgery, neurosurgery, oncology, etc.) in order to train and work with the Cambodian teams on site.

Development prospects and the desire to meet the Kingdom's needs

Denis Laurent's vision for development is first and foremost to consolidate what has already been achieved within the hospitals. All the more so since an annex to the hospital in Siem Reap was opened three months ago with 120 additional beds.

Its areas of development and work are based in particular on the country's needs. "In the future, we will need to specialise other departments to carry out more "complicated", less invasive operations. In particular, some people want to help us develop imaging so that we can carry out operations that don't necessarily require opening up, such as neuroscopy (neuroimaging) or laparoscopy", confides Denis Laurent.

As far as Siem Reap Hospital is concerned, "We have a large maternity hospital and we would like to develop prenatal diagnostics so that we can offer parents alternatives and be in a position to inform them of any problems their child may have, and above all to be able to react and carry out interventions immediately after birth", he adds.

The outlook for development can be summed up by a deep concern to improve the quality of services and develop new projects. Projects that have also begun to see the light of day, such as child psychiatry, which has been in place for barely a year now, and which is a much-needed service for children convalescing or recovering from major operations. There are also post-delivery operations, where heart or intestinal operations are carried out an hour after delivery following the detection of an anomaly on ultrasound. This upstream work enables the professionals at Kantha Bopha to decide on the operation and prepare the operating theatre.

The future is therefore taking shape around a pragmatic vision, taking into account all the conditions and possibilities. As Denis Laurent explains:

"We opened the oncology ward six months late because of a dengue epidemic. We had up to 18,000 children hospitalised for that alone. Given the situation, it wasn't possible to open another department in another speciality, because we had that priority.”

As far as this department in particular is concerned, a project for an oncology ward should see the light of day between September and October 2024 in Siem Reap, similar to the one in operation in Phnom Penh. The aim is to offer the same high-quality services to children in the capital as those in Siem Reap.

"High-tech intensive care units in a hospital give all the departments an edge in terms of more technical processes, greater control and a higher level of sterility. Now it's up to us, with our presence in Phnom Penh and Siem Reap, to move up a gear".

Today, in 2024, Kantha Bopha maintains the same values advocated by its founder and aspires to adapt even better to the health needs of the Kingdom's children.

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