New Children's Clinic Takes Shape in Phnom Penh
CHC's pediatric ward has been taking shape

With help from the GHC/CHC and generous donors, the largest public hospital in Phnom Penh is getting a brand new children’s wing. The construction now under way is transforming the run-down and understaffed pediatric ward of the Khmer Soviet Friendship Hospital (KSFH) into a site that offers high-quality integrated care to poor children with tuberculosis and AIDS. 

The new facilities will open just in time, as two foreign aid organizations prepare to transfer care of nearly 400 children living with HIV/AIDS to the Cambodian doctors of the pediatric ward and the CHC program. 

The renovation of the existing ward and new construction of an outpatient clinic is happening thanks to the Joseph P. and Jeanne M. Sullivan Foundation, a long-time supporter of the CHC. Sullivan, who died in 2006, was a Chicago executive, a founding board member of the American Refugee Committee, and a tireless advocate for refugees around the world. The new wing will be named the Joseph P. Sullivan Outpatient Center of Excellence for TB and AIDS Care of Children in his honor.

Approximately 12,000 Cambodian children are living with HIV and many times that are infected with tuberculosis. Because of poverty and lack of public resources, only a fraction of the children receive adequate medical care. For more than a decade, the CHC has been assisting Cambodian doctors and hospitals to deliver much-needed medicines and other care. Starting in 1994 with tuberculosis treatment and control programs in rural Svay Rieng province, the CHC has been a leader in rural health care. In 2004, the group started treating children with AIDS with its pioneering rural antiretroviral therapy (ART) program in Svay Rieng. In 2006, the CHC opened the Maddox Chivan Children’s Center in Phnom Penh, offering comprehensive array of educational, social and medical services to children infected or affected by HIV and their families. The same year, the CHC began working in the KSFH pediatric ward training doctors and nurses in AIDS and TB care, and providing technical assistance to the ward.

A Necessary Resource for Children with HIV and TB

The rebirth of the pediatric ward as a center for excellence in TB and AIDS care comes at a critical time for hundreds of children living with HIV/AIDS who will soon look to the Sullivan Center for life-saving medicines and care. In 2001, the KSFH was the site of the first cohort of Cambodian adults to receive antiretroviral therapy (ART) for HIV in a program started by Medicins sans Frontieres-France. Lately, the MSF clinic based in the adult infectious disease ward has also been caring for 200 HIV-positive children and adolescents. The MSF will shut down its Cambodian operations at the end of 2008, and asked the CHC and the pediatric ward to take over care of the young patients. In October, the pediatric ward staff began transitioning the children, 150 of whom are on ART, from MSF to KSFH care.

Dr. Olivier Marcy, the CHC clinical coordinator, has high praise for MSF's work. "When everyone said ART couldn’t be done in this poor country, the MSF just did it. They took the first step."  

As, the national HIV/AIDS program has grown, a new challenge is to assimilate the children’s care into the national system, Marcy explained. Only one in five children living with HIV in Cambodia was on ART as of December 2007. Expansion of ART is the responsibility of the Cambodian National Center for HIV/AIDS, Dermatology and STD (NCHADS), which oversees AIDS care in the country. While NCHADS has established as a goal the nationalization of all ART programs run by international programs  by 2010, it still needs partners to help to improve the quality of care, train staff, provide management, and fill in gaps in resources. As a local Cambodian NGO with a pioneering role in AIDS care in the country and globally, the CHC has a special role in assisting the KSFH to become a leader in AIDS and TB care of children in Cambodia.

In addition to the work of MSF, the American group Maryknoll provides ART for 200 HIV-positive children in group homes, family and foster homes near the KSFH, and they, too, have requested to transfer those children to the CHC-assisted pediatric service at the hospital. That will bring the number of children under CHC’s Phnom Penh umbrella to 450, including the 50 who now receive their primary ART medical care at the Maddox Chivan Children’s Center. The CHC also cares for 143 children with AIDS in Svay Rieng.

Building For the Future

Rising up two stories, the outpatient clinic will have five new consultation rooms and three counseling rooms, plus a pharmacy, a data storage room, a nursing station, offices for doctors and a large library. The inpatient ward will feature 20 beds, with eight reserved for children with AIDS. In addition, there will be isolation rooms for children with TB, neonatal care, emergency/intensive care, a game room/library, and space for staff, plus an activity room and playground for the children. Besides offering local children the care they deserve, the bright and well-equipped clinics will serve as important training and research resources for Cambodian doctors. 

Dr. Ann Kao conferring with Dr. Sam Sineth, Chief of the Pediatrics Ward on the care of a 1 year old girl with TB and AIDS prior to renovation
Once construction is complete in early 2009, the CHC will continue to help the children’s ward by providing training, equipment, medicines and technical support to supplement the resources of the hospital and the Cambodian Ministry of Health. In keeping with its integrated approach to delivery, the CHC will provide additional doctors, a social worker and a counselor to help care for HIV-positive children in the ward and outpatient clinic. Caregivers at the Sullivan Center will work closely with staff at the Maddox Chivan Children’s Center to make sure all young patients receive the social, psychological, and educational services they need. For its part, the hospital will guarantee free consultations and essential medicines to all HIV-infected children, and reduced-cost or free care to others.

The transformation of the dilapidated buildings mimics the CHC’s work in the KSFH adult pulmonary ward, which was completely renovated in 2006-2007 with support from the Japanese Embassy and the United States National Institutes of Health. That project transformed a crumbling and impoverished TB ward into a center for excellence for adult tuberculosis and AIDS care. The 120-bed pulmonary ward now helps about 1200 patients a year, many with TB and AIDS. Pulmonary ward doctors, trained and supported by the CHC, care for nearly 1000 adult outpatients with AIDS and lung problems in the KSFH infectious disease ward in cooperation with MSF-France.

With the pulmonary ward renovation the CHC also began to build the capacity for medical research to Cambodia. The KSFH serves as the main site of the CAMELIA project, the first major clinical trial to be completely sited in Cambodia. That trial is investigating the best time to introduce ART in profoundly immunosuppressed HIV patients coinfected with TB. The trial results will shape international practice in TB and AIDS care.

Help for All Children
Two children brought from an orphanage to the pediatric ward for care. The older girl on the left is the sister of the younger child who was receiving an IV for a gastrointestinal infection related to AIDS.

The Sullivan center has the potential to become a success story similar to the pulmonary ward, bringing better treatment and research for children with AIDS and TB. However, the current efforts will serve not only those children. The facilities upgrade will improve general inpatient and outpatient care for all children in the KSFH service area including neonatal care as it is adjacent to an extremely busy maternity ward with approximately 1000 deliveries a month.

Despite the fact that the hospital sits in a densely populated area of the growing city, only half of the inpatient beds are usually occupied, and the outpatient department sees an average of five patients per day.

Part of the problem, says Chief of Pediatrics Som Sineth, is that people have not trusted the KSFH, where a lack of equipment and medicine has left the doctors unable to do their jobs. The cooperation with the CHC will change that, she expects, so that when the children need a hospital, they will come to the KSFH. "We hope that in future we can give the children a better start," Dr. Sineth says. "We can help them have a better life."