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24-Aug-2005
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HEALTH-CAMBODIA:

Alecks P Pabico *


BANLUNG, Cambodia, Sep 16 (IPS) - Living in isolated, idyllic villages in the lush, forested highlands that distinguish Ratanakiri from much of the Cambodian topography, the proud indigenous peoples of this north-eastern province have for years fallen prey to health problems bred by their natural, albeit harsh, environment.

These problems range from malaria, diarrhoea, acute respiratory infections, tuberculosis and intestinal parasites -- illnesses curable in this day and age.

But just as responsible for the indigenous peoples' plight are socioeconomic conditions that have to do with being 600 kilometers away from Phnom Penh, capital of this South-east Asian country.

In a country considered by the World Health Organisation as having the direst health situation in the Western Pacific region, the Khmer Loeu -- the collective term used to refer to the eight ethnic tribes of the Tampuan, Kreung, Jarai, Brou, Kavet, Kachok, Phnong and Lun - are among the most vulnerable sectors of the population.

The Cambodian government coined the word Khmer Loeu -- literally ''Highland Khmer'' -- in the 1960s in order to create a feeling of unity between the highland tribal groups and the ruling lowland ethnic Khmer. Reliable population figures are unavailable but the total Khmer Loeu is estimated at nearly 100,000 in Cambodia's total population of 13.36 million.

Poorer, more insecure and deprived of basic services than the rest of the Khmers, these indigenous peoples rarely get treatment and often succumb to illnesses that others in the country and in neighbouring nations have largely put under control.

It is not that Ratanakiri has no health centres. Each of the province's nine districts has one - Vouen Say district even has two -- but they are often inaccessible for those living in the upland areas.

But today, residents' access to the benefits of modern-day medicine has improved since a telemedicine clinic in the only provincial hospital in Banlung, the provincial centre, began functioning in April 2003.

A recent innovation in the field of medicine, telemedicine employs information and communication technologies, primarily the Internet, to facilitate the exchange of medical information so as to provide faster health-care delivery.

The clinic has a dedicated satellite uplink to allow attending doctors in the Ratanakiri Referral Hospital to send e-mails of the initial diagnosis as well as digital images of x-ray, ECG or ultrasound results done on patients.

Every month, five to 10 patients with serious or complicated illnesses from Banlung and the other districts are selected for the telemedicine programme.

Explains Ly Channarith, the hospital's deputy director who is now in charge of the clinic, of their routine: "We send information about the schedule of the clinic to the village schools so that the teachers can locate the patients. Then we inform the partner hospitals in advance so that they can open their computers and be able to reply immediately."

At the health centers, patients get checked by a nurse. Their conditions are transmitted to the clinic via the wireless connection to the Internet available at 15 solar-powered rural primary schools in the province. Those who are selected come to Banlung to undergo examination.

Usually, e-mail replies from health specialists in the partner hospitals arrive the following day. The team of doctors in Banlung then holds a meeting to discuss the assessment of the findings and recommendations regarding treatment and follow- up care from their counterparts in Phnom Penh or Boston.

"That way, we ensure that we make the right diagnosis and provide the proper medication," Ly says.

The Banlung clinic was established by the Markle Foundation with the help of medical partners Sihanouk Hospital Centre of Hope in Phnom Penh and U.S.-based Partners Telemedicine, which has brought in two U.S. hospitals -- Brigham and Women's Hospital and the Massachusetts General Hospital.

Equally crucial was the tie-up with the non-profit organisation established by Bernard Krisher, a former bureau chief of 'Newsweek' magazine who covered Cambodia in the 1960s -- the American Assistance for Cambodia (AAFC).

It is AAFC that allowed the 15 solar-powered schools here to enjoy Internet connectivity through the Internet Village Motoman Project - where motorcycles equipped with mobile access points allow the sending and receiving of data as they pass by the schools and the main hub in Banlung.

The Banlung clinic brings to two the number of telemedicine clinics in Cambodia. The other clinic, located in Robib village in Rovieng, Preah Vihear province, was set up in 2000 by the same partners of Markle Foundation.

Since its opening, the Banlung clinic has attended to 81 patients, 10 of whom had cardiac problems and were eventually sent to Phnom Penh for treatment.

A 79-year-old Tampuan man from Laoy village who needed surgery for a prostate disorder was eventually admitted free of charge at hospital.

Support for patients' hospitalisation, medicine and food were provided by the AAFC.

But for normal tuberculosis and malaria cases, the Banlung doctors are able to treat locally. Sok San, a 31-year-old general practitioner, treats TB patients and at the same time assists in the telemedicine sessions.

A 2000 graduate of the Faculty of Medicine in Phnom Penh, Sok says he finds his work very fulfilling as it helps develop his knowledge of diseases and their treatment. "Before, it was difficult for me to treat the patients because of my limited knowledge," he says in an interview.

As in many of Cambodia's provincial hospital, the delivery of health care suffers from a lack of doctors with specialisation in the various fields of medicine. Financial constraints limit training opportunities for health professionals.

Only recently has the Ratanakiri hospital acquired the services of two surgeons.

One advantage of the telemedicine concept, says Dr Gary Jacques, director of the Sihanouk Hospital Centre of Hope in Phnom Penh, is it allows volunteer health specialists to train and mentor their less experienced colleagues in the remote areas.

At the same time, they learn the practice of medicine in poor, resource-deficient countries like Cambodia.

But of course, telemedicine can only do so much. "We can't use it for emergency cases," says Ly.

In May, a two-year-old boy from Village III in Koun Mon district became seriously ill and died on the way to Banlung.

Still, the people of Ratanakiri, especially the Khmer Loeu, now have more opportunities -- previously unavailable to them -- to get better quality treatment for ailments.

(*This report is made possible by a reporting fellowship grant from the South-east Asian Press Alliance.) (END/2004)