Cambodia: A growing burden of disease

3 International staff : 43 3 National staff : 271 Cambodia is slowly recovering from its recent history of invasion and genocide (1974-79), which killed around two million people. Although the political situation seems to have stabilized after the unrest of the late 1990s, reforms and transparency in the administration are still badly needed. Cambodians face growing exclusion, a poor national health system and a high burden of infectious diseases, mainly HIV, tuberculosis (TB) and malaria. In Cambodia for ten years, MSF works closely with the Ministry of Health in the districts of Stung, Sotnikum, Bakan, Stung Treng and Thmar Pouk. In the remote former front-line areas of Nong Chan and Anlong Veng (where the conflict ended in 1998), MSF set up three health centers. In the provincial prison of Banteay Meanchey in Sisophon, MSF has set up a basic health care system. At the hospital in Sotnikum, an innovative pilot program contracts employees to make them accountable for their work and the hospital's performance, all to encourage a decentralized system of management. Training is essential in a society that has seen a whole generation of health workers wiped out. In Phnom Penh, the capital, MSF runs a basic surgery training program for doctors and nurses working in district health centers which have operating facilities. After ten years, a laboratory technician training program in the city recently closed. The highest HIV rate in Southeast Asia Cambodia has the highest HIV prevalence in Southeast Asia (3.5%). In the Norodom Sihanouk hospital in Phnom Penh, MSF runs a 60-bed ward for AIDS patients, which functions as a national referral center. MSF plans to introduce antiretroviral drugs for those patients in the year 2001. An HIV consultation service is in place in the provincial hospital of Battambang. MSF has three STD/HIV/AIDS awareness and prevention programs targeting primarily sex workers. Four STD (sexually transmitted disease) clinics have been set up in Svay Pak, Siem Reap, Sisophon and Poipet - areas with a high concentration of prostitutes. The scourge of TB TB is still rampant in Cambodia, with 539 new cases a year for every 100,000 people. In addition to treatment provided in the district hospitals, a home care DOTS (Directly Observed Treatment Short Course) program was set up in 1997 Phnom Penh. In 1999, the cure rate for patients in this program was 87.3%. Malaria remains the first health problem in many remote areas, with multi-resistant strains in the west. MSF is starting a new project in Anlong Veng and Sotnikum to strengthen malaria diagnosis and treatment at the community level.