Doctors at Cambodia’s hundreds of private clinics should undergo government-mandated testing to prove they are qualified and have their practices shuttered if it is found they are not, Dr Beat Richner, founder of the Kantha Bopha hospitals, has said in an open letter.
Richner posted the missive on his Facebook page on Sunday after 447 severely ill children were hospitalised on Saturday. One hundred forty-six of the most severe cases of dengue fever and encephalitis had been transferred to the Kantha Bopha network of children’s hospitals from private clinics the day before.
Richner said private clinics in Cambodia lack the professionalism, knowledge and resources to adequately diagnose and care for children, something crucial in a disease’s early stages.
“On the night from Saturday to Sunday about 55% of children hospitalized at Kantha Bopha in Phnom Penh and at Kantha Bopha III in Siem Reap Angkor had been incorrectly treated without any diagnosis,” Richner told the Post via email yesterday.
“Sometimes there are a lot of cases of severe encephalitis, meningitis, or dengue, but the outcome of the illness depends on how much time passes between the first symptoms and getting the right treatment,” he added.
Richner sounded a similar alarm in 2012 amid a deadly breakout of what the WHO ultimately diagnosed as a form of hand, foot and mouth disease, which claimed the lives of 64 children.
At the time, the Swiss physician publicly said he believed many of those lives would have been saved had they not received incorrect treatment at private clinics before being taken too late to one of the Kantha Bopha hospitals.
Other health professionals spoken to by the Post yesterday agreed that health care in Cambodia’s private clinics is routinely subpar.
“The private clinics are working only to get money, they aren’t following national or WHO [World Health Organization] guidelines,” said a community health worker in a children’s health organisation who asked to remain anonymous.
“For example, when kids get diarrhoea, it can be treated through oral rehydration. But if you go to the private clinic they usually get an IV and antibiotics, which is unnecessary and costs more money,” they said, referencing a widespread overuse of antibiotics in the Kingdom.
In his letter on Saturday, Richner noted that patients are often kept too long at clinics for no reason other than to milk them for fees.
But some private health care practitioners yesterday said it was unfair to presume all private clinics were offering poor-quality services.
“It depends on which clinic you go to. People can come in the clinic and judge whether the standards are where they should be,” said Dr Som Leakhena, medical director of the Khema International Polyclinic in Phnom Penh.
“Before we open a clinic, we need to get permission from the Ministry of Health, and they have certain criteria that we have to follow,” he said, rattling off a checklist that included x-ray and laboratory facilities as well as the required presence of a doctor at all times.
Even so, he admitted that those requirements were more likely to be met in the Kingdom’s larger cities. “I’m not sure how well the clinics in the provinces meet the criteria, but in the cities, it’s followed.”
Attempts to reach a spokesman for the Ministry of Health were unsuccessful yesterday.
Richner, however, who was named an adviser to the ministry in March, says that he is confident they will follow his recommendations.