Chenla Children’s Healthcare has completed its first 1.5 years of operation and has greatly strengthened the provision of pediatric care at Kratie Referral Hospital with more than 12,500 patient encounters and the monthly admission rate to the pediatric ward increased by more than 500 percent. Therefore, Chenla is entering a new stage. In line with our strategic plan, we aim to further strengthen our organizational structure, continue our work on quality improvement and soon begin support work in Cambodia’s other eastern provinces. Chenla’s public/private partnership model allows for fast paced change in this remote region where the most recent survey reveals that 1 out of 12 children dies before their 5th birthday. https://dhsprogram.com/pubs/pdf/FR312/FR312.pdf
While Chenla has driven the amount of service provision to children affected by poverty and disease upwards, we remain committed to not becoming a parallel structure. We remain an integrated part of the public system. This distinction is important in order to avoid mission drift. While Chenla tilts the ethics of resource allocation towards meeting current urgent healthcare needs of children, our long term goal is simply to strengthen the public system’s capabilities. Indeed, our experience so far is that this is also the long term desire of the local provincial health department and community.
The case history of Samnang* (Lucky) a critically ill child that the Chenla team recently cared for illustrates best our model.
Samnang is a 12 year old boy from Snuol district in Kratie Province 1.5 hours away from Chenla Children’s Healthcare. His parents are laborers and earn approximately $3 per day each. For employment reasons, they have lived in 4 different places since Samnang was born, and they have three other children to care for. Due to their moves from place to place, Samnang was not fully vaccinated. When he recently became ill with body aches and weakness, members of the community in Snuol recommended that his parents take him to Chenla Children’s Healthcare’s ward at Kratie Referral Hospital because they had learned of the new ward when Chenla did outreach clinics in their Snuol community.
Upon arrival at Chenla, Samnang was immediately taken to the emergency room and no requirement for payment or promise of payment was made before being fully assessed and treated. This is an important point as financial constraints are a very common barrier to seeking healthcare in a timely and safe fashion in Cambodia in towns where charity hospitals do not exist.
One Cambodian nurse who is a full government employee and one Cambodian nurse who is a full Chenla employee with more than 10 years’ high acuity pediatric experience quickly triaged Samnang realizing that he was severely ill. Then, one of Chenla’s on site physicians who is a government employee with some incentive paid by Chenla was called to assess Samnang. Just touching him caused his body to go into spasm and his face to clinch up into a tormented grin. The doctor realized Samnang had tetanus.
Left untreated, tetanus has a mortality rate of up to 50% and the clinical course always entails much suffering. Once the diagnosis was made, the Chenla team did what they do best – they worked as a team. Samnang required extra nursing care beyond the usual 1;1 for a critical ER patient, therefore some nurses covered for others while Samnang was stabilized. Tetanus immunoglobin was needed but not immediately found in the referral hospital’s pharmacy, therefore Chenla’s support staff immediately took the steps needed to quickly obtain the immunoglobin. Samnang’s airway had to be maintained and he had to be stabilized for transport. Chenla’s backup physician came in to assist with these tasks. After his initial treatment and stabilization, Samnang was transferred to a higher level facility seven hours away where he was in the ICU for a week before returning to Chenla to complete his in-hospital treatment. Without this coordinated care, his chances of dying or having other complications would have been much higher.
Some key elements found in Samnang’s care were:
• Integration of care with the Ministry of Health System.
• Coordination of care within the Chenla Children’s Healthcare ward at Kratie Referral Hospital.
• Coordination of care with higher level hospital accepting the patient as a transfer.
• Elimination of any financial barriers for the patient.
• Reimbursement for the patient’s care through the Health Equity Fund System.
• Timeliness of care due to community’s awareness of the project and trust in the new system.
• Quality of care due to expertise of the Cambodian staff.
Of course future prevention of cases such as Samnang’s is paramount and Chenla works with local health authorities to screen as many children for proper vaccination status as possible. However, eastern Cambodia will continue to have a high prevalence of diseases related to poverty status into the foreseeable future and therefore Chenla aims to strengthen its presence.
*Not actual patient’s name and other identifiers