Newsletter. Angkor Hospital for Children. Happy Holidays from AHC! Contents. December

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1 Contents 2014 Angkor Hospital for Children Newsletter December Outpatient Department Renovations Equals More Patients Seen 4 AHC s Neonatal Care Continues to Advance in AHC Launches HIV Peer Educator Workshops 8 Dear Friends, Happy Holidays from AHC! On behalf of the staff at Angkor Hospital for Children I want to wish you a very Happy Holiday Season. And of course from all of us at AHC we also want to say thank you. It is through your generous support that the hospital is able to continue to grow and provide free, high-quality compassionate care for more Cambodian children each year has been a year of great progress. Cancer care beginning with eye cancers has become a new area of focus; new HIV Peer Educator Workshops have been performed in order to help replicate AHC s successes in this field; the well-worn Outpatient Department received much needed and long overdue renovations; the new Neonatal Unit celebrated its first year anniversary helping to address neonatal mortality which is one of Cambodia s top public health challenges; and perhaps most importantly, an official collaboration with the University of Health Sciences in Phnom Penh has been established allowing AHC to train 50 medical students a year ensuring that the successes of Angkor Hospital for Children will be replicated for many years to come. AHC Launches New Program Hosting Cambodian Medical Students 10 None of what has been achieved would have been possible without your support. Looking forward we remain excited but we need your ongoing commitment. Currently, we are facing a funding gap for 2015 and we are asking for your help. We are proud to say that every dollar of support and every ounce of engagement in volunteerism and training goes to assure that no child has to be turned away. Again, on behalf of everyone at Angkor Hospital for Children, thank you for your continued support. Angkor Wat Half Marathon... A Success! Sincerely, Pheaktra Ngoun M.D, DCH, DTMH 1

2 2014 IN NUMBERS Note: The statistics are a comparison of January - November 2013 versus the same period in 2014 Descriptions Total number of patient 138, ,208 visits Outpatient Department 105, ,884 visits Inpatient Department 3,331 3,103 admissions Low-Acuity Unit patients 1,071 1,080 Emergency Room 16,506 18,448 patients Intensive Care Unit patients Social Work counseling 1, sessions Physiotherapy patients 2,607 3,370 Dental patient visits 11,079 12,745 Eye Clinic consultations 9,652 11,430 Neonate admissions Patient visits to the 16,769 19,298 Satellite OPD Admissions to the 1,469 1,446 Satellite IPD Satellite Emergency Room patients Major surgeries 1,541 1,540 performed X-ray & Ultrasound 9,087 10,230 procedures Lab tests performed 87,901 89,125 Most Common Diagnoses Sepsis Asthma Malnutrition Typhoid Meningitis Lower respiratory infections Dengue Fever Gastroenteritis Neonatal infections Dysentery 2

3 Outpatient Department Renovations Equals More Patients Seen When Angkor Hospital for Children first opened its doors in 1999, it comprised of a single building that was the Outpatient Department (OPD). AHC s Director of Nursing and one of the ten original Cambodian nurses, Sophal Som, recalls they saw just over ten children on that first day. Now, as a result, in less than a year since the renovation took place, AHC s OPD team has been able to see more than 114,000 children and their families - a 9% increase from the same period last year. And all the while, AHC continues to provide each child and their families with the utmost level of high-quality, compassionate care they deserve. Thank you to all our supporters who helped make this possible. The team in 1999 before the hospital first opened its doors. By the year 2000, the OPD saw approximately 23,000 patient visits that year. And by 2013, over 145,000 patient visits OPD Improvements 5 new consultation rooms (an increase from 7 to 12) Triage and vital sign rooms are isolated Improved infection control Reduced patient waiting time from approximately four and a half hours to under three hours Improved patient privacy and patient flow Four new doctors hired on rotation New meeting room for doctors to hold weekly case discussions New pharmacy dispensing area with enlarged storage room New play area for children in the waiting room In these thirteen years, one major renovation took place and by 2014, it was time for another... Busiest Day in AHC History! On September 29, 2014, more than 800 children and their families came to AHC to seek medical attention. This day also happened to be World Heart Day a day in which AHC hosted a Heart-healthy Environment Workshop. The workshop educated all patients and their families waiting to be seen in the Outpatient Department about the risks of heart disease and the steps they can take to prevent it. 3

4 AHC s Standalone Neonatal Unit Celebrates its One-Year Anniversary Meet Cheata* On September 9, 2013, Cheata* was delivered at the Provincial Hospital in Siem Reap. She experienced complications at birth and had to be resuscitated before she was stable enough to survive the ambulance transfer to AHC. Upon arrival at the Emergency Room, our medical team assessed Cheata s condition, administered the necessary medication and immediately put Cheata in the neonatal baby warmer since she arrived hypothermic. When she was more stable, Cheata was transferred to the Inpatient Department (IPD) later that day to free up needed beds in the ER. She remained in the IPD for three days until September 12, one day before the official opening of the independent neonatal ward. She was the first neonate to be moved into this new ward where she was able to receive more specialized neonatal care and have less chance of infection by not being mixed with the general patient population in the IPD. Cheata remained in the Neonatal Unit for three days receiving care and then was discharged home, and we never saw Cheata again until this year September 13, 2014 when she returned to AHC to help celebrate the one-year anniversary of the Neonatal Unit. *Patient s name has been changed for confidentiality 342 In the first year of AHC s standalone Neonatal Unit, 342 neonates were admitted into the unit of which 95 percent recovered and were able to return home with their families. The neonatal team looks forward to growing in size, as well as increasing its number of beds. In months like March and April when the amount of more chronic cases decreased (meaning shorter length of stays in the ICU), the team was able to care for a higher number of neonates as more beds became available. Operating at 100 percent capacity, the team hopes to have three additional beds by the end of the year in order to have a full functioning ICU to provide specialized care for more of Cambodia s most vulnerable population. 4

5 Satellite Clinic Serving as the pediatric ward of the government hospital, AHC s Satellite Clinic seeks to provide high-quality compassionate care to children living in this rural district. Neonatal Ward in Operation 2014 marks the start for the independent neonatal ward at AHC s Satellite Clinic (SC). The team was very happy to move the first neonates from the Inpatient Department to their very own designated ward. This will allow for improved care for the neonates by having a breast feeding counseling room, a designated milk preparation and medication room, as well as a space available for the parents to rest outside. Staff, visitors and caretakers are limited with their time in the designated unit to ensure optimal infection control for the vulnerable neonate patients. To read more about the neonatal scenario training taking place at Satellite, check out our article here. Currently, the Satellite Clinic team is making an initial round of visits to various surrounding health centers to inform them of their neonatal services and to find out the barriers to neonatal referrals. Following this initial survey, they aim to improve timely and safe access to care through strengthening health center staff capacity and referral systems. SC OPD Improvements Like at AHC, the Satellite Clinic underwent improvements in its OPD seeing an 18 percent increase in the amount of children that came to seek treatment this year; oftentimes with as many as 100 children and their families coming to seek care in a single day. The more efficient use of space has led to an additional two consultations rooms making a total of four, which ensures patient flow is maintained and there are no excessive waiting times to see a doctor despite the notable increase in the number of patients seeking care. The new environment directly improves the quality of care the team is able to provide, and helps them respond to the dual need of the increasing number of outpatients and the specialist needs of neonates the most vulnerable and high risk patients at Satellite. Meet Chu Li* Shortly after Chu Li* was born, he was experiencing muscle spasms and stiffness, and having a difficult time when it came to feeding and sucking. His mother brought him to AHC s Satellite Clinic where he was diagnosed with neonatal tetanus a disease caused by umbilical cord contamination during an unsanitary delivery, together with the lack of maternal immunization in most cases, this results in death. Neonatal tetanus is easily preventable with good hygiene and antenatal care, ensuring maternal immunization with tetanus vaccine during pregnancy, yet it is commonly seen in developing countries like Cambodia. In the rural communities that the Satellite Clinic serves, traditional health care practices are still very prevalent. In the case of Chu Li, while taking the history from his mother, the Satellite team discovered that traditional medicine made from the hive of an insect was placed on his umbilical cord after birth likely causing the infection. Just recently, Chu Li came to Satellite for his second admission. As his symptoms progressively worsen, the team at Satellite is able to provide symptomatic care and teach the mother how to make Chu Li as comfortable as possible. At Satellite, the team will be able to ensure palliative care and support for the mother in the new neonatal ward. In addition, the education group of nurses working with the local health centers, will provide education and prevention messages to the community. *Patient s name has been changed for confidentiality 5

6 AHC Launches HIV Peer Educator Workshops March of this year saw another exciting project launched at AHC. By working with both KHANA, the largest integrated HIV prevention, care and support service provider in communities in Cambodia, and with the Flagship Project, AHC launched a series of HIV peer education training workshops. The aim of the program is to train children infected with HIV to become peer educators, to help them gain insight into the mechanisms of behavior change and to be a good role model for other HIV infected children. By sharing information and by working with counselors to develop healthy relationships with their peers, we hope to help them integrate better into society. By using our strong network of community-based implementation partners, AHC is working within the sociocultural context of communities affected by HIV. And together, AHC s Homecare Team has structured a program that will aim to make a real difference for communities, families and children living with HIV. Topics covered: 1) Introduction of Peer education 2) Communication 3) Self-value/Self-esteem 4) Public speaking skills/group facilitation 5) Puberty/Sexually Transmitted Infections (STI) 6) Basic knowledge of HIV/AIDS 7) Antiretroviral Therapy (ART) 8) Side effects of ART drugs/what to expect 9) How to keep medications at home 10) Diarrhea and hand washing hygiene 11) Food Safety 12) Dental hygiene 13) Adherence to the treatment 14) Lessons on how to cope Kaemra s* Story 22 patients trained this year to be HIV Peer Educators Just last week, we had the chance to meet a very kind 15-year-old boy named Kaemra*. He is one of the 22 peer educators in the program and he was very courageous to share his story with us. *Patient s identity has been undisclosed to respect his privacy In 2004, Kaemra fell ill with a high fever, cough and stomach ache so his father brought him to AHC for medical attention. After being assessed by AHC medical staff - as well as learning from the father that Kaemra s mother passed away in 2000 and he suspected it was due to HIV/AIDS though tests were never able to be done - it was believed that HIV was the cause for Kaemra s sickness. The team provided pre and post HIV counseling to his father, and Kaemra was then tested for HIV. Unfortunately, the test results came back positive for HIV as well as Tuberculosis. As Kaemra was only six years old, after counseling sessions with AHC s HIV Counselor his father decided not to tell him of his condition just yet. In Cambodia, there is a stigma associated with HIV/AIDS and Kaemra s father did not want him to be ostracized at school as a result of telling others of his condition before he was old enough to understand what it all meant. 6

7 For the next two years, Kaemra came to AHC frequently for treatment. The HIV Homecare team traveled to his house once a week as well to provide counseling, education about safe hygiene practices, and check on how his family was both storing and providing his medicine. Over the years of being treated by AHC s doctors, Kaemra came to understand that he had a chronic condition. When he was eight years old, he asked his father if he had HIV. At the time he asked, his father thought he was finally old enough to understand so he told him the truth. We asked Kaemra how he felt when he found out it was HIV and he told us, I was very scared and afraid but from what I learned in school, I knew there was medicine for people with HIV to help make their lives longer. Since 2004, Kaemra has been receiving prophylaxis treatment and tuberculosis treatment here at AHC and faring quite well. In 2012 however, his CD4 count dropped dramatically which meant it was time to start Antiretroviral Therapy as soon as possible. A week later he started the treatment and as is common, he came down with side effects to the medicine and was admitted to the Inpatient Department where he stayed for four days. It was here that Kaemra s behavior changed as he became sad and depressed and did not want to return to school. When we asked Kaemra what happened next, he said, I quit school for one year because I had a skin infection from the medicine and I didn t want my classmates to suspect I had HIV. But now after talking with other peer educators who are the same as me, I am confident I can still study with the infection so I decided to return to school. I am happy to be a peer educator now and encourage orphans who have HIV that they can still go to school too like I do, because most of them do not have parents to teach them about HIV and how they can still have a good quality of life while living with HIV. 15-year-old Kaemra comes to AHC once a week after school to be a peer educator for other young children living with HIV. So far, he has helped over 30 children learn how to cope with their condition and maintain a high quality of life despite the many challenges they will face. We are all so proud of Kaemra and the 21 other peer educators just like him. The difference they are making in other children s lives is incomparable, and their courage commendable. 7

8 AHC Launches New Program Hosting Cambodian Medical Students It has been a long-standing goal to be able to host Cambodian medical students at AHC. We were therefore extremely excited to announce the launch of a new program hosting students from the University of Health Science in Phnom Penh. The internship will provide students the opportunity to work in five areas of the hospital: Outpatient Department, Inpatient Department, Neonatal Unit, Surgical Unit and Emergency Room/ Intensive Care Unit. In the first year, 48 medical students graduated from the 20-week pediatric internship program fulfilling one of the four rotations student doctors are required to complete to receive their medical degree in Cambodia. We spoke with one intern, Ms. Pech Many, who said: My rotation at AHC allowed for a lot of hands on bedside training and all AHC staff were really attentive to providing our group of interns with many educational opportunities. One of the biggest things I learned from AHC medical staff is concerning patient care no matter what economic level the patient and their family were, AHC staff treated everyone as equals and patient care was really important to them. The program aims to help extend AHC s national outreach and impact by teaching high-quality pediatric care to student doctors, who will hopefully go on to work in healthcare facilities throughout Cambodia. 8

9 Your Support Matters Thanks to you, AHC has been able to see over 150,000 patient visits so far this year. Thanks to you, AHC is able to provide free high-quality, compassionate care to Cambodian children who may not have otherwise had access. Thanks to you, AHC is able to save lives like baby Kaneka*. Kaneka s* Story Kaneka* came to AHC on June 17, 2014, when she was just a day old. She was diagnosed with severe pneumonia, sepsis and acute respiratory distress syndrome (ARDS) the latter a life-threatening disease in which the lungs are failing and critical support is required. Kaneka was placed on a breathing machine immediately. Ten days later, Kaneka s mother told the doctors she needed to take Kaneka home with her because she has another child who she needed to take care of so her husband could go back to his job as a farmer. Kaneka s father is the sole provider for the family earning less than a $1.25 a day, so his being out of work was causing a huge strain on the family. AHC s social work team began counseling Kaneka s mother, and they also learned she was feeling hopeless that her daughter was going to survive much longer. Curing a patient with severe ARDS can already be difficult in the West, in Cambodia it is all the more impressive. To do this anywhere in the world, you need a medical team that can provide a very high level of skilled ICU care. -Dr. Varun Kumar, CO-Chief of Medical Education Kaneka s mother took her home despite the advice given to her by the medical team and social workers. For the next four days, AHC social workers called Kaneka s parents to offer them counseling and hope that Kaneka s condition can be cured. They informed the parents that AHC will hire a caretaker to be with Kaneka 24/7 during her stay, so her mother can take care of their other child back in their village, and the dad can return to work. On the fifth day, Kaneka s mother brought her back to AHC to continue her medical treatment. From the moment Kaneka came under their care, the ICU team provided the highest quality of medical attention and were able to cure Kaneka of a condition that has a 40% mortality rate in developed countries such as the United States. AHC care did not stop after Kaneka was cured of her life-threatening illness. From being on a breathing machine for so long, it is common for infants like Kaneka to develop sucking and swallowing complications as a result of having a tube in the throat for so long. If Kaneka was discharged to go home, she wouldn t be able to drink or swallow and could quickly become malnourished and eventually die as a result. Kaneka was transferred to AHC s Inpatient Department so she could continue to receive the comprehensive care she needed to make a full recovery. AHC s Breastfeeding Counselor, Nurse Phannsy, is working with Kaneka daily to help improve Kaneka s ability to suck and swallow so that eventually she will be able to eat and drink. When they first started, Kaneka was entirely unable to suck and swallow, but now she is sucking on Nurse Phannsy s pinky finger with a bit of strength and is slowly but surely progressing on her ability to swallow. Last week, more than five months since Kaneka first came to us, she began to make even greater progress with her swallowing and was moved to the Low Acuity Unit, where she will remain until she is able to eat and drink on her own. Read the full story here. 9

10 Angkor Wat Half Marathon Weekend... A Success! This past Sunday, we were excited to welcome over 40 of our international supporters to Siem Reap to participate alongside 68 AHC staff in the Angkor Wat Half Marathon on behalf of AHC s OneTeam OneRace OneDay event. On the day before the race, all participants joined the welcome reception held here in the Visitor s Center. In addition to food and fun, there were speeches from Mrs. Sinketh Arun, AHC External Relations Manager, and Dr. Bill Housworth, AHC Executive Director, and most importantly, many thanks were given to all those that helped make the marathon fundraising efforts a great feat. We are all incredibly grateful for their fundraising efforts that took place in the months leading up to the marathon weekend. We know the hard work they put into it and we want to take this opportunity to say thank you again. On the morning of the marathon while it was still dark out, all participants hopped in their tuk tuks and headed out to Angkor Wat for the race. We are proud to say that all participants completed the race and most importantly, reported having a great time running around the beautiful temples and through the Cambodian countryside. A big highlight for everyone were the crowds of Cambodian children alongside the course cheering and high-fiving them along the way! As donations are still coming in, the final amount raised has not yet been determined. If you would like to contribute to this cause, you can do so at the following link by selecting OneTeam OneRace OneDay from the drop down menu: Next year we hope to welcome even more supporters to take part in this great event! To see more great photos from the weekend, check out AHC s Facebook album here and the full article on the website here!

11 What Your Donation Supports It is through your support that AHC will be able to help many more Cambodian children receive the care they need to live happy and healthy lives. AHC relies primarily on donations and therefore it is a highly cost efficient hospital where every dollar donated goes to effective use to help the children. US$5-100 $5 Pain medication for 50 children $10 X-ray per patient $17 Child s care in Outpatient Department $50 Continuing education for 50 medical staff $70 Emergency Room treatment for one child US$100-1,000 US$1,000 + $100 Two nursing students training materials $ Homecare patients food supplies $250 Supporting a premature baby s daily care in the Neonatal Unit $350 Patient s stay in Intensive Care Unit for one day $500 Weekly lectures for nursing staff for one year $ blood tests in laboratory $950 Dental Clinic patients medication for six months $1,000 Treating a malnourished child for one month $2,000 Inpatient Department daily care for eight children $3,500 One open heart surgery operation $5,000 Medication for all Intensive Care patients for six weeks $10,000 Annual salary for two nurses $20,000 Six months supply of oxygen for all patients 11

12 Every donation to Angkor Hospital for Children makes a difference in the lives of the children entrusted in our care. Currently we are facing a funding gap for 2015 and we are asking for your help to assist us to continue providing free high-quality, compassionate care to Cambodian children. Here are 10 ways you can help: Donate to AHC here: Hold a fundraising event like this one here: Running a marathon, going skydiving or on a cycling adventure? Perhaps consider doing it on behalf of AHC and rally your friends and family to support your efforts like this Indiegogo campaign did here: Having a party? Instead of asking for presents this year, perhaps you can ask for all guests to pool together a donation to help support the children treated at AHC! Already shop on Amazon? Simply select Angkor Hospital for Children Inc as your charity to benefit when shopping on Amazon and they will automatically donate.05% of all your purchases directly to AHC: Company matching program: Check if your company has a program that matches donations made by its employees as a way to encourage charitable giving.. Many do! Gifts in kind: Check out what supplies and services AHC is in need of and see if your company could provide them: Does your company have a Corporate Social Responsibility program in which AHC s mission could be considered for support? If so, perhaps you can introduce the work of AHC and our Development Department by ahc@angkorhospital.org Have friends coming to Siem Reap to see the temples? Send them our 2013 Annual Report and let them know they can arrange a tour at the hospital to learn more by ing ahc@angkorhospital.org Facebook: Invite your friends and family to like AHC on facebook to help spread the word about our work. We keep all of our international supporters informed of our work here: If you have any other ideas or questions, please ahc@angkorhospital.org