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Dengue Deaths Sweeping Cambodia Highlight Healthcare Failures

Saing Ratha lies semi-conscious, her thin body shaking with fever as her mother tries desperately to cool her by placing blocks of ice under her arms.

Her 10-year-old bother Saing Sokun lies curled around a block of ice next to her in this spartan rural clinic.

Both have been struck down by dengue fever that has killed almost as many children in the first six months of this year as during the whole of 2006 in an outbreak that is expected to worsen with an early monsoon.

"In my village every house has been afflicted by dengue -- in some homes all the children are sick," says the children's mother, Chhiv Thy, as she wipes down the 13-year-old girl's body with wet towels.

For five days they have lain on crude wooden beds in a small alcove off one of the clinic's wings. Saline drips are tied to metal posts and the windowsill next to their cots is piled high with cooking pots and dirty plates.

Chhiv Thy says she has not worked since bringing her children to hospital. The medical care is free, and good, but the beds cost 30,000 riels (7.50 US dollars) each.

Since January some 7,655 Cambodian children under the age of 15 have been hospitalised with dengue, with 109 of them succumbing to the mosquito born illness, which punishes its victims with fever, vomiting and crippling muscle pain.

The most serious cases result in heavy bleeding as blood vessels disintegrate, and can quickly kill children.

Compared to last year's total of 6,149 cases and 158 deaths, "this year is much worse," said Ngan Chantha, director in the health ministry's dengue programme.

Doctor Un Sam Ath gestures up and down the bare hallways of the Krouch Chhmar clinic, saying that only a few days before they had been crowded end-to-end with beds and sick children.

Since May Krouch Chhmar referral hospital has received 20 dengue cases.

"Much more than 2006 , when we had five cases total for the whole year," he says.

Two children have died. Un Sam Ath says he wanted to send them to the provincial hospital in Kompong Cham city, about three hours down a dirt road pitted with deep muddy holes.

"But their families were too poor to afford the trip. We have no ambulance and transport is a problem," he explains.

"We are so worried about the coming months -- parents are always waiting too long to bring their children to our hospital. By the time they arrive they have already fallen in a coma," Un Sam Ath says.

Those who can afford transportation to Kompong Cham will be okay, "but what about the poor?" he says.

The outbreak, which has stretched several hospitals in the capital Phnom Penh to capacity, highlights the many failures of Cambodia's health system, which like all of its public institutions is struggling after years of civil war and neglect.

"The total level of public financing for health is simply too low," the World Bank said in its 2007 equality and development report, which found that rural Cambodians still lacked significant access to healthcare.

The government spent only four dollars per person on health expenditures in 2006, the World Bank said, while Cambodian health officials admit that paediatric care is especially thin.

"We have not enough health care services for children -- it is still at a limited level," says Mam Bun Heng, a secretary of state with the health ministry.

A lack of basic health knowledge is also particularly deadly for uneducated rural Cambodians like many of those seeking help in Krouch Chhmar.

This combination has left Cambodia woefully unprepared for the current dengue outbreak.

"People's understanding of sanitation is still very low," Mam Bun Heng says. "We are educating them," but about three million dollars will be needed to fight yea rly outbreaks of dengue.

Despite massive public education campaigns already warning people of dengue fever, Un Sam Ath said most people simply tune out the radio and television spots offering advice on how to combat the illnesses.

"People just want to watch the other programmes," he says.

"They need to understand more about this problem. Dengue fever outbreaks spread very quickly, and many people don't know how it spreads."


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