3, Boulevard Preah Monivong
Phnom Penh, Cambodia
Professor Heng Tay Kry & Dr Jean Claude Prandi
Tel: +855 12 22 27 78 • Fax: +855 23 72 31 74
admin@cardiocambridge.com.kh
The Country
Independent from France since 1953, Cambodia covers 181,035 km2 (69,879 sq. miles), sharing border with Thailand in the northwest, Laos in the northeast and Vietnam in the southeast. The population is 14M inhabitants and Phnom Penh is the capital with 1.5M. More than 35% of the population is under 15 years old. The income per capita is $2,400.
The Heart Diseases Situation
In terms of cardiovascular treatment, the needs of the country are enormous: over 200,000 people suffer from heart disease and 20,000 of them are children suffering from serious cardiac pathologies.
- In adults, the primary cardiovascular diseases are: rheumatic valvulopathies 20%, dilated cardiomyopathies 15%, coronary diseases 5% (but the prevalence is increasing rapidly), pericarditis (more and more cases), and above all, hypertension (35 to 40% of cardiac patients and 15% of the entire general population).
- In children, investigations, still rare, permit the observation of various cardiac pathologies in 5 to 10% of all school-age children. Half of these cases concern rheumatic valvulopathies; the other half of children were born with congenital heart disease: ventricular septal defect 25%, atrial septal defect 15%, tetralogy of Fallot 15%, patent ductus arteriosus 17%.
- Well-suited structure with high performance facilities
Implementation
The national tragedy of Cambodia in the 1970s to early 1990s resulted in the wholesale slaughter of the educated class by the Khmer Rouge. This left the country devoid of physicians 45 or older, who would have been the expected teachers of the younger generation of physicians. In 1999, Prof. Alain Deloche, president of La Chaine de l’Espoir, proposed to the King and the government of Cambodia to design the Phnom Penh Heart Center to help support lastingly the great social and financial cost of indigent children suffering from heart diseases while training a new generation of Cambodian surgeons.
In 22 months the Center was implemented, thanks to the active support of private international corporations, foundations, and donors; the full back up of the Cambodian authorities with the Cambodian Medical Foundation chaired by King Sihanouk, funding surgeries of resources children and training program of the staff; – the Prime Minister donating the land and granting tax-exempt status.
In 2001, the 28-bed PPHC was inaugurated by King Sihanouk in the presence of the Prime Minister and the 22-bed Children’s Pavilion for indigent children, in 2003, by the Minister of Health.
The Facility
Hospital Program
The Center is contained in a two-story building with 2,000m² (21,528 sq. ft.) of floor-space and is comprised of:
Exterior view of the Children’s Pavillion- 2 operating rooms
- 1 angiography room
- 8 recovery beds
- Standard operational facilities (sterilization, cleaning facilities, staff lounge…)
- 8 rooms with 2 beds
- 4 individual rooms
- 4 examination rooms
- 1 pharmacy, 1 blood bank, 1 laboratory
- Administrative offices, technical facilities (laundry and store rooms), 3 administrative lounges
- 1 lecture hall
- Children’s Pavilion with 800m2 (8,611 sq. ft.) of floor space, 22 hospitalization beds, 2 examination rooms, 1 game room to accommodate indigent children with a relative before and after their operation at PPHC.
The Departments
SoH mission team Perfusionist, Kevin Charette, CCP, setting up blood transfusion machine before surgery.The Center is divided into five departments:
The Department of Cardiovascular Diagnosis
Equipped with: electrocardiogram, echocardiography, stress test, and radiography machines. This equipment will facilitate, at fully capacity, 20,000 examinations per year (averaging 80 examinations per day, over 250 working days)
The Department of Medico-Surgical Treatment
Covers the surgical costs for rheumatism, congenital heart disease and all other cardiovascular pathologies. The department will annually perform 1,000 operations (averaging 4 per day, over 250 working days). Currently, the average number of operations per day is 2 and in 2004, it will perform 500 operations. In the future, the Center will also be able to handle other cardiac diseases, thanks to advanced vascular imaging.
The Department of Research and Information
Studies heart disease, especially Acute Rheumatic Fever.
The Department of Training
Oversees, with the support of knowledgeable cardiac and surgical associations, the medical instruction of the Center’s more than 80-person staff. In the long-term, the department will host external personnel for training that is integrated with university study; the department will also train 15 full-time students.
The Department of Interventional Cardiology
Carries out examinations on the coronary and peripheral arteries and performs angioplasty.
The Staff (September, 2006)
94 people in total work at the Center (86 Cambodians and 8 Europeans):
- Administrative staff: 12
- Medical staff: 9
- Paramedical staff: 27
- Maintenance staff: 46
The number of staff will increase in the future, allowing for a greater volume of operations that the Center will be able to perform.
The Organizational structure
The Center is an autonomous legal entity created by the Cambodian Ministry of Health and La Chaine de l’Espoir. It is directed by a Board of Directors and benefits from the advice of a consultative body on ethics and medical strategy. The Center functions according to Cambodian law. The administration of the Center is independent of the Ministry of Health; however, its special status exempts it from all direct and indirect taxes. The president of the Center is Prof. Alain Deloche, MD, president of La Chaine de L’espoir, and founder and member of the Board of Surgeons of Hope Foundation.
The Administration
The operation of the Center is ensured by a management team that acts as a delegation of the Administrative Board. This team is responsible for the daily running of the Center and for implementing the decisions of the Administrative Board. More generally, the operation of the Center must take into account its assumption of financial responsibility for 50% of the destitute children it treats; these patients are entirely subsidized by the Social Services of the Center, which is managed by the Cambodian Medical Foundation.
- Chaired by the King of Cambodia
- The CEO of the Center is Prof. Heng Tay Kry, MD, CEO of Calmette Hospital
- The director of the Children’s Pavilion is Ms. Natacha Prandi, pediatric cardiologist
The Training Program
SoH mission team anesthetist, Dr. Johanna Schwarzenberger of NY Presbyterian Hospital, training a local staff in preparing a child for anesthesia before surgery.One of the innovations of the Center is the presence of resident surgeons and doctors (Western and Cambodian), as well as rotating guest practitioners. The role of the resident medical team, in addition to its daily rounds and operations, is to guarantee the ongoing treatment and imparting of modern medical practice and technology in Cambodia.
The training of the staff has been done in two phases: the first priority was to form and train a founding team; since the opening of the Center, and thanks to the prolonged presence of foreign experts, the medical team has been expanding both its size and its knowledge.
The training process has three forms:
Staff of a hundred trained at PPHC in five years by SoH and European partners.- Internships of 2 to 6 months at the Heart Institute of Ho Chi Minh City. The professionalism of their surgical teams, the similarity of their patients, and their cultural proximity makes this a fundamental phase of training. These internships are required for all medical personnel; they also allow for the definitive selection of candidates.
- Internships of 6 to 12 months in Europe or USA, according to the level of the candidate; it is also possible to renew these internships.
- Training at the Center by resident foreign experts and surgical missions.
Accomplishments 2001-2006 (October)
- 40,700 consultations and 1, 470 operations performed since the opening in 2001.
- 1,000 surgeries: non-paying indigent children.
- Trained more than 100 local permanent staff.
- Cost of surgery per child: $3,000
In Cambodia, as of 2006, SoH has performed 75 cardiac procedures on indigent children. Three cardiac surgery missions have been organized at PPHC by SoH: one in July, 2004 led by Dr. Bernard Vasseur, Reading Heart Center, PA and two, in February, 2005 and March, 2006 led by Dr. Jonathan Chen, Director, Pediatric Cardiac Surgery at New York Presbyterian Hospital. Thanks to the financial support of our generous donors – Central Presbyterian Church, NY; Edwards Lifesciences, Irving, CA; and AGA, Minneapolis, MI – all the children operated on and treated by SoH missions were accommodated with a member of their families at the Children’s Pavilion.
The Center also received important donations of equipment and supplies: and Echocardiograph machine ($100,000), three Ultrasound Philips ($45,000), NY Presbyterian Hospital, 600 stent from Medtronic ($600,000), more than 60 cardiac valves from Edwards Lifesciences and St. Jude Hospital.