The Kingdom of Cambodia is known for the incredible ruins of Angkor Wat and the brutal repression of the Khmer Rouge. A defunct healthcare system is a legacy from that era that ordinary Khmers still live with. While the country hobbles back to relative stability, thanks to an influx of foreign investment, much remains unachieved. Cambodia is 21^st on the list of high-burden tuberculosis countries. A substantial number of cases remain undetected. As of 2007, around 13,000 Cambodians have died annually from the disease. The following project documents the struggle of the Siem Reap Provincial Referral Hospital as it tries to check the TB tide.

The overall tuberculosis prevalence in Cambodia is extremely high. With 703 cases per 100.000 population per year, it is the highest in Asia (after East Timor) and the 7^th highest in the world. The burden of the disease poses great challenges to the national health system, even though the National Tuberculosis Program, with the support of major organizations, donors and the NGO sector, has made considerable efforts to stem the TB tide.

 

In spite of the significant strides in healthcare post Khmer Rouge regime, the system suffers from cash crunch. As a result on Saturdays and Sundays all departments other than the emergency are closed.

 

The TB ward of Siem Reap Provincial Referral Hospital. Even though the National Tuberculosis Program has sustained high treatment success rates of over 90% for more than a decade— human resource capacity, and laboratory capacity to perform smear microscopy, culture, DST and new diagnostic technologies, remain major challenges.

Rean Sokha aged 51, is a soldier with Royal Cambodian Armed Forces. He started coughing blood and decided to get himself admitted for check up. He has been at the hospital for three months.

A unique feature of the Cambodian Hospitals is the fact that family members stay with the patients to provide care. Lounh Bourng, whose father is a patient of the TB ward at the Siem Reap Provincial Referral Hospital complains, “Hospitals are understaffed and the doctors and nurses tend to neglect the poor patients. So at least one family member has to stay back with the patient.”

Farmer Oum Khun stays with his wife Chum Ly, 52, at the hospital undergoing treatment for TB. The couple say they are happy with the treatment and expect a fast recovery.

Patient number 36 of TB ward at Siem Reap Provincial Referral Hospital suffers from HIV and TB. The third national seroprevalence survey showed a further decline in HIV prevalence among TB patients from 11.8% in 2003 to 7.8% in 2007. Collaborative TB/HIV activities and community-based DOTS have been further expanded.

Doctors prepare Ceftriaxone injections for the TB patients at Siem Reap Provincial Referral Hospital. Ceftriaxone injections along with Rifampicin (150 Mg) and Isonazid (75 Mg), collectively known as RH is used in treatment of Category II TB to prevent development of resistance.

Doctors at work in the TB ward of Siem Reap Provincial Referral Hospital.

A patient shows his daily dose of medicine at the TB ward of Siem Reap Provincial Referral Hospital. The treatment takes eight months in total and the patients are required to stay back at the hospital for the first three months.

A TB patient at the Siem Reap Provincial Referral Hospital.

TB patient Seng Sal, 31 looks on as his wife Oeun Sang sews his clothes. Seng, a farmer, is thankful to his NGO for providing him financial assistance. His Oeun Sang is afraid of being infected with TB but still remains with her husband at the hospital to look after him.

Sourn Mao, 37 is a widow. She has no one to look after her. Her son Bun aged 12 helps her to take care of her two month old baby. Sourn Mao is thankful to her NGO for giving her financial support. A bed at the TB ward requires a one-time payment of $40, which a vast majority of poor Cambodians who live on less than 2 USD a day are unable to pay for.

Navy, 33 developed a pain in her trachea and started coughing blood. She was diagnosed with TB and has been receiving medication since 2 months. She has a son and is afraid of infecting her child.

A patient suffering from Multi Drug Resistant TB at the Drug Resistant TB ward of Siem Reap Provincial Referral Hospital. The treatment for the multi-drug resistant form of the disease is extremely costly, and patients must follow a strict regime for two years and suffer side effects including severe nausea. What’s more, there is no guarantee that MDR-TB can be cured.

Interviews and Photography by Chhandak Pradhan