Rehabilitative Care in Cambodia
Disabilities come in many forms, but more often than not affect those in society who are the most vulnerable: children and the elderly. Disabled people in Cambodia are more numerous than in many other countries as a result of 30 years of war with the accompanying lack of normal medical care, and because so much destruction took place in the country, patients tend to be very poor and unable to afford what health care is otherwise available.
Such people tend to fall into several groups:
- Landmine victims who lose limbs and eyes, and may have painful stumps.
- Children with congenital defects, such as club foot, cleft lip, cerebral palsy, meningocoeles, and so on
- People who are disabled from infectious diseases such as polio, or osteomyelitis.
- Trauma victims such as children who fall out of trees, or are knocked down by cars.
- Burn victims who either cannot afford treatment of their burns, or end up with severe contractures of their limbs.
- Old people who go blind because of cataracts, or cannot walk because of broken hips
While in developed countries the disabled are embraced ever increasingly into society, the process may be far behind or non-existent in developing countries. Disabilities cause a tremendous amount of suffering and have the potential to destroy social integration, happiness, economic productivity and quality of life.
The majority of physical disabilities can be improved or eliminated by relatively cheap procedures and techniques such as surgery, and prosthetic devices. Unfortunately, surgical projects unjustly tend to inspire a negative reaction with donors who imagine large, expensive, non-sustainable, high tech units soaking up the limited health resources of a developing country, and performing complex operations for a limited elite. This is not the case at CSC where rehabilitative surgical procedures are cheap and sustainable and the material costs for surgery are cost equivalent to the treatment of many infectious diseases: (around US$35 - 200 per operation). The surgical techniques can be easily learned by local surgeons.
For example, a child born with a cleft lip or palate in a country like Cambodia has a dismal outlook and is unlikely to go to school, marry, or find a job, but will be stigmatized and probably malnourished. A repair of the defect, will take 45 to 90 minutes at CSC, and utterly change the child's life. Similarly, with surgery, a polio victim who is only able to crawl along the ground, may have his or her hips released, and be able to walk with crutches:, and a land-mine victim may be able to be fitted with a comfortable functional artificial limb to enable him/her to work again. All operations are free to the patient at CSC, since the vast majority of the patients are too poor to be able to afford treatment at any other facility.
The costs
No patients are charged for operations or treatment at CSC, although they may have to pay for drugs or tests at outside facilities if they are seen only in consultation and if they are not inpatients.
Over 80 Khmer staff work at CSC: doctors, nurses, physiotherapists, and support people (performing cleaning, maintenance, administration and security). Salaries are the biggest monthly expense, followed by surgical supplies and then utilities and operating costs. Every year, a rough "cost per operation" is assessed by dividing the total amount of money spent, by the total number of operations performed. In 2009, with $700,000 spent on about 5,000 operations, the cost per operation at CSC was approximately $140. This cost per operation has been steadily rising, as more complex operations become available, and more expensive materials or investigations are required. However, no one doubts these operations are done at a bargain price: free to the patient, and cheap for CSC.
Needs
The greatest need is for ongoing contributions to everyday running costs. CSC is always looking for sponsors who will donate funds to maintain the program in its present form, and even to expand into new procedures such as spinal surgery to cure or ameliorate such conditions as paralysis due to tuberculosis of the spine. Prospective donors who wish to make a specific donation targeted at a group of patients, or a particular program, can always communicate with info@csc.org to discuss such support.