Cardiac Center

Angkor Hospital for Children believes that every child has the right to a healthy,
active life. We want to improve the health and well-being of Cambodias children by becoming an effective pediatric heart center. AHC hopes that many thousands of Cambodian children who suffer from congenital heart disease and live in poverty will be able to benet from a stronger heart program at AHC and eventually in other hospitals in Cambodia. AHC is proud to be one of only two facilities located in Cambodia with the ability to correct congenital heart defects. The hospital stands alone as the only free option for cardiac care in the country.

ANGKOR HOSPITAL FOR CHILDREN

Angkor Hospital for Children (AHC) is a charitable organization that serves as the pediatric department for Siem Reaps Provincial Hospital, treating local children as well as children from neighboring provinces. AHC has distinguished itself as the premier childrens medical facility in Northern Cambodia. Although their standard of living is steadily improving, many Cambodians still suffer from endemic poverty. So AHC provides outpatient, inpatient, intensive, surgical, and HIV care, as well as other services, free of charge. Patients or families who can afford to make a small contribution are asked to do so.

Cambodia 1999- An estimated 100,000 children died before their fifth birthday Cambodia 2010- An estimated 23,500 children died before their fifth birthday This is an encouraging improvement over ten years. But if the death rate in developed nations were applied to Cambodias population, this number would be only about 2,200 more than 90% lower. So we still have far to go.
AHC has gained the trust of Cambodian families, as evidenced by the great distances many travel seeking care, as well as by the support AHC gets from local, national, and international health organizations. Over 900,000 children have been treated since the hospital opened its doors in 1999. In 2010, the outpatient department saw 400500 patients daily and maintained 55 inpatient beds. The need for charity pediatric care in northern Cambodiaremains great. In 1999, 1 in 5 children died before their fth birthday. Today the ratio has improved to 1 in 15, but this is vastly unequal when compared to a rate of 1 in 160 in more developed nations. The hospital also supports greater Cambodian health care self-sufciency through its Medical Education Center (MEC). AHC was ofcially recognized as a teaching hospital by the government of Cambodia in 2005. The MEC provides high-quality training and education to hundreds of Cambodian nurses and doctors each year. AHC also serves as a training site for the World Health Organizations Integrated Management of Childhood Illnesses Program (IMCI). AHC also provides community outreach in a variety of ways, including our HIV/Homecare, Capacity Building and Health Education, and Nutrition programs. By supporting patients, families, and healthcare workers in their own communities, AHC helps to achieve sustainable, positive change. Signicant, lasting change will be accomplished only by strengthening Cambodias health infrastructure from within through the training of doctors, nurses, and other health professionals as well as rural government health workers and communities. Extensive education programs for doctors, nurses, and other health professionals have been a priority of Angkor Hospital for Children since its beginning. AHCs excellent reputation, coupled with its efforts to collaborate directly with the Cambodian Ministry of Health, have led to high demand for its training programs. Hundreds of health professionals enhance their education through a variety of programs at AHC. While healthcare efforts in Cambodia have certainly evolved from emergency care into a development phase, the need for donor support has remained steady. Current health care expenditures by the Cambodia government amount to approximately $6 per person per year. Cambodians themselves pay an average of $33 per person per year for healthcare related expenses. Clearly, these sums are insufcient in providing a system of adequate pediatric services in a nation where one-third of the population lives on approximately $1 per day. AHC has become anintegral part of Cambodias health system and its efforts must be maintained and expanded to secure a healthy future for Cambodias children.

Cardiac Issues In Cambodia

By conservative estimates, there are 40,000 children affected by congenital heart disease in Cambodia today. Yetthere are very limited surgical resources for those children needing operative repair. For some, the Phnom Penh Cardiac Center in the capital offers an option. But for most patients, whose families cannot afford to pay, there is no viable option for curative treatment. In 2009, thanks to the constantly increasing capacity of its resident surgeons, AHC has also started to focus on congenital heart disease. Children aficted by congenital heart defects face many hardships. Throughout their lives, these children are challenged in everyday living activities due to a lack of circulation of adequate oxygenated blood. Without treatment of this condition and early intervention, the prognosis for the longevity and quality of the childs life is poor. Children with such an untreated condition normally are chronically ill and require frequent follow-up care and long-term medication. Too often, though, they get suboptimal care, and many die at an early age. For an average Cambodian family, a child with such an untreated condition magnies its burdens.

IMPACT

Angkor Hospital for Children

Angkor Hospital for Children currently monitors over 1,000 children with various heart defects and diagnoses new cases every few weeks, highlighting the enormous need for the continued development of heart surgery services. Left unaddressed, these defects can to lead to chronic illness, and the risk of developing more serious conditions will escalate. To date, AHC has performed 35 open heart procedures with over 99% success and helped tounlock the potential of each of these children. They have been given the opportunity to experience a life that would have been out of their reach without the efforts of Angkor Hospital for Children. Through partnerships with volunteer surgical teams from Singapore, the United States, and Australia, AHC surgeons have become adept at closed-heart procedures to repair a common congenital heart disease known as patent ductus arteriosus. With the assistance of Dr. Sriram Shankar, his surgical team from Singapore, and fundraising efforts through aiutare ibambini Foundation in Italy Angkor Hospital for Children was recently able to purchase a new a heart-lung bypass machine and some basic needed equipment to begin doing more open-heart procedures at AHC. Staff members continually make great strides towards performing these operations independent of volunteer advisement.

Things that are easily xed should be xed. -Dr. Shankar

Current Limitations

As long as Cambodian children suffer from heart defects, Angkor Hospital for Children will strive towards helping to give each of them ahealthy, active life through cardiac procedures. AHCs heart program has already improved the lives of many, but the hospitals current facilities constrain our programs potential impact. AHC currently has only one operating theater, which is used for all general procedures. Due to high demand from general surgical procedures, access to this one theatre is limited. Insufcient availability of the theater and resources has forced us to put a number of cardiac surgical patients ona waiting list. Cardiac medication and equipment such as cardiac monitors, ventilators, a heart-lung machine, and infusion pumps are needed to perform these complex cardiac surgeries.

Before Surgery

So

Patient

So is a one year old girl from Sdei Village in Battambang Province where she lives with her mother and grandmother. In September 2010 So came to AHC and was diagnosed with Total Anomalous Pulmonary Venous Return and Pulmonary Stenosis. These two disorders cause Sos heart to beat rapidly and her breathing to be extremely fast. Her heart has to work much harder to circulate oxygenated blood throughout her body and as a result is abnormally large. You can see this clearly when you look at the size of her chest. Her appetite has always been very small and her growth is slower than a healthy childs. Sos familys income is less than $100 a month and without the help of AHC there would be no way they could afford surgery. The life expectancy of patients with TAPVR can be as low as one year depending on the severity. So has made it past her rst birthday and the urgency of her surgery was increasing each week. The 17th of March, 2011 was a day to remember for Sos mother. As nurses prepared her daughter for surgery, Sos mother was nervous but placed her full trust in AHC. Dr. Shankar and the surgeons at Angkor Hospital for Children were able to nd and correct both of Sos congenital heart defects. She stayed at AHC for a week for observation and antibiotics and has now returned home. So is thriving and her appetite has increased. Her mother is overjoyed that her daughter was given a second life. She cannot thank the doctors and staff enough for the care and kindness they have shown her and her daughter.

After Surgery

Stories

Before Surgery

Hong

Three year old Hong was diagnosed with Atrioventricular Septal Defect in May of 2010 at a private clinic. He has two holes between the chambers of his heart and problems with the valves that regulate his blood. This defect causes high blood pressure in the lungs and can lead to heart failure. Hongs future would be short and lled with sickness if his defects are not repaired. Hongs parents are divorced and he lives with his grandparents in Bavel Muoy Village in Battambang Province, over 200 km from AHC. His heart condition causes frequent respiratory infections and he has been hospitalized several times for treatment at a private clinic. His grandparents income is less than $100 per month which makes seeking treatment for his condition at the Phnom Penh Cardiac Center impossible. With the help of a neighbor, Hong and his family were able to seek help at Angkor Hospital for Children. Without the help of AHC, Hongs health would not improve. His life expectancy, although hard to estimate, would be around 20 years. On the 19th of March, 2011 Hong was operated on by Dr. Shankar and AHCs Dr. Vuthy. All the defects in his heart were found and closed successfully. He spent just over a week at AHC on antibiotics and painkillers. A nal ultrasound was conducted and he was released. In the next few months, several follow-up visits will be done to ensure his recovery is going as expected. Hongs grandparents are extremely pleased with the outcome of their grandsons surgery. They admire the quality work of the hospital and the love that is shown to the children. They are very grateful for the efforts of Dr. Shankar, his team from Singapore, and the AHC doctors, nurses, and staff. They thank them for saving Hongs life. In addition, they would like to thank the donors who made this opportunity available to their grandson. They no longer worry about Hongs future and they dream he will one day attend a university and have a successful life.

After Surgery

Proposed Cardiac Center

To continue the growth of Angkor Hospital for Childrens heart program, the vision of a new Cardiac Center must be made a reality. This center will allow AHC to provide an expanded, more complete, and much-needed heart surgery service to its growing list of patients. The planned Cardiac Center will focus on specialty treatment for cardiac surgical patients. To develop and expand AHCs cardiac program, the hospital will need to develop new capabilities and obtain new resources. The Center will provide a separate operating theater to be dedicated to heart and other thoracic surgeries (which require an even more sterilized atmosphere to avoid infections) and a dedicated Intensive Care Unit for treating cardiac surgical patients. AHC will provide exceptional pre-operative, intra-operative and post-operative care for the cardiac patients. This will require staff to attend training in Singapore and Vietnam. They will also continue their involvement with the Singaporean and Australian heart teams. The Cardiac Center will also be used to alleviate the current overload of other surgical problems such as a two year wait for hernia repair, cleft surgeries, and orthopedic cases. To provide training for the Cardiac team staff, AHC hopes to include an Education Center in the Cardiac Center equipped specically for cardiac procedures. To optimize access for the Cardiac team, the Education Center will be located immediately above the Cardiac clinical management area. Other essential facilities that will be required include cardiac surgical ward, sterilization facilities, equipment storage room and ultrasound/ radiology procedure room. To optimize treatment and minimize movement of patients, the ICU and post-operative area will be located immediately next to the operating theaters suite. Finances will also need to be attained for specialized equipment including cardiac monitors, cardiac medication, ventilators, heart-lung machine, infusion pumps and specic operating theater equipment.

Cardiac Center Staff

Cardiologist and ICU -Dr. Pises Heart US and ICU -Dr. Lyda Head Surgeon -Dr. Vuthy Assistant surgeon -Dr. Vann Thy Anesthesiologist -Dr. Sem Chenda and Ly Bun Rum Perfusionists -Siev Peng and Im Uom Scrub nurses -Chhoy Chan, Ho Sophal, and Chan Sothy

The average annual cost to operate the new Cardiac Center is approximately $390,000. Only $3,500 of fundraising is required for each patient. This is a very low price to pay for the lifesaving benets achieved. This point will allow the sponsorship of individual cases to yield very positive results. The Cardiac Center will benet the children of Cambodia and distinguish Angkor Hospital for Children as the only free cardiac program in the country, an element that will grow the support of the hospital in the future. Help us improve the health and well-being of Cambodias children.

Cardiac Center Budget

PHASE 1
Operational Cost Annual personnel expense OTPS Total for Operational Cost Indirect Cost 10% of Operational Cost Total for Operating Cardiac Center Phase 1

2011
50 Cases $16,230 $123,000 $139,230 $13,923

2012
150 Cases $208,840 $209,000 $417,840 $41,784

2013
150 Cases $226,920 $236,500 $463,420 $46,342

2014
200 Cases $252,174 $290,815 $542,989 $54,299

2015
200 Cases $273,783 $369,106 $642,889 $64,289

2016
200 Cases $296,472 $386,565 $683,037 $68,304

Total
950 Cases

$1,274,419 $1,614,986 $2,889,405 $288,941 $3,178,346

*Appendix 1-1 *Appendix 1-2

$153,153 $417,840 $509,762 $597,288 $707,178 $751,341

Committed Support for Operating Costs

Annual Donation Dick Haugland RICE AIB Singapore-Children of Cambodia Total
$300,000 $30,000 $50,000 $75,000

$455,000

If full donor is not found-$250,000 on average needed to fundraise annually

Personnel Budget
PHASE 1
Code Existing Surgeon Existing Physician Senior Existing Anesthesia New New New New New Nurse-junior $ 250 -$ 450 Nurse- Team Leader $ 475 - $ 605 Ward Clerk $ 150 - $ 243 Assistant to Sterilization Nurse $ 150 - $ 243 Housekeeper $ 150 - $183 Items 2 3 2 21 5 1 1 1 3 $450 $450 $1,080 $14,250

Appendix 1-1

2011
Full Time Staff 50 Cases

2012
150 Cases $29,200 $42,900 $14,400 $75,240 $28,500 $8,400 $2,400 $2,400 $5,400

2013
150 Cases $30,660 $45,045 $15,120 $86,640 $29,925 $8,820 $2,520 $2,520 $5,670

2014
200 Cases $32,193 $47,297 $15,876 $31,421 $9,261 $2,646 $2,646 $5,954

2015
200 Cases $33,803 $49,662 $16,670 $32,992 $9,724 $2,778 $2,778 $6,251

2016
200 Cases $35,493 $52,145 $17,503 $34,642 $10,210 $2,917 $2,917 $6,564

Total
950 Cases

$161,348 $237,050 $79,569 $157,480 $46,415 $13,712 $13,712 $30,918

$524,382

$104,880 $119,124 $134,080 $534,214

Existing Nurse- Unit Manager $ 700 - $893

Total

39
Existing Costs

$16,230 $208,840 $226,920 $252,174 $273,783 $296,472 *$1,274,419

$0 $94,900 $99,645 $104,627 $109,859 $115,351

New Costs $16,230

$113,940

$127,275

$147,547

$163,924

$181,121

$750,037

Operating Costs Budget

PHASE 1
Items Disposables Each Surgery Medical Supplies Medicines Energy Sterilization Room Supplies Insurance (new Building) Telecommunications Accounting Services Laboratory Expenses Training Travel Ofce Supplies Housekeeping Supplies

Appendix 1-2

2011
50 Cases $50,000 $15,000 $10,000 $10,000 $4,000 $0 $1,000 $6,000 $10,000 $10,000 $2,000 $4,000 $1,000

2012
150 Cases $100,000 $20,000 $15,000 $15,000 $8,000 $1,000 $2,000 $6,000 $20,000 $8,000 $2,000 $5,000 $7,000

2013
150 Cases $120,000 $20,000 $17,000 $17,000 $9,000 $1,100 $2,100 $6,300 $24,000 $5,000 $2,000 $6,000 $7,000

2014
200 Cases $150,000 $30,000 $20,000 $19,000 $10,000 $1,200 $2,200 $6,615 $28,800 $5,000 $2,000 $8,000 $8,000

2015
200 Cases $200,000 $40,000 $25,000 $20,000 $12,000 $1,300 $2,300 $6,946 $34,560 $5,000 $2,000 $10,000 $10,000

2016
200 Cases $200,000 $50,000 $25,000 $20,000 $12,000 $1,400 $2,400 $7,293 $41,472 $5,000 $2,000 $10,000 $10,000

Total
950 Cases

$820,000 $175,000 $112,000 $101,000 $55,000 $6,000 $12,000 $39,154 $158,832 $38,000 $12,000 $43,000 $43,000

Total $123,000

$209,000

$236,500

$290,815

$369,106

$386,565

*$1,614,988

Capital Budget
PHASE 1
Items New Building Medical Equipment Anesthesia Machine Oxygen Concentrators Monitors Syringes pumps Otoscope Ophthalmoscope Laryngoscope Pulse oximeter I Stat Machine ICU Beds Ward Beds Portable Ultrasound Machine Operating Theater Table Operating Theater Light with remote Camera Sterilization Room Equipment Autoclave Medical Equipment Washer Wrapper/Sealer Ofce Equipment Photocopy Machine Lap Top Computer Desks Desk Top Computers Refrigerators Table (Leeco) Cabinet (Leeco) Exam Table Qty 1 Unit Price Total

Appendix 2-1

$800,000
$20,000 $2,000 $8,000 $2,500 $200 $200 $750 $500 $6,000 $2,000 $200 $60,000 $5,000 $15,000 $20,000 $20,000 $80,000 $50,000 $400 $400 $2,250 $2,000 $24,000 $8,000 $1,200 $60,000 $5,000 $15,000

1 10 10 20 2 2 3 4 4 4 6 1 1

$288,250
2 1 1 $5,000 $30,000 $30,000 $10,000 $30,000 $30,000

$70,000
1 3 4 2 2 6 7 2 $3,200 $1,300 $200 $600 $300 $200 $200 $720 $3,200 $3,900 $800 $1,200 $600 $1,200 $1,400 $1,440

$13,740

Total Capital Budget

*$1,171,990

William Housworth MD MPH

Executive Director Angkor Hospital for Children Siem Reap, Cambodia (855) 077 534 535 Skype: 502 442 0588

AngkorHospital.org