8/8/2019 Grass Roots Initiatives
1/1
For 30 years, the paediatric ward of theKhmer Soviet Friendship
Hospital
stood crumbling at the southern end ofthe Cambodian capital
Phnom Penh.
In 2008, supported largely by private dona-tions, the Cambodian
Health Committee,a non-governmental organization (NGO),transformed
the ward into the Sullivan Out-patient Center for children with HIV
andtuberculosis (TB). Later that year, MdecinsSans Frontires (MSF)
entrusted the care of205 HIV-positive children to the centre.
Now called the Global Health Committee(GHC), the Cambodian group
was born in 1994at a refugee camp on the CambodiaVietnamborder. The
genocidal Khmer Rouge regime
targeted health-care professionals, so, when itsreign ended in
1979, those who survived wereleft with no medical
infrastructure.
Since its inception, the GHC has caredfor more than 5,000 HIV
patients and cured25,000 people of TB, says Anne Goldfeld,
thegroups co-founder and professor of medicineat Harvard
University. With donors rang-ing from the drug company Eli Lilly to
theUnited Nations World Food Programme andthe US National
Institutes of Health, the GHCprovides medicines, meals and care for
anestimated 15,000 people. The group managesfive centres for HIV
and TB care and research
in Cambodia, stretching from rural provincesto Phnom Penh.
Community involvementIn 2008, the group expanded its model
toEthiopia. Staff members have also visitedrefugee camps in
Pakistan, and are discussingplans to move into Swaziland and
Vietnam.Their approach differs from other missionsthat deliver care
after war, says Paul Hamil-ton, project director at an aid
organization inUganda, who is not affiliated with the GHC.I think
their commitment is longer and theyreally work on incorporating the
community.
And the second thing that is really different isthat they do a
lot of basic research.
Many international medical NGOs are inthe process of leaving
Cambodia. At times like
these, the [GHC] becomes more important.says Didier Laureillard,
a physician specializ-ing in HIV and TB at the European
GeorgesPompidou Hospital in Paris, who volunteeredwith MSF in
Cambodia.
The group owes its success inCambodia in part to sustaina-bility
brought about by trainingand working with the commu-nity. Its staff
members visit patients at homeand enlist local health-care workers
to monitorthe nutritional quality of meals eaten by thosereceiving
antiretroviral drugs from its clinics.
Goldfeld also initiated basic research in the
mid-1990s. Her team is conducting a clinicaltrial on the ideal
time for those co-infected withTB and HIV to begin taking AIDS
drugs.
There were a lot of people who doubtedour ability to do it
because Cambodia had noinfrastructure, she says. Not only did we
end
up recruiting 661 patients but, whats more,weve enhanced care
all over Cambodia for TBand AIDS.
Fighting the brain drainGoldfeld has mentored local clinicians
inwriting proposals, designing studies andpublishing results. That
training is bound tohave a broader impact, says Kristian Olson,
aclinician educator at Massachusetts GeneralHospital and health
advisor for the GHC.
If you create this cadre of inquisitivephysician scientists that
are driven to answercompelling questions, youll do a lot for
staff
retention and reverse the brain drain, Olsonsays.
Olson volunteers with GHCs outpost inAddis Ababa, set up with
the Ethiopian Min-
istry of Healths approval, tocombat HIV and TB. Accord-ing to a
2008 World HealthOrganization report on Ethio-pia, 40% of TB
patients tested
there were HIV-positive.The Cambodian team has repeatedly
visited
Addis Ababa to train local doctors. Last year,with funding from
the JoliePitt Foundation,it opened the Zahara Childrens Center
for
HIV-positive kids modelled after the groupssimilar Maddox Chivan
Childrens Center inCambodia.
With some tweaks, the GHCs model forbuilding medical
infrastructure will workin any impoverished, war-torn country,
saysSok Thim, a former Cambodian refugee andthe groups co-founder.
We have the modeland the means to deliver it, Thim says, Wewant to
help wherever there is great need forTB care.
Extending models to other countries isharder than it sounds,
cautions Hamilton. Iveseen good models work in one country but
not
transfer to another. For example, he says, theEthiopian
government is wary of NGOs. Yet those affiliated with the GHC say
it has suc-ceeded in Ethiopia partly because it works inpartnership
with the Ministry of Health.
As a survivor of the killing fields, povertyand TB, Thim relates
to the frustrations ofEthiopian health-care workers, Olson
says.
Care providers in Addis Ababa see Thim asa medical expert who
easily could have beenthe poor refugee, says Olson. After
trainingwith Thim, Olson says, I heard them goingfrom no confidence
to feeling like they will be[part of ] a centre of excellence. nAmy
Maxmen is a freelance writer in New York
City.
GrassrootsinitiativesA Cambodian group has developed a
pioneering
community-based approach to HIV and TB care and
research. Amy Maxmen describes how this powerful
model is being expanded to other war-torn countries.
The Cambodian group has cared for many
children infected with HIV and tuberculosis,
including Ye How (at age six in 2006, top; andafter successful
treatment a year later, bottom).
GHC
They really work
on incorporating the
community.
HIV worldwide
S20
15 July 2010OUTLOOKHIV/AIDS
www.nature.com/outlooks
