FIDR is a non-governmental organization working to support children in developing countries and people affected by disasters.


Inside Kratie Provincial Referral Hospital's construction site: Safety measures we take

Image of the completed building

A new building of surgical ward and maternity ward is under construction in Kratie Provincial Referral Hospital (KPRH) to improve the hospital environment, especially the environment for pediatric surgical treatment.

Worker preparing the bricks for the wall construction

Currently, the structural works for the ground floor is finished, ready for other works to be done such as: wall plastering, ceiling work and floor tiling. ​The progress for the first floor, installation of brick wall and structural work of the roof are under construction. Mr. Phoung Sopha, the site engineer, expressed that the construction workers have not faced any problems with safety, since its commencement in the end of December, 2020.

Construction worker working at tall area using personal protective equipment

Mr. Yait Vannak, the superintendent, expressed that safety measure is one of the most important duties at the construction site, in order to manage the construction schedule and protect the construction workers. On construction site, personal protective equipment such as high visibility clothing, safety helmets, gloves, foot protection, safety belts are always required. Furthermore, installing fence around the construction area and placing signs are to keep both workers inside and patients and hospital staff outside.

Signs at the construction site 

Workers posing with their alcohol sprays

Everywhere around the world is facing challenges to control the spread of Covid- 19, and our construction site is no exception. Workers wear masks, check their body condition daily by measuring temperature, and keep their hands as clean as possible by placing hand washing area at the site and using alcohol sprays.
Having construction work at the hospital area needs further care to implement the safety measures, to ensure comfort and safety of the hospitalized patients. As the new hospital building is expected to be completed by the end of 2021, the safety measures will be implemented strictly during the work.


An online medical study session between Cambodia and Japan was conducted

FIDR has been providing trainings for surgeons and medical staff in Kratie Provincial Referral Hospital (KPRH) which is located in the northeast Cambodia with the purpose of improving the medical services in the area.

In-hospital training is one of the trainings. The aim of this training is to review the daily work and improve medical services by sharing knowledge and experience about diseases and treatment methods between hospital’s staff.

As a part of in-hospital training, the first online medical study session was conducted on March 11, 2021. Surgeons and nurses from the Department of Surgery at KPRH and anesthetist, Dr. Kobashi Yurie from Japan, participated in the session.

The theme of the session was "Anesthesia for Caesarean section" and participants actively exchanged opinions on the differences between Cambodia and Japan regarding the flow of anesthesia procedures, written informed consent to be obtained from patients, preoperative examinations to be performed, restrictions on food and drinking water before the surgery, types of anesthetics and methods of usage, etc.

In particular, they seemed to be interested in the criteria for choosing between general and spinal anesthesia in patients undergoing a cesarean section, the differences between anesthetics and methods of determining the level of anesthesia for patients.

One hospital staff said, "I learned a lot about the usage of different anesthesia methods depending on the urgency of surgery". Furthermore, there were a number of findings for each staff, such as no significant differences in the type of consent forms obtained from patients, the type of tests performed before surgery, or the time of dietary restrictions.

Other staff mentioned that "By explaining our anesthesia method to a Japanese doctor, we were able to concretely understand that what are commonplace for us may differ in other countries such as Japan”. This was a valuable opportunity to have a look at their skills and knowledge.

In Cambodia, due to the spread of the novel coronavirus, the movement of people is restricted which had an impact on the project's activities. Dr. Kobashi commented, "In order to continue conducting online study sessions, a stable internet environment is necessary. I am glad to know that the Internet environment is getting better in Cambodia, and we can conduct such an online study session without any problems. I think we need to hold more training sessions like this in the future."

We will continue on providing trainings for surgeons and hospital staff by applying new methods which are suitable for the situation.

Pediatric anesthesia - prevailing in rural areas
Picture in the right: Dr. Kobashi
Picture in the left: KPRH staff, Ms. Ariun - Project’s deputy manager, Kimratanak – FIDR Project facilitator.


Consciousness of hospital staff as well as in-hospital environment has been improving

Pediatric anesthesia - prevailing in rural areas

Kratie Provincial Referral Hospital (KPRH) is a main healthcare facility of the region which has a responsibility to protect the health of 400,000 residents in the area.
Four years have passed since FIDR started Pediatric Surgery Project at KPRH. During 4 years, we can see the changes in hospital staff’ consciousness as well as in the in-hospital environment.

Before the project started, the in-hospital environment was not so good with rubbish everywhere and bad smell from clogged toilets. Neither hospital staffs nor patients problematized the situation.
However, there were some staff who wanted to make changes for the better. Those were the Director of the hospital, some doctors and nurses who had been trained at National Pediatric Hospital with support from FIDR in the past.

Together with these members, FIDR supported in improving the environment of toilets, water place and garbage collection area. The more improvement was made, the more hospital staff became aware of the importance of the cleanliness in the hospital. Toilets of other departments were renovated with the initiative of hospital staff. The area which used to be full of rubbish was turned into flower garden.
“We always want to make a comfortable place like this”. The thought of the chief nurse became a driving force for changes. Now, hospital nurses call on the patients to keep the hospital clean: “This toilet was rebuilt beautifully by Japanese people. Now it’s our responsibility to keep it always clean to show them our appreciation”

It was not only hospital staff’ awareness toward the improvement of the hospital environment but also awareness toward the patients have been changed.
It’s important to do a post-operative care after patients were discharged from the hospital. However, not so many people return to the hospital for the health check-up. Therefore, there were nurses who said “We would like to visit patients who were discharged from the hospital”.

Pediatrician - Dr. Tomohiro Ishii, who has been involved in FIDR’s Pediatric Surgery Project for years as an expert, said “Whenever I visit KPRH, I, together with hospital staff, have been thinking about what we need to do to improve the Pediatric Surgery Department. Recently I feel their consciousness has been changing in a positive way. As staff of the main hospital in Kratie Province, now they have realized how important their roles are to Pediatric Surgery”. Dr. Ishii also pointed out the importance to keep supporting hospital staff to take the initiatives and feel fulfilled in their duties.

Support from outside organization like FIDR is just an opportunity to encourage local people to make changes. The sustainability of the impact depends on each hospital staff. FIDR will keep moving forward with hospital staff, who play the most important role in the hospital, so that KPRH will become a reliable hospital that could treat children in rural area.


Pediatric Surgery Project Featured on Radio Program in Kratie Province

Pediatric anesthesia - prevailing in rural areas

In Cambodia, especially in rural areas, residents do not go to medical institutions despite experiencing symptoms of illness. The Health centers, the nearest medical institution in the village, are available for these residents, but sometimes they do not feel the need to go to, or rely on traditional medicine, which may delay their visit. Since young children cannot explain their symptoms or condition in words, if adults do not have the correct knowledge, it can be too late to receive proper treatments.

Pediatric Surgery Project is carrying out public awareness activities through radio, in order to help children to be treated properly and timely.On Jan 29, two FIDR staff members and a surgeon from the Kratie Provincial Referral Hospital (KPRH) appeared on the radio and spoke about ‘Symptoms of Pediatric Surgical Diseases’. (Simultaneous broadcast through radio and Facebook Live.)

Dr. Mab of KPRH described the following cases among pediatric surgical diseases: The first is about diseases that require urgent treatment and those that do not. The second is common diseases that patients tend to rely on traditional medicine and delay the consultation of medical doctors, such as burns, fractures, and animal bites.

Furthermore, he introduced the Health Equity Fund, which covers medical examinations and surgical operation expenses for those with low-income so that parents won’t have to worry about the financial strain of visiting a doctor. He added that hospitals could also consider exempting these expenses. He appealed to audience, “The top priority is to bring your child to the Health Center when getting sick. In the case that the condition is serious, hospitals can provide the treatment instead of the health center. Remember to go to health center first to save children’s lives”.

During the broadcast, audience immediately asked about medical facilities in Kratie province where pediatric surgical patients could receive treatment as well as the possibility of surgery. The fact that the number of views on Facebook exceeded 800 in the first day after the broadcast indicates a high level of interest in this topic among residents. The radio segment will be rebroadcast for a month, and Facebook and YouTube videos will be archived.

Picture: (From the left) Ms. Ariun - Project’s deputy manager, Dr. Mab - Surgeon of KPRH and Mr. Rotanak, FIDR project facilitator. Background is the front gate photograph of the KPRH.


Construction of surgical ward and maternity ward of Kratie Provincial Referral Hospital has started

Pediatric anesthesia - prevailing in rural areas Groundbreaking ceremony

Currently, a new building of surgical ward and maternity ward is under construction in Kratie Provincial Referral Hospital (KPRH) to improve the in-hospital environment, especially the environment for pediatric surgical treatment. Its groundbreaking ceremony was held on January 11.

Around 60 participants, including the Governor of Kratie Province, representatives of Provincial Health Department and hospital’s staff attended the ceremony. Monks were also invited to the ceremony, and together with all participants prayed for the completion of the construction. The ceremony lasted about an hour, and the Governor of Kratie Province expressed his gratitude to the people of Japan for their continuous support to Kratie province and commented that "Today I am very glad that surgical ward and maternity ward of KPRH is renewing their buildings, so I would like to request all hospital staff to take good care of the patients and provide good service".

Since the current building of surgical ward is separated from the operating theatre, before and after the surgery, patients have to be transferred by stretchers outside through the buildings of two wards even in rainy or sunny weather. In order to improve this situation, the new building of surgical ward and maternity ward will be built next to the operating theatre.

In addition, the new building is also nearby pediatric ward, which means all the clinical departments related to child care will be physically integrated. So, these departments will easily cooperate to provide the appropriate care to pediatric patients depending on their growth condition and symptom. Mr. Saeki Kazato, the Country Representative of FIDR Cambodia, emphasized the importance of realizing the "Team Medicine" and said, “When each staff and each department work together and utilize their speciality to treat patients, KPRH can become the role model of team medicine in northeastern Cambodia”.

Pediatric anesthesia - prevailing in rural areas Image of new buildings

Currently, foundation work is underway to complete the construction at the end of 2021. The construction is proceeding speedily with the noise and safety measure being taken so that it will not disturb hospitalized patients.


Post-operative care is important to improve the quality of pediatric surgery.

Pediatric anesthesia - prevailing in rural areas

Post-operative care is essential to check whether patients are recovering smoothly without complications and whether the treatment was appropriate or not. However, in Cambodia, once patients are discharged from the hospital, they do not usually return to the hospital for the health check-up, even if doctors ask them to do so. Patients of Kratie Provincial Hospital (KPH) are no exception . FIDR has been supporting nurses of KPH visiting houses of patients who were discharged from the hospital for post-operative care.

On October 21, 2020, FIDR staffs visited a 3-year-old boy in Banley village, Kratie Province with Mr. Ketty, the nurse of KPH who had taken care of the boy since he was admitted to the hospital. The boy was hospitalized at the end of March 2020 for one month due to burns on both legs. Before he visited KPH, his mother and her neighbors had not known how to treat the burns. Therefore, his mother applied "toothpaste" to his burned legs at home and had the burns disinfected at an acquaintance's clinic. After four days, he visited KPH with his wound worsened.

It seemed that after discharging from the hospital, the boy had no concerns about complications or abnormal movement disorder. However, a part of the burns became red-black keloid scar. If this scar expands, there would be a concern of causing dysfunction of the body that needs further surgical operation. Therefore, Mr Ketty advised the mother to observe her son carefully.

The mother seemed relieved to hear that the post-operative process of her son was going well. It was also the first time for Mr. Ketty to visit a patient's home to check the patient's recovery condition after discharging from the hospital, and he could reaffirm the importance of post-operative care. He shared his phone numbers to the mother, so that the mother could contact to get his advice when she has any concerns. The mother deeply appreciated Mr. Ketty and said, "Thanks to Mr. Ketty, my anxiety has eased."


Actions for Preventing COVID-19 in Hospitals and Other Health Institutions

In Cambodia, the first infected case of COVID-19 was reported in late January and its spread hit the peak in mid-March. Although the number of new cases was temporarily increased in July, it has been decreasing. Only a few new cases were reported in September. During this term, FIDR has been taking various measures to prevent COVID-19 depending on the spreading situation.

1. Challenge during the operational suspension
In late March 2020, FIDR was forced to suspend the project activities due to the increasing infectious risk. In Cambodia, especially in provinces, health facilities didn’t equip preventive materials and disinfectants enough. Receiving the support request from our counterpart, Kratie Provincial Health Department, FIDR remotely conducted the emergency relief providing 140 boxes of surgical masks, 27 forehead scan thermometers, and one foggy machine for alcohol disinfection on 22nd April to Kratie Provincial Health Department. The materials were distributed to 1 department, 3 hospitals, 26 health centers, 14 health post, and other 3 health institutions. This relief was enabled by the financial commitment from one Japanese company, Sonton Holding Co., Ltd, the supporting corporate member of FIDR.

2. Learning how to wash hands in the hospital
In May when the number of infected cases started to decrease, FIDR resumed activities.
In June, FIDR collaborated with hospital nurses to conduct “Patient Education” in Kratie Provincial Referral Hospital. The nurses gave short lectures on “How to wash hand?” for patients and their families. They learned the proper way of hand washing using soap and practiced inside the patient room. One of the participants said, “I got to know that there are several steps to wash hands thoroughly. I will keep practicing handwashing to protect myself and my family”.

3. Advocacy in the community
FIDR also supports health centers in the community to conduct trainings sharing knowledge of surgical diseases. In villages of provinces, people could hardly learn health instruction directly in person. We are planning to invite public health officers from the authority and utilize this opportunity to disseminate preventive measures of COVID-19 to local people.

The heath staff was disinfecting the buildings and facilities of Kratie Provincial Health Department using the donated foggy machineThe heath staff was disinfecting the buildings and facilities of Kratie Provincial Health Department using the donated foggy machine

A hospital nurse shared the appropriate hand washing way with soap to patients in Kratie Provincial Referral Hospital.A hospital nurse shared the appropriate hand washing way with soap to patients in Kratie Provincial Referral Hospital.


An opening ceremony of new project phase in Kratie province

Pediatric anesthesia - prevailing in rural areas

The pediatric surgery project which has been implemented by FIDR at the National Pediatric Hospital (NPH) from 1996 for the past 20 years has expanded its activities to Kratie province - a northeastern province of Cambodia since this fiscal year. To commemorate this event, an opening ceremony was held in Kratie province on August 7. In the ceremony, we had an opportunity of welcoming approximately 100 people including Mr Okamatsu - FIDR’s director board member, Doctor Ishii who have a huge contribution in the project for a long time and Mr Okada - FIDR’s Secretary General coming from Japan, as well as Director of NPH, Director of Health Department of Kratie Province, Director of Kratie Provincial Hospital, Director of Health Centers in the province, and the doctors/ staffs of Kratie Provincial Hospital who will be the target beneficiaries of the project.

Mr Okamatsu introduced the significance of FIDR's support on surgeon's postgraduate training at NPH that"There are still many areas in developing countries where the access to surgical operations is limited. If patients who need surgery can access surgery operation easily and receive appropriate treatment, more children can be saved their lives".

Director of Health Department of Kratie Province mentioned that "Since the emergency referral system in the province will be strengthened with FIDR support, we will take our first effort on calling to the parents and caretakers of pediatric patients to bring their children to the hospital for examination".

Finally, Mr. Okada FIDR Secretary General presented the plate engraved with the names of Cambodian Ministry of Health, Kratie Provincial Hospital and FIDR.

Through this new phase, we try to build a medical system in which Kratie Provincial Hospital will be in the center of pediatric surgical management in the northeastern Cambodia with a strong partnership, so that more children can receive appropriate treatment in the local.


Proceeding to New Stage

Pediatric anesthesia - prevailing in rural areas

In April 2017, the new local basis of FIDR is going to set up in Kratie province, one of the northeast area in Cambodia. Departing from Phnom Penh, 6-hour driving brings you to the province where many tourist likely visit to enjoy nature and to meet wild dolphins. On the way to Kratie, you will see peaceful landscape along national roads, crossing the bridge “Kizuna” constructed by Japanese governmental aid, and sometimes rough and sandy roads make your travel thrilling.

You can see Kratie Provincial Referral Hospital in the central city of Kratie. The hospital is the biggest general hospital in the province. That’s exactly our next basis for new Pediatric Surgery Project. Furthermore, they receive referrals from other hospitals and even other provinces that indicates possibility, in the future, to become a hub hospital in this region.

So far, FIDR has supported National Pediatric Hospital (NPH) in Phnom Penh over 20 years. The extremely long-term cooperation enabled the hospital to sufficiently provide treatment for patients in medically satisfying level. Over ruin of medical human resource and building due to past civil war, FIDR had been proceeding with NPH in order to help surgeons, anesthetists and nurses develop more and more as well as supports for facility reinforcement. As a result in NPH today, it becomes the national leading institution of pediatric surgery for both performance and education in Cambodia.

From such kind of experience, you can see a new age coming that skill and knowledge of pediatric surgery should be succeeded from Cambodian persons to Cambodian persons.

In 2017, FIDR and stakeholders in Kratie province will commence a new project for 5 years. Skill and knowledge of NPH would facilitate medical staff in Kratie to provide pediatric surgical treatment appropriately. Of course, health staff of NPH is highly expected to work out as resource persons.

It seems that a long way is waiting for us for the achievement. However, for the sake of children, FIDR is going to move forward together with the help of NPH, health institutions and medical staff in Kratie, and all stakeholders as well as Ministry of Health, and Japanese experts.

« Introduction of Team »
The team of Pediatric Surgery Project has been elaborating to weave a new project plan everyday. You can watch video messages from us, telling what kind of impression through experience in FIDR, and also wishes to this new project!

Chea Sophal (Project Manager)

Dok Bunsovann (Project Coordinator)

Prum Tiny (Senior Project Facilitator)