ANNUAL ANNUAL ទ យ រព ស ហ REPORT រ ម ន ណ ល នក សង ឃ ម REPORT. r of HOPE SIHANOUK HOSPITAL

Transcription

1 ANNUAL ANNUAL REPORT REPORT ម r of HOPE Cente ន ទ យ រព ស ព ហ រ ម ន ណ ល នក សង ឃ ម SIHANOUK HOSPITAL

2 Table of contents Donation and letter from Her Majesty... 1 Country Director s note... 2 Message from the CEO... 3 Fighting the rising tide of non-communicable diseases... 4 Where do SHCH patients come from?... 5 Institute of Tropical Medicine and SHCH... 6 SHCH take the reigns in fight against anti-microbial resistance... 7 SHCH hosts Cambodia s first Breast Cancer Day... 8 When a donation makes the difference... 9 Women in the workplace Meet a Resident Ask your SHCH pharmacist update from the laboraory Protecting our community From refugee to director of nursing A hospital for all Cambodians Affordable Care Model What it means to support SHCH Get involved Financial Report Major Partners and Supporters... 21

3 Many thanks to Her Majesty Queen Mother for her generous, long-term support. Best wishes for her health and happiness as she continues to serve the people of Cambodia. Her Majesty Queen Mother invited SHCH s CEO Dr.Thai Sopheak, CMO Dr. Lim Kruy, COO Mr.Yan Sadin, and HOPE Medical Center s Dr. Minh Phanavarin and Mr. Chanthy Oeon to receive her donation at the Royal Palace in a formal ceremony. The Queen Mother s generous gift of $10,000 provides lifesaving support to the many patients at Sihanouk Hospital Center of HOPE. I truly appreciate the Sihanouk Hospital Center of HOPE, which has been providing free treatment to poor and needy patients for more than 20 years. The hospital honors the sur name of His Majesty the King Father Norodom Sihanouk, who lives on in the hearts of poor Cambodians throughout the Kingdom. I regularly provide generous gifts to support life-saving care for poor patients at SHCH and encourage the Ministry of Health to continue to cooperation with the hospital, helping the poor in need. I hope that Sihanouk Hospital Center of HOPE will have lasting sustainability for the Cambodian people. - Her Majesty Queen Mother Norodom Monineath Sihanouk (unofficial translation) 1

4 Country Director s note Dear all, As I reflect back on 2017, I find myself thinking about the importance of family. With the honor of overseeing all of HOPE worldwide s programs in Cambodia, I have come to realize that Sihanouk Hospital Center of HOPE is not just an organization, it is a family. Our staff, our supporters and our patients all work together to make SHCH a success. I am so proud to be a part of it. From our Cambodian patients and doctors, to our international volunteers, to our donors spread far and wide across the world, each member of this family brings their own unique strengths and experiences to this hospital. Yet we all share one vision - a Cambodia where everyone can access the same level of high-quality care, no matter their income. Everyone from the highest manager to most vulnerable patient is treated with the same level of respect, the same kindness, the same compassion. Only family could persevere together through the challenges SHCH has endured in recent years. Only family could love one another in the face of such competing demands and limited resources. Only family could see one another suffering and jump in to help, no questions asked. Mr. John Louis SEA Country Director When I accepted my current position at HOPE worldwide this past May, I had no idea how much of an impact this concept of family would have on my approach here at SHCH. It bonds us together, lifts us up, and it is the compass we will use to continue growing and strengthening this incredible hospital. With love, Board Members Mr. Bernard Krisher Founding Board Member, Chairman Ms. Deborah Krisher Steele of Japan Relief for Cambodia Mr. Robert Carrillo of HOPE worldwide, Former Secretary Mr. John Philip Louis of Hope worldwide, Secretary Ms. Midori Miyazaki of World Mate Mr. Kevin O Brien of World Mate Mr. Keith Rose of HOPE worldwide 2

5 Message from the CEO Dear friends, Looking back on 2017, I see a hospital that has been challenged, has evolved and has overcome successfully. While there remains much work to be done, I applaud the SHCH community for the incredible accomplishments made in I am in awe of the teamwork and dedication that our staff, volunteers, and donors demonstrate each day, no matter the hurdles we encounter. Without the combined determination of these special individuals, our hospital could not have provided the 45,466 free consultations we did this year. In 2017, SHCH experienced first-hand the struggle of overseas aid cuts. As the country opens up to rapid development after decades of conflict, our population is growing exponentially - and so is the gap between rich and poor. The poorest Cambodians find life becoming increasingly difficult as they face rising healthcare costs, are unable to access mainstream services and unable to meet their daily basic needs. SHCH s work is just as important today as it was when we opened our doors 21 years ago. Our hospital continues to stand as a model of excellence in the Cambodian health sector. Our patient volume is up, and we are actually seeing more patients than ever before thanks to our affordable care model. Our work remains critical to reach the most vulnerable and disadvantaged in the country. Dr THAI Sopheak Chief Executive Officer To adapt to pivoting trends in the nation s healthcare needs, SHCH is prioritizing an increase in non-communicable disease programs, strengthening our tertiary care services and developing new approaches to high-burden illnesses such as diabetes and hypertension alongside our long-standing infectious disease programs such as HIV and Hepatits C. Our focus on training remains a priority, with a renewed emphasis on continuing professional development and collaboration with international fellows. This year has also brought new partnerships, like our surgical training program with the University of California-Irvine, new ideas, like universal diabetes screening, and new research, like our cervical cancer diagnostics study. Existing support partnerships, like our valuable HOPE Medical Centers, have been strengthened. I am pleased to share many of this year s accomplishments with you in this annual report.thank you for your continued support and for rising to the challenges that we face here in Cambodia every day. I look forward to seeing what more we can do for our patients in With much gratitude, 3

6 Patient Consultations Patient visits since 1996 as of December 2017 in ,466 1,396,684 Fighting the rising tide of non-communicable diseases treatment but nothing seemed to help. Thankfully, the family heard about SHCH. When Hen came to SHCH he was diagnosed with diabetes, hypertension and was found to have recently had yet another stroke. Hen s presentation at SHCH is similar to many of our other patients. Missed diagnosis, late treatment, and a multitude of risk factors all mean that poor Cambodians are at high risk of mortality from chronic illnesses. In 2016, cerebrovascular disease was the leading cause of death among Cambodians. Diabetes was the 7th leading cause of death. Traditional transport: a cyclo driver pushes his passenger through the streets of Phnom Penh on a hot day. Three years ago, Yang Hen had a stroke. Not knowing any other option, the family borrowed $1,000 for treatment at a nearby hospital. The 59 year-old father of four from Takeo Province did not have the means to pay the money back any time soon. The treatment he received was expensive and poor quality. Hen spent the next three years, up until his admission to SHCH, with undiagnosed diabetes and poor hypertension control, and he struggled to recover from the stroke. For Hen, the pain and discomfort was nothing new. He had spent over 20 4 years working as a cyclo driver in Phnom Penh, earning around $4 per day. Driving a cyclo is physically demanding, and the the work took its toll on Hen. In 1996 he was diagnosed with arthritis and eventually had to leave his cyclo job. When he moved back home to Takeo, Hen joined his wife and grown children working on the family farm. Then last month, Hen came down with a high fever and difficulty breathing. He stopped sleeping and eating. The family sent him to a nearby hospital for After several weeks of inpatient treatment at SHCH, Hen is feeling like himself again. He is receiving the correct medications and rehabilitation, and is nearly ready for discharge. The only person more excited about this than Hen is his wife, Yang Phall. Without SHCH, my husband would be waiting to die at home, she says. SHCH gave him new life again!

7 Where do SHCH patients come from? Oddar Meanchey Ratanakiri Preah Vihear Banteay Meanchey Mondulkiri 11% 32% 10% Kandal 6% 16% 8% 69% of patients are women Svay Rieng 68% come from rural areas Top 10 reasons for visiting SHCH 1. Diabetes 6. Cardiovascular disease 2. Hypertension 7. HIV, TB, Hepatitis 3. Sepsis 8. Liver disease 4. Neurologic disorders 9. Kidney disease 5. Stroke 10. Other gastrointestinal disorders 5

8 Institute of Tropical Medicine and SHCH : a long-lasting collaboration with impact Since 2001 ITM Antwerp and SHCH, with the support of the Belgian Development Cooperation, have partnered for an institutional capacity-building program. The aim of the partnership is to develop the clinical research and training capacity of SHCH for the benefit of the clinicians, laboratory technicians, patients and other health care institutions in Cambodia. As a treasured collaborator with the hospital, ITM has enabled SHCH s development into a research center of excellence, attracting some of the brightest research minds from around the world. This partnership has not only benefitted SHCH patients and staff, but Cambodia as a whole. SHCH builds capacity of national programs and universities, regional networks such as the Oxford University Clinical Research Center in Vietnam, as well as other NGOs. SHCH serves as a model of best practice for infectious disease management, thanks to the dedicated mentorship of our ITM colleagues. During the 18 years of collaboration we have conducted clinical studies to better manage HIV, TB and hepatitis C in the Cambodian context. We have studied invasive bacterial diseases such as melioidosis and documented an important problem of antimicrobial resistance in patients presenting with fever at the hospital. The latter required strengthening of the laboratory facilities at SHCH and developing skills of microbiology, antibiotic stewardship and infection prevention for the hospital s antibiotic committee. The two institutions have collaborated on over 60 research publications in peer-reviewed journals over the past 15 years and more than 80 oral presentations and abstracts. All studies have informed national and international guidelines. 6 I have been involved in the project with SHCH for over 10 years now now. It s wonderful to see how SHCH has become a role model for patient care in Cambodia and serves on the frontlines of the nationwide action to contain antibiotic resistance. SHCH has also warmly welcomed and coached my PhD students from the North. Prof. Dr. Jan Jacobs, Head of Unit of Tropical Laboratory Medicine, ITM Cambodia and SHCH are like my second home. During my annual visit I meet with friends, physicians, laboratory technicians that have become real experts in clinical care and research. I see the happy faces of patients who get good quality care, and who still remember me from the early days when we were fighting to get access to life saving antiretroviral therapy. There is by now so much know-how and expertise in SHCH that I feel fortunate to continue to count them among my research partners and friends. Prof. Dr. Lut Lynen, Department Head of Clinical Sciences, ITM

9 SHCH takes the reigns in fight against antimicrobial resistance Since 2007, SHCH has been active in the fight against global antimicrobial resistance.through a robust partnership with the Institute for Tropical Medicine (ITM), SHCH has conducted numerous studies on bacterial treatments and resistance over the years, and developed guidelines which were adopted by the Cambodian Ministry of Health. This year, taking things a step further, SHCH and ITM formalized an agreement with Takeo Province Referral Hospital to provide on-site, targeted capacity building and training. The hospital, located about 2 hours south of SHCH, is a government facility which has long struggled to provide appropriate treatment for bacterial infections. The landmark partnership is developing capacity for Takeo medical professionals to effectively manage all patients suffering from sepsis (bacterial infections in the blood, potentially fatal) and its underlying diseases. Through quarterly staff training sessions, provision of second-line antibiotics, and support for 2,000 blood cultures per year, SHCH has already seen improvement in patient outcomes and provider knowledge at Takeo Province Referral Hospital. With an increased volume of blood cultures and improved prescribing practices, targeted and appropriate antibiotics are being given. With four more years left to continue the project, Takeo is expected to continue improving stewardship of antibiotics. SHCH and ITM will also gather data and conduct research at Takeo, helping to better understand the scope of the problem and gauge how well the interventions are working.with strong data, this project can be replicated at other hospitals, and even scaled up to the national level. 7

10 SHCH hosts Cambodia s first-ever Breast Cancer Day Oct 21 SHCH s director of surgery, Dr Preap Ley (second from left) and Chief Executive Officer of AIA Cambodia, Mr. Richard Bates (third form left), are interviewed by Cambodian news outlets. Five of SHCH s breast cancer peer educators, all survivors who received their treatment at SHCH, are interviewed on stage. Cambodian singer Pich Sophea, a judge on Cambodia s version of The On Saturday 21st of October, 2017, SHCH made history by hosting the country s first-ever public breast cancer event. SHCH s Breast Cancer Initiative, supported by AmeriCares and AstraZeneca, is now in its 10th year and has been Cambodia s leading women s cancer program since its inception. This October event, sponsored by AIA (Cambodia) Life Insurance Plc, drew in more than 1,500 people from around the region for a full day of breast cancer screening, games, healthy foods, zumba and yoga, educational speeches and finally a highly entertaining Khmer pop concert. Everyone in attendance was educated about breast cancer s signs and symptoms and the need for early detection and prompt treatment. Throughout the day we screened 174 women and identified 4 cases of breast cancer, and all women have been referred to SHCH for care. All $10,000 raised from the event has gone directly to SHCH s breast cancer program. Voice, performs for free at the event. Breast cancer in Cambodia is a very different story than breast cancer in countries like the United States. Here in Cambodia, there is no Susan G Komen Fund. There is no Cancer Society or pink ribbon campaign or public awareness programs. Breast cancer s mortality rate in Cambodia is unacceptably high nearly half of all Cambodian women who are diagnosed die from the disease - due to the fact that women here seek treatment too late. Lack of awareness, lack of public support, and lack of treatment options are deadly obstacles to fighting women s cancers here in Cambodia. An attendee shows off her temporary tattoo in support of breast cancer treatment.tattoos were given free with a $1 donation. 8 But that is changing, and SHCH is leading the way. All four women who screened positive at the event have begun treatment at SHCH.That s four lives, four families, and four futures that now have a much better chance of survival. We are spreading the word, treating women earlier, and fighting back against breast cancer in Cambodia.

11 When a donation makes the difference Choung Kosal at his most recent follow-up appointment Choung Kosal is a 67 year old retired teacher from Kompong Chnang province. Kosal lives with his wife and they have five children.their children have all stopped studying.two of them are already married and the other three children work in a nearby factory to support the family s daily living. Kosal and his wife stay at home because their ages and health problems keep them unable to work. Kosal in particular has suffered for many years with diabetes, Hepatitis C and hypertension. In early 2017, his health deteriorated even further. He felt tired, had difficulty breathing, and had numbness and pain in his arms and fingers that pushed him to visit a nearby clinic. At the private emergency clinic near his home, Kosal spent $500 borrowing and taking loans - but his health did not improve. After leaving the clinic, he spoke to his neighbors. They motivated and encouraged him to come to SHCH, which treated Kosal for free. At SHCH, Kosal was diagnosed with angina and was given an immediate dose of nitroglycerin. Following the advice of Dr. Long, SHCH Emergency Department Manager, Kosal is using the medication at home whenever he begins to feel an attack coming on difficulty breathing or chest pain. He is now feeling much stronger. With better management, his symptoms are no longer life-threatening, and he follows up at the SHCH outpatient clinic once per month to monitor his symptoms and medication supply. Kosal said he has never had such a good service like at SHCH I really appreciate that the doctors here work very hard without discrimination. Not only me but everyone gets an equal right to get the treatment, and with free medication I can recover. The words thank you cannot describe how I feel to your kindness; you all have a very kind heart. Kosal s nitroglycerin was provided as a donation through our long-time partner Americares. Americares works tirelessly to collect and distribute donations of vital medications and supplies to hospitals like SHCH. Without their support, Kosal s story would have a very different ending. We are honored to partner with Americares to save Cambodian lives. 9

12 Women in the workplace: SHCH s gender equity campaign Cambodian women face many barriers to education, employment and career advancement, with pressure to adhere to more traditional roles as mother and housewife. Gender-based violence, cultural norms and social marginalization all play a role in making a Cambodian woman s journey more difficult than the average man s. And gender imbalances have a major impact on health outcomes, putting women and the entire community at risk. So when SHCH CEO Dr. Thai Sopheak was promoted to her position last year and she became the hospital s first Cambodian female leader, it was considered by many to be a groundbreaking accomplishment. But to the staff at SHCH, it was a simply a practical choice for a hospital that prides itself on merit-based promotion and equality. 55% of senior leadership positions at SHCH are held by women. Gender parity means more than women in leadership, though. It also means cultivating diversity in traditionally female-dominated fields such as nursing. 54% of SHCH nurses are male, compared to the United States average of just 10%. With our eyes on the future and a goal of changing the landscape of the health industry in Cambodia, SHCH welcomed 45% female healthcare students in This aims to further improve our gender ratio of medical doctors, where over 1 in 4 SHCH doctors are female. SHCH prides itself on breaking down barriers and creating a culture of respect, where all employees are given the same opportunities regardless of gender. SHCH joins the nation in creating change and promoting equality. We continue rising to the challenge. 10

13 Meet a Resident Name: Chhay Rithy All clinicians take the time to assess what the patient and family need, whether it s medical, social or just discharge teaching. In my time here, I learned how to provide patient education something I d never seen anywhere else! Imagine that. Age: 25 years old Specializing in: General Medicine Current rotation: SHCH Emergency Department What do you plan to do when you finish residency? Eventually I want to open a GP clinic in my hometown. There are no healthcare options nearby, and people have to travel a long way some even travel all the way to SHCH to access quality care. 233 Students Trained in 2017 Genteral Physician: 40 6 What brought you into medicine? Gynecologist: I grew up in rural Kampong Thom province [central Cambodia] where my dad is a farmer and my mom runs a small shop out of our house. We didn t have much growing up. Becoming a doctor is the perfect way to support my family financially, and also do something great for my country. We need more doctors! Surgeon: 27 Nursing: 56 What is medical training like at SHCH? I m in my final year, so I m seeing 4-5 patients per day alongside my supervisor, Dr. Long. I work through all my cases, attend morning lectures in the SHCH auditorium and participate in daily rounds in the wards. It s busy but I m learning a lot! SHCH s senior doctors have high expectations from junior staff, but they are supportive and take the time to explain everything. Plus we get to learn from international volunteers who provide a great perspective. Is SHCH different from other hospitals you ve rotated at? It s very different, and in a good way! First, SHCH has teamwork. Everyone supports each other to ensure the patients are well taken care of. Gastroenterologist: 2 Other medical specialist: 4 Laboratory: 87 Pharmacy: 36 Throughout the years, I have never forgotten the importance of the word quality in our mission statement. So in 2017 we began expanding our training program to include in-house continuing professional development. This keeps us ahead of the curve in Cambodian healthcare and ensures our patients are receiving the most up to date treatment. - Dr. Lim Kruy, CMO 11

14 Ask your SHCH pharmacist Pharmacy Manager Ph. Kheng Amara shares her thoughts on why the SHCH pharmacy is the safest option for our patients, and why 2017 was such a great year. How does SHCH get its medication supplies? In 2017 we received an incredible amount of donated medications through our major partner Americares, DRI and also domestic companies. We purchase the rest of our medications from the regional market, ensuring high quality and fair price. With reliable supply, we were able to distribute life-saving medications to all of our patients. It was a great year! What s the most important thing SHCH pharmacists do? Educate our patients! Many of our patients can t read, so we use pictures and verbal teaching methods a lot. We advise patients about their medications, including how to take them, what reactions may occur and answer all of their questions. Throughout 2017 we worked with the medical teams to reduce medication errors and implement best practices. We made major progress to minimize dispensing errors and improve quality of patient counseling. How do you contribute to improving medication safety throughout Cambodia? We train third-year medical students from the University of Health Sciences nearby. It s important that they get this experience, so they can go on to provide excellent care and fulfill the government s plan for quality improvement. Pharmacy by the numbers: 2017 * 15 shipping containers arrived to SHCH, filled with donated medications and supplies * 209,514 prescriptions were filled * 1 new satellite pharmacy opened at SHCH s infectious disease department * 36 students trained 12

15 2017 updates from the laboratory * Performed 357,310 lab tests * Trained 83 lab students 2 government lab managers 4 residents * Researched sepsis and melioidosis In 2017, SHCH made great progress on its melioidosis research project. Melioidosis is an infection caused by the bacterium Burkholderia pseudomallei which is endemic to Cambodia.The bacterium lives in soil and water, which puts rural farmers at high risk during the rainy season. Worldwide, melioidosis has a fatality rate of over 80%, though that number is closer to 50% at SHCH. High fatality rate is one of the reasons that international security experts are so concerned that Burkholderia pseudomallei may be used as a bioterrorism weapon. In conjunction with the Institute of Tropical Medicine in Belgium and SRI in the United States, SHCH is contributing the a better understanding of melioidosis. This research will help develop prevention and treatment strategies keeping the world safe from bioterrorism and developing better treatments for our rural patients. 13

16 Protecting our community: environmentally-friendly radiology equipment Anyone visiting our bustling capitol of Phnom Penh will have noticed the heavy traffic, construction dust, and plastic garbage littering the streets. As the population grows, pollution throughout the region is getting worse. Many of the diseases our patients struggle with can be either caused or worsened by environmental pollution. These include respiratory diseases, skin infections, certain cancers and more. While the issue requires strong intervention at the national level, SHCH has been making its own efforts to improve the environment in our hospital and neighborhood. As a way to reduce our own waste generation, SHCH adopted a computed radiography (CR) machine in This unique equipment allows our radiologists to take x-rays with older analog machines, but create a digital image which doesn t need to be printed on film. Instead, 14 the machine displays the image on a re-usable cassette. This eliminates the need for harmful ink and plastic waste when creating routine x-rays. Patients are given the option of printing a film x-ray in cases where they need onward referral to a facility without computerized systems, or need one for their own records. In 2017, SHCH conducted 3,941 x-rays. Going forward, nearly 100% of these will utilize the CR machine s digital format. In addition to decreasing our environmental footprint, the CR machine produces less expensive x-rays, cutting costs for the hospital and allowing us to reach more patients. It is an enhanced system of managing patient diagnostics and keeps SHCH on pace with international health technology developments.

17 From Refugee to Director of Nursing: Keo Rotha s Journey Keo Rotha was five years old when her family fled Phnom Penh. Amid ongoing political conflict, the family found relative safety on the Thai border. They remained there, in a UN refugee camp, for the next 20 years. The daughter of a midwife and a politician, Rotha was raised in impossible circumstances with the desire to lift up her community. She does so every day as the Director of Nursing at SHCH. Growing up in the camps actually gave Rotha an advantage, she says. It wasn t perfect, but at least we were taken care of by the UN. They provided us with shelter and food, and even built schools. There just weren t many jobs. In 1996, Rotha got her first nursing position at a brand new hospital in Phnom Penh called Sihanouk Hospital Center of HOPE. The hospital had just opened, and it was hectic. I was one person doing the work of 20 we were all so overwhelmed by the number of patients needing our help. Anyone who has recently met Rotha could be forgiven for thinking that she was always as confident and assertive as she is today. I hated nursing at first. I was intimidated by everyone and I was terrified of blood! What kind of nurse is scared of blood? Now approaching her 21st anniversary Mrs. Keo Rotha During Rotha s 20 years in the Thai with SHCH, Rotha has risen steadily Director of Nursing Department border camps, there was a constant through the ranks of SHCH nursing shortage of skilled health workers. The UN was desperate to train us up.they let me into the program when I was just 17, she remembers. My mother pushed me to become a nurse because it was a guaranteed job. leadership and has served as Director of Nursing since Throughout the years, she has been responsible for training countless nurses and serving many of the 1.3 milllion patients who have come through SHCH s doors. What does it take to be an SHCH nurse? Here s what our team have to say: Our nurses never stop learning! New nurses all undergo a 3 month preceptored orientation. This is a make or break time. By the end, you are going to make a perfect head-to-toe assessment, give the perfect report to the next shift, and provide gentle, confident care to your patients. SHCH nurses are compassionate above all. We work here because we support the SHCH mission of caring for the poor. There is no room for arrogance or indifference. Our nurses all try to learn English, because it s so important for continuing education. We are a globalized world, and English opens up so many opportunities to learn through journals and regional workshops. 15

18 A hospital for all Cambodians Update on the affordable care model Throughout 2017, SHCH continued to increase patient volume and implement service improvements thanks to the affordable care model. The hospital has seen continued growth in services for the poor, with approximately 6,000 additional consultations compared to Patients can access healthcare without financial burden, thus reducing delays in treatment and allowing early intervention for chronic illnesses. That means better outcomes and a healthier Cambodia. Sihanouk Hospital Center of HOPE (main building) Number of outpatient consultations per month in 2016 & ,000 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Dr. Lim Kruy, CMO on the impact: As our country is developing, SHCH has had to continually adapt to our community s growing needs. This is why we opened our outpatient department (OPD) in September The SHCH OPD is the only place that many of our patients can go for early diagnosis and treatment. Now, we not only have a thriving OPD but a busy inpatient department as well. Since we swung our doors wide open with the Affordable Care Model, we now see a huge range of patients with a mixture of diagnoses and socioeconomic status (poor, lower middle income, middle income). Not only are the staff happy that we can provide more care, but also the patients are happy with how the hospital has grown. SHCH will never make a profit, because all of our money goes directly into care for the poor and training our students and staff. That s exactly how we want it, because so many patients need our help. I am very thankful for all of the donors and the staff who work so hard to make this dream a reality - especially my lovely nurses who care so generously for the patients. We as medical doctors could not do it alone - you are a gift for us to save lives together. 16

19 QA Affordable Care Model In late 2016, faced with a changing local economy and a decrease in foreign aid, SHCH embarked on a new journey toward sustainability by introducing its affordable care model for patient fees. SHCH remains committed to reaching all Cambodians in need with quality healthcare at a cost that they can afford and for those who cannot afford to pay at all, our services remain completely free. What is the affordable care model? All patients who visit SHCH are assessed by a trained Social Affairs Officer, who follows an internationally-recommended and context-appropriate rubric to assess the patient s financial status. Patients are then categorized on a sliding scale. Less needy patients pay for selected healthcare services like lab tests, x-rays, ultrasounds and CT, and non-donated medications and supplies, and are only required to pay what they can afford.we understand the strain that healthcare costs place on Cambodian families, and we remain committed to eliminating the barrier that cost places between Cambodians and health. Services that remain free for everyone: consultations and medical examinations, nursing care, donated medications and donated supplies, and special grant-funded programs like breast cancer treatment, blood culture and susceptibility screening, and the provision of broad spectrum antibiotics - to name just a few. Why does SHCH need this? Allowing higher-income patients to contribute just a small payment toward the cost of their care makes it possible for us to open our doors to a greater number of beneficiaries and to continue providing 100% free healthcare to those who need it. In the past year, our consultation numbers have increased and our services are now targeting the greatest needs of the population. Why am I still asked to donate to SHCH? We continue to rely on the generosity of our donors to fund the majority of SHCH services. That being the case, even our donors acknowledge the great impact that the affordable care model has had on service expansion.while patient fees account for a relatively small amount of income, this move toward sustainability will help ensure a long successful future for SHCH and also for the people that we serve. Every dollar helps save a life. How do patients feel about this? Patients who can afford to pay a portion of the cost are generally satisfied with the change. They know that they are receiving quality care at an affordable price and are pleased that they can help others in need. We are fortunate that Cambodia has a long and celebrated culture of giving. In fact, our patients were slipping their small banknotes into our waiting-room donation boxes long before we began charging on a sliding scale for services. 17

20 What it means to support SHCH For many of our volunteers, experiencing the unique hospital environment at SHCH is a highlight of their career. If you ask Dr. Peter Curran, an SHCH volunteer since 2009, the highlight has been witnessing SHCH (and Cambodia) develop over time. Dr. Peter Curran, an endocrinologist from Ketchum, Idaho and father of two, recently made his 8th trip to support SHCH. While there have been many changes, the hospital has remained remarkably consistent over the years in its mission of delivering health care to the poor and training young doctors, he reflects. A graduate of Columbia P&S, Peter went on to train in internal medicine and endocrinology at the University of Chicago. After years of experience in the United States, the decision to volunteer overseas was a natural one for him, as he grew up in a family with a long history of working internationally. Peter and his late wife Bonni spent time volunteering in countries like India, Bhutan and Uganda in addition to Cambodia. Over the years, Peter has mentored SHCH staff, 18 provided training in endocrinology, and worked with SHCH leadership to enable innovation and development. He is also a board member of Health Volunteers Overseas, an important partner of SHCH. When Bonni passed away in 2013, Peter honored her memory and her passion for Cambodia by helping to open the Women s Health Clinic at SHCH. The clinic is still running strong to this day, and has treated over 3,700 women. But the Curran family s impact does not end there. Peter serves as president of the PECO Foundation, a family philanthropic initiative. Recognizing an urgent need to address Cambodia s significant diabetes burden, PECO Foundation and SHCH introduced diabetes screening and treatment research at the hospital last August. So what is the draw that keeps Peter returning to SHCH year after year? I always enjoy seeing the enthusiasm and hard work of the generation of young doctors who train here, Peter says. He is also a big fan of the daily morning lectures, when all doctors gather in the auditorium to attend lectures, gain knowledge and share experience. When asked if he has any advice to future volunteers, Peter encouraged anyone to apply who is interested and has skills to share: The hospital engenders loyalty and enthusiasm for a core group of volunteers. I would encourage others to come to experience the Cambodian people.

21 Get involved SHCH welcomed 69 international volunteers in HIV Outreach Volunteers Medical Doctors Nurses Surgeons Women s Health Specialtists Radiologists Public Health Specialist IT Specialist We want you! Medical Professionals: Doctors, nurses, radiologists, surgeons, anaesthesiologists, physician assistants, nurse practitioners, lab techs, pharmacists. Public Health: Specific expertise is needed in research, bio-statistical analysis, epidemiology and health education with low-literacy populations. Non-medical Professionals: Communications, grant-writing, marketing, business development, human resources and IT. Volunteer Requirements * Minimum commitment of two weeks (10 working days) * Ability to self-fund all travel and local living costs * An open heart and mind * A willingness to both teach and learn * Experience in mentoring or teaching, especially in cross-cultural contexts Did you answer yes to all of the above questions? Visit sihosp.org/volunteers/ or send us an at volunteer@sihosp.org for more information Donating supplies If you are visiting Cambodia and you have some spare room in your suitcase, we could use your help! SHCH is always in need of basic medical supplies and medications. Even something as simple as a box of gloves goes a long way! volunteer@sihosp.org for an updated wishlist. Can t get to Cambodia? Other ways to help: Refer a friend Do you know a clinician that meets the criteria above and wants to do some good in the world? Send them our way! Hold a fundraiser Many of our volunteers and supporters can t donate themselves, so they hold fundraisiers for us in their communities. If you d like to fundraise for SHCH, please get in touch to discuss how we can help. We provide promotional materials and information to make your fundraiser a succes. Who knows - maybe you can help us buy our much-needed elevator! 19

22 Financial Report SHCH undergoes a voluntary external audit every spring, which we share transparently with all donors and volunteers. Check our website or get in touch! In 2017, SHCH continued to increase revenue diversity. With the expansion of the affordable care model, our sustainable income has increased which allows us to maintain reliable service and expand much-needed clinical activities. Grants 1,425, In-Kind Donation Unrestricted/Individuals/ Other 2,506, , Internal Services Revenues 707, HOPE Medical Centers Reference Service Revenues 409, ,195, Total Revenues FY 2017 (excluding in-kind donation) USD 4,933, Total expenses FY 2017 USD 5,305, HOPE Medical Centers: HOPE worldwide runs three medical clinics in Phnom Penh, all of whom donate their proceeds directly to SHCH. These clinics are called Community Medical Center, Embassy Medical Center, and Pochentong Medical Center. Unrestricted/Individuals/Other: These are donations from people like you! Individual donors, small foundations and companies provide donations to be used for the hospital s day-to-day needs such as electric bills, staff salaries, gloves, and all those necessities to keep a hospital open. Grants: This is funding from foundations, other non-profits and individuals for specific projects with specific objectives. For example, the Global Fund grant for our HIV and TB services or the AmeriCares grant for our breast cancer program. 20 In-Kind Donations: We receive donations of medicines, surgical supplies and small equipment from organization such as Direct Relief International and Astra Zeneca. Reference Service Revenues: This category includes income from our lab and pharmacy. SHCH s lab is a referral center for other hospitals and clinics throughout the region, and those other facilities pay a small fee for this service. Internal Services Revenues: This is income from the sliding scale patient fee system known as the Affordable Care Model. As opposed to making a profit, this is essentially partial cost-recovery revenue that helps redistribute our resources to where they are most needed.

23 Major Partners and Supporters AIA (Cambodia) Life Insurance Plc Americares Astra Zeneca Pharmaceuticals Australian Volunteers for International Development Belmont University Bonni L. Curran Philanthropic Fund Build Cambodia Cambodia Post Bank PLC Direct Relief International DKSH Guam Christian Church Harmony Home Association of Taiwan Health Volunteers Overseas Her Majesty Queen Mother of Nation Norodom Monineath Sihanouk His Majesty King Norodom Sihamoni Hodge and Schuyler Family Foundation Hoops for HOPE HOPE worldwide Canada HOPE worldwide Switzerland HOPE worldwide Taiwan Institute of Tropical Medicine International Contraceptive Access Foundation Japan Relief for Cambodia Leonard and Gina An Kim Lowell General Hospital Medical Missions Ministry of Health, Cambodia Mr. Tan Sava National Center for Parasitology, Entomology and Malaria Control National Center for TB and Leprosy Control NCHADS PECO Foundation Rotary International Sampov Meas Pagoda Stop TB Partnership Surgeons for Cambodia Team 15.1 The Benevity Community Impact Fund The Capital Group The Centers for Vulvovaginal Disorders The Global Fund to Fight AIDS, Tuberculosis and Malaria The Mayo Clinic The Place Fitness Center Union for International Cancer Control University of California-Irvine USAID Wheels for HOPE How can you help! $40 provides a life-saving basic cervical cancer screening for one woman $150 provides diagnosis and first month treatment for Hepatitis B $250 is the average cost of one general surgery at SHCH, free of charge $500 sends one junior doctor a regional specialty workshop $65,000 covers the cost of all SHCH programs for one week! Donate today at Sihosp.org Like us on Facebook 21

24 មន រ ពទ យ រព ស មណ ល នក សង ឃ managed by ហន ម Center of HOPE SIHANOUK HOSPITAL HOPE worldwide is a 501(c)(3) organization ANNUAL REPORT SHCH Annual Report 2017, version 1.0 Stories and articles compliled and writen by Dr. Thai Sopheak, Kathryn Marten, Sok Bouy, Phen Sovanarith and Chheng Many 2017 info@sihosp.org / Sihanouk Hospital Center of HOPE Local Address: Street 134, Sangkat Vealvong, Khan Makara 7, Phnom Penh, Cambodia P.O. Box 2318, Phnom Penh 3, Cambodia US Address: HOPEworldwide,4231 Balboa Ave. #330, San Diego, CA 92117, phone: , fax: ,