Some Implications of President Clinton’s Visit to Cambodia

January 14, 2007 at 8:05 am (Lee's Posts, Uncategorized)

President Clinton visited Phnom Penh, Cambodia, on December 4, 2006. It was a momentous and significant occasion—it was the first time that any American president (current or former) had ever visited the country. Before that, the most famous American to have ever visited Cambodia was Angelina Jolie. Some still consider her to be #1. Jacqueline Kennedy visited in 1965 to commemorate the completion of a USAID-built road between Phnom Penh and Sihanoukville (which was later destroyed by the Khmer Rouge and recently restored by private corporations—it’s a toll road now). But in my mind, President Clinton easily wins the title for “most important American to visit Cambodia.”

Anyway, President Clinton’s visit was a true success on five fronts:

1) It brought worldwide attention to the Cambodian government’s successful HIV/AIDS treatment program. Back in 1997, Cambodia had the highest HIV prevalence rate in Asia, and it was expected to keep growing quickly. But through successful and targeted prevention and treatment campaigns in a multisectoral response to the epidemic, the government health sector, together with the hard work of many local and international NGOs and international organizations, curbed the prevalence rate to 1.9% in 2003. It is thought to be at 1.6% today. Furthermore, the treatment program and national laboratory system have been streamlined (through large technical and financial contributions by the Clinton Foundation and others) and now boasts over 18,000 people on treatment, including more than 1500 HIV+ children. Cambodia has the highest percentage of people living with HIV/AIDS (PLHAs) who are able to access treatment of any country in Asia, and has the third or fourth most total number of PLHAs on treatment of any country in the world.

All of this had remained relatively unknown to much of the international community, but the President’s visit highlighted the accomplishments of the National Center for HIV/AIDS (NCHADS), a success story within what is usually considered an ineffective and corrupt government.

2) The positive attention and recognition described above, as well as the symbolic importance of a visit from a well-regarded former US President, was an incredibly positive step for Cambodian diplomacy and Cambodian self-confidence. Putting Cambodia on center stage in such a positive light will help to shed some of the massive cultural baggage and self-deprecation that has carried over from the Khmer Rouge. This self-understanding, an almost depressed nationalism, is ubiquitous in the population and can be sensed just below the surface.

3) The Presidential visit highlighted one of the Clinton Foundation HIV/AIDS Initiative’s (CHAI) most successful programs. The partnership between CHAI and NCHADS is seen as a model of seamless and productive collaboration that other programs seek to emulate. CHAI’s accomplishments in assisting NCHADS with massive reductions in the prices of antiretroviral (ARV) drugs, as well as increasing the availability of ARVs within the country, are impressive. CHAI has also helped to restructure NCHADS’ national laboratory system for HIV testing and its logistics management system, thereby improving efficiency in the government’s procurement, storage, and distribution of ARV medicines, lab reagents, and other consumables.

4) President Clinton and Cambodian Prime Minister Hun Sen signed a Memorandum of Understanding (MOU) that allows Cambodia to access UNITAID donations. UNITAID is a newly established drug procurement and donation mechanism, housed within the UN and funded principally by France, Norway, Brazil, and a few other countries. CHAI was asked to and accepted the role of organizer and distributor of these donations.

The signing of the MOU allows the Cambodian government to access large amounts of donations of pediatric ARVs, lab reagents, and therapeutic food supplements (or RUTFs, for severe malnutrition) in 2007 (with ability to renew and increase procurement in 2008). Importantly, it will donate some pediatric fixed dose combinations (FDCs–in this case, 3 drugs in one) and offer further purchases of these ARVs at greatly reduced prices, so that Cambodia will have the means to procure pediatric FDCs for the first time.

The significance of FDCs: adherence to a drug regimen, especially for impoverished people living far from a hospital or health clinic, is one of the most difficult issues facing HIV/AIDS treatment. These drugs are only effective when taken regularly, and FDCs have been shown to improve adherence by creating a simple regimen consisting of taking only one pill, twice a day. With increased access to these pediatric ARVs, NCHADS and CHAI can push forward together towards their goal of a pediatric scale-up involving 1500 new children on ARV treatment in 2007 (doubling the current number of HIV+ children receiving treatment in Cambodia, for a total goal of 3000 by the end of 2007).

5) With photographs of President Clinton hugging, laughing with, and admiring the song-and-dance performances of healthy, active HIV+ children at Maryknoll orphanage, his visit has generated a visual understanding of what it means to have a successful pediatric AIDS treatment program. Hopefully, these images will galvanize support, both technical and financial, in order to scale-up pediatric AIDS treatment programs across the globe. The goal will be to have as many HIV+ children accessing and adhering to an ARV regimen as possible, so that all can appear as active and healthy as the Cambodian children at Maryknoll. I recognize that this statement is simplified and to some extent naïve, and does not account for many issues such as dependence on foreign aid or the additional needs of HIV+ children such as education, nutrition, and psychosocial support (among a whole host of issues). However, as a broad goal it will do.

For more info on the visit, please see my Cambodia blog–there is a link to it on the right-hand side of this page.

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4 Comments

  1. Cambodia » Blog Archive » Bush's Cambodia said,

    […] to a land that unfolds itself “slowly-slowly”. My only complaint is that I still want more…. Some Implications of President Clinton’s Visit to Cambodia President Clinton visited Phnom Penh, Cambodia, on December 4, 2006. It was a momentous and […]

  2. misarita said,

    I especially appreciate your comments on the importance of national identity in effecting change. To me, that encapsulates the most important difference that I’ve found between Nigeria and India. In Nigeria, there was such a sense of fatigue with the gov’t and the way that things were being run. The most common phrase that I heard was, “ahhhh, Nigeria,” accompanied by a dejected shake of the head. Here in India, there is an undercurrent of energy. I attribute it to the improving economic situation of the country and people’s increasing ability to achieve bigger goals. I think that this has a lot to do with whether people are willing to invest in their own country. Given how much health care comes from non-governemental sources and donations, it has pretty large implications for health.

    About the photos–is there any talk of the ethics of using the photos of these kids for the benefit of CHAI/the Cambodian government? Certainly they are getting the benefit of the program already. Is that enough compensation in order to use the images?

  3. msoule said,

    I was struck by the enormity of the number of connections that were able to bloom as a result of Clinton’s visit. Not only were there a good number of new channels opened (UNITAID, communication with the UN and the global North that Cambodia is doing something very right with their HIV/AIDS program) but there was a great PR moment for all people living with HIV/AIDS: former President Clinton, admired and loved by many around the world, hugging HIV+ children. For many countries, the stigma carried by those with HIV/AIDS is completely socially crippling. Events such as these are vital to shedding light on their lives and making people realize that it is still possible to sing and dance and hug if you are infected and that it is okay to hug infected people. I only hope that millions of people see footage of this event. Lee, is there any way that CHAI can facilitate the spread of the documentation of this event? The opportunity should not be missed.
    Also, the international benefit to the Cambodian government cannot be underestimated. As Lee pointed out, they have lived under the shadow of the reputation of a killer regime for decades and the bureaucracy is rife with corruption. External benefits such as congratulations from powerful world leaders on the successes of a good bureaucratic program put pressure on the bad programs to shape up their acts. I think that the concern about the children being used for the benefit of the government is not warranted, especially since they are the benefactors of the government’s work and they only stand to benefit from having more attention paid to their situation.
    Bill, I have had some skepticism about your deeds in the past but this is a shining example of global leadership in an area that desperately needs it.

  4. Clinton’s Visit to Cambodia « .*. Haru no Yukino | Spring Snow .*. said,

    […] Visit to Cambodia 8 03 2007 Some Implications of President Clinton’s Visit to Cambodia « Brown for Global Health by Lee […]

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