By Ek Madra
PHNOM PENH, Oct 17 (Reuters) - Dawn has not yet broken but already more than 1,000 sick children queue outside a hospital in Phnom Penh in a desperate wait to get treatment for dengue, a mosquito-borne disease taking a heavy toll on Cambodia's young.
Dengue -- which causes fever, headaches and agonising muscle and joint pains -- has killed 389 people in Cambodia this year, nearly all of them children, in what is believed to be one of the worst outbreaks in years. "Please help my grandson. He has had a fever for three days now," pleads 50-year-old Loung Neang, tears rolling down her cheeks as she cradles the listless body of an 18-month-old child outside the hospital before dawn.
She travelled 80 km (50 miles) the previous day from the eastern province of Kampong Cham, where medical facilities are nearly non-existent. But she arrived at the overcrowded hospital too late to have the child admitted and must wait another 24 hours for a bed to open up when patients are discharged.
Whether her grandson will live that long is another question.
Outside the hospital, waiting children lie on reed mats on the ground, their arms hooked up to saline drips hanging from the trees.
Dengue has infected more than 38,000 people in Cambodia so far this year, government figures show.
"Every day, every ten minutes, a child is arriving in shock, without a pulse and with no blood pressure," said Beat Richner, a Swiss doctor and founder of four donor-funded hospitals in the war-scarred Southeast Asian nation.
In all, his clinics can treat 900 infants, but it is not enough.
"More will die as the dengue continues to spread," he said.
There is no vaccine for dengue but even if a treatment existed, the Health Ministry, which has an annual budget of $3 for each of Cambodia's 13 million people, would struggle to afford it.
Instead, the Health Ministry focuses its efforts on prevention, telling people in towns and villages to use mosquito nets, keep an eye on their children, burn rubbish and not allow pools of stagnant water, where the insects breed, to collect.
"We can change lots of things, but changing people's behaviour is hardest of all," said Ngan Chantha, head of the ministry's anti-dengue programme. "We tell them what to do, but as soon as we go away, they revert to their old habits."
Many people disagree, saying it is impossible to keep an eye on children when so many mothers and fathers have to work to provide for their families in what remains one of the poorest countries in Asia.
"I am poor and can't afford a private clinic. Where should I go now?" 43-year-old Pov Sokhom shouted at the policemen keeping order at the hospital gates as she covered her 7-month-old granddaughter with a wet cloth to keep her cool.
The child's mother is working in one of the many garment factories around Phnom Penh, leaving parental duties to grandparents.
"WORST EVER YEAR"
Even though dengue has always been a rainy season threat in the tropical Southeast Asian nation, Richner said this year appeared to be the worst yet despite government and World Health Organisation (WHO) campaigns.
He blamed the domestic and international authorities, which are responding to higher-than-normal levels of dengue across the region, for being slow to act even when it became clear in May that 2007 was going to be a bad year.
"That is very sad. It's a huge suffering for the children," he said.
The WHO, United Nations Development Programme, Asian Development Bank and International Red Cross have all chipped in to help provide pesticides to kill mosquito larvae.
Richner's Kantha Bopha hospitals, which offer advanced medical facilities to Cambodians for free, need $7 million a year to keep themselves afloat, but the size of the dengue outbreak is already causing them to eat into next year's budget.
Furthermore, raising cash is becoming harder because of Western preoccupation with diseases like bird flu, he said.
"Bird flu is a threat to the Western world, so they pour money and commitment into that," he said. "But dengue? There's no threat to the United States or Europe so nobody's interested."