Maddox Chivan Children’s Center

Access to HIV/AIDS treatment and support to children infected or affected by HIV

The Maddox Chivan Children’s Center (MCCC or the ‘Maddox’) was born out of a chance encounter between actress and director Angelina Jolie and CHC co-founder Dr. Anne Goldfeld on a flight to Cambodia in July 2004. In Phnom Penh, the women together visited a dilapidated TB and AIDS ward for adults dying of TB and AIDS in a time when HIV treatment was not accessible by most in the country. Together they saw children, with nowhere else to go, playing on dirty hospital floors near emaciated parents and other patients who were coughing and dying of HIV and TB. This visit led to a partnership and to the creation of the Maddox Chivan Children’s Center (MCCC) dedicated to helping children infected with HIV, and to help children who while uninfected with HIV themselves, lived in families decimated by AIDS.

Whether HIV-infected or not, children from families touched by AIDS invariably had missed months or years of school due to their own illness or because they were caring for sick parents. Most of the children had lost their father to AIDS, and were living with a mother sick with HIV/AIDS and a younger sibling who had been infected with HIV during pregnancy. Some as young as 7 or 8 years old were serving as their mother’s primary caregiver, scavenging garbage or begging for food for the family. All of the children faced stigma because of their own or their family’s HIV status.

The women saw an opportunity, and the Maddox was established as a daily outpatient center in Phnom Penh in 2006 to address the their unmet needs focusing first on medicine and nutrition. The Maddox became one of the first HIV treatment sites for children in Cambodia and was the first multisectoral program providing HIV treatment and medical counseling and care tailored to the age of the child who was starting lifelong HIV treatment. Hot lunch is offered to all present from toddlers to teens including parents and 2 snacks a day. Education is focused on trying to catch the child up to grade level and to at least to a 6th grade level. 2000+ children and teens have benefited from the Maddox, and countless others have benefited from the Maddox medical counseling approaches introduced to the National HIV Program at the Sullivan Center at the Khmer Soviet Friendship Hospital and the Cambodian National HIV (NCHADS) clinic in Phnom Penh.

Impact of the Maddox Chivan Children’s Center

1. HIV treatment: The Maddox was one of the first sites in Cambodia to provide HIV drugs to children. We chose to train physicians from the largest public hospital in Cambodia, the Khmer Soviet Friendship Hospital, in pediatric HIV care who worked with the CHC physician at the Maddox Center, so they could open a children’s HIV clinic at their hospital which cared for the poorest patients in Phnom Penh. HIV care was later transferred to the new Sullivan Pediatric HIV Center at the Khmer Soviet Hospital in 2009.

2. Age-specific medical counseling for HIV: A game-changing age-specific medical counseling approach and tool was developed by Marie-Pierre Sanchez-Die, the Maddox’s first director, with the Maddox team. This counseling manual used by the counselors to explain to children with HIV/AIDS their illness, helped children understand the necessity of daily medications in an age-appropriate manner as they transitioned from small child to teenager to aid them in developing the lifelong and lifesaving habit of adherence to the HIV medications.

3. A safe space: Both HIV infected and non-infected children from families roiled by AIDS faced AIDS-related stigma, and the MCCC became a safe sanctuary where these children could be just be kids with other children who were in similar circumstances.

4. Getting kids to grade level: The Maddox provides supplementary education in Khmer language, math, English, and computer topics to bring children up to grade level commensurate with their age. There are primary and middle school levels and a and a pre-school/nursury group. And, there are English and computer classes and activities for high school students

5. Horses, music, and dance, etc: The Maddox also has provided enrichment opportunities to children for enjoyment, to nurture talents, and to develop new skills with instruction in horseback riding, Khmer dance, and with support of the US-based NGO ‘Recorder’s of Hope’ over the years, music lessons (piano, recorder, violin). The horseback riding program that was conducted with the Cambodian Equestrian Association was not only an incredibly fun and therapeutic activity for Maddox kids, indeed several of the children became expert equestrians, meeting the King, and became members of the Cambodian Olympic Team. Some traveled to ASEAN competitions throughout southeast Asia. And one rider has become a horse expert and is working at a horse club in southern Cambodia.

6. Nutrition: Most, if not all, of the attendees of the Maddox, especially in its early years, came from families with great food insecurity. Thus, providing food became an integral Maddox intervention from its first days. A hot lunch is provided daily (Monday through Friday) for children and any accompanying adults as well as a morning and afternoon snack.

7. Psychosocial Needs: A counselor is available for addressing difficult behaviors of children and to assess and support families in times of social and psychological stress. As children have grown into teens and young adults, those who are HIV infected face the big challenge of navigating the transition to adulthood with a lifelong and contagious infection that needs daily medication. The MCCC has been focused on developing interventions to prepare these young adults to manage this transition.