AsiaLIFE

Hospitals across the border in Ho Chi Minh City are filled with Khmers seeking international standards of healthcare. Many expats choose to fly to Thailand for relatively routine surgery. Does this accurately reflect the state of healthcare provision in Phnom Penh? What facilities and treatments to an international standard are available in the capital? Mark Jackson talks to four health professionals about the state of care in Cambodia.

“In five to ten years the quality of hospitals will be similar to Vietnam or Bangkok,” claims Dr. Jean Claude Garen, the man behind Phnom Penh’s Naga Clinic. Few people are more qualified than Jean Claude to talk about the state of healthcare provision in the capital. Qualified as a general practitioner specialising in sports injuries in his native France, Jean Claude first came to Phnom Penh in 1994. At that time the only practising foreign GP was Dr. Gavin Scott. Jean Claude decided to stay. After unsuccessfully trying to establish his own clinic, he managed International SOS for two years, before opening Naga some eight years ago.

Why is Jean Claude’s outlook so positive? Why is it not shared by the stream of Khmers and expats who seem to head for the nearest border as soon as any illness becomes complicated? “It’s not perfect,” he admits. “But the young, specialist physicians trained in France, the U.K. and Australia are better than before.” This gives him grounds for optimism. He believes there will be a good level of general and orthopaedic surgery available in the foreseeable future. Those requiring more specialist surgery will have to wait longer.

Takes Two Generations to Make a Gentleman

Jean Claude’s optimistic appraisal of the state of healthcare provision in the capital is not shared by the one doctor who has been here longer than him.“From my point of view, things haven’t changed too much,” says Dr. Gavin Scott. Trained in St Andrews, Manchester and Liverpool universities as a general practitioner specialising in tropical and sexual diseases, Gavin first came to Cambodia in 1992 to establish the UN dispensary. He too decided to stay.Like many others, part of the attraction of Phnom Penh came from his elevated status, both professionally and socially, in comparison with back home.“It was rather pleasant being a big fish in a small pond,” he admits.This was not the only reason though. “The breadth of medical illnesses is very interesting, especially when compared with a GP’s surgery in Manchester,” he says.

Referring to the claim that it takes two generations – roughly equating to forty years – to make an English gentlemen, Gavin believes that building up an international standard of healthcare within the country will take time.“It’s a slow process,” he says. “Cambodia needs about 40 years – from 1980 – to have a reasonable infrastructure of hospitals and schools. There’s another 10 years to go.”

Catch 22

Apart from the well-documented destruction of the health service during the Khmer Rouge period, what are the route causes of the below par state of healthcare provision in the country? No stranger to controversy, Gavin believes that part of the problem is caused by the exodus for healthcare overseas. @If the Cambodian elite have any medical problems they go outside of Cambodia,” he says. The quantity of middle-class Khmers currently sitting in waiting rooms in Ho Chi Minh City suggests that it is not just the elite that goes overseas for care.

It is the classic Catch 22 scenario. Without international standard healthcare both expats and wealthy Khmers go overseas for treatment, but so long as they do go overseas the standard of healthcare will not reach an international standard.

Demanding Better Healthcare

Both Gavin and Jean Claude agree that the situation is changing for the better, despite their disagreement on timescales. Part of the reason for this is supply and demand.“The influx of foreigners is going to demand better healthcare,” claims Dr. Reid Sheftall, general and plastic surgeon at Phnom Penh’s American Medical Centre.

Recently awarded a contract to provide medical care for U.S. Embassy staff, the centre is one of three international quality health clinics in the capital. The other two are International SOS and Naga Clinic.Reid believes that as more and more global companies establish offices in Cambodia, the demand for international quality healthcare as part of the expat package will increase.Nor is it just relocating expats who are requiring better care. Phnom Penh is experiencing enormous demographic changes which are placing new demands on the existing services.

Brian Ritchie has been branch manager at International SOS clinic for the last five years. In that time he has seen a shift in his patient profile.“Cambodians have brought back experiences from overseas and fresh expectations,” he says. These returnees expect more than a backstreet quack.

Like at Naga and the American Medical Centre, Khmers represent the majority of SOS’s clients – many sponsored by companies and international organisations. Sue Kemp, business development manager at International SOS, says that the number of locals on occupational health packages sponsored by their employers is increasing. SOS is responding to this growing demand.

Shopping Around

Things might be changing, but what can people looking for international quality healthcare expect to get at the moment? Naga, SOS and American Medical Centre are general practice clinics. All have a range of doctors, both expat and Khmers trained overseas. As well as general practice, these provide specialist knowledge in areas such as gynaecology, paediatrics and plastic surgery. All three have outpatient beds. In addition they all evacuate patients in emergencies.

To the lay observer, the differences between the three seem minor. Part of the attraction of International SOS is that it is international. Part of a global group with 24 clinics and offices in 50 countries, members can use any clinic overseas. They can speak to a doctor, possibly based in Singapore, any time of the day or night. The clinic also has an in-house laboratory.

Naga has a small operating theatre, though this is for minor operations such as the removal of cysts – none of the clinics perform orthopaedic surgery. It also seems to have cornered the Francophone market.Reid emphasises the extensive experience of the doctors at the American Medical Centre. He also says that either he or one of the other doctors will accompany patients being evacuated rather than a nurse.Dr. Gavin Scott’s Tropical and Travellers Medical Services is a nine-to-five general practice. This means that you have to go somewhere else for emergency treatment, but you do know precisely which doctor will be seeing you. All the others are open 24/7.

The Personal Touch

Possibly the key difference lies not so much in the services available, as in you – the client.Choose the right doctor and practice for you and your needs. If you have a pre-existing complaint, it is best to find out which clinic has a specialist appropriate to your specific needs. “Establish a rapport with your doctor and a clinic,” Brian suggests. “Get to know your doctor.” One of the advantages of living in such a small international community as exists in Phnom Penh is that you can get to know your doctor. General practices in the West, especially in large urban areas, are invariably impersonal.

Another of Brian’s tips is to “see your doctor early.” He points out that as some services, such as ambulances, are inconsistent. It is best to plan ahead. “Time is certainly a factor,” he says. “Don’t leave it late as you might do back home.”

Emergency Evacuation

However well you get to know your doctor or plan in advance, there are certain situations where you will still need to be evacuated. SOS’s policy is to send the patient to the nearest centre of international medical excellence. Often this is overseas.

While Reid states there are many routine operations that can safely be carried out in Cambodia, there are times when the operation really should be shipped overseas. This is especially the case when the surgeon is operating on one organ and other major organs are at risk.“When you do a major piece of surgery and you have any kind of complications you want specialists on hand immediately,” he says. Quite simply there are far more specialists in Bangkok or Singapore than in Phnom Penh.

Although the decision to evacuate is determined by a number of factors including the risk of increased morbidity or even mortality likely to be caused by evacuation, ultimately it is patient who decides.“If he feels strongly about going to Bangkok, then we’ll send him to Bangkok, if that’s what he really wants to do,” says Reid.

Sadly, another determining factor is insurance provision. Check that your clinic of choice has an agreement with your insurance company. It’s much less stressful to hand over your medical insurance card to pay for essential medical treatment than your Visa card. If the clinic does not recognise the insurance policy you have, then you’ll end up using your flexible friend to pay for the treatment.

A Healthy Future?

The recent opening of the Royal Rattanak Hospital in Tuol Kork provides further grounds for optimism. Run by the Bangkok Hospital group that operates 17 private hospitals in Thailand, the hospital has 15 physicians and 25 nurses. The two operating rooms and one delivery room are available 24 hours a day for emergencies. It also has four Intensive Care Unit beds and support facilities such as a laboratory and x-ray unit with state-of-the-art equipment.All interviewed welcomed the arrival of the hospital. Both the Reid and Brian look forward to working with the hospital in the future.

With all agreed that the standard of medical care is on the rise, perhaps Jean Claude’s timeframe of five to ten years is not overly optimistic. The French doctor has plans to open a diagnostic centre and even a new hospital in a year’s time. In the not-to-distant future we might even find expats from Vietnam and Thailand popping across the border to receive competitively priced medical services to an international standard. Currently at least general practice is to an international standard.

With the general growth in the economy and the influx of both expats and returning Khmers, the standard of medical provision should improve. “In the future, it’s only going to get better,” says Reid. “People should feel very secure.”

True Cost of Medical Care

Can’t afford to pay a visit to the doctor? Think again. The truth is that the price of a consultation in Phnom Penh is very competitive, especially when compared with what it would cost back home – or the potential long-term costs of not visiting one. All four practices take drop-in patients.

American Medical Centre
Groun Floor, Hotel Cambodiana, Sisowath Quay
www.ANC-Cambodia.com
24-hour number 023 991 863
Consultations – US$15 for Cambodians, US$30 to US$40 for expats (depending on extent of treatment required).

International SOS
161 Street 51
www.internationalsos.com
Tel: 023 216 911
Consultations are from US$45 (depending on which doctor you see).
Membership from US$190.

Naga Clinic
11 Street 254
24-hour emergency: 011 811 175
Consultations are from US$15 for Cambodians and US$30 for expats.

Tropical & Travellers Medical Services
88 Street 108
Tel: 023 366 802 / 012 898 981
Clinic is open from 9am to 5pm.
Consultations: US$50.