AsiaLIFE

In 2009, AsiaLIFE published an article on the state of healthcare in Cambodia, in which local doctors were asked for their opinions. Jeffrey Staggs sees how the situation has changed, if at all. Photography by Dylan Walker.

Ann Kattheya has one eye. Doctors removed her right eye last month because she had retinoblastoma, an aggressive form of eye cancer. Kattheya was not interviewed for this article. She is 16 months old.

Her father, Vannara, took her to a government eye hospital in Ho Chi Minh City. They have been to the Vietnamese hospital three times and will go again in two months. Vannara says his local doctor recommended taking Kattheya to Vietnam or Thailand because cancer treatment facilities there are superior to those in Cambodia.

Perhaps little Kattheya's plight sums up the current situation: A Cambodian doctor advised a Cambodian patient to see a Vietnamese surgeon in Vietnam.

When asked how much healthcare in Cambodia has changed since she started working as a general practitioner at the International SOS clinic in 2004, Dr. Laura Watson answers succinctly.

"Honestly? Very little."

More specifically, she says "For serious or complex illnesses requiring surgery or complex diagnostics, the quality of care in Cambodia has still not reached international standards".

Dr. Jean Claude Garen is more optimistic. The founder of Naga Clinic has been in Phnom Penh since 1994. He believes the situation is improving, but, as he says, "not so quickly.” He estimates that 60 to 70 percent of a patient's medical needs can be met within Cambodia.

There is a greater range of medicine available, he says, "but we can not do all treatments here." As an example, Garen notes that there are no cancer centres in Cambodia. And thus a father must take his infant daughter to Vietnam to have her eye removed.

Watson notes "some improvements in lab quality and range of tests available." She and other doctors agree, however, that patients should seek treatment abroad whenever the word "complex" creeps into the conversation regarding treatment, diagnostics or procedures.

Since AsiaLIFE’s 2009 article, shiny new facilities have sprouted up all over town. But newer doesn't mean better, doctors warn. "Many people still find it hard to see past the gloss of a shiny facility and ask questions about the experience or qualifications of the staff working there," Watson says.

This sentiment is echoed by Dr. Gavin Scott, who started working in Phnom Penh in 1992 and thus will forever hold the title of being the city's first western doctor. In 2009 he was the most pessimistic of all the doctors interviewed. He is still the owner of Tropical & Travellers Medical Services—and he is still pessimistic.

"Expensive looking new clinics and some old hospitals now boast the latest equipment and advertise all sorts of things, so superficially the perception may be that things have improved," Scott says. "In fact things have improved more for the clinic owners—there are more patients with more money to spend—but not so much for the patients."

One such patient is a foreigner who has been working in Phnom Penh for four years. He went to a local hospital with severe stomach pains. A misdiagnosis led to an unnecessary appendectomy, and his employer provided an emergency airlift to a hospital in Bangkok. The correct diagnosis was a blockage in his colon.

What follows is a long, gruesome story. The short version: Five weeks in the hospital, 10 cm of colon removed, 20 kg of weight loss, a few weeks of recovery in Phnom Penh and three more weeks in the Bangkok hospital. He is back to normal now, albeit with a series of parallel scars on his abdomen that make him look like he narrowly escaped an encounter with Freddy Krueger.

This patient was sent to Bangkok by his employer. Scott says one reason that patients, both foreign and local, choose treatment abroad is "the confidence patients have in the many local doctors possessing medical degrees from Europe or America. Such confidence will in time come to Cambodia as more Cambodian doctors study abroad," he says, "but we are not there yet."

The Catch-22 remains: Patients go abroad for better healthcare, but healthcare can't improve locally if patients leave the country for treatment.

Doctors stressed that it is both Cambodian and foreign patients who seek treatment abroad. The facilities may improve, Garen notes, but the biggest obstacle facing doctors is overcoming ingrained attitudes. "The first step is to give confidence to Cambodians," he says.

It should be mentioned that these conversations centred on healthcare in Phnom Penh. Doctors agree that healthcare in the countryside lags far behind that in the city. This is not a Cambodian problem, according to Scott.

"Doctors will always migrate to the cities where the money is, therefore medical care is always better in the city," he says. In fact, while it is easy to fall back onto the "blame the government" argument, Dr. Scott offers praise. "I believe the Cambodian government has an excellent policy of requiring newly qualified doctors to spend some time in the provinces," he says. "Medical NGOs are the de facto providers of healthcare in some rural provinces."

What can a patient do to ensure quality care? Ask questions.

"Be sure that the health professional you seek advice from has the qualification they say they do," advises Watson. "All health professionals should be happy to share credentials and it's usually easy to check online whether doctors or nurses are registered."

Because treatment abroad is generally best for the most serious cases, doctors recommend health insurance that includes provisions for emergency evacuation.