In Roka, a small village of 1700 inhabitants in the province of Battambang, more than 200 HIV-infections have been discovered in the last two months. Among these are small children and people of over eighty. In one family with 16 members, 15 have been infected.

Cambodia has a good track record in reducing and preventing the prevalence of AIDS. The disease came to the country in the beginning of the ’90s, on the heels of the UN-mission. The presence and easy accessibility of prostitution caused a quick rise in the number of infections, especially amongst the usual groups: prostitutes and their customers, intravenous drug users and homosexual men. Since then, a targeted approach, backed by huge foreign support, has been successful. The spike in the number of infections was in 2003 and the number is still decreasing, contrary to the regional trend. So the sudden high number of infections in Roka is very remarkable, but seems, at least in part, related to the bad general condition of the healthcare in Cambodia.

Cambodia has a publicly financed system of healthcare, with local health centers and regional hospitals, free of charge or at low costs for most patients. Cambodians prefer not to go there, only 19% of expenditure on healthcare is spend in the public health system. . This is caused in the first place by the preference for traditional medicine of most Cambodians, which is delivered mostly through “Kru Khmer”, traditional healers. Even when Cambodians want to use the modern healthcare (mostly after trying the traditional healing first), when they have a bit of money they go to a private clinic, and preferably to a foreign doctor or nurse.  They have good reasons for it. If there is someone present in a health center at all, the patients will very likely be treated rude, they will get a wrong diagnose or necessary equipment will not be there. The salaries of the employees in the health centers will usually not be enough to maintain their families, so often they have or work at a private clinic as well. That causes the weird situation that they have an interest to maintain the quality of the health centers at a low level, because that causes people to go to their private clinic where the quality is better (or at least they’re not treated rude).

Better quality usually doesn’t mean good quality when the doctor or nurse has been educated in Cambodia (of course there are exceptions). The quality of the medical education is too bad and after training there’s no education to keep up with new developments. Until recently the medical studies at the universities were in French, while all other studies are in English or partly in Khmer. The use of French must have had a value in Cambodia in the ’50s and ’60s, when the elite spoke French and all good schools were French-language schools, but in the present Cambodia it’s nonsense. Hardly anyone speaks French at a conversational level, let alone at the level required to study medicine. That’s not a problem to the students, though, they just pay to pass their exams. This system educates doctors who diagnose in French, but then don’t have a clue what they’re talking about. The expat experience of Cambodian doctors making a wrong diagnose, is not so strange.

Cambodians themselves are not easy patients who listen to their doctor, accept the diagnose and stick to their treatment. They have their own preferences. When they visit a doctor, with whichever ailment, and they don’t get intravenous therapy, they’re not served well and go to another doctor. So everyone gets it, even for a simple cold. Probably, that’s what happened in Roka. The village had its own doctor, who freely gave intravenous injections, so was very well regarded. Basically not a huge problem, but this doctor re-used needles and syringes, preferably more than once. That of course is a great way to transfer diseases, not just HIV, and that seems to have happened here. Even then the number of infections seems to be too high for this one cause, so the investigation is ongoing.

Although nobody has died, and this is unlikely to happen in the short term due to the availability of medicine, the doctor has been charged with murder. That might say something about the condition of the legal system in Cambodia.


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