Burnt to a crisp, parts of his clothes fused to his charred skin, his face black and locked in an expression of pain and horror, the patient had been doused in petrol and set alight by an angry boss. Shuttled from health center to provincial hospital and finally making it at impossible expense to the city, he lay in a so-called “Intensive Care” bed where staff gave him IV fluids and an injection, then walked away. “Several hours later, a doctor came in. He told us the burn was very serious and he needed to clean the wounds. But we would have to pay him $100. He told this to my grandmother. She is old and she had just lost a leg to a land mine. Through the evening, the price increased to $150. I was crying. I told the doctor I didn’t have $150. The doctor said “Well, I guess we don’t need to clean the wounds”. He took off his gloves and walked away”. That was the last they saw of him. Transported all the way home again with no pain control or treatment, a few days later, he died. No charges laid, not even, it would seem, a wrap on the knuckles.
Cambodia’s Curse, The Modern History of a Troubled Land
Joel Brinkley, 2011
Summarised and quoted from Chapters 12 and 13
This week I met a range of people with a range of health complaints. Each and every one of them has a story worth being shared. There are too many to share them all so the three most significant ones are summarised briefly here.
- A woman with an unknown skin disease (? necrotising fasciitis) which seemed to eat the flesh from her skin. When she presented to hospital the doctor asked “How can I treat you if you do not pay me?”. Loans from neighbours combined with a loan from the bank, totalling $4,000 of debt later, she has had skin grafts and appears to be improving but without any of the physiotherapy or other services someone in her condition could expect to receive in the world where I come from. Lying on the tiled floor of her tiny room at the top of some filthy concrete stairs in a crowded apartment block, she explained that her 17yo daughter left school and is working as a waitress for $120 per month while her mother cannot work. Aware of her plight, the landlord reduces their monthly rent of $40 when he can afford to do so. Loan repayments are a minimum of $200 per month and she suggested we might cover the family’s food expenses to assist? Sadly this is beyond our organisation’s budget capacity. We walked away as I wondered at the point of plummeting someone into a state of starvation while claiming to treat their health, with images of doctors driving Volvos and BMWs floating around amongst my thoughts.
- Thinking I had seen and heard my shock for the day, we walked through a narrow alley, turned a corner into a wider path crowded with activity – freshly caught fish grilling on an open fire, naked children playing with stones, older children in school uniforms, a motodup driver loaded with groceries, neighbours socialising. On a hard wooden platform outside a tin shack, a woman groaning in pain, her eyes shut, hand holding the edge of the platform she lay on, abdomen the size of a large exercise ball, skin a satin sheen from the swelling. Her husband brought the clinical paperwork to show me and I deduced despite my French illiteracy, a diagnosis of cancer with metastases on private clinic letterhead. As outlined by Joel Brinkley in Cambodia’s Curse, accepted practice here is employment on low wages in the public health system of medical staff who refer patients to their private clinics when the under-resourced public system has no capacity for diagnosis or treatment. Sources cite the debt due to health care costs in Cambodia’s poorest (80% of the population) as being catastrophic.
Does she have any painkillers? The doctors prescribed some but it depends if they have enough money to buy them, so her husband has to look after her in the day, then at night her children stay with her and her husband can work as a motodup driver. If he earns enough then they can buy the medicine but they only buy a few days at a time as they can afford it. So in effect, as I’ve learned happens to so many, she is dying of cancer without analgesia. Luckily my contacts from previous projects were able to put me in touch immediately with an NGO called Douleurs Sans Frontieres (Pain Without Borders) who offer palliative analgesia to the poor for free. A Khmer doctor and nurse working with DSF attended that afternoon, calling me later to confirm she was now in their care and asking me to refer any similar cases to them. When I asked my colleague, are there any other clients suffering like this, she replied “Oh! But last month, but she died already and oh my god, so terrible!”.
- On 27 January I mentioned in my blog, a woman walking around with untreated Multi-Drug Resistant Tuberculosis (MDRTB), receiving no follow up and not wanting to take the medications due to severely unpleasant side effects and higher priorities such as finding food and a uterine prolapse causing much more discomfort than the blood she coughs up. Yesterday I managed to get her to a hospital who claim to deliver “24 hour, high quality, free medical care for the poor and disadvantaged in Cambodia“. Posters on the wall requested donations to assist in maintaining this “free care”. Hours of my day were spent in a waiting room with the patient coughing, complaining of chest pain, expressing concern that she had no money to pay a hospital fee, and asking me to take her home because she felt normal.
At the end of a long and taxing wait, having dealt with many friendly, helpful staff all addressing me in English, two well-heeled TB doctors, noses in the air, tended to her, listening to her claims of no cough, no sputum, feeling fine, etc. A normal response for a patient so impoverished and visibly unwell with a dangerous communicable disease which always requires a multi-disciplinary approach, would be to elicit any possible information from an escort. Instead, my presence was not acknowledged except to ask her in Khmer who I was and why I was with her and ignoring my attempts to speak. Knowing what I do about the treatment that patients receive from many in the higher ranks of the health system here, it became quickly apparent that her imminent death from TB was an unimportant detail in this company. We left, required to pay a small invoice which would have been a larger amount except that the very decent receptionist negotiated the cost down after I, still reeling from the black hearts in the TB Department, pointed to the “free care” signs, and likely seemed as if I was threatening to make a fuss.
Next week we will try again to find a way to see this patient supported to receive the TB treatment that she needs. Meanwhile, for months she has been transmitting a dangerous disease throughout her already-unwell community. Obviously Tuberculosis continues to travel unabated throughout this country, with untold unnecessary misery and death, primarily among the poor whose demise are mostly invisible and uncounted. Caught up in this pandemonium are reliable accounts of TB drugs, ostensibly regulated to reduce improper use, being available on a black market. The global public health implications of this should cause all of us concern regardless of where we live.
This week’s news headlines – difficult to find in any Google search – have told of a wealthy landowner who requested military intervention to remove people living on land she had taken dubious ownership over. One death and a number of injuries later, the landowner is said to have escaped the limelight, to her Australian home!
Phnom Penh Post : Families Vow to Fight On
Phnom Penh Post: Military Violence
I have often wondered at this quote by Nelson Mandela but in recent weeks I have started to understand what he meant and that poverty really is a man-made construction, built of corruption, greed, power imbalance and black hearts.