Prek Leap, Cambodia

We were woken around 06:00 this morning by the sound of amplified chanting from outside.

“Is that An’s radio?” I asked M. sleepily and none-too-intelligently.

“It’s probably a funeral,” she said, and rolled over and went back to sleep with surprising equanimity, despite the cacophony.

Her guess turned out to be correct. One of the neighbors, a haggard survivor of Democratic Kampuchea, had been sent home from hospital the night before and had died at home during the night. A local singer had been called in to chant prayers for him. R.’s housemates, who knew him from the university, went across the road to offer their condolences.

The dead man was sixty-four, which counts as old in a country where the average life expectancy is fifty-nine years and only 3% of the population reach sixty-five. One of the reasons must surely be the Cambodian healthcare system, which can most kindly be described as inadequate. Facilities are few, and the doctors are so poorly paid that many perform operations on the side or supplement their incomes with graft. One of M.’s colleagues described to her how a relative who was taken into hospital was simply hooked up to an IV and then ignored. Her care improved dramatically once the family sought out the presiding doctor and slipped him $5. This is not an option that is available to everyone in Cambodia.

When I last came to Phnom Penh, we went swimming with R. and a friend of hers, a young American woman who lived nearby. Today, we found out that R.’s friend had died a few months after our visit. She had been bitten by a friend’s dog while trying to break up a fight, and the minor wound had produced a case of blood poisoning that went undiagnosed until it was too late. A series of avoidable delays and unlucky chances had held up her evacuation to Thailand until it was too late. She was eight months pregnant at the time. The child also died.

For well-insured Westerners and the wealthier Cambodians, the preferred option in emergency is a rapid evacuation to Bangkok’s well-appointed Bumrungrad Hospital. But if a $5 bribe to the doctor is not an option for many Cambodians, a medevac to Thailand is unthinkable for practically everyone. The terrifying part is that even for those who can afford it, survival can still sometimes be a matter of getting there as soon as possible and not trusting to Cambodian primary care.

Things may be beginning to change. A recent issue of the local English-language newspaper carried a story about a Dutch-based NGO that has been given the task of reorganizing primary care in two Cambodian provinces, and has apparently started to make headway in reorganizing the hospitals under its jurisdiction, stemming the endemic graft that used to divert a substantial proportion of any funds available into official pockets and paying the doctors enough that they aren’t forced to sell off equipment and supplies in order to make ends meet. It’s encouraging news, but Cambodia still has a long way to go. In the meantime, the rule remains: bribe the doctor and pray for the first flight out.