Where health care means poor care

The room was 25 by 10 feet, crammed with five metal beds covered with blue rubber mattresses. Four of the beds were occupied: one by a semiconscious old man with a yellow fluid flowing into his arm via an intravenous tube; another by a middle-aged man with his pants bunched around his ankles awaiting an injection that was soon deposited in his ample gluteous maximus; a third by a young child whose plaintive protest I could hear as the doctor approached with an unwanted injection; and the fourth by my friend Tony’s wife, Paolla.

Tony had called me in an uncharacteristic panic, abandoning his post as a tuk tuk driver and asking for help. Paolla has been sick for months, first with a thyroid condition that required surgery and then with stomach and throat complications that leave her unable to eat, swallow comfortably or sleep through the night. Three days earlier, Paolla had stayed at home while we went to dinner with Tony and his three kids, and Tony had taken her to the doctor for yet another expensive shot just yesterday.

Her call to him for help – and his, in turn, to me – was bad news. We arrived at Tony’s “room” in Phnom Penh Tmey after a frantic 30-minute dash in Tony’s tuk tuk through Phnom Penh’s chaotic streets. We discovered Paolla curled up on their sleeping mat in the tiny 10×10 foot room they call their home. She was awake, listless and in extreme discomfort.

After Tony chatted quietly with her for a few moments, we helped her up and into the tuk tuk to take her to the nearby clinic, Tony declining my to the SOS International clinic where Gabi and I go when something ails us.  “Too expensive,” he protested, ignoring the fact that I’d offered to pay for the treatment.

So off to the local clinic we went, Paolla and me in the back of the tuk tuk and Tony weaving among the late-afternoon traffic. Pla reached out to me, placing a leathery hand atop mine and smiled.

“Orkuhn chran,” she said, looking me deeply in the eyes. “thank you very much.” She pointed out the clinic to Tony, who would have sped past had she not intervened, and after stopping at the pharmacy adjacent to the clinic we were directed towards an empty bed.

Welcome to health care,  Cambodian style, replete with dirty floors, unsanitary conditions (there were bloody gauze pads on the floor beneath Paolla’s bed) and an array of doctors with grubby lab coats, dubious credentials and questionable diagnoses and treatments. This is a country that spends less than $3 per capita per year on health care, less than half of what donor expenditures amount to. More than 75% of total health care spending is from private-pay sources, meaning you get care if you have money.

As the Cambodian saying goes, “No money, no honey.”

They plugged Paolla into a blood pressure machine, and one of the three doctors who would look at her in the next 20 minutes frustratingly tapped the machine in an effort to get it to work. It failed, and he walked away.

No one took her vital signs.

No one looked at the bag of pills I had suggested that Tony bring along to show what Paolla had been previously given for her ailments.

No one looked with any seriousness at the MRI of her throat that was taken at another clinic and had readings in French.

After sometime and several cursory visits by men and women in lab coats, a doctor appeared who was slightly older, seemed more credible, and thankfully spoke fairly good English.

“She has high blood pressure,” he announced, smiling and pointing to the sphygmomanometer attached to Paolla’s arm.

“140 over 102 doesn’t seem that high for someone who’s stressed, dehydrated and hasn’t eaten anything but rice porridge for weeks,” I thought to myself, and it dawned to me that my horribly limited medical knowledge might just rival that of the guy in a lab coat who stood before me.

I acquiesced, though, and took another tack.

“What is the condition of her throat?” I asked. HIPAA laws don’t exist in Cambodia, so docs here are apparently free to talk about anyone’s condition with any jerk off the street, so he willingly obliged.

“She has nothing wrong inside her throat. It is fine, just some pharanxitis. I am giving her medicine for that, and for her high blood pressure, and some to help her sleep.”

He seemed jovial, unconcerned and prepared to write off Paolla’s discomfort not as a serious malady but a nuisance for the poor woman that would either go away or that she’d learn to live with.

It dawned on me: This is the hard edge of life in Cambodia, and it’s a part of living here from which I am comfortably protected. As a westerner with a few bucks in the bank such harsh realities simply do not apply to me. There is no safety net for most poor Cambodians, no backup plan, no social program to step in and help the country’s most indigent and needy.

Cambodians are literally on their own, and as I watched Tony tenderly knead his wife’s calves, offering Cambodian-style relief that is their answer to most maladies, I felt their solitude. I felt how isolated they are  from the wonders of the world’s fantastic medical advances. I saw in this instant how little access they have to answers to  medical questions  we in the West ask with expectations for clear, conclusive and immediate response.

I saw the potential for misdiagnosis and error – it is literally a crapshoot, a guessing game with another human being’s life when you enter one of Cambodia’s roadside clinics. And though it’s not fair to assume that Cambodian doctors’ caring is as woeful as their formal training, I wouldn’t take a pet to one of this clinics in my home state of Massachusetts.

I also understood why Tony asked me along: for comfort and help, but also in hopes I might have a clue what was going on.

To that end, I failed him.

Here is the bitter reality of life as a Cambodian. Figure it out, pay for what treatment you can afford, get lucky, or the consequences are yours and yours alone. It’s a fact of life that people die in emergency rooms here every day from lack of competent care after accidents, illness or other trauma.

After about 30 minutes Tony informed me that his sister was on the way to stay with Paolla, and that she would be staying at the clinic “for long, long time.” So we got ready to leave. Minutes later, the doctor appeared again with a fistful of pills, some cryptic instructions in Khmer, and some quick but kindly answers to my questions about what Paolla could – and should – be eating to regain her strength.

And we were out the door, back in the tuk tuk and on our way to Tony and Paolla’s room, where she once again curled up with a fresh load of pills next to her. There was a quick conversation with a concerned neighbor, and a pat on my hand with a “sampeah” – hands clasped and raised to her face in a gesture of thanks and gratitude – and that was it.

Tony and I were off: him to seek a tuk tuk fare on the streets of Phnom Penh, me to catch up with Betsey and Gabi and resume the day’s activities.

Paolla returned to the isolation of a hot room, ills that won’t go away, and pills to take that do nothing to ease her pain. Alone and out of sight from a system that once again turned its back on its own.

      4 comments

      • Howie Sholkin

        It’s a sad commentary. Her blood pressure isn’t much different than mine and I don’t take medication. How about a second opinion at the clinic where you go?

      • Just read this, in an effort to inprove my social networking skills. After six years here I’ve had many similar experiences. Best place to take our Cambodian friends in these situations is the Sihanouk Centre for Hope Clinic on the road to the airport. It cost me $14 to get my former security guard’s blood pressure sorted after he had been put on (what turned out to be) fake pills by another clinic, and also dangerously injected with something to bring the pressure crashing down. Apparently this could have killed him, and they did it twice. SCHC has a new clinic not far from SOS and aiming more at westerners but without the high prices. Improving health care by showing role model doctors & nurses and best-practice clinics, and by raising the expectations and base knowledge of patients, is one of the key objectives of our new drama series, watch this space for details…..

      • Just read this, in an effort to inprove my social networking skills. After six years here I’ve had many similar experiences. Best place to take our Cambodian friends in these situations is the Sihanouk Centre for Hope Clinic on the road to the airport. It cost me $14 to get my former security guard’s blood pressure sorted after he had been put on (what turned out to be) fake pills by another clinic, and also dangerously injected with something to bring the pressure crashing down. Apparently this could have killed him, and they did it twice. SCHC has a new clinic not far from SOS and aiming more at westerners but without the high prices. Improving health care by showing role model doctors & nurses and best-practice clinics, and by raising the expectations and base knowledge of patients, is one of the key objectives of our new drama series, watch this space for details…..

      • Francie

        Two things occur here: that you are seeing the underbelly of a system that prevails in much of the world, and that you are insulated from it by virtue of being a Westerner. There is both sorrow and relief in your words — sorrow that you can see what they must cope with daily, and relief that you are not in their shoes. The sum of those parts is …. what? What action now? What forward movement to change it? What changes in your thinking as a result? In short, what will you do with this micro-view of life in Cambodia? (The extremity of these lives is profound. What DO we do to help?????)

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