Tuesday, September 27, 2011

When You Need a Doctor….

Where do you go in Phnom Penh? I am sure this problems confronts most expats at one time or another during their time in Cambodia. I believe a fellow blogger - ”LTO-Cambodia” - gave a pretty good run-down some time back of what’s available in Phnom Penh. My recent experience makes me take up that subject one more time.

Fortunately, I am a very healthy individual and don’t need a doctor much. Since I usually leave Cambodia at least once a year I have any necessary check-ups done abroad, formerly in the U. S., now in Europe. Although the health care system is excellent, the cost in the U. S. is prohibitive, now that I don’t carry U.S. health insurance any more. Germany has an equally excellent health care system, and the cost is only a fraction of that in the U. S., even as a private out-patient. The great advantage there is you only need to go see one doctor. They all have the necessary equipment in their office, e. g. ultra-sound, X-ray, their own lab, etc. In the U. S. you are sent from one office to the next, which really makes seeing a doctor a big hassle.

Unfortunately, my wife is afflicted with some more or less minor health problems, which I presume to be the consequences of her early childhood during the Pol Pot years. Of course, she used to go to local doctors, or clinics, which abound in the city. Later she got quality health care in the U. S. and in Europe.

Here are our experiences with health care in Cambodia. A few years ago, around 2005, my son needed medical attention and we took him to one of those store-front clinics. The sanitary and hygienic conditions were repulsive and disgusting. Bedsheets were a nice ‘grey’; although people walk barefoot, the floor was grimy. The doctor wanted to give my son an injection, which didn’t happen because of his needle-phobia, and I was grateful for it in that instance as we really didn’t know whether it would have been advisable to have that needle stuck into him. So we left. Of course, compared to Western fees, these services are outright cheap, but you don’t know whether you go home in better or worse health. Needless to say, that was the first and last time we went there.

Initially, my step-daughter didn’t live with us in the U. S. During that time she was suffering from a rather rare syndrome in her intestines (I don’t want to go into details here), which we didn’t know about as it had not manifested itself before. But then she started suffering from nausea, vomitting, stomach and abdominal pain. A friend of my wife’s took her to a clinic. The first thing they did was hook her up to an IV, as they always do in Cambodia, whether you need it or not. The diagnosis was as hazy as the doctor’s knowledge. It was during the year we came to pick them up to come live with us. During our stay that same friend advised us to see a ‘famous’ doctor, apparently one of the chief doctors at the Calamette Hospital. He did bloodwork, took X-rays, and seemed to examine her thoroughly. His diagnosis: she had water in her abdomen. How it got there and the cause of it, that eminent doctor didn’t know. Treatment: another IV. Charge: $50.

When we got to the U. S. her symptoms persisted and I took her to an internist who just by looking at her was able to diagnose the problem (there were outward signs by which an expert recognizes the syndrome immediately). Naturally, he ran all the necessary checks and tests on her, including endoscopy and colonoscopy and started a treatment, which brought about a remission of that syndrome. Now that we are Cambodia she is still sympton-free and enjoys the normal life of young woman.

In my early years here I had a stomach problem, which was accompanied by a slight fever. Fearing a malaria-type infection my friend suggested I see the Tropical & Traveller’s Medical Clinic. A Western-educated doctor examined me, diagnosed minor food poisoning and gave me appropriate medication. Charge: $50. That was in around 1996.

My son suffered from sneezing fits. On one of his visits it got so bad that I took him to a nose-ear-throat specialist at the Aurore clinic. The doctor found the culprit quickly; unfortunately, the cure would have involved minor surgery, which we didn’t want to have done here. My son got some medication though, which helped alleviate the problem. Cost: $15, plus medicine (2009).

Since Florida my wife suffered from chronic allergies. These abated when here – for whatever reason – but one time they came back and got so bad that we decided to see the same doctor at Aurore. He prescribed a range of medicines; one of which produced a severe reaction in the form of stomach pain. Result: she needed to spend a night there in order to settle down her stomach; of course, an IV was administered as well. This time though, it definitely was part of the healing process. Cost for all of this: $100 for private room, food, care, medication (2010).

This past May, my son was visiting. He arrived with a severe cold, which I also unfortunately caught from him. Having had a rather good experience with the good NET doctor we went there again. Again, as seems to be the practice in Cambodia he prescribed about 5 to 6 medicines for him and for me. Charge: $25 plus $15 for the X-ray.

They eventually helped and after a week or so he was ok again. I, however, couldn’t shake off that cold, and on top of it I lost part of my hearing in my right ear. All that multitude of medications didn’t help. I went to see him about the loss of hearing; he said I needed to be a little patient. It is connected with the cold. After 3 weeks it hadn’t gotten better one bit so I decided to seek help from the NET doctor – a Russian gentleman - at that new hospital in Phnom Penh Thmey – the Sen Sok University Hospital. He prescribed a simple remedy: close your mouth and nose by clamping your hand over it, then exhale strongly so that your ear pops. Then swallow. Repeat that three times a day. After a week the hearing should be back. Lo and behold, it was back after a couple of days. Cost: $50 (2011).

Heartened by this experience, we went there again for a case of suspected heart troubles some time later. Fortunately, it turned out to be a false alarm. Cost of consultation and ECG: $100.

A splitting headache caused us seek their help again. The doctor order bloodworks and once the results were back prescribed the usual plethora of medications. The medications helped; the headaches subsided. Cost: $100 for the bloodworks, $40 for the consultation, and $60 for the medications.

Like many people we self-medicate minor problems. A few times there were urinary infections, which were healed with anti-biotics. But the problem with anti-biotics and with medication to relieve headaches, like ibuprofen or aspirin, is that they affect the stomach and can cause an inflammation of the stomach lining if taken over a longer period of time.

This happened to my wife. So we went to Sen Sok Hospital again. The good doctor, after listening to the description of the problems, immediately inserted an IV – what else? Then he suggested that she stay overnight for observation; additionally an upper stomach fluid probe needs to be taken and tested. So far so good, I thought, as he explained he needs to rule out certain causes to be sure which treatment to administer. The test came back negative, that is, no bacteria, fungi, etc.; diagnosis: gastritis from overmedication. Cost for test and consultation: $60.00.

The next morning when I came to pick her up she was still hooked up to the IV – the third one she told me – and additionally there was another bag added to the drip. My wife complained that the doctor hadn’t been in to see her at all. I went to look for him. Well, I found him downstairs at the entrance cleaning his large Lexus SUV himself, watched by a couple of male nurses. I approached him and asked whether he would have a minute. So we went aside, he with sweat on his brow, and he explained that the second bag contained medicine for the inflammation of the stomach; once that was finished she could go home. As it happened, that took a little over two hours. The nurse mentioned that she wanted to hook up another IV, which met with our determined protests. We just wanted to go home.

A few minutes later, she showed up again with the bill in hand. The total: $297.49. I looked at it and thought there must be a mistake. After all, I had already paid $60 the previous night. They must have added the bill for the room by mistake twice. At the cashier’s office the woman explained that indeed this was correct as my wife had been there two days. She had checked in at around 5 pm. It was then 2:30 o’clock the next day, so she was charged $60 for the room, consultation, and nurse’s care twice. I objected strongly. Also on looking closer at the bill, I found that the charges for all medications were $125. I was wondering, “What on earth had been so expensive?” One IV was $20 to begin with, plus that special drip was $30. Long story short, I argued back and forth with the good doctor who finally agreed to reduce the bill. He had also prescribed 4 medications; for another $46, mind you. Two were for stomach relief, one was for fungi, and one – another anti-biotic - was for bacteria. Now that threw me. The tests were negative for both, and the anti-biotic was the culprit in the first place. How can that quack prescribe one redundant and one in her case harmful medication? I just told the nurse to keep them. In the end I paid $180, and made it clear to the doctor and the nurses that they wouldn’t see us again at their institution. That whole thing was a rip-off, if ever there was one. And the irony of this story: they advertise 50% discounts on a big banner at the entrance.

Now where does that leave people who look for qualified medical care in Cambodia? I still believe the Sen Sok Hospital is a rather good place to turn to. They have experts in almost all fields. Their diplomas are displayed prominently in the huge waiting area. Most have degrees from the U. S., France, South Korea, Thailand, or Russia. In addition to the NET, the OB-GYN is Russian as well. A few have Cambodian degrees. That international background persuaded me to go there in the first place, never mind the slightly higher cost. The way I see it the doctors there get a base salary and then receive premiums for patients treated and medications prescribed. It was rather conspicuous that on each occasion they wanted to keep my wife there overnight. I guess a way to avoid that is to talk to the doctor very clearly about the expenses.

The best-known hospital in Phnom Penh is the Calamette, a French-run hospital. At one time I needed to take an old aunt of my wife’s to the ER. The conditions there are appalling. People who look like they can’t afford it (e. g. that old aunt) are kept waiting for hours. Doctors simply refuse to look at them. That place is definitely not for foreigners, although from what I know it is the only place where emergency surgeries are performed. In general, if you are not going to be treated by a French doctor I wouldn’t go there.

The a. m. Aurore is a place with expert doctors as well, whether it is an internist, NET, OB-GYN, urologist, etc. The cost is pretty reasonable and although the place looks a little run-down, it is clean and has all the equipment needed. The experts also perform surgery in their fields. The rooms are located in the upper stories. At least you won’t have to bring your own food. They feed you too. A consultation is $25; the room with board is $60; an X-ray is $15. They also have an MRI; I don’t know the cost for that, though.

Another international-class hospital is the Royal Rattanak Hospital. This is a Thai-run institution; it is big and looks modern and clean. The drawback there is that they only provide general medicine, which may be enough in most cases, but I am a firm believer in specialized care. If you don’t earn a high income or have adequate health insurance you might not want to go there anyway; a consultation is $125, the rooms start at $250 a night.

Then there is the American Medical Clinic at the Cambodiana Hotel. It is staffed by American doctors; a consultation is $45. Again, the drawback here is only general medicine.

Other than that, I am sure there are a number of hospitals, clinics around that I haven’t heard of or know about. But who wants to try them out as a sort of guinea pig? We will most likely use the Aurore from now on.

A word about those ever-present IVs, people even ride on the back of a motorcycle attached to one; I don’t know for sure but I believe doctors prescribe them automatically as they know that strangely enough Cambodian people don’t seem to drink enough and may be dehydrated a lot of times. Dehydration is a major cause for headaches, and anybody who has ever come in closer contact with Cambodians knows that they suffer from headaches and migranes a lot.

But principally I go by two rules that a doctor whom I knew rather well gave me:

‘A cold will take a week to go away with medication, and 7 days without medication.’

‘Don’t ever have anybody stick a needle into you, or cut you open, unless it is absolutely necessary.’

And finally, depending on the kind of coverage, age, history, etc., basic health insurance is about $85 a month in Cambodia, which is cheap in comparison to the West but given the low cost of health care in general it usually doesn't pay to buy one. The big if is, of course, hospitalization for a grave illness, a traffic accident, or similar, treatment of which might run into the thousands, if not hundreds of thousands. Then you are screwed if you don't have one. Think about that when you go see a doctor next time, or better, get one now.


Ms Ana said...


I've just lost my cambodian maid passport. FYI, I'm Malaysian. What should i do in order to do a new passport for my maid? Need your kind help.

KJE said...

Ms. Ana,

There is only one way to resolve this; you need to contact the Cambodian Embassy in KL. This is part of their job. It will take forever, though, as your maid will have to provide documents that she is indeed Khmer, e. g. identity card, family book, carnet de residence, etc. If she doesn't have that with her, she needs to contact her family so they can send it by courier service. She must have a Malaysian work visa, which is another proof to show the embassy. I also believe if you make a donation to a worthy Khmer cause, you will get faster help.

Cao Mieng socialist said...

Thanks for the helpful info. I noticed many Cambodian travel to Viet Nam to get a medical treatment and surgeries. Not many people trust Cambodian establishments. However treatment for minor things should be rather affordable and there's no waiting lines and lots of educated bullshit we meet at the West. You know, I had a food poisoning, or something like that- I felt I was dying and my wife brought me to Mittapheap clinic on Monivong by the traffic police post (the Vietnamese doctor who worked there already left, so new doctors aren't good- no promotion intended), I got better after IV, and the next day left to home, sitting on moto with my wife holding IV behind me. Same-same as you described. I mean it's good. It's more or less affordable to poor and there's no medical license required to open a practice. It's more laisser-faire than Government backed, AMA covered medicine in the US. And there's local practitioners too, operating without premises. You know, in the Land of Freedom they finish not so nicely for operating without medical licenses and business license. So drastic state of Cambodian medicine might not be that bad in this sense.