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.

Thursday, September 22, 2011

Next Steps for the SRP

The Appeals Court reduced Sam Rainsy’s sentence by three years to seven. This has been the only item about him in the news for a long time now. Nevertheless some still ask whether he will get that royal pardon or not. I personally doubt it. This time the rift was too deep.

In that context I would like to quote two cables courtesy of Wikileaks. At about the same time I had come to the same conclusions – and I am no politician. Sam Rainsy is currently a non-entity in Cambodia. His virulent anti-Vietnamese rhetoric just does not resonate with the people as a whole. He merely panders to the geriatric Lon Nolists overseas with his diatribes.

Cable Jan. 29, 2010 - Excerpt
9. (C) The SRP Permanent Committee agreed January 28 to file an appeal later during the 30-day window, even though the initial public rhetoric will focus on the inability to secure justice and the futility of an appeal. Among the core SRP leadership, there is a realization that the loss of Rainsy's charisma, his dramatic speaking style, and his ability to unite will be keenly felt in Cambodia. A strategy to hold several digital video conferences with Rainsy from France and assurances of renewed commitment by the party faithful appear to be attempts to put a brave face on a serious setback. Some in the SRP worry that Human Rights Party (HRP) President Kem Sokha is already intent on stealing away SRP members to
the HRP in an attempt to make HRP the "legitimate opposition" that the CPP knows that it needs. Fissures in the SRP appear to be emerging with one group of accomplished and publicly
popular parliamentarians such as Son Chhay and Mu Sochua potentially squared off against an inner circle close to Rainsy and Tioulong Saumura, Rainsy's spouse and fellow SRP MP. Some observers see the Rainsy case as an old CPP tactic to divide and conquer the political opposition and suggest the CPP tactic is working.

-------
COMMENT
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10. (SBU) In both the prelude to the hearing and the reaction to the verdict, the SRP appeared uninterested in addressing the actual charges of Rainsy's role in property destruction and incitement, and instead focused on the larger issue of whether the border markers are improperly placed (Ref B). Rainsy continues to claim sole responsibility for the removal of the temporary border markers, despite video
showing he did not physically uproot them but brandished them for the cameras after others had pulled them up (Ref A). With the January 27 verdict, Rainsy cannot return to Cambodia unless he goes to prison or receives a pardon, which requires agreement of the government. In the meantime, without a leader present in Cambodia able to project a confident image and articulate opposition perspectives, the SRP faces tough decisions about what to do next and the ultimate direction of their party. In the end, most find it difficult to imagine how Rainsy's stunt will increase the SRP's political relevance in Cambodia, despite the headlines it attracted by Rainsy's very visible and vocal efforts to mobilize anti-Vietnam passion while most of Cambodia's population was focused on Thai border issues. However the SRP emerges from
this incident, it is clear that -- at least for now -- the playing field for opposition politics has been reduced as a result.
RODLEY

Cable Dec. 18, 2009 - Excerpt
Rainsy is doing nothing to calm the waters form his Paris venue, where he lashes out at the government a and attracts opposition funding. If Hun Sen sticks by his recent fit of pique not to pardon Rainsy until Rainsy has served two thirds of his sentence, the opposition may well have to readjust its leadership calibrations.
End quote

Meanwhile of late, the SRP members of parliament sent a letter to the local director of the World Bank asking that the WB maintain withholding funds from the Cambodian government until the Boeung Kak Lake issues have been resolved. Although those issues are indeed thorny and remedies are overdue and come rather late, if not too late, I have never read or known that MPs advocate measures aimed against their own country no matter of what quality they think the government is; those funds indirectly benefit their own constituents, among others. It is the WB’s perfect right to suspend funds, but for parliamentarians to ask them goes against the responsibilities and duties of elected members of parliament; it directly contravenes the principles of democracy in my mind. As long as the opposition is of such a caliber there is no chance on earth that they will ever have enough stature to be part of a government. So where is the alternative leadership the U. S. ambassador refers to? Isn’t it time for them to be more vocal? I haven’t read anything from them or about them. Two years until the next election is not a long time in terms of a campaign that has to make do without a lot of money for media exposure.

Friday, September 16, 2011

Boating in Cambodia

First off, there is no boating in the sense we normally understand it in Cambodia. There are a couple of charter boats in Sihanoukville for tourists, notably one run by a Kiwi and an Aussie – a 12m regular fishing vessel, with a small bar, head, and so on. They offer day trips to outlying islands. Other than that, you don’t see a whole lot of recreational fishing.

I am an avid boater and had to do without one for over a year now. I am really itching to get back on the water. Although, to be honest I am not that great a fisherman, this is still my most favorite pastime. People who fish know what I am talking about. There is nothing quite like it if you are out on the water dropping your lines to the bottom and getting that bite and the line starts reeling off like crazy. Of course, those are the great times. The other times are much more frequent though; you just sit there and nothing moves. It’s really frustrating sometimes. You see all those nice fishing reports online accompanied by trophy pictures or even videos of the catch, and you were out there to show zilch for it. The only consolation is that those great reports are usually written by pros – charter captains - this is one way to lure new customers to their business; and they know from long experience where the fish are. We all know the saying ‘You got to fish where the fish are.’ To find that out, though, takes time and patience, not to mention a bit of money for the gas. Those marine motors don’t just sip gas, they guzzle it. Nevertheless, the true fisherman never gives up.

Now if one were to believe boat salespeople the only thing you need is a great boat, preferably big, with big, powerful motors, and the fish will just wait to snap up your bait. Frankly, I succumbed to that sort of persuasion once myself. I got a nice boat that could take me out 100 miles offshore. More often than not, I didn’t come home with dinner for four, maybe for one. At $3.80 a gallon, I had just blown $100 for one fish.

Now I am ready to get back into boating here as well. After all, the main reason I bought land and built a house on a riverbank about 500 m from the open sea was that I could get out quickly, maybe just for a quick spin of an hour or two and head back in, hopefully with a cooler full of fish. But where to get that boat? I had been looking all over the place but apparently the only thing available were those traditional wooden fishing boats that lie low in the water and have a sort of a lawn-mower motor with a driveshaft and propeller attached to them. The bigger ones have Diesel engines; but they normally only produce 30 hp and that doesn’t get you anywhere fast. Those boats are affordable sure enough, but it really isn’t what I was looking for. They go about $2,500 for a smaller one (used with motor) to $20,000 for a bigger, new one as in the picture with a 30hp – Diesel.

10 m traditional fishing boat


Then one day I spotted an ad on www.bongthom.com – somebody was selling a 10 m traditional boat and a speed boat with twin 200hp Yamahas. The traditional boat was $5,000, if I remember correctly, but it had that diesel engine, bilge pumps, etc., so maybe this was an alternative. The speed boat was $40,000 and with those two motors would have burned a big hole in my pocket. I checked them out both. Not for me.

The seller, a guy named Rob (he won’t mind giving his name here as this will possibly help him) – friendly as he is – pointed me to another outfit in Koh Kong. They had a 22’ center console monohull with a 140hp Yamaha on it, which exactly fits my bill. So off I went to take a look at that boat.

If I ever saw a ‘great’ salesman, here he was. This was a boat made in Thailand by an American. Supposedly, it was new and hardly had any hours on it. The first look I got I thought that thing is at least ten years old. The seats were all mildewy, both outer and inner hull had nicks and scratches, the gelcoat was dull, and signs of rust all over the place. The motor seemed to have been either re-built or at least tuned and serviced lately. Anyway, the owner started by telling me he didn’t like the way the boat was built, e. g. the hull (gunwale) was not smooth, the beam was too narrow, etc., etc. I made that trip for nothing.

Looks good in the picture, but.....

On the positive side, though, this guy – an Aussie just like Rob – imports rigid inflatable (RIB) boats from Australia. They are really nice and I would indeed buy one of those if the price wouldn’t exceed my budget. Which brings me to the question of import duty and taxes. The salesman said he paid $2,500 for that Thai-made boat, but isn’t sure how much it would be now. My guess was that since boats are luxury items just like cars in Cambodia the import duty and tax would be the same, namely 115%.

This is a RIB

Now Rob back in Sihanoukville told me he is starting his own boat-building business in Sihanoukville, and maybe he could help me with that; especially since the approximate price he gave me was exactly within range of my budget. A locally built boat would not be subject to those outrageous duties and taxes. Of course, all the special marine hardware, brackets, etc. would have to be imported, but the duty on those is but a fraction (15% plus 10% VAT). The only downside I found was that the boats were going to be made of fiberglass-encased wood. I am a firm believer in full fiberglass boats; fiberglass doesn’t rot. Hardwood is too heavy for a speedboat, so the plywood used is particularly susceptible to rotting. I read up on that and found that another risk is called ‘delamination’, that is, when and if the fiberglass were to peel off the wood exposing it to water. You really got a problem then. Rob has a partner, Ted, who is the actual boat builder. He hails from Connecticut; and all the coastal states in the U. S. are prime boaters’ country. Ted honestly said he couldn’t deny that but this is where the craftsmanship of the boat builder comes in. You do shoddy work, you will have a problem; you do it right, we will all be happy.

Then my Khmer friend told me of a shop in Phnom Penh that makes full fiberglass boats. He used to work with him when he assisted in building a luxury wooden river cruise boat for a French touring company a few years ago. I looked for him and found him on state road no. 5 to Battambang along the riverside. It was a typical Khmer operation, which doesn’t really instill confidence in foreigners. I am used to that from car repair shops where I have never been let down, so I wasn’t put off too much. He only builds smaller boats up to 16’, 17’. That’s a little too small to go offshore. But he promised me he could help me import any boat I wanted. He also claimed that there is no import duty as Cambodia doesn’t have a code for boats yet. I was quite excited. Maybe, after all, I could get a nice fishing boat from the U. S. and promptly checked online. I found two excellent boats in California. The freight would be around $5,000, but if the tax was halfway like the guy said I was ready to go for it.

I wanted this beauty

He checked with the customs department. That took forever, of course, and in the end he emailed me some sample tax invoices which showed anywhere from 15% plus 10% to 100%. Bottom line, he didn’t really know.

So I contacted one of the larger freight forwarders in town. If they wouldn’t know, who would? As I had suspected import duty, luxury tax, plus VAT comes out at a compounded 115.25%, just as with cars. There went my dream of getting one of those nice boats. Because in the end I would have to shell out something like $40,000 for a boat that would sit idle about 90% of the time. I don’t believe in paying that kind of money for a used car, why should I pay this for a boat? That price is only an average price tag here for a 2008 model, most of them go for $60,000 to $80,000.

After some hard thinking, I made up my mind and ordered that boat from Rob and Ted in Sihanoukville. Here is a model of what it will look like except that it will be a center console and the deck layout as well as the transom will be designed differently. If you are interested in a speedboat for fishing, diving, snorkeling, here is his phone number 016 511 251. Hopefully in 6 to 8 weeks I will be on the water catching snapper.


Something like this

Incidentally, Rob does have quite a bit of experience with boats. First he is the operator of the Beach Club in Ream, where he uses two traditional boats for his guests there. He also has that 32-footer(I believe)with the twin motors, and operates three speed boats at the Sokha Beach Hotel activity center.

Friday, September 9, 2011

Population Growth and Its Price

Looking at a normal street scene one cannot help but notice the overwhelming majority of young people. They can be a pesky lot when they ride their motorcycles with abandon and without regard for their own, or other people’s lives. Traffic would run a lot more smoothly and with fewer accidents if it were not for those obnoxious young people (not to mention those motodups and tuk-tuks).

With all these young people, Cambodia is headed down a path that should be cause for concern. The people as such seem to be quite unable to raise, educate, train, or otherwise guide their young people so that they may become productive members of society. More than 50% of the population is under 25 years old (CIA World Factbook). As the World Factbook states, it will be the government’s daunting task to fashion a policy that helps create jobs. These jobs have to be generated in the civil sector, as the country certainly doesn’t need any more civil servants who while away their days pestering the people they are supposed to serve. In one of those leaked cables, the U. S. Embassy also notes that the PM and his government are faced with this great problem and may fear the consequences of this imbalance as those young people, after getting at least a minimal school education, all of sudden find that the world out there doesn’t have the jobs that would afford them a life that is portrayed in all those TV commercials. These commercials invariably show people driving shiny cars, having the latest cell phones, and all live in well-appointed houses or apartments. An especially stark contrast between reality and the TV dream world are the kitchens shown on TV. Even in more affluent houses in Phnom Penh you will hardly find any of those nice and shiny kitchens with the most modern appliances. (The fact is that an estimated 70% still cook their meals on wood-fires.)

It appears as if TV sets are turned on 24 hours a day. And since the young people have nothing to do but watch TV most of the time (excepting the better-off kids who own a computer and spend their time in front of that), they eventually find out that their expectations of what they can achieve are way overblown. This indeed does pose a grave risk for Cambodian society as a whole. High un- or underemployment among the young creates social problems. Dissatisfaction generates unrest, crime, and higher drug use.

A ghastly reminder of that happened just a few days ago when three young thugs robbed and shot dead a moneychanger in broad daylight in plain view of many people in front of a curbside market near the airport. Their take: $30,000. Especially horrifying was the calmness and magnanimity with which one gangster shot that woman, took his time arranging the box with the money to sit right when getting on the pinion seat of the motorcycle and then rode off into traffic. Dismayingly, nobody moved to help that woman on the ground. (The media report that the son-in-law tipped those people off.)

As Americans know very well, their country is among the ones with the highest crime rates in the world. Explanations often quoted are the disparity between rich and poor, the dwindling middle class, and the economic problems that led to an unemployment rate of about 10%. There are distinctive similarities between these two otherwise so different countries. In Cambodia the unemployment rate is around 20%, the disparity between rich and poor is even more drastic, petty crime is ever-present, serious, and violent crime an almost daily occurrence. Add to that the general lack of individual discipline, the disregard for rules, regulations, and the law, and you have all the ingredients for future social upheavals.

There is virtually no middle class in Cambodia. In fact, it probably is rather difficult to define social classes to begin with. We know there are rich people as evidenced by their flaunting their wealth with grandiose villas, multiple luxury SUVs, and spending habits that rival those of African chieftains and Arab princes. But where are the people that hold down clerical jobs in private companies and government? People that make, say, around $500 to $1,000 a month. The jobs paying that kind of money are far and few between, as anybody who is somewhat familiar with the local economy knows. Then, of course, we have the vast lower class; the people that just survive on the bare minimum. To be honest, after so many years I am still amazed how they do it. Everybody seems to own at least a motorbike, cars clog the streets of Phnom Penh, and even in villages many people are proud owners of a car.

But what are the prospects of all these people that enter the job market, where they cannot find jobs; sometimes for lack of knowledge, sometimes because they studied the wrong subject, mostly though, for lack of a broader economic base – there simply aren’t enough jobs. What they do know, however, to put it somewhat crassly, is how to make babies. All these young people seemingly get married before they are 22, at least that goes for the women, and the young men are not much older. Parents are afraid their daughters will become old spinsters if they are not married by that age. These parents are maybe not even 40 themselves, or barely over 40. And in most cases, within a year of their wedding the young people are proud parents of a baby boy or girl. A second one will be on the way shortly thereafter, and so on, and so on. In other words, that population growth will go on unabated exacerbating the serious situation in the job market exponentially. People in Cambodia as a rule have more than two children, the number that would sustain a population. Of course, part of the problem lies with the good old Asian tradition to have as many children as possible so these would support their parents in old age. But if those children have no jobs, no prospects in life, that tradition is going to blow up in their parents’ face. The children along with their parents will be destitute. The children can’t afford to support their parents any more. It may eventually lead to the children abandoning their old parents and who then have no way of supporting themselves. This dire picture is especially true for Phnom Penh and its surrounding districts that grow ever closer together on account of that resurgent building boom. It is an established fact that the urban poor’s plight is far worse than their fellow fellow citizens’ in rural areas are. The break-up of the traditional Asian family takes place first in the cities, and that is definitely noticeable in Phnom Penh. Sometimes, however, this is not restricted to just the young people.

Two cases in point:

A nearly 70-year-old couple gave up their son to a Canadian couple for adoption when he was 12 years old. They believed the son would have a better life there, and naturally thought, that he would support them later; which he did, being the good Cambodia son that he was.

That first happened in 1972 or so. Subsequently, wanting another child they brought up an adopted daughter who then unfortunately got married to a drunkard. The drunken husband fell off his bike and was killed in the accident. He didn’t provide for his family to begin with but now he left her with a baby girl and no prospects of supporting herself. She got married to another man, but obviously had a disposition to live with an alcoholic because that second husband was a drunkard too. They produced four children. Anybody can guess what will become of those children.

The in the meantime adult son in Canada fell on hard times with his business after the financial crisis in 2008 and was unable to support his natural parents further. Their adopted daughter was also unable to take care of them. In the end, these foolish (one cannot say otherwise) people borrowed money using their house, the only asset they had left, as collateral and used it in a small-time loan-sharking business. Loan-sharking because they charge outrageous interest rates, e. g. from 5% to 10% per month. Of course, it’s unsecured loans, as small as the loans may be, so a premium interest rate may be acceptable, but 120% per year? The reasoning goes like this: you have $5,000, you get $500 a month, which is enough for them live on. We all know the catch, of course. And that promptly happened after a while. Somebody couldn’t pay and they were out of their money, owing the bank, which threatened to take their house. To their great relief they found somebody who loaned them the money.

These old folks have an even older mother, around 98. Now this bleak situation meant they couldn’t look after her any more either, not that they had done that a lot before. They simply ignored the fact that the mother was still alive. Thankfully, the youngest son of that old lady and his daughter at least give the mother and grandmother shelter and a little food. Guess what? The situation isn’t much better in that part of the family. The granddaughter’s husband sired four children with his wife and two with his mistress - on a policeman’s salary.

And then there is this old lady, over 70, she doesn’t really know how old she is, who also adopted a daughter as her husband died before they had children together. She brought her up, but that daughter was in the habit of spending money she didn’t have. She always borrowed from neighbors and so-called friends. In the end, the situation had become so bad she had to leave the little village on the outskirts of Phnom Penh where they lived. She left the son she had with her mother. Needless to say, that the husband had left a long time ago. The grandson seemed to be a decent guy. He stayed with his grandmother and took care of her. But this only lasted until age 19. He got a job as a driver at a garment factory, met girl, promptly impregnated her, and under her threat of suicide married her. Here he was with hardly a place to live, no job (which he lost during the downturn after 2008), but with a wife and a baby. Eventually, he took off too to find a job elsewhere, forgetting about his destitute grandmother who doesn’t know where the next meal comes from. (She did find somebody who is helping her out though.)

These two examples show how poverty will eventually break up a family; and these are not singular cases. When push comes to shove, not much seems to be left of the moral fiber that normally makes up the core of family values in Cambodia. They also show that no matter how precarious their situation, people will produce babies regardless. In another post I had mentioned that in rural areas these values still seem be very much intact. Children take care of their old folks. But here too more and more young people migrate to the urban centers to find ‘better’ jobs in a garment factory or in the construction business.

Nonetheless, traditional values still play a determining role in starting a family both in urban and rural areas. These traditions and values only confound the population problem.

Another case in point:

A young man, by now 28, went to college and got a bachelor’s degree in tourism, which isn’t much worth in the grand scheme of things, but nevertheless, he got a better education than most. Best of all, nobody helped him. He paid his way through college by working in the mornings and at night. In the afternoon, he went to class. Now one would expect that he would go about planning his future a little better, and that always includes some sort of family planning. First of all, he got married before he graduated because his parents and the prospective wife’s parents put a lot of pressure on him. They threatened she might go with another suitor. After all, she was a ripe 22 years old and might miss the boat. His manly pride couldn’t take that. So he did the deed. In my typical Western concept I had advised him, first, not to get married before he had landed a proper job after graduation, and, second, don’t have kids until he was somewhat settled financially. He agreed wholeheartedly, but his in-laws had a different plan for them. Just four months into his marriage, his mother-in-law consulted with a fortuneteller who predicted that this year was very auspicious for the birth of a grandson. As things go, she ruled that her daughter was to have that baby this year and they promptly set to work. Not too long afterwards, we learned they were going to be parents. In the beginning, it didn’t seem all that bad, as he had indeed landed a job as a hotel manager and made $500 a month. Three weeks into that job the owners let him go as they found out that a rookie couldn’t really help them fill the hotel. Well, he found out the hard way that life ain’t that easy after all. Now he and his wife live in his in-laws' house, without a job, and a baby on the way.

At the bottom rung of society you have the absolutely ignorant, one is tempted to say dumb, people who have no idea that there is such a thing as birth control. Of course, these people are poor to begin with, they are absolutely uneducated, just scrape by, but their natural drives are well defined. They don’t know how to support the family of six to begin with, always complain about the poor hand they were dealt in life, but then before they know it, there is a fifth child on the way. The mother says, “I didn’t even know I was pregnant until I was 5 months along.” Suuure! There is an office of the The Reproductive and Child Health Alliance (RACHA) in Phnom Penh. They provide birth control devices for people free of charge. But one needs to know about these things first, right?

All these factors relative to the population and its growth come together in Cambodia, a country that is trying mightily to overcome its third-world status. There are no easy answers or quick-fix solutions available for this overwhelming problem. One answer surely is education both sexual and general, but that will take generations before any tangible results would be seen. China’s policy of a one-child family was cruel and drastic, led to infanticide, and was counter-productive. Surely, this is one thing the government here doesn’t want to even begin to consider.

Certain segments of the opposition conjure up social unrest as the one means to unseat the hated government. There is an email campaign underway called ‘The Lotus Revolution’. I have no idea who is behind it; I just somehow got on their mailing list and this is how I learned about it. This is a pipe dream at best in my opinion. The Cambodian people are submissive in character and won’t go to these extremes, not by a long shot. Nevertheless, a program needs to be put in place that stems the population growth. The government has so much influence on the mass media, especially TV. A PR campaign driving home the need for birth control over and over again would be a first step. Most assuredly, the statement on TV by a highly placed person in Cambodia that the country needs more people is not pointing the people in the right direction and I am just puzzled what that person was thinking. The government and NGOs helped bring down the number new HIV infections. Surely, this problem deserves just as much attention.

Sunday, September 4, 2011

The Ubiquitous and Mostly Incompetent Middleman

Anyone who has ever done business in an Asian country and Cambodia in particular knows that the use of an agent, or middleman, is virtually unavoidable. Much of the information someone needs in regard to especially real estate is not general public knowledge or available, say, on the internet. There are a couple of good real estate agents in Phnom Penh and Siem Reap but most properties for private or small business use are handled by middlemen. Industrial properties or concession lands are rarely handled by those agencies.
Now there are middlemen and middlemen. Some really work on behalf of the seller and these usually have the necessary information ready.

The great majority of them, however, have no clue what they are talking about. They could work as tuk-tuk drivers, motodops, waiters, policemen, or soldiers; the latter two, mostly higher-ranking officers, constitute the majority of all middlemen, at least in my experience, and they usually do have connections that can help. The other ones, on the other hand, just vaguely heard that somebody wants to sell something. They pass that information on among their friends and people they know. Eventually it will reach someone who knows someone who is looking for just that particular item, or piece of land.

A case in point is my search for an additional smaller working rubber plantation. I am looking for a plantation in Kompong Cham province, close to the one I already own. I happen to know a middleman who supposedly does have a good knowledge of what’s available in that sector. So I asked him to be on the lookout for me. I had been searching for some time already without any workable results.

After just a few days he got back to me with a few proposals. Though I had given him the district of my plantation, the ones he suggested were all about 100 km away. How can my manager work these two plantations on a daily basis, which is an absolute must.

Next he brought back three plantations near my district, albeit a little overpriced. When asked where exactly they were, he said the other middleman didn’t want to disclose it just yet. He was clearly afraid he might be cut out of the deal. So I said, ‘Let’s take a look.’ Prices can always be negotiated. On the day we were supposed to leave he called early in the morning, saying the one I was most interested in had already been sold; and he wasn’t so sure about the other ones; the guy he was talking to said maybe the soil isn’t that good (never mind that the plantation was 14 years old already), etc., etc. In other words, a typical case of ignorance where this middlemen just wasted somebody else’s time, but thankfully in this case no money. I just told him to forget about looking for another one. As is often the case, he didn’t know the owner directly but had talked to another middleman; and I am not sure whether that was the only one in the chain.

A while back something similar happened. A guy told me he had a 6-year-old plantation. Great, we were going on an inspection trip anyway, so we went to take a look a look at the same time. We picked up the
two middlemen and while we were talking on the way, the second guy mentioned that the trees were only three or four years old. I just dropped him off in the main district town, he was from the area anyway, and went on my way. Was he just looking for ride or what? I still amazes me that people would waste so much time for nothing.

I am sorry to say this is not limited to Cambodian middlemen. In my consulting job I source large plantations for foreign investors. I have come to learn that there are certain nationalities that I should be wary of.

One day I got a call from somebody overseas who said he has a client – a tire manufacturer - who wants to buy a large plantation. Since he made it clear he was acting as an agent and belonged to one of the nationalities I am usually somewhat suspicious of I didn’t want to harness the horses unnecessarily so I didn’t get in touch with some of my contacts. I informed the agent of the legal situation in Cambodia, and told him if he is serious he should come and visit the plantation. I was somewhat surprised when he actually did make plans to come and look at a plantation. So when he got here he told me he had another appointment in the afternoon, could we do this in the morning. We picked him up at his hotel and on the way he told us he would be picked up later in a town near our location. I had expected we would discuss his plans a little more in detail, but this obvious disregard of our efforts raised an immediate alarm with me, but we were on our way already. He was clearly on a fishing expedition and I presumed the whole thing would lead to nothing. So I showed him just any plantation. Long story short, this indeed didn’t lead to anything. He really didn’t have the clients lined up yet but was just trying to find buyers himself with the first-hand information he got from us. Finding investors is actually part of my job. So what did he think he can do differently? People just don’t realize that this scattershot system is a waste of time in 99% of the time.

Then there are the other kinds of middlemen, or rather facilitators. They are not middlemen in the real sense of the word but people who actually handle these things for the government in a semi-official capacity. There is usually one go-to guy who works at a higher level job in one of the ministries or is a military man with close connections to the minister or state secretary, sometimes the PM himself. They know their stuff and will take care of everything. Anybody wants to do business in Cambodia on a large scale where land concessions or blanket government approval is needed is well-advised to find such a person. Everything else is mostly not worth the time and money. And stay away from the dime a dozen middlemen that can only give vague answers and cannot get you in touch with the seller or owner directly.

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