Thursday, May 15, 2014

Health Care - A Non-Existent Priority

I had written about some of this before under the title, “When you need a doctor”. This past week, my family and I were faced with a crisis. My step-daughter, aged 24, needed to be hospitalized in an emergency. She was suffering from abdominal pain and blood loss. She had first gone to one of those omnipresent neighborhood clinics. They gave her a drip and then just left her to her own devices. Nobody checked even further about the blood loss.  When we heard this we immediately had a friend of ours take her to the Calmette hospital emergency room. Needless to say, nobody would look at her until we had made payment for the initial exams. She was then admitted and taken to the gastro-enterology department where, you probably guessed it, she got hooked up to a drip. This is what they always do in Cambodia, whether needed or not. But they arranged for an immediate blood transfusion as the tests had shown some serious loss. If it had continued it could have led to her bleeding to death.

However, they first wanted to find a donor. When my friend told me about it I wondered how they could find someone with the same blood type so quickly. They do have a strange system in place here. Anybody can donate blood which is then exchanged at the blood bank for the badge with the right blood type. This way they ensure that the blood bank does not run out of blood. Obviously though, there aren’t enough donors. In an emergency you can hardly find a donor right away – so this is the big drawback to this system, and one is left to wonder whether they would just let the patient languish at the hospital and possibly let her/him die? We did have two donors available so never learned what they would do if we hadn’t.
They also performed a gastroscopy to determine the cause of her pain. The diagnosis wasn’t clear enough. When we talked to the doctor the next day he said he would conduct a CT scan and another gastroscopy and possibly a colonoscopy as well. It goes without saying that we needed to settle all the bills first. The room was $35 a night, exams, medication, etc., another $100. So we paid roughly $200 for two nights. The blood transfusions cost only $10, as we had provided the donors.

All planned tests and scopes would probably run to more than $500. The only thing that deterred us was that the physicians kept us waiting forever. When we showed up the next morning, no doctor was in sight. When none had showed up after an hour we just discharged our daughter ourselves. We would consult a private specialist. After all, all these procedures can be performed at a number of hospitals in Phnom Penh now.
We learned of one GI-specialist who had got his degree in France. He knew what needed to be done. Long story short, we did go to the Calmette again because they had the best anesthetic facilities. In the end, we had to cough up more than $1,000 for this treatment. This is still a downright bargain compared to the $7,000 you are charged in the U. S. as a self-paying patient, or the more than $4,000 the insurance would pay out.

What this amply demonstrates is the glaring lack of any functioning health care system in Cambodia. People who cannot afford this will be left out in the cold. One does not need to be a socialist, as the right-wing segment in America would say, to call for universal health coverage; and that is the government’s job and responsibility. There has been talk of such as system but so far only members of the armed forces get free health care. The quality of that I cannot assess but I wouldn’t be surprised if they lacked both basic knowledge and facilities. I know of one 1-star general who suffered from diabetes. They didn’t have enough insulin in stock. He had to rely on relatives to send money so he could buy it on his own. Eventually he died from complications.


The population in general cannot afford the $1000 per year or so it costs to buy some private health insurance policy. The coverage there is minimal to begin with. I say it again, from being a tolerant observer of this government I have turned into a very disenchanted bystander. They do build roads that are in serious disrepair after only a short while and schools that deliver a questionable education but one of the foremost jobs just isn’t even on the horizon.

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