Health Care Challenges in Cambodia

9 10 2011

In case you didn’t get the memo on Facebook, the end of training means more time for catching up on the blog. Tim and I will continue to post daily for a few more days.

Anyway…

As most of you have figured out by now, I am a Community Health Education volunteer here in Cambodia. Since Tim has already written a post about the challenges found in the secondary schools where he will work, I thought I should share a little about the health challenges here.

Like nearly all institutions, the public health system was effectively demolished during the Khmer Rouge’s rule in the 1970s. Practicing physicians were killed, equipment was destroyed, and anything resembling modern medicine was banned. Instead, untrained individuals—often children—were drafted to practice forms of traditional medicine, which were often harmful to those receiving treatment. By the end of the Khmer Rouge, historians estimate that only 25 medical doctors remained in the entire country, alongside only 36 pharmacists and 28 dentists.

Today, Cambodia’s health care system is still suffering. Health centers are chronically understaffed and lack qualified medical personnel. Many centers do not have a practicing doctor, only secondary nurses, to meet with patients. Health centers are also criticized for providing poor customer service and even, at times, housing corruption. Patients generally have to travel long distances to reach their nearest health center, as there is usually only one per district. And once they arrive, patients sometimes have to wait for hours. Seeking treatment at the health center can seem like a waste of time and money—two very precious resources, especially in Cambodia.

Health Education at our Nutrition Seminar in Traing

 

This means that many Cambodians seek treatment outside of the public health care system, with pharmacies and traditional healers being two of the most common alternatives. One of the advantages of both is often location. Since there are frequently several traditional healers and many pharmacies in the same village, community members can cut down on the time and expense of traveling to the single health center. There is also less waiting on average at a pharmacy or traditional healer, which is important for busy farmers, housewives and shopkeepers. Unfortunately, these service providers come with many risks.

The challenges surrounding traditional healers are complex due to the high level of importance traditional medicine plays in Cambodian culture. Some traditional medicines used in Cambodia, herbal teas for instance, are fine remedies for ailments such as a cold or the flu. These remedies can and should be preserved as an option whenever possible. However, there are other traditional practices that can be harmful. For example, after a woman gives birth, she is often roasted. This means that she lies down for days on a wooden table over a fire, fully clothed including a winter hat and gloves. Cambodian women do this because they think that when they give birth, all of the heat leaves their body so they need to replenish their heat postpartum. Roasting plays an important social role that shouldn’t be ignored, but it can also result in burns, severe dehydration and the delayed onset of breastfeeding. Roasting, as well as many other traditional practices in Cambodia, can be detrimental to the patient’s health; however, even if the treatment itself is not harmful, patients often defer proper medical treatment until after they realize that the traditional treatments did not heal them, which can lead to further complications.

An Elephant Delivering Traditional Medications

 

On the other hand, in Cambodian pharmacies, much of the difficulty comes with regulation. For example, the medication itself is not tightly monitored, resulting in high levels of counterfeit drugs. Imagine going to the pharmacy to pick up your antibiotics (or your birth control!) only to unknowingly purchase a placebo. Another issue is that the person handing you your medication might be pharmacist’s 15 year-old nephew because he was the only one at home when you arrived. This is to say that oftentimes the person dispensing the medication has not received any formal training. Even if the pharmacist is there, he or she generally does not provide any in-depth consultation.

There are a few more challenges that seem to exist across all three of these health service providers. Antibiotics and IVs are overprescribed, for example. This is particularly detrimental in the public health centers because Cambodian law dictates that health professionals can only dispense three days worth of medication at time, meaning that many patients never finish their full round of antibiotics (usually 5-14 days) and thus can fuel drug-resistant bacteria.

The final issue that is seen across the health systems is a lack of education. This is most obviously true when talking about preventative health education (hand washing, nutrition, etc); however, patients are rarely educated even on the medications that they are prescribed. Many patients will leave a health care provider not knowing the name of their medication, when they should take it or what quantity to take. This again leads to improper treatment which has a wide range of damaging effects on the health of the individual and the community.

This is where I come in as health volunteer. I certainly will not solve all of these problems, even on a community level. But my job is to help strengthen the health of those living in Kampong Kdey, primarily through building the capacity of the public health centers. This means that I will engage patients directly in formal and informal education, but will also work with the health center staff to hopefully improve their customer service skills, managerial capacity, education techniques and outreach initiatives.

It sounds a lot more glamorous than it will likely be on a daily basis though. Most of my days will be spent making small talk with the patients in the waiting room, weighing babies or distracting small children while they get vaccinated. Some days I will hopefully travel to the 16 villages located in my operational district to lead short educational activities or simply get to know the challenges that face the communities. On rare occasions, I will attend meetings with the health center staff or with the staff at the provincial or district level.

The government of Cambodia asked Peace Corps to send volunteers to help improve and promote the public health system, and I will most certainly do my best to work toward this goal at site. Working as a health volunteer is a daunting, but important, task. Luckily, I think there are a lot of little ways to make big impacts.

(Note: I borrowed these pictures from other volunteers– thanks ladies!)

Katie

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2 responses

10 10 2011
Susannah

Wow – those are some big issues! It must be both so exciting and overwhelming to have an opportunity to help — but if I know you, and I think I do, you’ll leave a positive, helpful, and worthwhile impact on your community, even if you are only one small outsider :)

22 10 2013
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