PHNOM PENH: When the phone rings, former
Khmer Rouge soldier Ken Mon grabs a bag
stuffed full of medicine, jumps on his
motorbike and heads for an impoverished
Cambodian village with the haste of any
diligent local doctor.
Yet the 55-year-old Mon has no formal
medical training.
While ‘doctor’ is a self-granted title for Mon,
he — and others like him — are the only
source to treatment for thousands of poor
residents in Ang Ro Ngeang village, about 70
kilometres (45 miles) south of Phnom Penh.
Undeterred by his lack of qualifications, Mon
drives ten minutes down a bumpy track in
Cambodia’s southern Kampong Speu
province, arriving at the home of Chei Tana,
27, who complains of crippling stomach
pains.
“You have a lot of air inside your stomach,”
he explains after examining his patient,
giving him a packet of antacid pills.
Mon is one of hundreds of unlicensed doctors
treating patients across a country whose
medical system was eviscerated under the
brutal Khmer Rouge regime of the 1970s and
is yet to build a comprehensive public
system.
Seventy percent of Cambodians seek
healthcare from the private sector —
including from pharmacies, illegal doctors or
traditional healers, known as “Kru Khmer” —
according to a 2012 survey by the World
Health Organization.
But illegal doctors have fallen under intense
scrutiny after a mass outbreak of HIV at a
remote village in western Cambodia last
November.
Authorities say the original infection was
caused by an unqualified doctor, Yem
Chroeum, who has admitted he re-used
needles and syringes.
More than 200 of his patients have since
tested positive for HIV and Chroeum faces
trial on charges of murder, deliberately
infecting people with the virus and operating
an illegal clinic.
The scandal saw the government vow to
crack down on unlicensed health providers.
Their practice “affects the lives of the people,
and the reputation of the country”, according
to Sok Srun, director of the health ministry’s
hospital services department, which
oversees the licensing of medical staff and
clinics.
Despite their concerns, officials are yet to
come up with a policy to persuade newly-
trained doctors to leave the relative comforts
of the cities and head into Cambodia’s
remote, rural hinterlands.
Neither have they been able to adequately
boost the ranks of doctors, a profession
decimated by the Khmer Rouge who
slaughtered a huge proportion of the
country’s educated classes.
That legacy still haunts the
country today.
World Bank figures say Cambodia, one of
Asia’s poorest nations, has just 0.2 doctors
for every 100,000 people, on a par with
Afghanistan.
Similarly impoverished Myanmar has 0.4 per
100,000, while France boasts 3.2 per
100,000.
For millions of Cambodians, doctors like Mon
are their cheapest — and often only — option.
“I learned my medical skills at the university
of life,” he told AFP, adding authorities have
never stopped him practising medicine.
Ironically that education came from the same
people who destroyed Cambodia’s health
system.
Mon joined the Khmer Rouge as a fighter in
1974, shortly before the hardline communist
regime seized power.
When it was finally toppled in 1979 — after
causing the deaths of up to two million
Cambodians through execution, starvation or
overwork — he and many other cadres fled to
Samlot, a stronghold on the Thai border.
There he learned his medical skills, first from
Khmer Rouge medics and later from foreign
doctors working for the Red Cross.
“The first day, they gave me a syringe and
medicine and asked me to inject a wounded
soldier,” he recalls, adding he can now deal
with a myriad of procedures from treating
diseases such as malaria and typhoid to
suturing wounds.
Nuch Dy, a 56-year-old widow from a nearby
village, has never seen a qualified doctor.
“(The health centre) is far and I don’t have
money to pay immediately,” she says.
Instead she treats her long-time stomach
problems with painkillers and antacid pills
bought from Mon — often on a tab.
Neighbour Uon Sreang, 35, tells AFP that
everybody in the village is aware their doctor
has no formal training.
“But we trust him. He always used new
syringes and needles when he gave
injections to my family members,” she says,
her nine-month-old baby in her arms.
There is a logic to their faith in Mon’s skills
with official health centres often failing to
guarantee a better quality of care.
The WHO has said that 43 percent of the
11,000 health centres across Cambodia —
the first port of call for medical treatment —
are unable to provide full services due to a
lack of physicians, medicine or equipment.
Meanwhile, a World Bank survey last year
found only one in three official doctors in
rural health centres were able to correctly
diagnose a series of illnesses.
Of those who could, just 17 percent were able
to prescribe relevant drugs.
For the seriously ill — and the very young — a
city clinic is almost always the only option.
Outside a children’s hospital in Phnom Penh,
Heng Hen, 45, waits patiently with three sick
grandsons after making the 80 kilometre (50
mile) journey at dawn.
“Medics in the countryside don’t have ability
to treat children yet,” Hen says.
He admits the recent HIV outbreak has given
him pause for thought over the wisdom of
continuing to seek treatment from unlicensed
medics.
“But we have no choice because we are
poor,” he says.
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