Saturday, 7 February 2009

Not Only the Rich, but Also Middle Class People Go to Foreign Doctors - Thursday, 5.2.2009

Posted on 6 February 2009
The Mirror, Vol. 13, No. 598

“Phnom Penh: Disobeying medical ethics, the lack of human resources, the shortages of modern tools for analysis and treatment, result in a situation where many Khmer doctors no longer are considered as serious providers of care for Khmer citizens. The number of Cambodian citizens going to receive medical checkups and treatments in neighboring countries is greatly increasing.

“As the reasons behind, we found that the prices of treatments in foreign countries, especially in Vietnam, are similar to the prices in our own country, but the friendliness of foreign doctors towards patients is probably another factor that provides the warm feeling towards patients receiving health checkups and treatments in foreign countries, even though they know that it requires higher expenses contributing to the economy of other countries.

“Mr. Kosal (name changed to maintain his privacy), who frequently goes to Vietnam to receive health checkups said that in Vietnam, before a doctor treats an illness, they thoroughly check, they do not just say something and then inject drugs, or to set up a bag of fluid for an intravenous drip, as doctors in Cambodia almost every time do, to get money.

“He added that doctors in other countries speak friendly and from a position of medical ethics, hospitals show to have sanitation standards, and they have modern tools which make patients feel confident when going to have health checkups and treatments in other countries.

“He emphasized, ‘When I say so it is not to advertise their country, or to humiliate our own nation, but the lack of a medical ethos of Khmer doctors, besides their unprincipled words, uncertain checking methods and treating people just for money, demanding money before the treatment, extending the illness [so that patients have to stay longer and spend much money for the treatment], and unqualified skills, make patients no longer feel warmly toward such doctors.’

“He continued to say, ‘I don’t believe that there are no outstanding doctors in Cambodia, and these do not adhere to immoral values,’ adding, ‘but white doctor’s clothes represent pureness, but not all who wear such clothes do respect what the value of their white clothes indicates.’

“Whether those who go to foreign countries are mostly the rich was explained by Mr. Kosal like this. The fees for treatment in the country mentioned are comparable to Cambodia, but there are additional expenses: for the service of interpreters, for accommodation, food, and for travel.

Mr. Kosal added that middle class people also go for treatment, not only the rich. In addition to the mutual trust between those providing health checkups and patients in Vietnam or in other countries, pharmacies in these countries sell medicine to customers on the basis of prescriptions from expert doctors, and especially, in these countries, if a doctors do not have the specialization to treat a certain illness, they will not try to provide treatment, but they will help to refer such patients to another hospital with experts for the illness which a patient has.

“Mr. Kosal went on to say that in general in Cambodia - besides treating any kind of illnesses whether or not they are specialized, and injecting bags of fluid through intravenous drips, which is a method they prefer to use to get much money - some of the doctors scare patients, recommending to receive [unnecessary] operations, so that they can earn more money without really caring about people’s health and lives.

“Mr. Bunthoeun (name changed to maintain his privacy), who frequently goes to receive regular checkups for his liver disease, said, ‘Doctors in Vietnam carefully check illnesses. We learn from them and in their country, they work around-the-clock, making regular visits to take turn caring for patients, unlike in Cambodia, where doctors demand free time on Saturdays and Sundays.

“He added that in that country, people prefer to go to state hospitals rather than to private hospitals, because doctors at state hospitals earn bigger salaries than doctors at private hospitals, which are required to pay high taxes to the state.

“The basis for such trust is explained by Mr. Bunthoeun by saying that in that country, the government often sends doctors to be upgraded by training in foreign countries according to their skills, but not based on nepotism. On the contrary, in Cambodia doctors pay bribes to receive training, and if they fail exams they demand to continue their studies. As a result, when they become doctors, some do not have qualified skills for their career, and then they treat patients without certainty what to do, by just injecting drugs based on vague assumptions.

“Mr. Bunthoeun criticized also that some doctors in Cambodia, who have little knowledge, become proud of themselves, and even when they have almost created more problems for patients, they do not call them, and if they write prescriptions, they write them in French, in order to show off that they are knowledgeable, and their handwriting is difficult to read.

“He asked, ‘Why don’t they write in Khmer? If it is “vitamin,” why not write “វីតាមីន​” in Khmer, so that it is understandable? Why is it written in French?’ Creating trust will help reduce that patients leave to foreign countries, which wastes resources of the national economy, because if ‘doctors can create trust in the country, people will not go abroad.’

“The director of the Mekong Phnom Penh Clinic, which always sends patients to foreign countries according to their requests, Mr. Kong Kimchan, said that to send a patient to Vietnam costs between US$300 and US$400, adding that not only the rich, but also middle class people can go, and the fees for treatments are lower than in Cambodia, but a lot of expenses are needed for accommodation, food, and travel.

“As for the fact that many Khmer patients leave to go abroad, he said, ‘I do not know what to say about human resources in Cambodia, so that many people no longer have trust.’

“Mr. Kong Kimchan added that many factors influence people to no longer have trust; talking about human resources, we also have many, but the private services at some places, and the uncertainty people in general feel, and insufficient knowledge, are reasons affecting other human resources.
He went on to say that also belated transportation facilities in emergencies at some localities affect the trust of the people. Although patients are transported to state hospitals, they no longer have trust.

“He continued to say, ‘Reorganizing the system for all people at the basis is good, because patients are not only in the cities, and I do not believe that Khmer doctors exaggerate the general situation of illnesses, because they also want a good reputation.’

“Regarding the lack of tools as a problem, he said, ‘We have received assistance to have many tools, and human resources are also many, but we do not share information well. Therefore, people do not know what we did and how many people we saved. After we would have published such information, what can we do? Are there enough arguments to be presented? In other countries, they have arguments and they have tools.’ He added, ‘We still have shortages; we need additional tools and additional training of human resources.’

“Do hospitals in Cambodia really have the problems as mentioned above? The director of the Khmer-Soviet Friendship Hospital, Mr. Say Sengly, recognized, ‘The quality of our services is really limited if compared to neighboring countries, but at present, we are reforming everything, the medical ethos, the techniques, and the procedures for the care of patients.’

“He added, ‘If we talk about the rights of customers and of service providers, the service providers have to take care of patients, but we do not restrain patients, if they want to go to neighboring countries to find better qualified treatment. He continued to say that as for making patients afraid, and the excessive use of too many intravenous drips, it seldom happens at state hospitals, but frequently it happens in private clinics so as to receive much income.”

Rasmei Kampuchea, Vol.17, #4813, 5.2.2009
Newspapers Appearing on the Newsstand:
Thursday, 5 February 2009

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