An examination at the doctor’s office can cost more than $2.50 and getting a doctor to write a prescription for medicine can sometimes run as high as $5. For Bun Sam An that’s too much.
“Sometimes I think doctors take the opportunity to double the cost for us,” the 46-year-old father of three said.
So people like Bun Sam An go straight to the pharmacy when their children come down with a minor illness, hoping that the person in the white coat behind the counter will give them just the right drug to heal them.
Last week, Bun Sam An’s daughter had a cold, so he stopped off at the Pharmacie Mohasal, across from Phsar Tuol Tom Pong on Street 163. He says he trusts this pharmacy, which has a pharmacist working behind the counter and has given his family good medicine in the past.
Next door at the Pharmacie Vithura, a middle-aged man works his busy shop from behind the counter. He’s like a lot of people working in pharmacies across Phnom Penh. He isn’t a pharmacist or a medical doctor, but with a three-month training course and experience gained on the job, he says he knows enough to recommend medicine to sick customers.
“People tell me their symptoms and I know what to prescribe,” said the attendant, who would not give his name.
But health officials say people who skip medical consultations with doctors put themselves at risk by not getting a proper diagnosis and expose themselves to dangerous side effects if they take the wrong drugs. Additionally, if people overuse some drugs, such as antibiotics, they can build up an immunity, making future treatments less effective.
According to a 1994 law, pharmacists must be present in pharmacies at all times, according to Hong Sun Huot, minister of health.
But, he added, ministry officials understand that most pharmacists have other jobs that they must attend to. So, they only expect pharmacists to be present for just three hours a day.
More often than not, pharmacists don’t go to the pharmacies where they are supposed to be working, said Phon Nary, a general doctor at Preah Monivong Hospital in Phnom Penh. That’s because very often the owner of a pharmacy only pays a pharmacist to act as their “representative.” The pharmacist earns the pay just by putting his or her name on the signboard in front of the shop and on the certificate that is registered with the Ministry of Health.
Pharmacies also violate the law when they prescribe medicine for serious illnesses, Hong Sun Huot said.
But since pharmacies do not want to lose business, sick people can usually receive whatever brand of medicine and the amount of dosage they request, Phon Nary said.
One pharmacist who works for an NGO in Phnom Penh said many sick people don’t go to state hospitals because the services there are poor. And they don’t go to private clinics because they don’t have the money. “In the end, they choose to go to the pharmacy,” he said.
Seang Sophat, a general doctor at Kossamak Hospital in Phnom Penh, said sick people pay about 3,000 riel per visit to government-run hospitals and between 7,000 and 10,000 riel for consultations at private clinics.
But Phon Nary stressed the need for people to go to health clinics and hospitals, since pharmacists aren’t trained to know if someone’s symptoms could indicate a serious disease.
“Pharmacists cannot understand all of someone’s symptoms just by listening, so sometimes they make a mistake when giving medicine,” Phon Nary said.
Hong Sun Huot said there are 60 legal pharmacies registered with the ministry and more than one hundred non-registered illegal ones in Phnom Penh. Ministry officials have been trying since 1996 to shutdown illegal pharmacies, some of which allegedly sell expired or smuggled drugs.
“For a long time, we have asked the Phnom Penh municipality to help prevent [illegal pharmacies], but that has been ineffective,” Hong Sun Huot said.