Prime Minister Hun Sen on Wednesday lashed out at medical professionals in Cambodia, chastising doctors and hospital staff for refusing to treat patients who have no money.
“If doctors and hospital staff have no morals in their profession, then hospitals and doctors mean nothing,” Hun Sen said at a ceremony for the opening of a new wing at the National Pediatric Hospital.
“Physicians and staff are only thinking about money,” he said, “and do not think about the difficulties of the people and do not care about the patients.”
Hun Sen called for a “revolution” in medical ethics in Cambodia and warned public hospital staff to stop accepting or demanding money for services that are supposed to be free.
The prime minister’s attack on the hospitals came in response to recent news reports of a man who took his wife to a hospital in Phnom Penh for treatment of pneumonia, but allegedly was refused by doctors because he had no money. The woman later died.
Minister of Health Hong Sun Huot said he will question the director of the hospital about the incident and will report to Hun Sen after speaking with hospital staff. “If this case happened, it means the hospital staff broke internal regulations of the hospital, broke the ministry’s policy and acted against the morals of the profession,” he said.
Dr Wim Vandamme, medical coordinator of Medecins Sans Frontieres, said he welcomed Hun Sen’s comments, but he would be more happy “if Hun Sen created the conditions in which civil servants don’t have to do this.”
Vandamme and other health care experts say if the government wants to change the system, it needs to pay more money to doctors, who earn $10 to $15 a month.
“This system is unavoidable as long as staff does not get a decent salary,” he said. “Doctors sell drugs or ask for additional charges to cope. It’s more a coping mechanism than blatant corruption.”
Stephane Rousseau, executive director of the health care umbrella organization Medicam, also cautioned that people shouldn’t be too judgmental, considering how much doctors earn.
“It’s extremely hard to ask doctors to be ethical if they can’t make it,” Rousseau said. “It’s absolutely not justified to refuse treatment. But if it’s not justified, at least it can be understood.”
Cambodia has one of the poorest health care systems in the world, and the government in the past has spent annually only $1 per capita for health care.
Though experts acknowledge that improvements have been made, such as a 50 percent increase in this year’s health-care budget, not enough attention has been made to the salaries of public health care workers.
MSF last year severely criticized the government’s lack of progress in reforming health care and threatened to stop operations in the public health sector if improvements aren’t made.
Vandamme said his office is still facing pressure from its headquarters in France, which is demanding to see positive signs from the government.
“It’s becoming more and more difficult to convince our headquarters to continue working in the public sector,” he said. “The year 2000 is crucial.”
Dr Eav Sokha, an oncologist at Preah Bat Norodom Sihanouk Hospital, acknowledges that what Hun Sen said about the health-care system is true, but he doesn’t think the system will change any time soon.
“People want to change, but the government doesn’t really want to change,” Eav Sokha said. “The government so far does not have any real incentive to improve the quality of care. The national budget for health care is still very low. I hope 10 years later it will change.”
Henk Bekedam, team leader of the health sector reform project for the World Health Organization, said it’s very important that Hun Sen raised publicity on problems in the health care sector, but he hopes the prime minister will take it one step further.
Still, he says he is not very optimistic that an increase in the salary will provide enough of an incentive to get the attention of public health workers.
“Even doubling the salary would increase it to only $30 a month, which is not enough to cover the cost of living,” Bekedam said.
On the day Hun Sen made his comments, the man in the news reports that drew the prime minister’s attention was on his way to take his wife’s ashes to the mountains.
According to his wife’s wishes, Hem Han, 33, became a monk two weeks ago after his wife died, said Chea Sreng, a monk at Tang Ktrasang pagoda in Phnom Penh, where Hem Han had been staying until last Friday.
“Hem Han was very sad and very disappointed with the doctors,” Chea Sreng said. “There is nothing in his bag besides his wife’s ashes.”
