Poor Health Care Facilities Push People Abroad

Midway to the airport along Phnom Penh’s Russian Confed­eration Boulevard is the partially built Royal Phnom Penh Hospital.

When the $30 million facility is com­pleted next year-—filled with 100 beds, cardiac and brain specialists, and top-of-the-line equipment—it will be Cambodia’s finest medical facility.

Royal Phnom Penh will dwarf its sibling facilities in Siem Reap and near­by Tuol Kok district and, in many ways, be indistinguishable from the Thai hospital that operates all three in Cambodia. And that is precisely the point: to convince ill Cambodians—the ones who can afford it, that is—that they don’t need to go to Thailand or Vietnam or Mal­aysia or Singapore to get top-notch treatment.

If all goes as planned, the hospital, staffed with doctors from the Philippines and Pakistan, might be the first step to keeping Cam­bo­dian patients in Cambodia.

It is not altogether surprising that those who can, seek medical treatment abroad, as there are a great many maladies that cannot be treated here and which require all-too-common medical evacuation.

Among the many who leave for health care abroad, the best known is retired King Norodom Sihanouk, whom Chinese doctors have successfully helped fight B-cell lymphoma in Beijing. And Dr Heng Taikry, secretary of state for the Ministry of Health, flew to Singa­pore when he had a stroke earlier this year.

“We don’t have enough human resources,” admitted Dr Taikry. Otherwise, he insisted, “it’s the same standard…. For example, at Calmette [Hospital] we have the same equipment as Singapore: Two CT scans, angiography; we can do everything they do.”

And yet, people board buses and planes to get to hospitals in Ho Chi Minh, Bangkok, Singapore and beyond. “The middle [class] go to Viet­nam, the rich go to Singapore, the poor stay [here],” Dr Taikry said. “We have enough hospitals; we don’t have enough materials and human resources.”

Despite the investment in buildings and equipment, it is the human resource issue that may prove most difficult

The bulk of the nursing staff and “key personnel” at Royal Rattanak Hospital in Tuol Kok, which is the sister facility of forthcoming Royal Phnom Penh, are Thai. Some doctors are Cambodian, but many are foreign.

“The health care sector will take a long time to develop,” said Sueb­pong Intralawan, deputy director of Rattanak.

“You can develop business in Cam­bodia easily—if an investor comes here, done. But the development of human resources takes time, it is difficult to catch up with speed,” he said.

And Rattanak, with its 70 patients a day, is small potatoes compared to the places people are willing to fly to for medical treatment. Bum­run­grad, the best known of the Bang­kok hospitals frequented by foreigners, sees 400,000 patients a year.

But even when Rattanak tries to emulate the posh amenities of Bangkok—its lobby resembles a hotel, for instance, and patients get a meal with their checkups—the most basic necessities of keeping standards high require logistical wrangling.

“It takes time to import medical supplies,” said Dr Suebpong. “For ex­­­ample, most medication has to be imported from Vietnam. Then we have to translate from French,” he said, referring to the language that accompanies most of the medicine.

If Cambodia could manage to reverse the flow of patients leaving the country, siphoning back the middle class from Vietnam and the rich from Singapore, it might be the start of a much needed and profitable service.

The Ministry of Health was unable to provide data on the number of Cambodians who travel abroad each year for treatment.

Worldwide, medical travel is a multibillion-dollar industry, according to industry expert Josef Wood­man, who notes that: “While Cam­bodia’s health care infrastructure continues to improve, we would not yet view it as a desirable medical tourism destination.”

In a 2008 study by consulting firm McKinsey, it was found that 32 percent of medical travelers are those who “seek better care than they could find in their home countries, which are often in the developing world.”

Then there is the srising-tides school of thought, which holds that more money sunk into health care at the top levels im­proves facilities even at the bottom.

At least in one health sector, dentistry, Cambodia has managed that sort of reversal.

Through a concerted effort to stay abreast of developments in the sector, Cambodian dentists have managed not only to keep their pa­tients at home, but are now even lur­ing foreigners seeking more competitive prices than in their home countries.

“Compared with medical service, most Cambodians go to Vietnam or Thailand. For dental treatment, most Cambodians stay,” said Poch Sophearoth, former president of the Cambodian Dental Association and head of two private clinics in Phnom Penh.

“We always have the conferences and meetings and seminars. We always encourage our dentists to strengthen our quality,” he said.

“We are afraid [of being] like the medical sector,” he added.

 

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