Uncovering the Healthcare System of Angkor

About 15 years ago, French archaeologist Christophe Pottier found two skeletons while excavating the site of the 8th-century Prey Khmeng temple in Siem Reap province, and was looking for an expert to do a preliminary study on them.

Rethy Chhem, a university professor and radiologist, happened to be on vacation in Cambodia at the time. 

In a scene sculpted on the 12th century Bayon monument in Angkor Archaeological Park, a patient is cared for by medical workers. (Rethy Chhem)
In a scene sculpted on the 12th century Bayon monument in Angkor Archaeological Park, a patient is cared for by medical workers. (Rethy Chhem)

“In Cambodia, we have few experts in skeletons whatever the field,” Dr. Chhem said in an interview last week. “I was the only one—and on holiday—to have an expertise that was close to skeletons. So I worked at Prey Khmeng with this archaeological team.”

With the study underway, Dr. Chhem soon realized that he needed to X-ray the skeletons and do a computerized tomography (CT) scan. The equipment not available in the country, he had the skeletons sent to the National University of Singapore, where he was teaching at the time.

The test results showed that the remains were 2,000 years old and of a man who had a fracture in his femur—the bone had been reset but not quite right. This meant that there were bone setters in Cambodia two millennia ago, Dr. Chhem said.

This experience led him to initiate another dig, working again with Mr. Pottier, a member of the French research institution Ecole francaise d’Extreme-Orient. Together, they excavated a hospital in Siem Reap province’s Angkor Archaeological Park in 2006.

This was one of the 102 hospitals that, according to stone inscriptions from that era, King Ja­yavarman VII ordered to be built in the late 12th century. As Dr. Chhem will explain during a talk at the Royal University of Fine Arts on August 28, those hospitals were meant for all the kingdom’s subjects.

A 12th-century inscription found in the Say Fong region of Laos—part of the Khmer empire at the time—writes of Jayavarman VII: “He suffered the illnesses of his subjects more than his own; because it is the pain of the public that is the pain of kings rather than their own pain.”

The hospitals offered the equivalent of free state healthcare. Each one displaying in a shrine a statue of Bhaisajyaguru, the Buddha of healing and medicine, and followed medical innovations of the time, such as checking a patient’s pulse as part of a diagnostic test and using butter, oil, honey and molasses as medicine.

Each hospital had about 200 medical workers, the Say Fong inscription indicates, including doctors, pharmacists, astrologists and other health professionals.

By the time Jayavarman VII came to the throne, the kingdom already had a long medical tradition, according to Dr. Chhem.

In the 7th century, there had been a small dynasty of doctors at the Khmer court: one family of doctors spanning four generations, he said. Also during that century, Chinese chronicles mention that a Chinese Buddhist monk was sent to Cambodia for two years to study herbal medicine.

“Globalization existed before today,” Dr. Chhem said. “There was a circulation of knowledge across the region…. The profession that allowed this diffusion of knowledge is the Buddhist monks: They were diplomats.”

In addition to traditional medicine, which is still practiced in the country, there was a tradition during Angkor of Brahmin priests being doctors and caring for the king using Ayurvedic medicine of Hindu origin.

When Mr. Pottier and Dr. Chhem excavated the hospital site at Angkor, Dr. Chhem had hoped to find medical instruments of the time and a statue of Bhaisajyaguru—a sitting Buddha holding a jar of medicine or a plant.

They did not find a statue, but unearthed numerous jars probably used for medicine that will eventually be studied by paleobot­anists, Dr. Chhem said, adding that he hopes to resume excavation in the near future.

Considered an authority in paleoradiology—the use of nuclear technology to study human skeletons found at archaeological sites —Dr. Chhem has been called upon to study scores of skeletons and even mummies. This has included the remains of Pharaoh Ramses II, who reigned over Egypt more than three millennia ago, to determine whether he suffered from an arthritic disease of the spine. He did not, Dr. Chhem concluded in 2009.

Born in 1952 in Phnom Penh, Dr. Chhem was a medical student in the early 1970s. With civil war raging in the country, classes were constantly interrupted, so his family decided to send him to university in France.

He left on April 13 or 14, 1975, with a few dollars in his pocket, his family planning to send him money through bank transfer in the coming days.

With the Khmer Rouge seizing control of the country a few days later, that never happened. Alone and penniless, he took whatever job he could find and still managed to obtain his medical degree in France, specializing in radiology.

Wishing to teach, he moved to Canada in the late 1980s and taught at the University of Sherbrooke and McGill University in the prov­ince of Quebec. In 1997, he joined the staff of the National University of Singapore, and in 2003, returned to Canada as head of the department of medical imaging at Western University in London.

In 2008, he joined the International Atomic Energy Agency as head of the division of human health, and assisted Japan following the Fukushima Daiichi nuclear disaster in 2011.

Last year, he fulfilled a long-time dream of coming back to Cambodia. He took over as director of the Cambodia Development Resource Institute, a think-tank employing around 30 Cambodian researchers with Masters and Ph.D. degrees obtained abroad, he said.

For Dr. Chhem, the role of the institute is to provide the country and its policy makers with objective data and expertise to make decisions and compete in Asean.

“I think that Cambodia has reached another level where reform is necessary, where science is important to support policy formulation,” he said.

“Cambodia is moving,” he added. “Change is inevitable.”

Dr. Chhem’s talk on Angkorian medicine at the Royal University of Fine Arts begins at 5:30 pm and will be delivered in English and Khmer.

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