Unlicensed Clinics Prove a Tough Issue to Treat

Operating from a modest tin shack he shares with his wife and children near the Mekong River in Kandal province, 34-year-old Seurn Sokheang treats his neighbors for a wide range of ailments.

“The type of illnesses that I treat include fevers, colds, stomach problems, high blood pressure and typhoid,” Mr. Sokheang said during an interview in July.

For those seeking a quick fix to their sickness, Mr. Sokheang—who splits his time working from home and at Kandal’s Sarika Keo health center—regularly gives injections and hooks patients up to IV drips. He says his service is preferable to state-run health centers or private clinics because his rates are cheaper.

“The ill prefer my service because they are very poor. They can come to me and I treat them and charge them a reasonable price,” he said.

“My villagers trust me and they like me,” he added. “They can come to my house to get the service any time, even at night time I am also available.”

But according to the Ministry of Health, which has pledged to shut down unlicensed health clinics following a freak outbreak of HIV in Battambang province last year, Mr. Sokheang’s informal operation is illegal.

Despite seeing a regular flow of patients, Mr. Sokheang admitted that he never attended medical school.

“I just got skills from my father,” he said. “My father has worked in this village about 30 years.”

“I am not registered with the Ministry of Health yet, but I can run it because I informed the chief of the health center at Sarika Keo already and the authorities,” he said, adding that he plans to apply for a license “in the future.”

In December, an HIV outbreak was detected in Battambang province’s Roka commune, where more than 270 people were found to be infected with the virus. Officials have blamed the outbreak on Yem Chrin, an unlicensed medic who admitted to regularly reusing syringes and has been imprisoned on murder charges—at least nine HIV-positive residents of Roka have died this year.

In response, the Health Ministry has vowed to tighten regulations of the country’s largely informal health sector.

In June, Sok Srun, director of the ministry’s hospital department, announced that 3,000 unlicensed doctors operating across the country had received warnings to stop administering injections. Health Minister Mam Bunheng claimed the same month that roughly 80 to 90 percent of the country’s clinics had been inspected.

But unlicensed medical workers haven’t gone away. Last month, Chhuon Sarom, an unlicensed medic in Pursat province, was charged with intentional murder and jailed after a 49-year-old woman died due to an injection he gave her.

Despite the Health Ministry’s efforts, the demand for treatment from unlicensed medical workers and clinics remains, according to Indrajit Hazarika, a technical officer for the World Health Organization in Cambodia.

Dr. Hazarika said shorter waiting times, perceived notions of quality and more flexible operating hours all contributed to people’s decisions to turn to unlicensed options when medical problems arise.

“As long as the above mentioned factors prevail, and the option of private facilities remains more acceptable to patients, it will be difficult to shut down all these facilities. The demand will continue to drive the supply,” he said in an email.

“The supply will reduce when the demand of these services decreases. This will happen when the alternative options become more attractive,” he added. “In addition, stronger regulation that ensures that only qualified, competent health practitioners are licensed and allowed to practice their profession will be important.”

And the practice of unlicensed doctors turning to injections and IV drips when it may not be the best option will also be hard to change, said a foreign doctor working in the public health sector, who requested anonymity for fear of damaging relations with the government.

“What people want and what is best for people is rarely the same thing. All doctors respond to the pressure of the patients more than people realize,” the doctor said.

“What they [patients] want here are IV drips and injections and that’s what the doctor in Roka was doing and that’s what infected them all. At a health center you’ll get given pills, at a private provider you’ll get injections,” he said.

Sitting beneath his stilted home in Roka commune last month, Lorm Chea, who worked as an unlicensed doctor before the HIV outbreak, said he and four or five others like him in the commune had mostly stopped doing medical work.

“We have stopped completely but if somebody gets ill and they come and ask, the village chief can let us go ahead with an injection,” he said.

But Mr. Srun, the head of hospitals at the Health Ministry, said that was still illegal.

“It is illegal to give people injections from home,” he said. “We want to eliminate that because the people that give injections from home are not hygienic enough and that can cause problems.”

About 2 km from the home of Mr. Sokheang in Kandal province lives Yem Sophat, a doctor at a Phnom Penh hospital who said he also treats neighbors inside his house and does not have a license to operate privately.

“I don’t own the documents so I’m not yet licensed. When I’m here they come and I give them injections,” he said of his patients.

“When they get hot and get a fever, I sometimes use the IV drip.”

The doctor said he would go through the process of registering his practice once he retires from his other job.

“I will open up a clinic when I stop working at the hospital,” he said. “The people come to me as they trust me.”

(Additional reporting by Khuon Narim)

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