When the Needle and the Damage are Done, a Difficult Diagnosis Awaits

You can’t see the sun rise from Sunrise guest house. The original owner thought Sunset sounded too funereal, even though most evenings the murky waters of the Boeng Kak, which the guest house overlooks, are set alight by the reflection of the setting sun.

It was in this wobbly wooden house built over the water that 26-year-old Kieran Power died on April 29. Friends living nearby said he overdosed on drugs, the culmination of a weeks-long spiral into depression and substance abuse brought on by losing his job as an English teacher.

Police said Power’s body was in a state of advanced decomposition when they found it, and estimated the young Englishman had been dead for four or five days before being discovered. The smell, they said, was overpowering.

Power was one of an increasing number of foreigners drawn to Boeng Kak by the area’s reputation for cheap accommodations, weak law enforcement and easily available drugs. He was also on a growing list of Westerners who have died in grim circumstances among the maze of unsurfaced alleys and budget guest houses that lines the eastern shore of Phnom Penh’s largest lake.

Thierry, who lives in a dark first-floor room just along the shore from where Power’s body was discovered, said he already had a heroin problem when he came to Phnom Penh nearly two years ago. He’d been hanging out in the north of Thailand for two years on a narcotics-based extended holiday, making forays into the Shan state of Burma to score whatever drugs tribe members would sell him. Thai police started tightening up on drugs. So when a friend got in touch from Phnom Penh, saying teaching work was easy to come by here, there was little to stop him from making the move.

“My idea was come, make $2,000 and go back to Thailand, open a guest house in the Golden Triangle and swing in a hammock on heroin for the next 10 years,” he said.

Things turned out differently.

“It took me months to get a job, and I was doing a lot of heroin by then, $30 or $40 worth a day, so I ran up a $1,500 debt to my dealer.” The 28 year old has been here ever since, living in a small room in a Boeng Kak boarding house.

Thierry’s days are filled with the routines of addiction: Waiting for his dealer, a Cambodian man whom Thierry describes as a friend, who brings heroin to his room twice daily; cooking up his heroin fixes; and teaching English, which is how Thierry supports himself-and his addiction.

“All my salary goes towards my debt to my dealer,” he said. “I never have any money the day after I get paid. My dealer gives me a dollar a day to buy food.”

He said he is stuck here until he gets clean.

“There’s no way I’d go back home with a habit,” he said. “I can afford to be a junkie here, but I can’t afford to be a junkie at home-I’d have to be a criminal.”

Thierry’s salary is meager by expatriate standards, but being a heroin addict in Cambodia is still many times cheaper than it is in the US or Europe. And it’s getting cheaper.

As governments in Thailand and Vietnam crack down on shipping routes through their countries, more and more of Southeast Asia’s heroin-most of which comes from Burma-is passing through Cambodia, drug-prevention officials say. As availability goes up, the price goes down, a change Thierry has welcomed over the years he has spent here.

“When I first got to Cambodia, 2 1/2 grams of heroin would have cost me $100. Now, it costs me about $50. The price has more or less halved.”

Graham Shaw, program officer at the UN Office on Drugs and Crime, has also seen an increase in the quality and quantity of heroin appearing here.

“Most of the heroin coming through Cambodia is headed elsewhere in the region, or to Australia, Europe or the US, so the quality has to be quite good to make it worth shipping,” he said. “Thailand has been cracking down, so traffickers are using other routes. The availability is increasing and the price is going down, so it would seem to be being trafficked in larger quantities.”

Leaning on the counter of his hole-in-the-wall pharmacy as tanned tourists bounce past on motorbike-taxis, Boeng Kak pharmacist Kao Sakhon knows all about Western tastes for narcotics.

“Many foreigners come to my shop to buy syringes, the small ones. I sell about 10 of these a day to Westerners,” he said, digging into a large cardboard box and holding up a sealed hypodermic needle. “And a lot of Westerners ask me for morphine, but I don’t sell it. I think they get motodups to get it for them instead. They buy a lot of codeine, though,” he said, grinning.

John, a 30-year old recovering drug addict from England, can see why people who use drugs are drawn to Boeng Kak. “This place is a junkie’s paradise,” he said. “If I was at home, scoring heroin would be a huge hassle. Here, you can just send a moto off to get it for you.

“And the chances of getting into trouble with the police are minimal,” he added.

Sim Bunsong, the deputy police chief of Daun Penh district, which incorporates Boeng Kak, is in charge of incidents involving foreigners in the area. He claims drug-related incidents are declining.

“In the past, there were a lot of people using drugs in the area. The guest houses used to offer free marijuana, and some foreigners died from drug overdoses there,” he said. “Nowadays, the numbers of foreign drug users is going down, since our authorities started cracking down on the guest house owners.”

Despite his assurances, the area, tucked away behind Monivong Boulevard, seems far from the reaches of local law-enforcers. Some guest houses display anti-drug notices, but no one takes much notice: Unlike Thailand, Cambodian drug police do not have a reputation for targeting foreigners.

On an average evening in one of the half-dozen lakeside guest houses, backpackers lounge in clouds of marijuana smoke watching “The Killing Fields” or exchanging stories about the day’s sightseeing, while motorcycle taxi drivers stationed outside openly offer “ganja” to passers-by.

And though methamphetamines, opium and heroin are sold and taken more covertly, you don’t have to look hard to find someone willing to supply them. Not every tourist who passes through here will explore this seedier side of the local market, but for the few who do, the place can be spellbinding.

Jurgen Schwol had been backpacking for more than a year when he arrived in Boeng Kak in July to catch up with an old friend who was running a guest house. The 34-year-old German liked to dabble in hard drugs; his friend said he was particularly partial to ketamine, a powerful anesthetic with a short-lived, soporific affect.

No sooner had Schwol arrived in Phnom Penh than he was out on a weekend-long drinking binge, eventually returning to the guest house to ingest a mixture of ketamine and heroin that the friend said he bought nearby. Loud music blared from Schwol’s room for some hours, followed by loud snoring, then silence, the friend said.

On July 10, when he had not emerged for more than 24 hours, the friend opened Schwol’s door to find him covered in his own excrement and vomit, lying dead in his bed.

Schwol’s death was initially recorded as an overdose in the press, but when an official at the German Embassy was contacted about the case recently, she said doctors had since revised this diagnosis. She said Schwol, a physically fit young man, had died from cardiac arrest; that he had not been taking drugs, and that the initial overdose record had been false.

Many of the deaths involving drugs have conflicting diagnoses, making it difficult to know how widespread heroin overdoses are.

Just after New Year’s Day 2002, a young Frenchman died in his room at Boeng Kak’s oldest and most renowned guest house, Number 9. People living nearby said it must have been an overdose: The man seemed healthy and had been experimenting with the various substances on offer at the lakeside, they said. But staff at the guest house disagreed: “He drunk a lot of wine, and he did not have food in his stomach,” said a manager at the guest house who would not give her name.

“I do not remember his name or age,” the manager added.

Karl Howells overdosed on a combination of heroin and codeine in the toilet of the Same Same But Different guest house in Boeng Kak on July 8, 2001, according to the friend who found him. He had been teaching English in Phnom Penh for more than a year, and had been involved in the drug scene since his teens.

But Howells had only recently graduated to injecting heroin, as opposed to smoking or inhaling it, a few weeks before he died. People close to the 27-year-old Englishman say his overdose was deliberate. He was depressed about a recent family tragedy and was known to be unhappy about his inability to kick heroin. The friend who found him took the syringe from his arm, and at Calmette Hospital the doctors were aware of how he had died.

And yet the local press, reporting from local police records, described his death as caused by “massive head injuries after he had been drinking beer with a friend.”

Pierre Delaby, a 42-year-old French citizen, had been in Cambodia one month when he was found dead in his room at a guest house in Daun Penh district, near Boeng Kak, on Jan 8. The Foreigner Police recorded the cause of his death as a drug overdose, but officials at the French Embassy were less certain. “The police found drugs near his body, but no autopsy was conducted, so we cannot be sure of the real cause of death,” they said.

The cause of Kieran Power’s death has also been shrouded in confusion. Although the friends who found his body said his death was clearly caused by a drug overdose and the Foreigner Police recorded it as such, by the time news reached Power’s mother in Ireland, the diagnosis had changed to Dengue fever.

“He was all black and swollen; it looked like he’d been beaten,” said a friend who was called to help when Power’s body was eventually found. “Apparently that happens with overdoses sometimes.”

Power’s mother wanted to get in touch with someone who had known her son in Cambodia, so the British Embassy passed on the friend’s contact details, he said. This led to a distressing correspondence: “I was getting e-mails from Kieran’s mum saying, ‘I’ve been to see my doctor, and he said normally people with Dengue are really sick for weeks before they die. How could this have happened?'”

The vague nature of police and medical records means it is impossible to tell how many foreigners have died from overdoses in Cambodia. Thierry has his own theory about why the facts are so cloudy when it comes to drug-related deaths. “It’s bad for tourism, and the police don’t want to go around asking awkward questions,” he said, shrugging.

According to Graham Shaw, the inaccuracies come down to a simple lack of police resources and training. “The police are often unable to secure a crime scene, so evidence is getting tampered with or removed,” he said. “Corruption and the lack of forensic science and autopsies also make it very difficult to get an accurate record of how someone died here.”

Kao Sakhon, the local pharmacist, considers overdoses a very regular occurrence at Boeng Kak. “Many foreigners die from drugs here, lots of them,” he said, his voice rising. “I can remember five just this year.”

Thierry said he has witnessed the fatal overdoses of several friends and heard about many more-especially since he’s been living at Boeng Kak. Most of the time it’s occasional users who overdose, he said, or people who had a habit in the past but haven’t used heroin for a while. For hardened addicts like Thierry, it would take an unusually pure or toxic batch to shock his system into overdose.

Most of all, though, it is ignorance that lies behind most overdoses.

“People are mixing,” Thierry explained. “Using other drugs with it, and especially alcohol,” he said. Combining heroin with any other intoxicant is known among users to be extremely risky.

“It’s also about toxicity, about how run down you are and about your surroundings, your psychological state at the time,” he said. A backpacker may have been away for months, have crossed continents, been on anti-malarial or prescription drugs, and may be both physically and mentally run down. Their systems are often simply unable to cope.

“People just aren’t used to the purity of the heroin here,” Thierry continued. “Because it’s made for export [mostly from Burma], it’s compressed, it’s in a block. I’ve known lots of people who have died from [using heroin], here and in other Asian countries, and none of them were officially recorded as overdoses.

“It’s always alcohol poisoning, asphyxiation, liver problems, heart attacks and so on,” he said.

To Thierry, it seems obvious why someone would want to disguise the cause of death of an overdose victim. “We had a friend who died [elsewhere in Asia], and we all chipped in to get the police report changed so his parents didn’t find out he’d overdosed.”

Thierry said they did it to protect the dead man’s family: “When someone close to you dies, you’re always looking for someone to blame; it would just have made them angry, on top of all the grieving.

“And what difference does it make? They’re dead, and finding out how they died isn’t going to change that. Does anyone want to know, really?”

A spokesman for the British Embassy refused to comment on the details of Powers’ death, but acknowledged how difficult it is to obtain a reliable cause of death.

“With the standards of forensic science here, you can never really confirm whether you’re dealing with an overdose or not; it’s only if police find drug paraphernalia near a body that they record it as that,” the spokesman said.

Foreigner Police Chief Pol Pithey echoed this uncertainty. “We are not sure about how foreigners die,” he said. “Maybe some use drugs, but we have no records about this.”

Statistics from Phnom Penh’s Calmette Hospital, located a stone’s throw from Boeng Kak, are no more enlightening. The hospital registrar recorded a total of 17 foreign fatalities since the start of 2000, but catalogs them in categories as broad as intoxication, hypertension, or heart and liver failure.

Most people who pass through the Boeng Kak neighborhood never encounter the area’s darker side. But for the few whose compulsions bind them to this place, finding a way out can be far harder than simply booking a ticket to the next destination.

“There’s a saying among heroin users,” said John, the former addict. “There are three possible outcomes to a heroin habit: You’re either going to end up in jail, in an institution or dead.”

There are currently no drug rehabilitation facilities in Cambodia and law enforcement is notoriously weak, so the chances of a Western drug-user ending up in prison or a hospital here are negligible. For foreign heroin addicts, John added, there may only be one outcome left.

The Phnom Penh chapter of Narcotics Anonymous meets weekly and can be contacted on 012 949 421 or 012 990 927.

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