Villagers in a remote district of northeast Cambodia’s Kratie province say obtaining medical treatment has become extremely difficult since the government reinforced a ban on unlicensed health workers and clinics earlier this month in the wake of a mass HIV infection last year.
The Ministry of Health on March 9 urged local authorities to implement the ban in response to the crisis in Roka commune, in Battambang province’s Sangke district, where nearly 270 villagers have tested positive for HIV/AIDS since November 2014.
Authorities have since charged Yem Chhrem, the unauthorized medical practitioner who worked in an unlicensed village clinic in Roka, with murder and other crimes related to the mass infection after he admitted to reusing needles to treat patients.
Prak Sengly, a resident of Sre Cha commune in Kratie’s Sambo district, told RFA’s Khmer Service Tuesday that, ever since the ministry directive on unlicensed health care, villagers have been required to travel around 20 kilometers (12 miles) to the nearest licensed clinic for treatment.
“I don’t think state-licensed doctors are much better than doctors at private clinics,” Prak Sengly said.
“The private doctors were helping us,” he said, adding that receiving medical treatment in remote areas of the province had been much more convenient before the ban was reinforced.
Prak Sengly said that while Sre Cha commune has a licensed health referral center, the facility only has six beds and the doctors and nurses who are normally stationed there had left, along with the center’s medical equipment.
Sre Cha commune chief Tuy Yuk told RFA earlier this month that provincial officials and local authorities had forced unlicensed area health care providers to suspend their businesses and attend classes.
He acknowledged that since the directive from the Ministry of Health, his villagers had found it very difficult to seek medical attention, and said if they had a health emergency in the middle of the night, it was nearly impossible to find treatment.
“In remote areas, villagers were relying on [unlicensed] private doctors, but now they have shut down their businesses,” he said.
Private health care
Ministry of Health spokesman Ly Sovann said his agency is working with the Ministry of Interior and local authorities to improve private health care providers.
“We had this measure in place long ago, but there was little implementation, so we must reinforce the private health sector to be effective,” he said.
Ly Sovann urged villagers to report to the ministry if they encountered any state-licensed health care centers with no doctors or nurses present.
According to the Ministry of Health, 5,757 private clinics became licensed in Cambodia between 2009 and 2014, and the ministry is working to approve additional facilities.
Cambodia’s dearth of licensed medical practitioners stems from the bloody 1975-79 era of the Khmer Rouge regime, when physicians, lawyers, teachers, engineers, scientists and professional people in any field were murdered, together with their extended families.
According to the World Bank, in 2012 Cambodia had a mere 0.2 physicians for every 1,000 people, or nearly 3,000 in a nation with a population of just under 15 million at the time.
Fear of vaccines
Meanwhile, villagers in Kratie told RFA they remain fearful of seeking immunizations for their children following the mass infection in Roka commune, where six HIV-positive patients—five elderly and one infant—have died since the outbreak was detected.
Yum Sreyneang, a villager from Kor Lop commune in Kratie’s Chet Borey district, told RFA Monday that residents believed the HIV infection in Roka was linked to injections, rather than reused syringes.
“I have heard rumors, so I am afraid to take my children to get vaccinated,” she said.
Kor Lop commune chief Chhum Chhoy confirmed that residents of the area were concerned about HIV infection and were avoiding medical treatment because of it.
“The villagers believe these unsubstantiated rumors,” he said, adding that residents of neighboring districts had also refused to get their children vaccinated.
Sixth Roka death
On March 7, Roka resident Tim Tuoy, 69, became the sixth patient to die in the commune, days after realizing he had developed AIDS, according to his daughter.
The Phnom Penh Post quoted Ly Penh Sun, director of the National Centre for HIV/AIDS, Dermatology and STD Control (NCHADS), as saying last week that support for Roka was a "long-term" commitment, and a number of ministries were involved in establishing a wide-ranging action plan for the area, which would last for "at least five years."
He said that even when the plan had ended, the government hoped to leave behind an apparatus of support, such as medical units, to continue helping the community.
But residents told the Post that beyond material and medical support, they were concerned that the very make-up of the community was changing, with fears that the elderly would soon be gone and the youth left with a hopeless future.
Reported by Preach Chev for RFA’s Khmer Service. Translated by Samean Yun. Written in English by Joshua Lipes.