Cambodia's self-taught doctors, a Khmer Rouge legacy
10 Apr 2015


A Cambodian child rides his bicycle past a health centre at a village in Kampong Speu province. About 70% of Cambodians seek healthcare from the private sector -- including from pharmacies, illegal doctors or traditional healers, known as khru khmer -- according to a 2012 survey by the World Health Organization. (AFP photo)

When the phone rings, former Khmer Rouge soldier Ken Mon grabs a bag stuffed full of medicine, jumps on his motorbike and heads for an impoverished Cambodian village with the haste of any diligent local doctor.

Yet the 55-year-old Ken Mon has no formal medical training.

While 'doctor' is a self-granted title for Ken Mon, he -- and others like him -- are the only source to treatment for thousands of poor residents in Ang Ro Ngeang village, about 70 kilometres south of Phnom Penh.

Undeterred by his lack of qualifications, Ken Mon drives ten minutes down a bumpy track in Cambodia's southern Kampong Speu province, arriving at the home of Chei Tana, 27, who complains of crippling stomach pains.


Unlicensed Cambodian doctor Ken Mon poses on his motorcycle, which he uses to make patient visits at a village in Kampong Speu province. When the phone rings, the former Khmer Rouge soldier grabs a bag stuffed full of medicine and heads for an impoverished Cambodian village with the haste of any diligent local doctor. (AFP photo)

"You have a lot of air inside your stomach," he explains after examining his patient, giving him a packet of antacid pills.

Ken Mon is one of hundreds of unlicensed doctors treating patients across a country whose medical system was eviscerated under the brutal Khmer Rouge regime of the 1970s and is yet to build a comprehensive public system.

About 70% of Cambodians seek healthcare from the private sector -- including from pharmacies, illegal doctors or traditional healers, known as khru khmer -- according to a 2012 survey by the World Health Organization.

But illegal doctors have fallen under intense scrutiny after a mass outbreak of HIV at a remote village in western Cambodia last November. Authorities say the original infection was caused by an unqualified doctor, Yem Chroeum, who has admitted he re-used needles and syringes.

More than 200 of his patients have since tested positive for HIV and Chroeum faces trial on charges of murder, deliberately infecting people with the virus and operating an illegal clinic.

The scandal saw the government vow to crack down on unlicensed health providers.

Their practice "affects the lives of the people, and the reputation of the country", according to Sok Srun, director of the Health Ministry's hospital-services department, which oversees the licensing of medical staff and clinics.

Despite their concerns, officials are yet to come up with a policy to persuade newly-trained doctors to leave the relative comforts of the cities and head into Cambodia's remote, rural hinterlands.

Neither have they been able to adequately boost the ranks of doctors, a profession wiped out by the Khmer Rouge, who slaughtered a huge proportion of the country's educated classes. That legacy still haunts the country today.

World Bank figures say Cambodia, one of Asia's poorest nations, has just 0.2 doctors for every 100,000 people, on a par with Afghanistan. Similarly impoverished Myanmar has 0.4 per 100,000, while France boasts 3.2 per 100,000.

For millions of Cambodians, doctors like Ken Mon are their cheapest -- and often only -- option.

"I learned my medical skills at the university of life," he told AFP, adding authorities have never stopped him practising medicine.

Ironically, that education came from the same people who destroyed Cambodia's health system.

Ken Mon joined the Khmer Rouge as a fighter in 1974, shortly before the hardline communist regime seized power. When it was finally toppled in 1979 -- after causing the deaths of up to 2 million Cambodians through execution, starvation or overwork -- he and many other cadres fled to Samlot, a stronghold on the Thai border.

There he learned his medical skills, first from Khmer Rouge medics and later from foreign doctors working for the Red Cross.

"The first day, they gave me a syringe and medicine and asked me to inject a wounded soldier," he recalls, adding he can now deal with a myriad of procedures from treating diseases, such as malaria and typhoid, to suturing wounds.

Nuch Dy, a 56-year-old widow from a nearby village, has never seen a qualified doctor.

"(The health centre) is far and I don't have money to pay immediately," she says.

Instead she treats her long-time stomach problems with painkillers and antacid pills bought from Ken Mon -- often on a tab.

Neighbour Uon Sreang, 35, tells AFP that everybody in the village is aware their doctor has no formal training.

"But we trust him. He always used new syringes and needles when he gave injections to my family members," she says, her nine-month-old baby in her arms.

There is a logic to their faith in Mon's skills with official health centres often failing to guarantee a better quality of care.

The WHO has said that 43% of the 11,000 health centres across Cambodia -- the first port of call for medical treatment -- are unable to provide full services due to a lack of physicians, medicine or equipment.

Meanwhile, a World Bank survey last year found only one in three official doctors in rural health centres were able to correctly diagnose a series of illnesses. Of those who could, just 17% were able to prescribe relevant drugs.


Cambodian women with their babies sit in front of the Kantha Bopha hospital in Phnom Penh. (AFP photo)

For the seriously ill -- and the very young -- a city clinic is almost always the only option.

Outside a children's hospital in Phnom Penh, Heng Hen, 45, waits patiently with three sick grandsons after making the 80-kilometre journey at dawn.

"Medics in the countryside don't have ability to treat children yet," Heng Hen says.

He admits the recent HIV outbreak has given him pause for thought over the wisdom of continuing to seek treatment from unlicensed medics.

"But we have no choice because we are poor," he says.

General Mackevili wrote:"You need IV drip."

prahkeitouj wrote:Many trained doctors now but most of them want to live in the city because people in the city have more money to pay for doctors. It showed that they think money is priority. What are the differences between trained and untrained doctors if the trained doctors have skill but no consciousness of job?

When I was young I stayed with my aunt in province. I knew some of her colleagues didn't go to school before they work as nurses. I felt very surpriesed ,but she told me that because our area lack of doctors so they just helped till became nurse( civil servants). I thought if I want to be a nurse, I don't to go to school I just help my aunt then I can work for public health care. But I don't like that job.. so not a nurse now.

MekongMouse wrote: Maybe Cambodia could force doctors to spend a certain amount of time at a provincial hospital for their residency requirements. They'd be new graduates, but at least they'd be have a degree.