Doctors discriminate against the poor

Cambodia is instructing doctors to practice without regards to
socioeconomic status, according to the country's top health official,
amidst reports that women had been left to die during childbirth and
other patients have been refused treatment because they did not have
the money to pay for services.

Minister of Health Mam Bunheng said Friday that improvements in
healthcare quality and service had over the past two years
substantially decreased the number of maternal and child fatalities
across Cambodia, which has the highest infant mortality rate in the
Southeast Asia.

He said that since 2010 the ministry had worked to teach doctors not
to differentiate between the rich and the poor—a practice which had
led to some doctors refusing to admit pregnant women and other
patients who could not cover certain medical fees.

"We are working on a process to improve maternal and child health,"
Mam Bunheng said, adding that the ministry is also in the process of
drafting a code of conduct for midwives.

"We are also working to improve our midwives in health centers and
referral hospitals," he said. "We are working to train midwives to
work in communities."

Mam Bunheng said that doctors had been instructed to admit poor
patients and that the Ministry of Health had allocated equity fund
reserves for providing treatment and food to the underprivileged.

He said that the government has helped about two million poor patients
nationwide through the equity fund foundation.

Expensive fees

But the health minister's statement runs contrary to reports that have
recently surfaced in Cambodia about discriminatory practices against
the poor in hospitals around the country, particularly in rural areas.

Nob Mean, a farmer from northwestern Cambodia's Banteay Meanchey
province, told RFA that he had been referred to a hospital that had
charged him a number of fees for medical services.

"The referral hospital has asked me for money to pay for my bed. It's
expensive," he said.

"The hospital charged me 81,500 riels [U.S. $20]. It's a lot of money
for the poor," he said, adding that he considers service in the
country's health industry to be about 60 percent positive, but that he
would like the government to bring the standard closer to 100 percent.

Lor Vannthary, a physician who works for a domestic health
nongovernmental organization, said that while the government has paid
more attention to health issues in recent years, a number of problems
remain in the industry.

"Referral hospitals have been built, but they lack a sufficient number
of doctors. Young graduating doctors are refusing to work in remote
areas of the country and instead prefer the city," he said.

"Also, some doctors don't pay close enough attention to patients
staying in state hospitals because they have their own private
hospitals—the doctors are not being paid enough to work."

Heng Tai Kry, a secretary of state with the Ministry of Health,
acknowledged that some doctors are unable to pay enough attention to
their patients, adding that it was largely due to working long hours
with many different patients.

He denied the claim that negligence on the part of doctors was a
result of low pay.

"Doctors are paid enough to live, but sometimes the demand is too
great and we can't please everybody," he said.

"The same problem exists even in places like the U.S. and Singapore."

'Desperately poor'

Cambodia's Ministry of Health oversees more than 1,000 hospitals and
5,000 doctors across the country.

According to the London-based nongovernmental organization Health
Poverty Action (HPA), some 78 percent of Cambodians live in "deep
poverty" with four of out five living on less than U.S. $2 a day. The
group calls healthcare provision in the country "desperately poor."

Some 58 percent of people in mountainous areas were living below the
poverty line in 2004, it says, up from 40 percent ten years earlier.

"While poverty has decreased overall in recent years, the health of
indigenous people living in mountain areas has declined dramatically,
along with the quality of health services available to them," the
group said.

HPA says that with 98 deaths per 1,000 live births, Cambodia has the
highest infant mortality rate in Southeast Asia.

Health Officials Demand Equal Care
Cambodia's health ministry says doctors cannot leave the poor untreated.
2012-08-06

Reported by Tin Zakariya and Sok Serey.
Translated by Samean Yun.
Written in English by Joshua Lipes.

http://www.rfa.org/english/news/cambodia/healthcare-08062012174311.html