Heath care issues
We had heard that health care could be a bit tricky in Cambodia but had also heard that the local hospital was good and that if something happened, we could probably get reasonable first stage care there. This is probably true if you have money. But for people with no money, the story is different. Of course, in all societies this is true. It just takes on a different look in each place, but the same issues are faced: lack of supplies, overwhelmed staff, underpaid staff, and an inability to see the humanity of those understood to be “lesser than”.
Our friend’s aunt was pregnant with her second child and went into labor. She is 43 years old and lives in a very remote, rural area. She traveled the one hour to the local hospital, but it was the weekend and the doctor wasn’t on duty. He should have been but wasn’t. Because they are poor, no one bothered to help them much in any way. Then the hospital said that they didn’t want to be responsible for her and sent her by ambulance to the regional hospital, in Kampot. The “ambulance” is a van with no equipment. The road is paved but bumpy. On the way, the baby died. They had to do a C-section at the hospital and got the baby out. She was given an IV with antibiotics and fluids but that was it. The family ran around trying to find blood to buy but none in her type was available.
The hospital staff asked if the family wanted them to bury the dead baby. It would cost too much money, so they could not afford that. The other option would be to transport it back to their homeland for burial. But in Cambodia, no one will transport a dead body because it is believed to be bad luck. So there was no way for the family to deal with the body. The hospital staff wrapped it in plastic and threw it in the garbage.
After 2 days, the staff was no longer coming to check on the aunt because the family was too poor to pay the fees (bribes) to the staff to come into the room or to do tests. She was being given Tylenol and some antibiotics and that was the extent of the care. She had lost an incredible amount of blood but none had been replaced. She was swollen and the family didn’t know what to do. I asked what blood type she was because I thought I could ask around to find a donor. I assumed I would not be a suitable donor because I have B+ blood, which in the US, only 8% of the population has. It turned out that the sister had taken the paperwork with her bloodtype back home. I didn’t want to call this woman, who was now out planting in the rice fields, for her to read English letters and possibly get it wrong, thus risking killing the aunt. So I asked if my friend thought the hospital had any records. Of course, with the doctors and nurses not talking to the family, any question is problematic. I asked my friend if showing my foreign face would help. She said yes. So our goal was to get the blood type and to see if anything could be done to get the aunt’s swelling down (ie get some sort of care).
I bicycled to the hospital, which is a nice, airy, bright, clean facility. There is minimal equipment and services. For example, the beds are red cross beds donated, so there are not mattresses but instead a piece of linoleum flooring on the frame, so that it is easy to clean. Blankets and towels and pillows are brought to the hospital by the families. Families are responsible for cooking and feeding their sick members and themselves. Clothes can be washed outside in a bucket and hung on a communal drying line. Of course, the uncle was not prepared for this stay, so they did not bring a cooking pot or rice or anything to eat. My friend and her family were cooking at home and bringing meals into the hospital (a 30-minute bicycle ride) or giving money for them to buy food from vendors who are nearby. There are no beds for family members, so the uncle slept under the bed on the floor and his wife slept on the bed.
In the same room was another woman who had also just had a C-section, although her baby lived. Both the mother and the baby were very skinny and weak. Her husband had been able to buy blood—one pint—for his wife. But she needed more and there was none available and they were poor. A pint of blood can cost anywhere from $75 to $150 depending on the availability (in Phnom Penh, the capitol, it is closer to $150, whereas in the provinces it’s closer to $75). To give an idea of this cost, people who work in hotels and as cooks and even teachers make about $50 to $60 a month. So it is asking more than your month’s salary for a pint of blood.
As I entered the room, I saw the two women lying on the beds and a man attending to the woman with the baby. My friend and I greeted her aunt and then we sat on the empty bed—there were two more beds that were empty and being used as seats by the families. I thought the guy with the woman was the doctor, but it turned out that he was the husband. We had to leave the room to find the doctor. So we went to the nurses station and found someone there to talk to. She was quite rude and wanted to know what I wanted. I spoke clearly and slowly and June, my friend, helped translate when the person did not understand. She was quite abrupt and dismissive. I thought she was a nurse—she wore the traditional skirt and a white coat. But it turns out she was the doctor. We asked whether the hospital had other records of the patient’s blood type or whether we had to go get her typed again because the sister had taken the papers home. The doctor suggested we take the aunt over to get typed again. I was able to use the fact that I am not fluent in the language to ask again if the hospital had records. She said she would look and we could wait in the room.
We went back to sit in the room and the others all said that they didn’t think she would help us at all because we hadn’t paid anything to get her to look stuff up. We waited about 20 minutes. We were just strategizing about how to be a nice pest and see where we were at, when the doctor appeared and we went to have a conversation again. It turns out that the aunt has B+ blood as well and that the reason she is so swollen is because she needs blood. I say immediately that I will give blood.
Now, I have never given blood because I get faint if I see blood, I hate needles, they can never find my veins and end up using the smaller ones on my hand, which collapse and we don’t get the blood we need. I am really not excited about this prospect. And of course we’ve been warned to make sure that the hospital uses a new needle. But after the aunt’s experience, and knowing the history of this country, the small jab to help is nothing. June and I go to the lab to give my blood.
They call the doctor to come. He arrives from someplace and opens the office. I explain my fainting problem and how I don’t want to see my blood and how difficult it is to find my veins. He says “yes yes yes” has me make a fist and then and jabs me, expertly finding the vein on the first go. Poor June, who seems only slightly more able than me to cope with blood, watches and I keep asking if it’s working. They get the pint, give me something to drink, I get a bandaid, which June holds on my arm, and they finish the paperwork. Then he wants to give me my pint—still warm and nearly still circulating in the bag—to bring to the aunt. He takes one look at my face and puts some paper around the pint bag. June carries it out.
We go back to the doctors in the C-section part of the hospital. They prepare for the transfusion and realize we didn’t bring some tubes that were supposed to come with the pint. They blame June. She goes out and back to the lab. The doctor is gone and everything is locked up. She calls him on her own cell phone. He is driving his motorbike someplace. He comes back. The other doctor sends June out to get the tubing. It’s raining and she comes back soaked but with the tubing. The doctor and nurse set up the blood and find a vein—the aunt is so swollen that this is difficult. They leave. The blood stops flowing. We have to go find them again. Sorry to bother them. Sorry sorry. Can they please come look. The doctor comes back—chastises the aunt for moving her arm (I swear she hadn’t moved at all), moves it and the blood starts again. She leaves. It stops. We go find her again. Sorry sorry. She comes back. Moves the needle around, it starts again. She leaves. It stops. We find her again. Sorry sorry sorry sorry. She finally comes and stays a while, showing June how to apply pressure to the vein to get the blood to go in. She leaves and June applies pressure. It stops again but this time we move things around and apply pressure and it keeps going. After half of the pint is in the aunt, her color has changed part way down her face. It’s like a science fiction movie—her skin changes color as my blood drains into her. It’s an hour and a half. The blood is nearly in. The other patient’s family starts saying that it must be done because it is now “white blood” that is going in. We go get the doctor again. That is the end-it’s the platelets and they don’t use the platelets, so they are finished.
In the end, we paid about $12 for this: $2.50 to take my blood; $5 to initially put it in, and $2.50 more for the trouble with the veins and the extra work the doctor had to do by coming back and forth. Pretty cheap, since usually you pay for the blood as well.
I came back the next day—the family wanted to say thank you and I wanted to see how she was doing and to see if she needed another pint. A different doctor was on duty and seemed nicer. She looked at the charts and announced that the other patient was in more need for blood than the aunt. That is possible but now it is awkward because we wanted to help the aunt. But of course, it’s blood and if someone else needs it more, then we should give to them. Chris is O+ and can give too. So because the family was in the same room and knew that the other family did not pay for our blood, we thought it would be OK to donate—the doctors could not charge them either. But I would like to know some reason for this decision. So they did another blood test and June called me with the results later. The aunt had 19 and the other woman had 12 (after a pint of blood already—this means she must have lost a lot). I called my mom to see if she could figure out from some random numbers what they could be and what that could mean. She immediately said what it was and that a normal person has 35 or more. In the 20’s would be fine, but 19 and 12 were anemic and the 12 could have a heart attack. OK. We will give again.
Chris gave on Monday morning, with the doctor expertly massaging his arm and having him make a fist and getting the blood immediately. He had brought needles for the doctor to use and to donate some as well but the doctor used his own. They were new and wrapped but it does give pause to think for a second and hope it’s OK. He stayed to watch the blood go into the other woman as well.
Both women left the hospital the next day. I went to say good bye to the aunt and the other one had already left. The aunt told a harrowing story about the night after I had donated blood. First, a cleaning woman came by and asked if the foreigner had also given money to her. She said no, that the blood was certainly enough. At night, the doors are closed and the families can put a padlock on the door from the inside, which they did and went to sleep. In the night, two people started banging on the door and demanding that they open the door. The families told them no and told them to go away. Finally, they went away. The family suspects that because I was there, other people thought they now had money and wanted to come steal what I had supposedly given them.
There is no way to know how my presence will affect things. It can be positive—I started talking about big families and how people had to be tested and donate blood. The aunt will get a pint from a sibling when she goes home. It can be negative—the family being put in danger because I have a connection with them. I try to remember this, and try to act in a way that I believe in and which I hope is helpful and not harmful. Dealing with my position and not just who I am as a person has wider implications that I am confronted with in ways that I had not anticipated.
