Thursday, December 9, 2010

Medical Care in Cambodia

Recently I have had the unfortunate opportunity to survey some of the local medical facilities. Personal health issues have sent me to the hospital more than once in the past couple of months, most recently in need of emergency surgery. While this has impacted my ability to blog regularly, it has also given me opportunity to reflect on the medical facilities in Southeast Asia, in Cambodia and Thailand in particular.

I am not a medical professional, have no significant medical training and am in no way qualified to make a professional evaluation of the local medical facilities, doctors, nurses, medical staff or equipment. Nor have I made a comprehensive survey. The following is strictly the opinions of a layman and born of nothing more than my personal experiences with the medical facilities here in Cambodia and Southeast Asia. Please do not take it for any more than that.

First, a note on Cambodian doctors. As a general rule, I do not go to Cambodian doctors in Cambodia. I do not avoid them because they are Cambodian, but because most of them were schooled in Cambodia.

While the medical schools in Cambodia may be perfectly fine educational institutions, the endemic corruption in this country leads me to question how those who have graduated earned their degrees. For those people honorable enough to have studied and passed their exams based on medical knowledge, their resulting medical degree may represent that of a competent and well-trained physician. But because of the corruption in Cambodia including various educational institutions, I simply do not have confidence that the sheepskin on their clinic wall represents the successful effort of a medical student rather than his societal station and/or wealth. If I must go to a Cambodian doctor, I look for a medical degree earned outside the country - e.g. in France, the US, or for older doctors in the old USSR.

For my lack of faith in locally trained doctors, given the opportunity I will almost always choose to go to a western doctor or international clinic/hospital. Amongst the western doctors and clinics available here, I have come to trust Dr. Reid Sheftall at American Medical Center, Dr. Gavin Scott at Tropical & Travellers Medical Clinic and International SOS Medical & Dental Clinic. None charge local prices, especially the latter, which is amongst the most expensive in town. But I have found all to be properly qualified (to the best of my knowledge) and, in my personal experience, medically competent at the very least. I have found Dr. Sheftall to be particularly helpful in matters of trauma and injury, Dr. Scott to be excellent with medical problems common to Southeast Asia and SOS to be well-equipped and quite helpful in the medical care of my children.

There is a certain Australian nurse in Phnom Penh who, in the past, has offered (and perhaps still offers) medical services and is popular amongst some foreigners in town. I have nothing against seeing a nurse instead of a doctor for minor ailments. But, personally, I would avoid this nurse like the plague. While she may be qualified and competent as a nurse, in the past she has misrepresented and wildly overstated her medical qualifications. I say this not from hear-say but from personal and direct experience. She told me that she was a doctor, even stating the sort of medical degree she had and the institution where she earned it. None of it was true. She is a nurse of some sort. Misrepresenting one's medical qualifications is, in my book, a cardinal sin amongst medical professionals and taints everything that may follow. For this reason, I do not trust her and will not use her services.

One Cambodian clinic with which I have had more than one positive experience is Polyclinique Aurora. They are equipped with X-ray and ultrasound equipment, are open 24 hours, are much more reasonably priced than foreign run places and in my experience have attended competently to both major and minor injury cases. If money is an issue, I would be relatively comfortable going to Polyclinique Aurora.

Of the various hospitals in Cambodia, I have had the most experience with Royal Rattanak Hospital here in Phnom Penh and Royal Angkor International Hospital in Siem Reap. Both are connected with the very reputable Bangkok Hospital in Thailand and neither is particularly cheap. Both are new and modern, fairly well equipped and staffed largely with Thai doctors, some Thai nurses and local Cambodian staff. I have found both to be something of a surfacey imitation of their counterpart in Thailand, but not too detrimentally so. I spent time as an in-patient at Royal Rattanak in Phnom Penh and received attentive, appropriate if not somewhat spendy care. The private room was comfortable and not unlike a three-star hotel. I had one significant complaint while I was there about a failure of their procedures and it was dealt with promptly and appropriately. My only other negative observation is that they seem a bit too anxious to order up expensive MRIs, but who am I to second guess a doctor's orders?

Royal Angkor International Hospital in Siem Reap has received a number of negative reviews from expats, not due to a failure of medical care, but centered primarily around claims of inflated prices and a two-tier pricing system seemingly aimed at bilking foreigners. That said, my single personal experience at Royal Angkor was positive. My son, being the boy he is, took a nasty spill and split his lip open, requiring stitches to put him back together. We took him to emergency at Royal Angkor where they attended to him promptly, properly and with appropriate sensitivity to a scared little boy. He was there for a couple of hours, received three stitches, and we got out of the place for less than US$100. I was satisfied with the experience.

All this said about Cambodian medical facilities, if you have the time, money and opportunity, it is still better to seek medical care outside of Cambodia in one of her neighboring countries - i.e. Thailand or Vietnam. Cambodia's rich and powerful all travel outside the country for medical care and there is a reason for that. Medical care is simply better in Vietnam and Thailand than in Cambodia - better facilities, better treatment, better doctors.

Vietnam's medical facilities are surprisingly good and getting better all the time. And Vietnam is easier to reach than Thailand, at least overland. It is only an inexpensive 6 hour bus or taxi ride from Phnom Penh to Ho Chi Minh City. If you are medically able to make the journey, Ho Chi Minh is probably the least expensive, closest  and easiest option outside of Cambodia.

Thailand's hospitals are undoubtedly the best in the region if not some of the best in the world. If I was in the US or Europe, had a medical problem and the opportunity to choose my hospital, I would fly to Bangkok for medical treatment - Bumrungrad Hospital in particular, the Cadillac of hospitals. Bumrungrad offers a full range of world-class medical professionals, facilities and services. The patient is king at Bumrungrad and the room facilities and service are like that of a five-star hotel. The level of attentiveness and kind assistance is unrivaled by any medical facility I have been in my life. Bumrungrad is perhaps the most expensive hospital in Thailand but is still only a fraction of the cost of medical care in the west. Other hospitals in Bangkok include Bangkok Hospital and Samitivej Hospital, both of which are very well-reputed and somewhat less expensive than Bumrungrad.

Lastly, a word about medical insurance and evacuation. Cambodia's medical facilities are limited in scope and capability. If you have a simple broken leg or burst appendix in Cambodia, they'll probably take care of you just fine. If you have a severe spinal or head injury, you're as good as dead in Cambodia. As has often been said in the guidebooks, major medical problems will require air evacuation to another country for proper treatment, probably to Thailand or Singapore. And evacuation is not cheap. A medical evac flight from Phnom Penh to Bangkok runs US$10,000-US$15,000. And they are going to want payment up front. While medical care is comparatively inexpensive in Southeast Asia, especially in Cambodia, evacuation is exorbitant and serious medical problems can cost you thousands of dollars at a good facility like Bumrungrad. Get expat medical insurance (for example, Aetna Worldwide offers a range of plans,) and unless your insurance guarantees payment in advance, have a stash of emergency cash or a credit card at the ready. When you're in desperate need of evac, laying there on a gurney at clinic with your brains spilling out of your skull after a motorcycle accident some Saturday night, it will be no time to start pleading for charity, bargaining over price or promising that your parents will send the cash when the bank opens on Monday. You won't make it and they won't care. Be prepared.

American Medical Center
Hotel Cambodiana, Ground Floor, Suite #3, Phnom Penh
Tel: 023-991863, 012-891613

Bangkok Hospital
#2 Soi Soonvijai 7, New Petchaburi Rd., Bangkok, Thailand 10310
Tel: +66 (0) 2310 3000

Bumrungrad Hospital
33 Sukhumvit 3 (Soi Nana Nua), Wattana, Bangkok, Thailand 10110
Tel: +66 (0) 2667 1000
www.bumrungrad.com

International SOS Medical & Dental Clinic
#161, Street 51, Phnom Penh
Tel: 023- 216911

Polyclinique Aurore
#58-60, Street 113, Phnom Penh
Tel 023-360152, 012-779824, 012-667561

Royal Rattanak Hospital
#11, Street 592, Khan Toul Kork, Phnom Penh
Tel: 023-365555, 099-631427, 099-674303

Royal Angkor International Hospital
National Route 6 (Airport Road), Siem Reap, Cambodia
Tel: 063-761888, 012-235888, 063-399111

Tropical & Travellers Medical Clinic
#88, Street 108, Phnom Penh
Tel: 023-366802, 012-898981

US Embassy, Phnom Penh - List of medical facilities

Canby Publications - List of medical facilities in Phnom Penh

2 comments:

  1. I have had very positive experiences at Royal Angkor International Hospital. It's a bit pricey but my insurance (Forte's Figtree Blue plan) covers the entirety of my visit or stay. I've had the good fortune to both visit as an outpatient and inpatient thanks to some nasty and persistent parasite infections. I scanned all of my medical reports and labs to my doctor at home who confirmed my course of treatment as it was given. This raised my confidence level immensely.

    The only downside: the hospital doesn't understand Celiac's or gluten intolerance so I have to be very specific when ordering meals.

    All in all, I prefer Royal Angkor International Hospital to SOS.

    One thing I have noticed across the board is that doctors in Cambodia are very eager to hand out antibiotics. So, ask loads of questions to see f they're really necessary.

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