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Jobs or health: A Cambodian village's stark choice

After mass HIV infection, residents forced to choose between health and livelihood

Abby Seiff, Battambang

Abby Seiff, Battambang

Updated: November 29, 2015 08:34 PM GMT
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Jobs or health: A Cambodian village's stark choice

A spacious new hospital is being built in Cambodia's Roka commune, where 264 people became infected with HIV. A year later, many families are struggling to make ends meet. (Photo by Abby Seiff)

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In Roka commune, money is getting tight.

After an HIV outbreak in 2014 saw 264 people infected in the small northwest Cambodian village, aid flowed in, showily. The prime minister's wife delivered hundreds of kilos of rice, the health minister brought socks and sarongs, nongovernmental organizations came by with cash donations.

But a year after the mass infection was first detected, patients and their families are struggling to make ends meet.

In September, 21-year-old Huot Sieng gave birth to her first child. Half a year before that, she became just another one among hundreds in Roka to have been found infected with HIV.

The results have put her small family in a tenuous situation. In order to stay healthy she needs to receive monthly antiretroviral treatments. In order to receive the treatments, she has to be in Cambodia. In order to stay in Cambodia, she has to give up the only source of income open to her: illegal migrant labor.

"Everyone here works in Thailand," said Mat Phanny, Sieng's friend. "We cannot find work, it's hard to find any job near here."

In this way, Roka is like thousands of places across Cambodia. Enter a rural area in much of the country's north or west and you will find villages devoid of residents older than 15 and younger than 50. Grandparents raise grandchildren among empty homes; everyone of working age is in Thailand.

For many of the estimated 500,000 migrants, Thailand doesn't represent some amazing opportunity — it is simply the only way to have employment as a poor Cambodian.

And now, in Roka, there goes that option.

In December 2014, health officials uncovered an HIV outbreak. A popular village doctor — unlicensed and untrained — had inadvertently infected hundreds of people while reusing needles. By the time testing was finished, 264 people had been diagnosed HIV-positive. Medication and treatment were quickly dispatched, but for some it was too late. In the intervening months, at least nine people died.

The immediate impact was visceral: terror, anger, shock and sadness. With time, however, the overarching concern has boiled down to simple economics.

A pharmacist sits outside a health center in Roka commune. (Photo by Abby Seiff)



For more than a decade, Chom Sor and his wife worked in Thailand, making enough in four or five months to support their children back home. The couple was over the border when they got the news that both their son and daughter had tested positive for the virus.

"Now we cannot go far away," said Sor, 35. "We need to look after them."

In the intervening months, the family has made money like this: "We had three cows. We sold two. We still have one."

When the last cow is sold, it's anyone's guess how the family will get by.

With international aid groups mostly out of the picture, the local Catholic prefecture and Buddhism for Development, a local NGO, have struggled to pick up the slack.The government covers the cost of medication, but doesn't provide transport to the hospital or other financial assistance. An expansive new road now stretches through Roka commune but residents struggle to meet basic needs.

"They won't give us food to eat, but they give us a big road," said Roern Ry, whose husband died shortly after being diagnosed with HIV.

When the outbreak was detected, officials vilified Yem Chhrem — the unlicensed practitioner. He is in jail awaiting a verdict due in December on charges of murder, intentionally spreading HIV and practicing medicine without a license; the case has prompted a crackdown on thousands of local "doctors." But more than anything, what happened in Roka has highlighted a mass disconnect between what is needed and what is provided. 

After Chhrem was arrested, the health department installed a real doctor. She has not been a success.

"The new doctor stays far from here and we have to convince her to come and treat the people with HIV," said Klang Suot, Sieng's mother. "With the old one, when we called anytime, he would come."

At the commune health center, villagers are treated with derision. They preferred their unlicensed "doctor" because they were ignorant, said Sin Suon Chainoun, a physician at the commune health center.

"We only have real medicine here, not serum," he said, referring to the saline drips that remain perhaps the most popular catch-all medical treatment throughout Cambodia. "Most villagers believe in injections, not medicine."

That attitude is keenly felt in Roka, where — in spite of the death and destruction — villagers speak warmly of the "old doctor."

While medical treatment at Cambodia's public hospitals is meant to come free of charge, patients nearly always have to pay to ensure they will be seen. Everything from the gauze to the needles are priced separately, families must bring their own bedding and food, and bribes are necessary for service.

Sieng, the new mother, delivered her baby in the provincial hospital, which was successful in avoiding mother-to-child HIV transmission but failed to prevent other problems. Back home and suffering from postnatal complications, Sieng was forced to pay $100 to convince the newly appointed commune doctor to make a house call.

"For the poor people, they don't really take care of us," she said. "They never treated people well and we never got better. [That's] why we need a private doctor."

The government has installed a wide road running through Roka, though the roads deeper into the village remain in disrepair. (Photo by Abby Seiff)


Behind the commune health center today stands the bulked out skeleton of a new hospital. Provincial officials have described it as a place where villagers can receive antiretroviral treatment for the rest of their lives, but after a lifetime of experience with government-provided healthcare, some are skeptical.

"I'm not sure about the hospital. We'll have to wait and see how they serve the patients," said Ry.

The hospital, which is bone white and looms over the small health center that nobody trusted, will have 13 beds. Babies can't be delivered there. Surgeries can't be performed there.

When it opens in the next month or two, high-ranking officials will drive down the spacious new road for a ribbon-cutting ceremony. Doubtless they will bring more donations with them and villagers will be photographed smiling while they receive a traditional Cambodian scarf, a bag of rice, some fish sauce.

When they go they will leave behind: one shiny hospital that doesn't offer much in the way of medical services, one nice road that no one can afford to transit, one more commune that has nothing in the way of jobs.

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