20 Cambodian Medical and Pharmaceutical (ISSUE 01 in December 2017)

Medical Care in Cambodia

In Cambodia, the medical environment is improving that enables foreigners to live more securely. There are several medical institutions, mainly in Phnom Penh, where expat doctors and dentists treat patients. The expat medical doctors, conducting medical treatment, include general practitioners, general surgeons, and various medical specialists such as otolaryngologists, digestive system surgeons, orthopedic surgeons and brain surgeons.

In October 2016, a Japanese hospital was established in Phnom Penh to provide a 24 hour/365 days a year accident and emergency department. It is also expected to contribute to the improvement of advanced medical care and emergency medical standards in Cambodia. There are also plans to open new medical institutions and pharmacies in the future, medical care environment with a higher standard will be in place .

A national medical doctor’s examination was finally introduced in 2012 to bring a higher standard to the examination system. Cambodia has very little specialists comparing with surrounding countries and the standard of doctors is low.

According to Dr. Ken Okuzawa of Ken Clinic, the first Japanese practitioner in Cambodia, “First, Cambodia does not have national qualifications for doctors like we have in Japan. If you graduate from medical school, then you will get a doctor’s qualification. Discrepancies in diagnosis and the recognition of diagnostic tests is very common amongst Cambodian doctors.  For example, there is a blood test called “QFT” in the examination of tuberculosis, but some medical personnel do not know the existence of this test.

Also, there was a case where a patient was diagnosed with diabetes mellitus, but a blood test called “HbA1c” which is an essential test in Japan was not performed. The tests are available in Cambodia and medical personnel should be able to conduct the test, but I think such cases arise because they are not firmly recognized within the medical staff.” However, regarding the knowledge and level of Cambodian doctors, he said “We have more and more information from abroad and I think that it will get better in the future. Most Cambodian physicians have some overseas medical experience. I think that overseas experience is very important in developing the level of medical care in this country.”


Medical Evacuation

There are places where you can receive emergency treatment at major private and public hospitals in Cambodia, but there are variations in the quality. Secondary or tertiary emergency cases may be transported to neighbouring medical eligibility countries, like Bangkok or Singapore. (Reference: The transportation fee by an aeromedical service is about 20 – 40 thousand USD. Hospitalization expenses and surgery fees are not included.)

In 2015 the World Health Organization (WHO) surveyed the total number of road traffic deaths per 100,000 population in 180 countries and regions around the world, 17.4 people are at a risk of losing their lives in a traffic accident in Cambodia, compared with 4.7 people in Japan. It suggests that Cambodia has about 3.7 times higher risk than Japan. In case of emergency, it is important to properly understand and secure emergency transportation means in Cambodia.


Staying Healthy in Cambodia

Foreigners should manage their health in Cambodia based on the fact that it is different from your home country. In particular, consideration of sanitary environments is indispensable. Many diseases in Cambodia are climate and geography specific disease, and some specific to lifestyle habits. Diseases caused by climate or geography include infections such as common colds, dengue, infectious diseases and abdominal pain. Diarrhea associated with food is also common. Diseases derived from lifestyle habits include diabetes, hyperuricemia, hypertension, dyslipidemia with increased triglyceride and cholesterol levels.

Dr. Okuzawa of Ken Clinic warned that he sees many foreigners who have gained weight in Cambodia, but the reason for this is believed to be the local diet. He says, “Dietary habits of Cambodians tend to ingest abnormally large amounts of white rice, with few side dishes, and the proportion of side dishes and white rice is different from what we eat in our country. The main cause of obesity, diabetes, and hypertension is carbohydrates such as white rice, I think that it is becoming easy for these diseases to occur when people live on diets like Cambodian people.” Cambodian drinks contain a lot of sugar, even milk contains sugar, so you have to be careful about an overdose of sugar.

Many of the foreigners living in Phnom Penh are business people who are busy, so they will often neglect their health. Dr. Hideaki Nonomura, a Japanese doctor and nurse registered at Sun International Clinic (SIC), said about lifestyle diseases, “The prevalence of chronic diseases such as lifestyle diseases may be low, as it is assumed that the age group of foreigners living in Cambodia is relatively young. However, according to a survey that tracks the illness of a foreigner who has stayed long-term in a developing country, there are many with respiratory disorders, digestive disorders, and infectious diseases.” As well as self-management on a daily basis, it is important to consult a medical specialist before it gets severe if you feel something unusual in your physical condition regardless of your age.

It is not just sickness that you must be careful of. Dr. Okuzawa of Ken Clinic said, “Injuries are mostly caused by accidents that occur while riding a motorcycle. For example, being in contact with cars and other motorcycles, skidding and being dragged during a bag snatch. Bag snatching also occurs while people are out walking or even when riding a tuk-tuk. In the worst case, we have had patients with a shoulder joint dislocation which is a condition where the collarbone and shoulder blade ligaments are completely ripped out of the socket.” According to him, the incidences of bag snatching and the damage caused by it is increasing.


Health insurance for Cambodians

The NSSF (National Social Security Fund) is operating a social insurance system to help poverty caused by labor accidents. Employers with 8 or more employees must register for the fund, but the insurance premium is as low as 0.8% (The least premium is about 0.4 USD, up to about  2 USD) of the monthly salary. However, the hospital where the insured recipient can receive treatment is specified.

Dr. Yoshimori Araki of SIC said, “I think that the development in this industry will be very limited without health insurance and a public healthcare system. In Cambodia there is only private insurance, so people who can use medical facilities will always be limited. To raise the medical level, it is necessary for many people to use the medical institutions, so both the patients and the medical institutions can move up to the next level. With the current financial problems that the government faces, this may be difficult. The Japanese government also has shown interest in helping the setup of a public medical insurance, and I hope that such efforts go well.”

Under these circumstances, the role of private insurance companies is large. Mr. Jeffrey J. Whittaker of PEOPLE&PARTNERS INSURANCE(P&P), said regarding the Cambodian insurance market, “The insurance market in Cambodia has recorded double digit growth over the past few years and will continue to grow in the coming years. Health insurance and personal property insurance are growing rapidly among them, and it is becoming a major field also in the health business.” The factors behind the rapid growth of the insurance business are the increase in the middle class due to economic development and the growing interests in health problems and disaster countermeasures.

Mr. Whittaker adds, “In recent years, employees are interested not only in wages but also in the welfare benefits that companies can provide them, especially group medical insurance and Personal Accident insurance. These are now commonplace in Cambodia.”


Health insurance for Foreigners

In general, it is not easy for foreigners to choose a good hospital in Cambodia. When choosing a hospital, it is desirable to choose a medical institution that has introduced international medical standards, with foreign specialists or Cambodian physicians who have trained abroad or gained foreign medical doctor’s licenses. Also, in the case of long-term residents, they may not receive the assistance of medical expenses in their home countries. Even if you have a residence certificate, to apply for refund is a bothersome process, such as gathering application forms, receipts, and medical certificates (Attending Physician’s Statement).

On the other hand, overseas travel insurance is expensive for residents as it contains many unnecessary compensations such as aircraft delay and personal effects protection. For those who emigrate to Cambodia for an unlimited period, such as locally hired employees, it would be most appropriate to make contracts with a local insurance company.


Pharmacies in Cambodia

Pharmacies in Cambodia are often managed by staff with limited medical knowledge. Therefore, there are cases where the quality of the medicine or the state of presentation is poor. Cambodian people tend to purchase medicine at the pharmacy first and try to cure themselves because of financial reasons. It is hard to get appropriate medications because there are a lot of pharmacies where staff have not graduated from a pharmaceutical institution, and selling medicines without prescriptions.

It is important to choose a reliable medical institution that will properly prescribe according to your symptoms and physical conditions.