In the fall of 2009, Vietnam put up several posts that were intended to demarcate a portion of Cambodia’s disputed border with Vietnam. This was still a volatile issue for Cambodians, as many still did not recognize Vietnam’s claim to the Mekong Delta region in southern Vietnam. In response, Sam Rainsy pulled off a perfect politician’s publicity stunt. With reporters in tow, he yanked six of these border posts out of the ground and made a show of lambasting the government for “enforcing a Vietnamese government order.” Hun Sen immediately slapped him with a lawsuit. But first he had to strip Rainsy of his parliamentary immunity, which his parliament promptly did, for the third time in the previous few years—during a closed assembly session.
Rainsy had often promised to stop provoking Hun Sen. In 2000 he told interviewers, “I will soften my stance. I realize that my aggression seems to create confrontation, which is not productive.” Ron Abney, his longtime friend and adviser, said he often told Rainsy: “You’ve got only one issue, pal, and that’s Hun Sen. That’s the way it was, and that’s the way it is now.”
A few weeks before his border show, Rainsy told me, “We need to go back to what we should have been doing. Telling how we will address the concerns of the everyday people. Land issues, education. How we will put people back to work. We will concentrate more on issues, not on persons. We’ll talk less about Hun Sen.”
That resolve didn’t last long, and after the assembly acted against him, Rainsy took off, to plead for support from his friends in the bleachers. He was in France when a court sentenced him to two years in prison for “racial discrimination and damaging public property.” In a televised address to his followers a few days later, Rainsy put on a pitiable expression and vowed to remain in (comfortable) exile in his Paris home “until all people jailed in land disputes are set free and their land returned.”
In the meantime, he promised to do what he liked best: complain about Hun Sen to sympathetic foreigners. “Now,” he said, “is the time for diplomatic and political approaches to friendly nations and international organizations.” Hun Sen responded by filing new charges against him, for “using fake border documents”—the maps Rainsy had proffered to show where the “actual” border was. Meantime, two villagers who had helped Rainsy rip out the border posts had been convicted at the same time as Rainsy. Now, while Rainsy plotted in his Paris
palais
, they were serving their long prison sentences. One was reported to be seriously ill. In September 2010 a court sentenced Rainsy in absentia to another ten years on charges of “spreading false information.” Hun Sen said he had no intention of intervening in Rainsy’s court case. For the moment, at least, Cambodia was effectively a one-party state.
Across the board, all of these cases ended badly. Leang Saroeun’s killer was never punished. A few weeks after the crime, the colonel who set him on fire moved to Vietnam. Top Chan Sereyvudth remained the undisputed chief prosecutor of Pursat Province. No one was prosecuted for hanging and strangling the victims in Pailin. Moeung Sonn and Sam Rainsy remained in exile. As Youk Chhang put it, “Everywhere you turn around, there is no justice today.”
CHAPTER THIRTEEN
W
hen a society is sick, then even the institutions that are intended to make people well are infected. Ask Cambodians what their government does for them, and they still cite roads, bridges, and reservoirs—the public works of the Angkorian kings. But sometimes, just sometimes now, they also cite health care.
For some people Cambodia’s hospitals and health clinics are a lifesaving godsend in a nation that had no modern health care until just a few decades ago. Naturally, that applies only if they’re among the lucky few who can afford it. Health care is supposed to be free for everyone. But then, this is Cambodia. And so for many people hospitals are the source of nothing but pain, sorrow, and untimely death.
Erin Soto, head of USAID’s office in Cambodia, had a meeting one day with the deputy minister of finance. They were going to discuss problems in the nation’s health clinics, “how people have to sit in a clinic for hours and hours to see a nurse—while the people who pay something up front get served right away,” she recounted. “And he told us: ‘It’s just like a restaurant. You have to tip to get good service.’ It made me realize we have a long way to go. They just thought” that paying bribes “was the way it was supposed to work.”
That was the way it worked for Let Ting. Her charred husband had been shuttled from a small regional hospital to a bigger one until finally he wound up at Preah Kossamak Hospital, a large facility in downtown Phnom Penh. At the smaller so-called “referral” hospitals, doctors and nurses had given Leang Saroeun intravenous fluids and salve for the burns. That’s all. “We arrived at Kossamak Hospital at midnight,” Let Ting related. “They, too, gave him an IV and an injection and then walked away. Several hours later, a doctor came in. He told us the burn was very serious, and he needed to clean the wounds. But we would have to pay him $100. He told this to my grandmother. She is old, and she had just lost a leg to a land mine. Through the evening, the price increased to $150. I was crying. I told the doctor I didn’t have $150. The doctor said, ‘Well, I guess we don’t need to clean the wounds.’ He took off his gloves and walked away.” That was the last they saw of him. Leang Saroeun, the victim, “was crying through this,” she went on. “He was in a lot of pain, saying, ‘I’m too hot, I’m too hot.’ He just laid there until the next day. Nothing but an IV. By now his body was starting to swell. So we packed him up and took him home. We had no options. All they were doing was giving him IVs. And he was swelling up, very, very big.” The next day he died.
Chhay Sareth, the provincial council chief, said he never heard about this case. “I think the authorities have covered it up. But if you commit a crime like this, you are like Pol Pot.”
Teng Soeun, director of Kossamak Hospital, was a troll-like fellow, short and round. But his manner was concerned, soothing, and seemingly sincere. “As the director I feel sick that a man died without any treatment,” he said. “It is against the ethics. I have to tell you that any patient who comes here, they have to get treatment. We have this hospital to help the poor even if they cannot pay for treatment.” He said all that with a straight-eyed stare and an unwavering manner of conviction.
“I was on duty that day,” said Ek Sonsatthya, a nurse. She and several others who had been involved in Leang Saroeun’s care were sitting on a sofa in the director’s large office. (Missing, of course, was the doctor
who had asked for the bribe.) On the floor was an inexpensive oriental rug. “He got a prescription injection on 20 June and an IV,” she said, consulting the dead man’s case file. “His wife stayed with him. He had burns on 80 percent of his body. It was so bad that it was hard to find a vein to make an injection.”
“His condition was very serious,” said So Saphy, chief of the hospital’s intensive care unit. “I told the patient’s mother.”
“According to our rules,” the director interjected, “we have to treat the patient to the last breath. And if a patient dies here, we give them a free coffin. We cannot force them to leave, and we usually advise them carefully. But if he dies,” he said again, “we give him a free coffin.”
But what about the demand for $150?
“There have been cases in the past,” the director allowed. “I agree in past times there was corruption. But now no more. We will try to clean up all this mess. We try to implement the regulations. Our hospital is one of the honest hospitals.” Of course, any other hospital director would say the same, he acknowledged, chuckling.
When the discussion ended, So Saphy offered a tour of the intensive care unit, downstairs. Fourteen patents lay on battered old metal beds with straw mats they’d brought from home, laid on bare wood frames. The ICU had two respirators, three oxygen saturation machines, and no other medical equipment. In the adjoining medication pantry, So Saphy pointed to a glass cabinet that held two dozen IV bottles, neatly arranged. “This is the serum for patients who pay,” she said without expression. Then she pointed to a low cabinet on the other side of the room and slid open a metal cabinet door. The cabinet was full of rags and other debris, but she reached toward the back and pulled out two IV bottles. “This is the serum for patients who can’t pay.” She held up one bottle. The expiration date, in bold blue letters, was five months earlier. She allowed me to look at the drugs in the medicine cabinet, assorted bottles and jars, nearly all with expiration dates long past—six months, a year, two years. Looking at one dated the previous year, So Saphy just pursed her lips and shook her head.
Asked about that later, the health minister, Dr. Mam Bunheng, a gynecologist, offered scant reassurance. “That is not allowed,” he insisted. “We have a monitoring system. We check every year.” But that may have been among the least of his problems.
Mith Ran, forty-nine, had a well-worn artificial leg and a doleful expression affixed to his face. He had served in the Khmer Rouge army and lost his right leg to a land mine. Decades later he lived in Pailin, still home to many Khmer Rouge veterans. Mith Ran’s wife was recently deceased, another unfortunate death, and as a result four of his seven children, the youngest of them, were in an orphanage because, he said, he could not care for them alone. The others, pulled from school, were at work in a cornfield.
One evening, he sat on the front steps of his little home just like all the others: one room, small, dark, and bare. An empty bag of corn lay on the ground beneath him. Chicks pecked at the few remaining kernels as he told of his wife’s death. She was pregnant; this was her eighth baby. One night the previous month, when she said she was ready, he rushed her to the hospital in Pailin at about ten o’clock. The medical staff wheeled her to the maternity ward, “and thirty minutes later a doctor looked at her and said she was not ready. I said, ‘Please help my wife. This is her eighth baby.’” He told the story as if he had related it more than once before, which he had. Human-rights workers had come to see him and promised to take his case to court.
She went into labor at 3:00 a.m., he said, and “asked me to wake up the nursing staff. I knocked on the door several times, but the nurses were asleep. I pounded on the door. They would not come out. At 3:30 one of them finally did come out, a girl with slightly crossed eyes, and she brought in the doctor. I asked him please to take her to the delivery room. The doctor said, ‘Do you have any money with you?’ I asked how much. He said 100,000 riel,” or $25. For Mith Ran the sum might as well have been $25 million, given how unapproachable the doctor’s bribe request was.
“I said no. He asked where I lived. I told him.”
“Do you have relatives there who can lend you the money?”
“No.” Then, like the doctor at Kossamak Hospital, this one “pulled off his gloves and walked away.”
Later, his wife’s water broke, and “I called the medical staff. I banged on the door. They would not come out for a long time. I pleaded with the medical staff, ‘Please, please, help my wife. I am poor. Please!’”
He sat on his false leg; a battered black wing-tip shoe covered the artificial foot. He looked at the ground and shifted from his story into a litany of woes. “I own no land. I am just a worker on other people’s land. I did own land, but I had to sell it to get treatment for my leg. I stepped on a land mine in 1993. The bone was infected, so it was expensive. I am a former Khmer Rouge soldier in Battambang. I cannot read and write. I didn’t go to school. I joined the Khmer Rouge when I was thirteen. My parents were killed, beaten to death by a plantation owner.” Then he broke free of his dark reverie. “Help my wife,” he said again, looking up. “I asked the nurses, ‘Please, help my wife!’” A few hours later his wife and their baby died.
At the Pailin hospital maternity ward the next afternoon, two women lay with their newborn babies on wooden-slat beds covered with straw mats the patients had brought from home. Fluid from an IV bottle dripped slowly down a tube into one of the women. The clear plastic bag hung from a crooked bamboo pole tied to the side of the bed with white string.
If the ward had a nursing staff, the nurses were out of sight. But then a blue door was closed—the same door Mith Ran had pounded on over and over again. A sign on the wall above, in Khmer, declared “Duty Room.” Now, once again, repeated knocks on the door brought no reaction. Not a sound. So I opened the door. A nurse, in bed, asleep under a blanket at three in the afternoon, woke up with a start, rubbed her eyes, and slowly got out of bed. Minutes later she came out. Sun Thida was her name, and she said she was the duty nurse. She was
thirty years old and wore a red shirt festooned with panda cartoons. Her eyes were slightly crossed.
“I wasn’t here” when Mith Ran’s wife died, she averred. “That wasn’t my shift. But I heard about it. That was a complicated case. But I was not on duty.” Sun Thida said she had been a nurse “for five or six years. I had twelve years of school and a short course in nursing once I got here. A seminar, three days.”
Dr. Sou Vichet, the hospital’s new director, had a nervous tic. He simultaneously blinked and squinted when he was nervous. Now he was blinking away at a pace so rapid that he could barely see. “That night I was not here; I didn’t have this job yet,” he said. “But I’ve investigated. At that time there were two or three nurses and two or three medics on duty” in the entire hospital. “The doctors were gone. Some were at a seminar to improve their education. The director of the hospital was not here, either. I can’t say if they were violating regulations.”
He sat at a battered old gray metal desk in the hospital’s administrative office. He’d been on the job only a few weeks, but now, he said, doctors were required to be on duty around the clock. As for sleeping during the duty shift, “I don’t blame her. She probably had a late shift,” but then, blinking away, he insisted, “It is not routine that medical staff sleep during their duty shift like that.”