Banteay Meanchey: A Journey into Rural Cambodia

By Annika R Malmberg

CSC volunteer, medical student at University of Washington School of Medicine, former UAA student in the WWAMI program

After five hours of being slammed up and down in a bus seat across miles of bad roads, and feeling envious of the bicycles and ox-carts we passed, our bus finally arrived in Banteay Meanchey to join the US marines and navy corpsmen at their medical mission site in rural Cambodia. 

On first impression, it wasn’t much. No accommodations meant we all had to stay in tents set up by the navy, sleep in cots, and bathe out of buckets of water obtained from the local pump or from the seemingly endless bottles of water supplied by the marines.  Though we were far from any city, we arrived to find 200 Cambodians patiently waiting for us and the western medicine we brought.

That first day was a whirlwind. The navy and marines set up the tents, moved tons of bottled water, and established a clinic and a pharmacy in the district political party’s headquarters. We created walls for each “exam room” out of boxes of bottled water; established a flow of paperwork and patients; and teamed off with one western doc, one Royal Cambodian Armed Forces doc, and one translator to each room. 

During the next 9 days, cases of end stage liver disease with severe ascities, tuberculosis that had never been treated, pneumonia, hernias, cleft lips, scoliosis, parasitic diseases, and dermatologic conditions filtered through the door. Patients with diseases and growths that had gone on for far longer than ever would be found in the West, lined up to be seen in our make-shift clinic.

As the days progressed, the mornings got earlier and earlier. Patients started to come before dawn in order to get into the front of the line. They came in oxcarts pulled by family members, three-wheeled chairs for double amputees, and one in a wheelchair made from a pair of wheels attached to a plastic lawn chair. Four hundred patients in the morning and 400 in the afternoon could only make a temporary dent in the lines of people, who came from further and further away and slept in hammocks by the roadside, patiently waiting to be seen. 

To accommodate this crowd, a small town sprang up around our area of remote Cambodia.  Mobile sandwich and noodle shops came in attached to motorcycles, while fruit stands, and convenience shops sprang up around us.  Our clinic became a place to be treated, a social gathering and a curiosity. Everything that happened inside our clinics (especially the dental clinic) was witnessed by dozens of people staring in at the proceedings.

Though I was curious to see how Western medicine would be received by a population that mostly utilized traditional medicine, I found that they not only accepted, but embraced it.  People came for second opinions, and treated the vitamins and Tylenol they would receive for their minor aches and pains as miracle cures. 

These people taught me about how health care for the masses works in Cambodia.  It is a system based on poverty and beliefs. The poor go to traditional doctors. If they want western medicine, they go to the lay pharmacist – who is anyone with enough money to buy some drugs and open up a store. There they are, invariably, inaccurately treated, because everything is over the counter in Cambodia. Two pills of amoxicillin and some Tylenol seem to be the standard cure from one of these a “pharmacists”.  Those with more money or more severe problems might go to a Khmer physician.

We saw people on all levels of the social scale. Many distrusted the treatments they had received, no matter where they had received them. 

A woman with end stage liver disease came from a second opinion from her traditional healer who had simply burned marks onto her belly to make the pain go away, and loaded her up on herbal remedies. Another brought an ultrasound report in order to get a second opinion of her uterine fibroids that had been diagnosed by a Khmer physician with a recommendation for a hysterectomy. Though all this was a provided insight into the current medical care in Cambodia, it was a joyous old woman who zealously pinched my cheeks that made me realize how grateful these people were.

As the days went by, the patients would double back in an attempt to get more free medications, or advice for different problems. The stories became convoluted; problems that received the most medications became everyone’s favorite ailment. Hundreds of women suddenly had unbearable vaginal discharge and 7 year old kids came in with a convoluted story meant to be acid reflux disease. 

It was the longest and hardest 10 days I have worked in my medical school career due to the journey I took from being a western-trained medical student to becoming a competent Cambodian physician. 

I started out the first few days stressed that I was missing something big, couldn’t have follow-up, and couldn’t order the tests I would normally order in the US. By the last few days I came to accept the many conditions that I couldn’t do anything about, pick up on the people coming in with fake problems, and adequately treat those who had manageable issues. 

Ath, a Cambodian medical student and translator, taught me about different presentations of parasitic diseases, and some physical therapy techniques for our patients with back pain. The chance to utilize the medical knowledge of everyone on the team proved to be an invaluable asset and gave me an education I wasn’t expecting. 

I left with a sense of accomplishment, a new found knowledge of tropical medicine, and an understanding of the healthcare system of another country. 

Ten days in Banteay Meanchey provided me with more education than 3.5 years of following doctors around in the United States ever did. 

Overall, this was truly an educational experience, and for anyone thinking about participating in the medical missions to rural Cambodia, all I can say is that Banteay Meanchey was truly an amazing, and worthwhile ride.