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Nursing in Cambodia



This is told by Susan, a retired nurse.

I worked as a nurse for a community in Cambodia from 1986-1987. In many ways, it was the best and worst time of my career.

Infirmaries in Cambodia

At the time, I worked in a small community. There was no hospital, and only a couple of infirmaries.  The larger of the two infirmaries had 8 beds with 2 being considered critical.  Beds were hand carved bamboo, however they did have mattresses, similar to what we would find on a futon bed.  The beds were not adjustable as hospital beds in the U.S. are, and of course there were no call nurse buttons averrable for patients.  there were several people trained in what Americans would think of as CNA’s and they took turns spending the night the in infirmary with the patients.  A physician visited every other week, and in the meantime all patients were seen and evaluated by nursing staff. 

Healthcare in Cambodia, the Facts Today

The lack of accurate statistics and surveys makes planning for the development of the health care system difficult. There has not been a census since 1962, and the system is plagued by a lack of trained personnel, lack of knowledge of public health and epidemiology, security problems related to the continuing war, and severe infrastructure problems from the war years.
Over the last 20 years, landmines have been planted in many regions of Cambodia, as they are still today, leaving a trail of injuries, deaths, and mine-infested lands. A 1989 United Nations Development Program Needs Assessment Study,  recommends that measures be taken to educate local populations on how to locate areas affected by landmines and to develop measures to deal with them.
In 1979 and the early 1980s, Cambodia's health system depended on the many Vietnamese experts present in the country; the system is based on the Vietnamese model, with vestiges of the old French system. Most major hospitals in Phnom Penh, and some hospitals in the provinces, are assisted by medical teams, from both Western and Eastern bloc countries. Although there are attempts to coordinate services among the Red Cross teams, the NGOs, and UN agencies, there are some communication difficulties. Attempts have been made to standardize drug importation from Western countries.
Health care is in theory free for all citizens, but in fact there are many charges for services, and when supplies are unavailable in hospitals the patient must purchase them on the open market. Each province has a separate budget, and provinces receive different amounts of humanitarian aid.

Major Health Problems

According to the dean of the faculty of Medicine, the most important health problems are malnutrition, malaria, tuberculosis, and diarrheal diseases. The Dr. estimates that 2 million Cambodians have malaria and 200,000 have tuberculosis. Agencies working in Cambodia identify major health problems somewhat differently, focusing on diarrheal diseases, acute respiratory infection, malaria and dengue fever, and childhood illnesses. War injuries, dysentery, typhoid, hepatitis, venereal diseases, yaws, and intestinal worms are common as well.
The Department of Epidemiology in Phnom Penh states that "prevention is better than treatment." However, the health care system is essentially based on curative medicine, with minimal emphasis on primary health care. As the health system has gradually strengthened, changes are being made. The Department of Epidemiology has been working with UNICEF on primary health care, and distributes preventative health educational materials via radio, television, newspaper, posters, seminars with flip charts, and audio-visual displays, often in coordination with labor unions and women's associations NGOs incorporate principles of primary health care into their programs: "clean water, clean food, clean living."

Maternal and Child Health Care

Between 40 and 50 percent of Cambodia's population is under 15 years of age. With an infant mortality rate of 120 per 1,000 births up to age one, and 200 per 1,000 births for children from one to five years old, Cambodia has one of the highest rates in the world. NGO health personnel report that the major causes of child death are diarrhea, dengue hemorrhagic fever, malaria, respiratory infections, and malnutrition.
In 1985 a system was designed for children under the age of five who were suffering from acute malnutrition, diarrhea, and dehydration. Centers were established for rehydration, immunization, nutrition, and education (RINE Centers). In 1989 there were ten centers in Phnom Penh, and nine in all the provinces. There is also a system of day care centers, or "creches," which increased from one in 1981 to eighty centers in 1987.
Immunizing children has been one of the Ministry of Health's priorities, with vaccination coverage in Phnom Penh reaching 80 percent. Coverage in the provinces is much less, ranging from 30 to 60 percent. Children are vaccinated against pertussis, diphtheria, polio, measles, tetanus, and tuberculosis. Some infant mortality still is attributed to tetanus and measles, and other preventable diseases.
Sadly these are alarming statistics, and not likely to change in the near future.

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