PHNOM PENH—Authorities in the northwestern Cambodian province of Pailin are investigating six doctors over the death of a pregnant woman in their care, sparking renewed concerns about how the country's health care system treats the poor.
Van Yoeub, 37, died along with her unborn baby after trying to get medical help at the Pailin Referral Hospital on March 20.
Widower Mit Ran, 48, who has only one leg and has been left to care for the couple's eight children, said he was summoned to the hospital late in the evening after his wife went into labor, but was told he had to pay 100,000 riels (U.S. $25) in medical fees.
...Doctors didn't care about the victim, causing her death."
Pailin Governor Y Chhean
Mit Ran said that he was also told to prepare to pay a service fee of 1,000 Thai baht (U.S. $29) once his wife had given birth.
"A demand of 100,000 riels is what they actually said to me. They said it was a service fee—a bed fee," he said, adding that several doctors repeatedly ignored requests for help after his wife experienced severe abdominal pain and profuse bleeding.
A court in neighboring Battambang province has called doctors Prak Sokhon, Luy Chantha, Yin Buntha, Taeng Saraoth, Suon Thida, and hospital deputy diretor Ang Neang in for questioning as officials probe what happened on the night of Van Yoeub's death.
Pailin's provincial governor said the doctors hadn't done their duty as medical professionals and called for their removal.
"The important factor is that the doctors didn't care about the victim, causing her death," governor Y Chhean said.
"Secondly, there will be measures taken to ensure that the doctors will not continue like this. They have to be replaced to improve treatment—the doctors have to be replaced as a lesson for the future," he added.
Pailin provincial health department director Sang Ran said responsibility for Van Yoeub's death lay with the state-run hospital, which has been ordered to treat people regardless of their ability to pay medical fees.
"The doctors are to take responsibility, because it is somehow related to a technical issue on the night," Sang Ran said.
"We didn't check everything well. We didn't conduct an examination when the patient arrived, so this case fell through the net for a clear assessment."
Van Yoeub and her husband's pleas went unheeded by doctors, despite her feeling that she would die without medical help.
"My wife said to the doctors, 'Please help me, because without an operation, I will not live.'"
"Then I asked, 'Can you help her, doctors?’ They didn't say anything, so I said no more. I paced back and forth until my wife died. She died at 5 a.m. with the baby inside her," he said.
Hospital authorities said Van Yoeub died because of extreme complications surrounding her pregnancy.
"She was bleeding too much," deputy hospital director Ang Neang said. "I gave her blood, oxygen, and serum, but we couldn't save her life."
He confirmed Van Yeoub's death at 5 a.m.
"Doctors from everywhere gathered to help to save her life. The doctors told them that the fee for delivering a baby which is in a serious condition is 100,000 riels," Ang Neang said.
Many Cambodians have reported similar experiences, leading to many deaths among women in labor.
Battambang Regional Doctors' Association president Sao Soeun said many similar cases had occurred across the country but had later been covered up by the authorities.
"This is the doctors’ fault, not the patient’s, because she came to get medical services," he said.
"The doctors didn't treat her—they thought only about money. It definitely contradicts the code of conduct," he said, adding that similar cases would continue to arise unless doctors were constantly aware of their professional ethical code.
Article 2 of Cambodia's physicians' code of conduct, adopted by the Council of Ministers in 2003, states that doctors must respect people’s lives, bodies, and dignity.
Repeated calls to Cambodian Health Minister Mam Bun Heng went unanswered during office hours.
Layers of bureaucracy
A village chief in the central province of Kompong Chhnang said only a few people could get easy access to health care in his region of the country.
"Most people complain that the hospital takes too much money from them, so some people who get sick just stay at home until they die," Ou Russey village chief Ly Loh said.
"However, a number of people who are rich get medical services in time."
He said poor people also face an additional layer of bureaucracy before they can get medical attention.
"The people who are very poor are required [by the health center] to be certified by village and commune authorities, which takes too long," Ly Loh added.
A 2006 study published in the British medical journal The Lancet found that user fees, adopted by low-income countries during the 1980s as a way of offsetting spiraling health care costs, left poor patients at a disadvantage, although health care equity funds in Cambodia had improved the attitude of hospitals and clinics to the poor.
The study's authors concluded that universal free health care offered the best approach to redress social injustice in societies still recovering from conflict, in which a high proportion of the population lives in impoverished rural areas.
Original reporting in Khmer by Sophal Mony and Tin Zakariya. Khmer service director: Kem Sos. Translated by Uon Chhin. Executive producer: Susan Lavery. Written for the Web in English by Luisetta Mudie. Edited by Sarah Jackson-Han.