Hunsenomics and Its Discontents - Hun Sen's Cambodia - page 142

The ordeal left the family 440,000 riels ($110) in debt—a king's ransom in rural Cam-
bodia. Neighbors pitched in to help the family with hospital costs, but to pay them back
Ros Peun was forced to sell two of his four hectares of cassava fields. Today he laments
the fact that there is so little information available for first-time mothers, and no subsidies
that could have allowed his daughter to see a doctor early on. “She had no money,” he
said, “so she just waited and waited until something bad happened to her.”
The ordeal of childbirth is known in Khmer as chhlong tonle , or “crossing the river,”
a phrase that encapsulates the very real dangers facing mother and child. These include
the low quality and high cost of health care, demands for “fees” from medical staff, and
the drastic shortage of midwives and skilled birth attendants. Five Cambodian women
still die in childbirth each day, according to the UN, and maternal mortality forms a dark
counterpoint to the blessings of Cambodia's economic boom, actually increasing from
440 deaths per 100,000 live births in 2000 to 460.8 in 2008. It has since dropped to 250,
according to the UN, 34 but giving birth is still feared by women in rural areas, where ma-
ternal mortality rates are three times higher than in the city. 35 In Trapaing Prolit, up the
road from the house where Peun Say used to live, Pheap Sophany awaits her own perilous
river-crossing. Eight months pregnant, she has only visited the doctor a couple of times,
and worries about what will happen when she enters labor. “I think about where I will
go,” says Sophany, a 22-year-old with brightly painted nails. “I think about the safety. I'm
very frightened.”
Like agricultural development, health care occupies a marginal position in the scheme
of Hunsenomics. According to the World Health Organization, the Cambodian govern-
ment spent just $11.50 on health care per person in 2011, compared to $38.30 in Vietnam
and $152.30 in Thailand. 36 In theory, the government offers free health care to the poorest
members of society, and claims 3.8 million poor Cambodians accessed such services in
2012. 37 But few people in Trapaing Prolit seemed to have benefited from the program. Set
Sam, the village chief, said just 30 of the village's 150 families were judged poor enough
to receive official “poverty cards” making them eligible for free health care. The expect-
ant mother Peun Say was excluded, even though she had no money to pay for checkups;
so was Seng Cheun, the ex-soldier suffering from stomach problems.
The etiolated state of the Cambodian health-care system means that those who can af-
ford it look elsewhere for treatment. High-ranking government officials and expatriates
fly to Singapore or Thailand. The middle classes often board the daily buses from Phnom
Penh to Ho Chi Minh City, where they can obtain affordable care at Vietnam's state-run
hospitals. Everybody else relies on inconsistent private hospitals and clinics, handouts
from foreign NGOs, or Khmer traditional medicine. With nowhere else to turn, the
poorest are susceptible to the claims of mountebanks and mystical healers promising
cheap and instant cures. In October 2013, people from across the country converged on