I was delusional in Siem Reap. My self-medication story.

The year was 2015 and I had come down with a terrible stomach bug or sickness. Probably triggered by dehydration. I was staying in a small guest house. On the tuesday night I went to bed at 9:00pm and I never woke up until 9:00 am, not 12 hours later: a full 36 hours later.  I still felt groggy, and I needed some kind of suitable medication, so I got dressed, went downstairs on wobbly legs, and found a tuk-tuk to take me to a Pharmacy.

Pharmacy Siem Reap

I didn’t speak Khmer and the staff were having trouble with my Kiwi accent. The answer was to let me make my own selection. I never expected the results.

When I went in the three staff were stocking the shelves and chatting lightly.  One of the young women came to the counter and asked if she could help.  I tried explaining about my upset stomach but also my headaches and the alarming 36 hour blackout.  In my rambling kiwi accent however, I probably sounded drunk, I couldn’t convey what sort of medication might help.  What did she suggest?

The assistant kindly invited me around to her side of the counter and gave me the freedom to find the medication that I needed. There was a whole wall of unfamiliar bottles and creams and boxes.  here’s where my problems multiplied.  I’d forgotten to bring my glasses.  The labels all looked like a blur.  I tried my best to make words from the fuzzy shapes.  I could see from the names that many prescription drugs were made in India, and reasoned that these were probably knock-offs of well proven western medicines.

I looked for anything that might relate to stomach, or head-aches or fever.  If you use Dr Google you’ll know the same feeling.  You start by typing in a brief symptom, a sniffle, and before you know it you’re scrolling through the awful possibility of leprosy or gangrene.

My fuzzy-eyesight obviously took me to these same uncertain places, right here in the pharmacy.  Still, after 20 minutes I felt I’d found two bottles of pills that would do the trick.  I paid the shop assistant and went by tuk-tuk back to the guest house.  I was dying for sleep once more so I took two of each type of tablet and drifted off.

Well 12 hours later I woke feeling very weird.  My stomach was settled but I felt, well, just out of sorts.  I felt – I can’t describe it – but somehow strange. An out-of-body feeling. What were those tablets I’d taken?

This time I put on my glasses. Bingo – one of the bottles contained tablets for the relief of upset stomachs.  Smart choice.  But the other bottle? Well it wasn’t what I expected and may well have caused my disorientation.  It was a bottle of female hormone tablets.

PS. Incidentally in 2017 the Cambodian Ministry of Health placed a ban on selling anti-biotics without a prescription.  It seems I was not the only one rocking up to a pharmacy and buying stuff without a prescription. The concern was raised by doctors that if the population kept using enough antibiotics, then the population would lose their resistance to serious infection: a case where less is better than too much.

For another true story from my Brush with Medicine files: click here.

For a local health issue see a report on Cambodia’s fight against smoking: click here .

 

 

 

 

 

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Cambodia needs more than wells to achieve universal clean water access

FRESH WATER

UNICEF reports that 6 million Cambodians do not have access to safe, clean, drinkable water.  The problem is not just lack of wells.

The latest drought across Cambodia has shone the spotlight on the need for clean fresh water.  State initiatives to bring clean bottled water to drought-stricken villages has been useful, but only for the short term. What every Cambodian needs is steady, reliable access to clean fresh water. A recent UNICEF report, dated 2014, calculated that 6.3 million out of Cambodia’s 14.9 million population lacked access to clean drinking water. The problem is, in particular, a rural problem (80% of Phnom Penh’s population has access to clean drinking water,) and the main reason for the problem – the report stated – was that the Government has simply made other developments a higher priority. New roads have higher priority than access to water.

  • Some 40 percent of primary schools and 35 percent of health centers in the country do not have access to safe water and sanitation.
  • The lack of access to clean water leaves Cambodian children vulnerable to diseases such as diarrhea, which is the second leading cause of death among children under five, according to UNICEF.
  • According to WaterAid at least 380 children die each year from diarrhoeal diseases caused by unsafe water and poor sanitation.

Since 2014, according to international aid agency WaterAid there is now a national strategy, outlined by the Government, of reaching universal access to clean water by 2025: an objective that will not only play catch-up with the 6 million who lack adequate water supplies today, but will need to also reach the expanding population projected to reach at least 17.5 million by 2025.  Can they achieve this?

The digging of wells is the main solution in the rural villages though for the cities the provision of mains supply water is the main emphasis: treating lake, river sourced or well-sourced waters with full filtration systems as well as chemical treatment such as flouridation or chlorination.

Compounding the problem is the presence of two hazards in the ground and surface waters usually drawn upon by villages.  One hazard is naturally occurring arsenic: an issue that affects the whole Mekong delta region.  On this front Cambodia’s official ‘acceptable’ limit is 50 parts per million – in contrast to 30ppm in most Western countries.

An even more significant hazard is the presence of TTCs (thermo-tolerant coliform bacteria). For these bacteria, water treatment is needed.

Today in the face of drought, now and in the future, the provision of wells is a laudable initiative, and their are many agencies engaged with this – and worth supporting. My friend Savong has helped many well-building projects in rural Siem Reap.

But Cambodia also needs more reservoirs to effectively store water gathered during peak rainy periods and create a top-up for groundwater which, many experts believe, is sinking significantly.

The more wells or holes dug into the groundwater, the more pressure it loses causing well water levels to drop. That’s according to Mekong River Commission technical adviser Ian Thomas as reported in the Phnom Penh Post, last March 4th. A February Stanford University study found the more wells Cambodians dig, the harder it will be to extract water.

The building of reservoirs, (Angkor’s  East and West Baray are good examples from 1,000 years ago,)  would provide greater eco-stability for farming, fishing, and general water supply.

But for now, reservoirs and wells are just the start. Treating the water is also necessary. Water filters are a big part of the story. If you are supporting a water project, ask about the need for water filtration and treatment.

  • Sixty dollars will by a good basic bio-sand filter via Water for Cambodia.
  • Or Ceramic Filters, (they look like clay pots,) which are also recommended, are available through Resource Development International – who also supply water testing kits if you are worried about arsenic levels.

Further reading in this blog:

For more on the politics of water in Cambodia Who owns the Mekong? The intricate politics of water.

Also about the 2016 Drought

For other Facts and Figures about Cambodia

 

 

 

Where there’s smoke…there’s TB. Cambodia joins the fight against smoking.

A problem for health authorities is that cigarettes are priced so cheaply, even the poorest sector can get hooked on smoking.

A problem for health authorities is that cigarettes are priced so cheaply, even the poorest sector can get hooked on smoking. It doesn’t help that a leading Senator is importing cheap cigarettes.

A recent factoid caught my eye the other day –  the value of cigarette imports to Cambodia. Cigarettes  are, by value, one of the leading imports to this nation. What an extremely  unfortunate  thing to trade  in exchange for the hard labour that goes into producing rice,  Cambodia’s leading export crop.

In 1999 one researcher reported that the very poor spend a 2-3 times greater fraction of their income on tobacco relative to the rich. In urban areas, a poor Cambodian might spend in excess of 7% of their income on tobacco, as opposed to 2% or less spent by the affluent. A secondary analysis of the 1999 Socioeconomic Survey of Cambodia indicated that the annual cash expenditure of Cambodian smokers on cigarettes was about $US69.44 million. This annual expenditure on cigarettes is enough to buy 274,304 tons of quality rice, 1,388,382 bicycles, or construct 27,778 wooden houses.

Alarming figures! And that’s without counting the health costs associated with smoking. By 2011 the annual spend on tobacco was just this side of $US100 million.

The Ministry of health in Cambodia  has set objectives to reduce the percentage  of smokers  who are,  overwhelmingly,  males. in 2011  a thorough survey estimated that 42% of males aged 18+ a tobacco users.  Of these males,  20% began smoking before the age of 15.

Tobacco usage amongst females, as we see in other parts of Asia,  is relatively low – in the single digits –  and,  in Cambodia,  often reflected in tobacco chewing rather than smoking.  Tobacco chewing  this often seen as a mild stimulant that eases period cramps.

In total  there are 2 million tobacco users in Cambodia.

In many countries  smoking is not an option for the very poor,  due to the prohibitive cost of cigarettes. However  price is not a barrier in Cambodia, and mainstream cigarette brands  are available for less than $.40c for a pack of 20.  (In 2011 the average price per pack of 20 was 20 cents.) So without a serious barrier, the demographic group most likely to be smoking in Cambodia are poor, rural males.

Cigarette tax  seems to be most obvious way of curbing the number of smokers in Cambodia. Some  90% of the population agree that smoking is bad for once health, and a similar figure support the idea of a tobacco tax. Would it work? When the National Institute of statistics conducted its adult tobacco survey in 2011the fieldworkers were instructed to take note  of cigarette packs of the users they interviewed. Some 95%  of these packs for the seal of existing government taxes –  evidence that  black-market cigarettes are less well is distributed and some had feared. So a tax hike would be realistic.

Any  visitor to Cambodia  will have noticed the big billboards promoting cigarettes as glamorous –  real Marlboro Man stuff! There is widespread public support  for banning such advertising.

Change usually has to come from the top – the very top. For  what it’s worth, Prime Minister Hun Sen, a lifelong smoker himself,  recently announced that he had quit. Perhaps that clears the air  for a more concerted public policy  to prevent young Cambodian males in particular to take up cigarettes.

That seems unlikely. Oknha Ly Yong Phat, a CPP Senator, and previously an economic adviser to the Prime Minister is President of LYP Group that imports high nicotine cigarettes from Indonesia, Hero brand and Jet.