Cambodia

Introduction


Cambodia, formally known as Kingdom of Cambodia is a country in the Southeast Asian Region bordered by Thailand to the northwest, Laos to the northeast, Vietnam to the east, and the Gulf of Thailand to the southwest. It has a population of 15 million with Phnom Penh being the capital of Cambodia. The population is 90% Khmer, 5% Vietnamese, 1% Chinese and 4% comprise other ethnic groups. It is home to the magnificent temples of Angkor Wat.


“Cambodia gained independence in 1953. The Vietnam War extended into the country with the US bombing of Cambodia from 1969 to 1973. Following the Cambodian coup of 1970, the deposed king gave his support to his former enemies, the Khmer Rouge. The Khmer Rouge emerged as a major power, taking Phnom Penh in 1975 and later carrying out the Cambodian Genocide from 1975 until 1979, when they were ousted by Vietnam and the Vietnamese-backed People's Republic of Kampuchea in the Cambodian–Vietnamese War (1979–91). Following the 1991 Paris Peace Accords, Cambodia was governed briefly by a United Nations mission (1992–93). The UN withdrew after holding elections in which around 90 percent of the registered voters cast ballots. The 1997 coup placed power solely in the hands of Prime Minister Hun Sen and the Cambodian People's Party, who remain in power as of 2016.”


Despite being considered an impoverished nation, Cambodia is considered to have one of the fastest growing economies in Asia with Agriculture being the dominant economic sector.

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Cambodia and Land Mines


As a result of three decades of war, Cambodia is now facing a challenge regarding land mines which are prevalent in the rural areas. The country has an estimated number of 40,000 amputees. The Cambodian Mine Action Centre estimates four to six million mines that were placed by governments and factions that clashed during the Civil War in 1970’s and 1980’s. A survey in 2002 revealed that 20% of the majority of the villages are still plagued with land mines.

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Patient Access to Physical Therapy Services/Entry Point


With the brief background, Non-Government Organizations mostly from European and Western countries such as Norway, Australia, Canada and the US has been helping the people of Cambodia rebuild and address the healthcare issues of the country. Based on actual interviews, patients do have direct access to Physical Therapy services. NGO’s have established rehabilitation centers all over the region to where patients can walk-in and receive physical therapy without referral from a doctor. They have built dormitories where patients who came from far flung areas can stay for months to be able to receive care. Occasionally, when cases become complex, doctor referrals are made.
People who live in the cities such as Phnom Penh, in the Outpatient setting, it is common that doctor referrals superseded physical therapy visits.

Therapist Preparation

Degree/Credentialing: According to WCPT data, International University which has its main campus in Phnom Penh offers Bachelor of Science in Physiotherapy.Per the Cambodian Physical Therapy Association, national qualified PT’s graduate from Technical School for Medical Care, University of Health Science, and Ministry of Health. The curriculum is mostly patterned from European and Western school systems.

Professional Associations

The Cambodian Physical Therapy Association, a member of the World Confederation of Physical Therapy since 2007, was established in 1994 by a team of physical therapists. It was recognized by the Ministry of Interior, Royal Government of Cambodia in 1997. CPTA provided free physical therapy consultations and raised awareness about the profession by performing outreaches to high schools.

Information about patient community

Per Dunleavy, there are four levels of physical therapy provider systems. “Rehabilitation workers were trained during the war in refugee camps and afterwards in rehabilitation centers, professional physical therapists were trained in a university program after the conflict ceased and community follow-up workers and community-based rehabilitation workers were trained to address some of the geographic accessibility issues.”
Many of the patient population consist of people who were affected by physical disabilities that require prosthetics, orthotics and adaptive equipment. Recently, with the continuous modernization of healthcare provision, neuromuscular and musculoskeletal conditions such as arthritis, back problems, hemiplegia, leprosy, polio, meningitis, developmental conditions and bone and brain tuberculosis are amongst the prevalent conditions.


According to Dr. Samedy, the most important health problems are malnutrition, malaria, tuberculosis, and diarrheal diseases. The top five causes of death are Coronary Heart Disease, Tuberculosis, Stroke, Influenza and Pneumonia and HIV/AIDS.
Per interview, family support is strong amongst patients however due to socioeconomic status and geographic considerations, some families are finding it difficult to be physically present with the patients.

Delivery of Care


Per interview with a volunteer, delivery of care is organized and efficient since a lot of healthcare providers are streamlined according to the Western system. Dutch physical therapists are not uncommon in Cambodia. Upon research, most settings are through NGO run rehabilitation centers and private centers. It is said that in theory, healthcare delivery in Cambodia is free amongst its people however some provisions that are harder to acquire, patients have to pay for.

Resources

  • Central Intelligence Agency, The World Factbook, cia.gov/library/publications/the-world-factbook/geos/cb.html. Accessed November 19, 2016
  • En.wikipedia.org/wiki/Cambodia. Accessed November 19, 2016
  • Gray, Amarillo Globe-News, Rats become heroes in Cambodia’s vast mine fields, Amarillo.com/news/2016-02-24/rats-become-heroes-cambodias-vast-mine-fields, Feb 2016, Accessed November 20, 2016
  • Land mines in Cambodia, en.wikipedia.org/wiki/Land_mines_in_Cambodia
  • Catholicireland.net/wp-content/uploads/2014/07/Landmine-victims.jpg. Accessed November 20, 2016
  • Globalgiving.org/pfil/7819/ph_7819_25143.jpg. Accessed November 20, 2016.
  • Chantheung, Cambodian Physical Therapy Association, wcpt.org/sites/wcpt.org/files/wptday/15/activities/WPTD2015_cambodia_CPTA_report.pdf
  • Dunleavy, Physical Therapy Education and Provision in Cambodia; a framework for choice of systems for development projects, Disabil Rehabil, 2007 Jun 15-30;29 (11-12):903-20
  • McGrew. Healthcare in Cambodia, culturalsurvival.org/publications/cultural-survival-quarterly/Cambodia/health-care-cambodia, 1990. Accessed November 20, 2016
    *Special thanks given to the members of Academy of Filipino American Physical Therapists for their contribution towards opening contacts to PT’s who worked in Cambodia especially to Ms. Chona Serra, PT, 2008-2009 Volunteer PT Trainee in Battanbang Rehabilitation Center and Kompong Speu Rehabilitation Center