One of Phnom Penh's 200 legal pharmacies, which compete with

nearly 500 illegal dispensaries

Two years ago the Government tried to crack down on illegal pharmacies, but as

Chea Sotheacheath discovered, the businesses are still flourishing , dispensing

dangerous and inappropriate drugs to those with the money to buy them

A DOCTOR'S consultation or prescription is unnecessary. Just tell the person behind

the counter your symptoms and a colorful array of tablets and medicines will be handed

over - maybe not the correct medication for the illness, but medication nonetheless.

The Post visited several pharmacies in Phnom Penh and much of the sales patter was

the same.

"No. No, I do not take that yellow tablet ... It makes me sleepy," a 32-year-old

woman, Seng Vanna, said to one pharmacist. "But it is good for you," the

pharmacist replied. "It can heal all injuries to all parts of your insides ...

Don't forget to take it after meals," she added, as she put about 20 tablets

in a small plastic bag.

Vanna has had a chest infection for a long time and she has been taking unprescribed

medicine for almost five months. She has not bothered to go and see a doctor because

she said it would be a waste of time and cost money.

But she admits that accepting the advice of the pharmacist has not always been beneficial.

"Sometimes it worked, sometimes it made me more sick," she said coughing.

Yem Phoeun, 21, a waiter at the Capitol Guest House, has the same story. He said

he has taken lots of medicine over the past three months to cure the pain in his

chest. Some times the pharmacist gave him an injection instead because he said he

was fed up with the tablets.

"I ate medicine like I ate rice. Then I always felt hot in my stomach,"

he said.

Phoeun is now back at work despite not feeling any better.

The lack of enforcement of the medicinal drug laws has attracted unqualified people

to the retail pharmaceutical business.

It is a trend which has horrified professional pharmacists.

Cambodia Pharmacist Association director Yim Yan said that people were risking their

health rather than obtaining a cure by buying medicines from the illegal pharmacies.

"People take a handful of assorted medicines just for a minor illness. It is

very dangerous. It is like they are swallowing a handful of poison," he said.

"It is not a simple business [to run a pharmacy]. It is a professional business.

They cannot sell medicine like fish."

The Ministry of Health's ideal is one pharmacy per 2000 people in the countryside

and one pharmacy per 3000 people in urban areas.

However, the number of legal pharmacies in the countryside is well below that target

while in urban areas it is much higher.

The illegal pharmacies have made up for the rural shortage: there are 2686 in Cambodia,

2206 of them outside Phnom Penh.

There are laws regulating the sale of prescription drugs, enacted in 1996, but the

one attempt to enforce them ended in disaster for the Ministry of Health.

In 1997 five people were charged in court and found guilty and fined for running

illegal pharmacies, but the decision was later overturned.

Health Ministry Secretary of State Ung Thyrun said that the Ministry was then accused

of illegally having people arrested and stealing their property (the drugs seized

as evidence).

He said the failure to successfully prosecute the five people opened the flood gates

on illegal drug sales.

The failure has also led to accusations of corruption within the Ministry.

One Ministry source said that officials there were deeply involved in the trade.

He said many of Cambodia's 60 drug import companies are either owned or work in collusion

with Health Ministry officials to bring in more drugs than they are permitted to.

He said this leads to a situation where it is financially disadvantageous for officials

to reform the health sector.

"They know very well the worst [of the current disordered system of health care].

They do not want it to be better. Because they think they will lose their personal

benefits if it is changed," he said.

He said that Ministry officials should be prohibited from business dealings in the

health sector.

"It is like football: the referee should not also be a player," he said.

Ung Thyrun denied any Ministry officials were involved in importing drugs but he

admitted some of them with academic qualifications had sold their names for between

$100 to $200 a month to allow other people to conduct a supposedly regulated business.

"As you know, the civil servant's salary is low. So there are some staff who

have sold their names to other people to run a pharmacy business," he said.

Yim Yan said most of Cambodia's drug stocks pass through the 30 pharmacies in Olympic

market.

He said some of the wholesalers are completely unscrupulous and indulge in practices

such as selling fraudulent medicines or changing the use-by date on old medicines.

"They are afraid of nothing. Some just use a packet of cigarettes to bribe police,

then can run their business," Yim Yan said.

The people running the illegal pharmacies are open about their trade.

One seller at Olympic Market did not hesitate to admit that he is not a pharmacist

and his pharmacy is illegal.

"I know my business is illegal. But aren't those officials making illegal business?

Let their arses be cleaned first. Then they can clean other people's," he said.

He said people always respect the law but the law has never been enforced, because

the law-makers themselves [the corrupt officials] always break the law.

He said if the law is to be enforced it should start at the top.

Meanwhile the wider issue of people bypassing doctors in favor of over-the-counter

medicines for cost reasons has been recognized by the Health Ministry.

Ministry Secretary of State Tep Lun said the Government had tried to improve the

health system but did not have enough money to subsidize health care.

He said each citizen spent an average of $29 a year for their health care, of which

between $4 and $6 had been paid by NGOs and other humanitarian groups while the government's

contribution was $1. Tep Lun said that the aim was to drop the patient contribution

to $8 to $9 a year.

But Yim Yan claimed the data used to reach these figures was skewed because of the

lack of control in the health sector.

"How can they get the correct data when everything is out of control?"

He asked.

"Do they know exactly how much medicine had been imported? And how much medicine

had been used?"

Unlike other ministries such as defense, the Health Ministry has always had a small

budget and much of that money has been misappropriated.

Tep Lun said that in 1996 the Ministry of Health allocation was 59,970,000 riel,

but the Ministry got only 41,966,000. The remainder went missing.

In 1997, the Ministry got 43,694,000 of the 61,234,000 riel allocated.

In 1998, the Ministry got 43,160,000 of 68,296,000 riel.

In 1999 the allocation is 80,116,000 riel, but he is not clear how much money the

Ministry has received.

"It is a mystery. The money is always missing," Tep Lun said.

"Some say the missing money was paid in tax or the government did not have enough

money. I do not know. Maybe it got lost along the street," he said, chuckling.