Cancer patient Panh Pal, 60, lightly runs her hand over the imprecise source of pain around her chest area.
“My lungs aren’t working well,” she says. Beneath her thin cotton shirt, she reveals a scar marking her slight frame from a mastectomy she underwent five years ago for breast cancer.
Her health was fine until recently, when this new pain made it hurt to breathe. She returned to the oncology unit at Phnom Penh’s Khmer-Soviet Friendship Hospital – the only public hospital that treats cancer in the Kingdom – to find out what was wrong, and ended up staying for weeks. The cost of her coming to the city to receive treatment is crushingly high.
“I can’t afford it, so I had to sell the farm and everything I had to take care of myself,” she says from a bare tiled corridor. If she is too weak and needs to spend the night on the ward, she has to pay a fee. None of her family can afford to accompany her to Phnom Penh, so she hangs around the hospital between treatments.
“In my village, a lot of women [get cancer]. They cannot afford to come here to heal, so they just take traditional medicine.”
If all goes well, there will soon be a place built specifically for people like Pal – the country’s first women-only hospital, the project of one driven Canadian expat.
In Phnom Penh in 2010, Canadian expat Janne Ritskes was also diagnosed with breast cancer. Within weeks, the fiery middle-aged lady, who by a stroke of luck had only just taken out insurance after decades of overseas aid work and missions, was undergoing surgery at a private hospital in Singapore. The treatment was successful and Ritskes was soon back at work at Tabitha Cambodia, the bustling women’s NGO she founded in 1994.
On hearing about her cancer, Ritskes found herself bothered by one sentiment echoed over and again by well-wishers: “It shouldn’t have happened to you.”
“Well, why not?” Ritskes says impassionedly from behind her desk at Tabitha’s BKK office. “What makes me so special?”
In Cambodia, breast and cervical cancer is often not caught at the earliest stages, and gynecology is an often inaccessible service – as well as a source of embarrassment to many women.
In many countries, a women’s hospital would cater exclusively to these health problems. In Cambodia, there is no single hospital devoted to gynecological and women’s cancers; a facility where a desperately sick woman can go and not face overwhelming financial burden for undergoing treatment.
“Children get sick – women always put the kids first, and if the husband gets sick, the women will always put him first. The woman is the last one anybody looks at, and by the time anybody is aware of how sick she really is, it’s way too late.”
Ritskes’s illness also made her deeply affected by the idea of chronic pain, everyday life made miserable by untreated infections.
“What do [Westerners] know about pain? Nothing. We get a toothache, we go to a dentist. My menstrual period is too harsh, I get a pill and go to a doctor...There is no relief here, and the increase in pain [leads to] the increase in pressure on the family . . . ”
She came to the decision that a women’s hospital was the only solution to what had become for her a moral dilemma. She posed the idea to Minister for Women’s Affairs Dr Ing Kantha Phavi, with whom she gets on well, and was offered immediate support from the minister herself. The pair are now two of four official founders (including Phavi’s husband Trac Thai Sieng, vice governor of Phnom Penh) of the Nokor Tep women’s hospital, an ambitious 200-bed facility in Phnom Penh’s Dangkor district, a place where “no woman will be denied treatment because of inability to pay the basic fees”, according to its glossy sponsorship kit.
A medical doctor by training, Dr Phavi , believes that by “narrowing the scope” of its patients to women suffering female-specific illness, the quality of services will be as high as anywhere in the world.
“When I went down to the field, I saw a lot of women suffering from poor health, especially women’s health. They are quite shy – they don’t want to see a medical doctor, especially a male doctor. When they can come to the health centre, it’s a little too late,” she says.
“Cancer is an emerging issue for public health. The establishment of this hospital will complete what the Sihanouk Hospital [Khmer-Soviet] cannot do.”
In the worn-looking surgeries of the Phnom Penh Municipal Referral Centre, long-term women’s and maternal health medic Dr Sorn Chenna says cervical inflammation is a constant complaint among her patients. A doctor for 25 years, Dr Chenna is concerned by the number of women who come to her with obvious signs of cancer.
“It is a big problem in Cambodia. I see a lot and we refer them directly to the Khmer-Soviet hospital,” she says.
Once at the Khmer-Soviet, head of oncology Professor Kouy Samnang says the majority of patients come in with second stage or beyond cancers. Last year, around 1,400 new cases were diagnosed (men and women) with cervical and breast cancers the highest for women. There are 38 beds in the department.
Dr Samnang is enthused by the idea of a women’s hospital. It would take the burden off the country’s only public-hospital cancer treatment ward, and he believes women would benefit from being treated by women.
“It would be great – women can take care of each other . . . if it gets enough support,” he adds.
Ritskes wants international support from an array of donors. Running the hospital for one year is estimated to cost $30 million. The1.5-hectare land and building construction is priced at $8,300,000 – so far, the earthworks have been done.
Ritskes believes women are routinely looked over in favour of “popular” funding subjects, and she has a particular dislike of Western aid funding preventive health projects – something she herself promoted in her previous career.
“I am so horrified by preventative health care . . . there’s a true cruelty involved in that. Because what you do is you actually educate people – ‘these are some of your issues.’ They can’t do anything about it because they’re poor and there’s no medical facilities, and we turn around and we walk away,” she says.
“I think there’s nothing crueler in life than saying, ‘Hey, you’ve probably got breast cancer. See ya.’ That’s what preventative health care does. I’ve done it in other countries, and I detest it like you wouldn’t believe.”
A decade ago in Cambodia, cancer was usually a death sentence, Dr Samnang says. That has changed, but he thinks once more services are offered, the high number of cancer among Cambodians will become apparent.