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Shopping on the red market

and January 16, 2016
and January 16, 2016

In 2011, the journalist and author Scott Carney popularised the evocative phrase "the red market": the sometimes legal (but more often not) trade in human body parts. It’s a business, he says, with which people feel fundamentally uncomfortable – evoking some sense that "the body should not be a mere assembly of spare parts", as Al Gore put it in a 1984 address to the US Senate.

For decades now, people have found ways to make money through simple "red market" sales in Cambodia. Common options include selling hair (legal) and blood (outlawed in 1991, and increasingly uncommon).

Last year, Cambodian courts handed down the country’s first conviction for organ trafficking, in a case which saw at least three men persuaded to cross into Thailand to have a kidney removed.

A man displays a scar from kidney removal surgery. Heng Chivoan
A man displays a scar from kidney removal surgery. Heng Chivoan

A US company evocatively named Ambrosia Labs in the past few months started paying 10 women in Stung Meanchey to have their breast milk pumped, packaged and shipped to the US.

And as the Kingdom’s medical facilities have improved, it’s opened even more new avenues for what some deem to be exploitation.

According to Carney, author of The Red Market: On the Trail of the World’s Organ Brokers, Bone Thieves, Blood Farmers and Child Traffickers the conditions necessary for a sophisticated "red market" to flourish are simple.

"Red markets flourish anywhere there are high quality hospitals and medical infrastructure in close proximity to sizeable populations of desperately poor people," he wrote in an email to Post Weekend.

Following Thailand’s crackdown on surrogacy last year, IVF clinics have moved across the border. As a result, Cambodia’s first generation of babies impregnated as part of commercial surrogacy arrangements are due to be born any day now and that the eggs of Cambodian women are being used to impregnate infertile women.

Amid questions about the morality and legality of certain trades, Cambodia’s authorities are playing a game of catch-up.

Confusion rules over what the ultimate ruling will be on surrogate births, with the government issuing and then contradicting statements on whether the trade would be treated as human trafficking or not.

And even in the case of the sale of organs – clearly outlawed under Cambodian law – there is room for uncertainty.

"We used to hear from other countries that people donated [kidneys] to family members without money, but they would just say thank you to the donor or financially support the family which was poor after the donation," said Keo Thea, deputy head of the Phnom Penh Municipal Anti-Human Trafficking and Juvenile protection office.

"I am not sure whether it is wrong to do it," he said of the unofficial support that recipients might provide to donors, adding that it was also extremely hard to establish whether money was changing hands.

Medical professionals say Cambodia’s lack of high quality surgical theatres is the condition that is currently holding Cambodia back from becoming a destination for the darkest aspects of the red market trade.

"We don’t have organ selling to control because we don’t even have modern medical equipment to operate on organs such as the kidneys, liver or others," said Dr Chea Por, a physician and general manager at DN Polyclinic.

Accoring to Por, sick patients will not undertake major surgery of any kind in Cambodia.

But transplants are not impossible in Cambodia. Indeed, in 2014 a supposed kidney trafficking ring was discovered to be operating out of Preah Ket Mealea military hospital – an allegation that was subsequently retracted amongst considerable confusion when it was announced that the transplants were part of a voluntary training scheme. Keo Thea said he was unsure of what the end result had been.

"It is really a mystery to try and control it," he said of the potential trade in organs.

Perhaps a more transparent index by which to gauge Cambodia’s medical infrastructure is the readiness of international companies to use the country as a cheap destination for clinical trials – a money making option that Carney brackets under the same red market label.

Kheng Chen (left), 48, who sold her hair to make some extra money, sits in a temporary shelter at a relocation site for former Borei Keila residents in Kandal. Heng Chivoan
Kheng Chen (left), 48, who sold her hair to make some extra money, sits in a temporary shelter at a relocation site for former Borei Keila residents in Kandal. Heng Chivoan

In a 2011 article for Outsourcing Pharma, journalist Nick Taylor proclaimed that Cambodia and Vietnam were the next countries on the "outsourcing map" for clinical research organisations (CROs) who pay patients to get sick and test run potential cures.

But while Vietnam has followed the trajectory anticipated by Taylor, Cambodia has yet to establish itself in this potentially lucrative market. When contacted by Post Weekend, both Roche and Quintiles – the two organisations Taylor thought might be interested in setting up operations in the Kingdom – said they had yet to make a move.

A Roche representative explained via email that a "certain infrastructure" was still lacking in Cambodia that would make trials feasible.

The significant exception to this rule is in the field of malaria research. In Pailin, known globally as the point of origin for drug resistant malaria, companies studying the effects and potential cures have little choice but to go to where the patients are.

And as Didier Ménard, head of the Malaria Molecular Epidemiology Unit at the Pasteur Institute, explains, it’s a situation that has introduced the same uneasy financial transactions that typify red market trades.

He recounts an anecdote from a friend working in Pailin, who encountered two children trying to get malaria because of the payout they’d likely receive: $10 or $20 depending on whether a hospital stay was required.

"We need to pay the patient because they waste their time – we have to compensate them for lost time, so we need to pay. But after that...how much? What is the good price? I don’t know."

If Carney is to be heeded, the conditions necessary to avoid these clashes of money and morality multiplying in Cambodia would have to be a rise in living standards for the general population that matches the arrival of sophisticated medical technology on offer in the capital.

"If [new] hospitals can attract high paying patients from abroad or from within the country then you have all the right ingredients for exploitation," he said.

Hair

The easiest and the quickest sell: in rural villages and poor city areas, roaming hair collectors will make a few visits every year to cut the hair of women looking to make some cash. A full head of long "virgin" hair (meaning it has not been permed, dyed, bleached or chemically processed in any way) can net upwards of $25, but many women choose to only have the under layer of hair cut short, so they can keep up the appearance of having long hair. One woman interviewed by Post Weekend said of the Vietnamese traders who visited her village: "It was like they had magic to convince me to sell hair to them". The sale of hair is legal, with several large scale export operations setting up shop in Phnom Penh over the last few years as the billion dollar global market continues to grow. Prices for a half-head of extensions made of Cambodian hair sell for between $90 and $190.
Breast milk

Cambodian breast milk is currently being flown from Phnom Penh to the US by a former Mormon missionary who set up the company Ambrosia Labs in June 2015. Ambrosia Labs representative Ryan Newell told Post Weekend via email that the company currently pays 10 women to pump their breast milk twice a day at their Stung Meanchey facility. Newell said that the women were paid an average of $6.40 per day (including travel and bonuses) for providing the service. Women will produce on average about 158ml of breast milk per pumping, which Ambrosia lightly pasteurises and ships to the US. A pack containing 1,500ml of Ambrosia Labs sells for $150. The selling of breast milk is not regulated by the Food and Drug Administration (FDA) under American law, although they recommend against purchasing it online.
Kidneys

To date, there has been at least one case of organ trafficking brought to court in Cambodia: a 2014 incident which saw a woman and two accomplices persuade at least three Cham men to travel to a Bangkok hospital to have a kidney removed. Each man received between $3,000 and $6,000 as payment, but later said they had been unaware at the time that the recipient had been charged double their payout for their new kidney. While kidneys are often donated between close family members, selling them is illegal everywhere in the world apart from Iran. Consequently, the three victims all had forged Thai identity documents that matched their surname with that of the recipient. In March 2015, the traffickers were each sentenced to between 10 and 15 years in jail. At the time of sentencing, a representative for the UN Office on Drugs and Crime told AFP that the case could be "the tip of the iceberg" in Cambodia.
Blood

Selling blood for transfusions remained a lucrative trade for Phnom Penh residents long after it was banned by the government in 1991. Back in 2008, patients at the National Blood Transfusion Center (NBTC) told the Post that they were being forced buy blood from brokers to survive. According to one unofficial broker, a unit of blood could cost up to $70 – $15 for the "professional" donor, $20 for blood laboratory staff, $10 for the security guard and $25 for the broker himself. But as Cambodia’s donor-driven blood transfusion network has picked up pace in the years since, trade has been on the decline. Friends International told Post Weekend that the organisation believed instances of blood selling by street children – once a major problem – had dropped off sharply in recent years and staff at the NBTC stated that their blood banks were now entirely donor supplied. However Srey Buntha, 66 – a motodop driver who works outside the clinic’s entrance – said that blood sellers would still come in the evenings, a fact Post Weekend could not confirm with others at the hospital.
Wombs

Following the outlawing of surrogacy in Nepal, India and Thailand over the course of 2015, Cambodia has become a destination for families looking for surrogate mothers. A decision has yet to be made by the government as to whether the procedure is legal. Meanwhile, the first group of surrogate mothers are about to give birth in the Kingdom – many of them Thai women who migrated to Phnom Penh after the crackdown back home. According to documents obtained through agency websites, the intended parents pay upwards of $30,000 for each pregnancy with the surrogate receiving up to $10,000. If legalised, one founder of a Cambodian IVF clinic claimed commercial surrogacy could potentially be worth between $500 million and $1 billion per year to the Cambodian economy.
Eggs

The recent flurry of surrogacy agencies and IVF clinics setting up in Phnom Penh has created the facilities for women to sell their eggs – a trade that is unregulated in Cambodia. Companies such as New Genetics Global and New Life Cambodia recruit potential egg donors online. On New Life Cambodia’s Facebook page, women between 18 and 28 are encouraged in Khmer language posts to donate their eggs as "it does not affect your health and is without surgery!" The advertisements quote a $1,500 payment for the procedure, while clients will pay upwards of $11,000 to have an egg implanted via IVF. Selling eggs involves taking a course of hormones, then having a suctioning needle guided into each ovary through the vagina. It is common to experience physical side effects, and there is potential for serious damage to internal organs.