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Our medical system fails the poor

Venerable Sao Chanthol blesses Keo Kolthida ‘Kol’ Ekkasakh’s bones after her cremation on January 21
Venerable Sao Chanthol blesses Keo Kolthida ‘Kol’ Ekkasakh’s bones after her cremation on January 21. PHOTO SUPPLIED

Our medical system fails the poor

Recently, my sister Keo Kolthida Ekkasakh (Kol) passed away after a long struggle with cancer. She was born in 1959 in Phnom Penh to my mother, Keo Nann. Kol was deaf and the youngest of five sisters. Kol and I were just two years apart, so we were like best friends.

Lacking the ability to communicate with all but those trained in sign language, she learned to depend on herself and the few people who had the patience and love to know her. Yet, despite her circumstances, she had an incredible spirit and a personality that could light up a room.

When the Khmer Rouge took control of Cambodia in 1975, I lost contact with her, and while we reconnected after the fall of the regime, both of us had already forgotten much of our sign language. Over the years, our ability to communicate decreased, until this past year, when we began spending a great deal of time together. We discussed the death and disappearance of loved ones, and her experiences during the Khmer Rouge regime.

Like many Cambodians during this time period, she worked in the fields, planting vegetables and clearing forest. Like all victims, she learned to survive by sheer instinct – eating roots, leaves and insects to forestall starvation. I was amazed by the description of her experiences and I was awed by her indescribable spirit and the resourcefulness she must have had to endure as a deaf person during this atrocious period.

The time I spent with her in the past year meant so much to me, and it was why in her final days I prayed for a miracle in her health.

But like many Cambodians who suffer dire medical circumstances, she was at the mercy of an under-developed medical system in which inefficient and unethical practices persist as much as technological shortcomings. I spent many days and nights supervising her medical care, and waking medical staff during the night to ensure her proper care. Lacking immediate incentive or a more professional approach to a patient’s care, medical workers are often lax in their duties, particularly when the patient is poor. While in most modern medical systems, the patient’s well-being is of paramount concern, in Cambodia, it is the certainty of payment and thereafter the prospect for additional gratuities that guarantees the quality of care. Such a system fails the impoverished, and it does a disservice to the generation that suffered so greatly to persevere as a country in the wake of the Khmer Rouge.

My sister officially died on January 19, but she did not die without a fight. On January 13, nearly a week prior, she was pronounced dead by her doctors. Her vital signs appeared to have stopped, and she seemed to have no life. The doctors pronounced her dead and had we not thought differently, she would have been cremated alive. Upon the doctor’s advice, we sadly took her to the Wat Langka pagoda, but rather than cremating her, we prayed. We prayed and the monks chanted and burned incense. We prayed over her body for hours and at one point a monk, Sao Chanthol, noticed tears on the side of her right cheek. She began to move her arms and open her eyes. I immediately showed her drawings of her memory for the American deaf researcher Erin Moriarty Harrelson. If miracles happen, then one occurred that evening.

My sister lived for another week. She told us how she saw everyone who she knew in life and who died during the Khmer Rouge regime. She met my father, sister and neighbour – all who died during this time period.

My sister survived (and thrived) for another week but then abruptly passed on the evening of January 19.

Keo Kolthida ‘Kol’ Ekkasakh
Keo Kolthida ‘Kol’ Ekkasakh

I wish there was more that I could have done to comfort her, just like I wish there is more that I could do for victims of the Khmer Rouge regime. Cambodia continues to struggle to this day with the history of this period. While we often look to politics, education and religion as the prominent fields that harbour the residual effects of this horrific period, the medical system as well bears this period’s scars.

While all societies struggle with improving their respective medical system, I don’t believe my sister’s circumstances were isolated or unique. Had we not been at her side imploring the consistent attention to her care or inquiring into, with secondary medical opinion, her actual condition, I question how long she may have truly lived. The cool indifference to the poor or the casual triaging of medical care based on economic circumstance disguise a deeper sentiment than mere distraction, incompetence or laziness. The vestiges of horrific regimes can often reside in our own understanding, empathy and concern for our fellow human beings both in casual interaction as well as professional service, and it is in this light that Cambodia still has much more to do.

Youk Chhang is the executive director of the Documentation Center of Cambodia.

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