In October 2023, Dr. Brodkin spent two weeks volunteering in Kampot, Cambodia, where he taught medical residents and supervised patient care at the local hospital. During that time, he developed a close friendship with the internal medicine residency director, who provided him with much of the background information that helped prepare this article. This piece also reflects his own personal observations and experiences while he was there.
Following the fall of the Khmer Rouge regime in 1979, Cambodia was left with a decimated healthcare infrastructure.
Pol Pot transformed Cambodia from 1976 until his overthrow in 1979 into a one-party state, which he called Democratic Kampuchea. Seeking to create an agrarian socialist society that he believed would evolve into a communist society, Pol Pot’s government forcibly relocated the urban population to the countryside and forced it to work on collective farms. Pursuing complete egalitarianism, money was abolished. Between 1975 and 1979, an estimated 1.5 to 2 million people—approximately a quarter of the population—died from starvation, overwork, disease, and execution.¹ Those targeted included the country’s intellectual and professional class: teachers, civil servants, engineers, and physicians. Medical education was halted, hospitals were emptied, and traditional knowledge was dismantled.
Forty-five years later, Cambodia’s hospitals have evolved from near non-existence into functioning, if still developing, institutions. The Khmer people have been a nation relying on foreign healthcare personnel to rebuild their healthcare industry. At this point, they have become less dependent on outsourced aid. This article draws on first-hand observations and ongoing collaborations in Cambodian hospitals to highlight the progress, remaining challenges, and unique features of hospital care in a post-genocide healthcare landscape.
Infrastructure and Admission Workflow
Modern Cambodian hospitals have adopted digital platforms such as Practo, a health information electronic health record system based in India, for managing inpatient records and orders. Patient admission now mirrors systems in higher-resource settings: physicians record history, physical examination, diagnostic findings, differential diagnoses, and treatment plans within the electronic system. Most hospitals in Phnom Penh and provincial capitals now have reliable internet, facilitating system-wide integration.
Despite this digital advancement, the infrastructure remains basic in many rural facilities. Air conditioning, elevators, and diagnostic equipment such as CT scanners or automated labs are often absent or inconsistent at these hospitals. These limitations shape both the scope and speed of care delivery.
Caregiving and Workforce Dynamics
A notable aspect of Cambodian hospital care is the extensive involvement of family members, who serve as primary caregivers during hospitalization. They assist with feeding, hygiene, ambulation, and medication procurement. Hospital stays without a family member are virtually impossible. Families are also expected to purchase any non-formulary medications or supplies not available in the hospital, sometimes from their provincial cities, to Phnom Penh, which may take up to eight hours to travel.
The physician-nurse dynamic also reflects a steep hierarchy. Nurses, particularly younger or less experienced ones, are often hesitant to question physician orders—even when safety is a concern. Bedside rounds are physician-led, and interprofessional dialogue is limited unless explicitly encouraged. Nurses primarily carry out physician directives rather than engaging as co-managers of care, a significant contrast to systems where shared governance and nursing autonomy are emphasized.
Access to Medications
In rural provinces, common causes of fever requiring hospitalization include typhoid fever, leptospirosis, scrub typhus, dengue, and tuberculosis. These illnesses can be clinically difficult to distinguish during their early stages, particularly in resource-limited rural hospital settings. Laboratory testing is typically outsourced, with results taking five to seven days to return. In the meantime, empirical antibiotic treatment is often necessary to save lives. However, rising antibiotic resistance is increasingly undermining the effectiveness of these treatments, complicating clinical management.
Opioid availability for terminal care remains critically limited. Long-acting opioids like sustained-release morphine or fentanyl patches are largely unavailable outside a few select non-governmental organizations (NGOs), such as Douleurs Sans Frontières, which occasionally supplies short-acting morphine tablets. Most public hospitals do not stock opioids due to regulatory barriers, risk aversion, and lack of training in palliative medicine. As a result, patients with end-stage cancer often suffer extreme pain in their final weeks, a situation that has been described by local physicians as “the silent agony.”²
Cultural and Traditional Considerations
Traditional healing practices remain widely used and accepted in the hospital. Techniques like kaw-kjal (skin scraping) and chup kjal (cupping) are applied to stimulate circulation and “release bad wind.” It triggers an inflammatory response and increased blood flow to the skin, thereby potentially enhancing the immune response to the illness. These therapies are typically used in parallel with biomedical care and rarely conflict with hospital treatment, though misunderstandings occasionally arise.
Discharge and Cost of Care
Upon discharge, patients or their families pay for services at the cashier. If they cannot afford the charges, they may undergo an immediate social work assessment to qualify for financial assistance. A five-tiered classification system determines the discount rate, from full payment (Status A) to full subsidy (Status E). Villagers may present a “poor card” issued by their commune chief to access free care, although this system is subject to misuse and inconsistencies in eligibility.
Cambodia’s National Social Security Fund (NSSF), launched in recent years, offers a government-subsidized insurance scheme primarily used by public sector employees and factory workers. The NSSF reimbursement to hospitals is only $7 total for the consultation, labs, imaging, and medications. Unfortunately, the hospital loses money overall. NSSF will also cover ED visits, appendectomies, cholecystectomies, and C-sections at more workable reimbursement.
Most Cambodians still pay out-of-pocket for their hospital visit, although mobile banking and QR code payments have made transactions more accessible. Private insurance and international health coverage remain rare.
Steps Forward
Cambodia’s recovery of hospital medicine is a testament to resilience. The Pol Pot government robbed entire generations of the Khmer people of local physicians to tend to their healthcare. From near obliteration of its medical system, the country now boasts functioning hospitals with electronic health records, trained general practitioners, and slowly growing specialty services. International collaborations, returning diaspora clinicians, and NGOs have all played vital roles.
The development of a national health insurance system, even with its imperfections, represents a significant milestone in providing financial assistance for hospitalized patients. Continued investment in postgraduate training, palliative care capacity, essential drug access, and interprofessional education will be key to the sustainable progress of growing hospital programs.
Cambodia still bears the scars of genocide, but its hospital wards now echo with the sounds of recovery—patients being treated, families caring for loved ones, and physicians and nurses navigating the complexities of modern care. The Khmer people are shifting their focus toward longevity and quality of life. The days of famine and despair are becoming a distant memory, replaced by the steady rise of homegrown hospitals and a renewed commitment to national healing and growth.
Dr. Brodkin
Dr. Brodkin is a traveling flex medical director, leading care teams across diverse hospital systems, and is actively involved in humanitarian efforts, providing nutrition support and health screenings in underserved international communities. He is deeply committed to cross-cultural learning, healthcare innovation, and delivering compassionate, patient-centered care.
References
Kiernan B. The Pol Pot Regime: Race, Power, and Genocide in Cambodia under the Khmer Rouge, 1975–79. Yale University Press, 2008. https://yalebooks.yale.edu/book/9780300144345/the-pol-pot-regime/
Douleurs Sans Frontières. https://www.douleurs.org/