Rise in Deadly Diabetes Hitting Poor the Hardest

Doctors providing critical care services to Cambodians with diabetes and kidney disease are struggling to meet the needs of a growing number of patients who require lifelong treatment for chronic conditions.

Hundreds of thousands of Cambodians have diabetes and associated health concerns, according to the latest estimates, and experts say not nearly enough attention or resources are being directed toward prevention and treatment that could save or extend thousands of lives, and reduce pain and discomfort for many more.

Patients undergo dialysis at Preah Ket Mealea Hospital in Phnom Penh on Thursday. (Siv Channa/The Cambodia Daily)

The World Health Organization (WHO) estimates that 5.9 percent of Cambodians have diabetes, or nearly 900,000 people, according to its 2016 country briefing, including 6.1 percent of women and 5.7 percent of men, while the International Diabetes Foundation reported a prevalence of 2.6 percent in 2015, causing 5,432 deaths that year.

The pervasiveness of risk factors associated with diabetes was also significant, according to the WHO, with 16.4 percent of Cambodians regarded as overweight and nearly 3 percent classified as obese.

“Collectively, diabetes, car- diovascular disease, cancer, and chronic respiratory disease caused 43 percent of deaths in Cambodia in 2014, up from 36 percent of all deaths in 2011, and this figure is projected to continue to rise,” a representative of the WHO said.

Chan Sovandy, deputy director of the Sen Sok International University Hospital and head of the hospital’s Cambodia-Japan Friendship Blood Purification Center, said the number of patients seeking treatment was constantly growing, putting pressure on existing facilities. “I think the five centers in Cambodia are not enough, because every month the number of patients increases,” he said on Monday.

The blood purification center is one of only five in the country fitted with dialysis equipment, and a majority of its patients are diabetics, Dr. Sovandy said.

Patients with hypertension, nephritis, autoimmune disease and polycystic kidneys were among those treated at the center by specially trained doctors and nurses for a fee of $55 per session, a cost that was occasionally discounted for poorer patients.

The expensive treatment and lack of widespread properly equipped facilities—all five centers are in Phnom Penh—meant many patients were going without treatment, essentially resigning themselves to death, Dr. Sovandy said.

They face a double whammy: paying money for each day of dialysis, while earning none —an untenable situation for so many, he said. “If they have a problem with their kidney and don’t have hemodialysis, the patient will die.”

The doctor said he intended to provide free consultation services from his own home on weekends in order to meet demand, and called on the government to subsidize patient payments and help increase access to services. “To create a hemodialysis center, the first thing you need is the machine. One machine costs $10,000. And secondly, professionals: training for nurses and doctors,” he said.

“If the government would provide the building or the machine, I would give the training to the doctors and nurses free.”

For the past six years, a team of Japanese doctors have made visits to Cambodia’s International University Hospital to train doctors in dialysis therapy, but progress has been hampered by a lack of basic medical equipment and costly travel expenses.

Additionally, once trained, doctors often move to another hospital or open their own practice, according to a recent research paper by the Osaka City University Graduate School of Medicine’s Department of Urology.

“We are also aware of the country’s circumstances, in which only the rich can afford this treatment due to the average monthly wage of USD 150 and lack of national health insurance,” the paper says.

“However, medical professionals in the country are highly motivated and this treatment needs to be available.”

Sok Kanha, a spokeswoman for the Health Ministry, referred questions on the issue to Kol Hero, director of the ministry’s preventive medicine department, who declined to answer questions and suggested sending a letter to Health Minister Mam Bunheng.

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