[dt_facility_container title=’Cambodia 2000 an Analysis in the year 2000′ subtitle='”By Dan Smith M.D.’]
[dt_hr_title tag=”h2″]The Political History of Cambodia[/dt_hr_title]
Cambodia is a country about the size of the state of Colorado, located in southeast Asia between Vietnam on the east and south and Thailand on the west and north. Cambodia was annexed by France in 1863, saving this peaceful country from being overrun by Thailand or Vietnam; except for 1941 to 1945 when southeast Asia was controlled by the Japanese. Cambodia remained a French colony until given its independence in 1953. In 1941, just prior to Japanese control, the French made an 18 year old prince, Norodom Sihanouk, the king. He turned out to be a shrewd political manipulator who for over 50 years would ally himself with anyone in order to keep himself in power. In 1955, he abdicated the throne (making his father the king) and started his own National Socialist Party which was elected into power because of his “divine credentials”. He remained Prime Minister from 1955 to 1970 when he was toppled in a right wing military “coup d’etat”. That coup was led by Lon Nol because of Sihanouk’s left wing pro-Vietcong, anti-US position in the late 1960’s. From his refuge in Peking, China, Sihanouk became the titular head of the Cambodian Communist insurgent Khmer Rouge, whom he had previously violently opposed. The Khmer Rouge never trusted Sihanouk, but used his name and stature with the common people of Cambodia to pursue their ruthless objectives. After five years of a bloody civil war, concluding with a four month siege of the capital city of Phnom Penh, Saloth Sar (better known as Pol Pot or Brother Number One) and the Khmer Rouge took over the country on April 17, 1975. This began almost four years of a reign of terror by the Khmer Rouge, commonly known as the “killing fields”.
[dt_sc_blockquote align=”center” variation=”grey”]To understand the present condition of Cambodia, one must understand the “killing fields”. During a three year, ten month period of genocide in which 30% of the seven million Cambodians were killed it was the Khmer Rouge’s goal to create a perfect socialistic society in which everyone was a rice farmer and equal (New People). To do this required a complete evacuation of all cities and towns and the elimination or “purification” of all urban dwellers. [/dt_sc_blockquote]
On the morning of April 17, 1975, all prominent leaders were executed. By mid-afternoon, the Khmer Rouge were evacuating two million people from Phnom Penh, being hurded like cattle into the waterless countryside in the searing heat of mid April. By the end of April, every city and town had been evacuated and were “ghost towns”, remaining that way until January 1979. People were spread like manure in the rice fields to be “purified” and remade into new creations, worthy of the socialists’s utopian world of “equality, freedom and justice for all”. This brave new world was ushered in by the Angka Loeu (organization on high), with an army of gun-toting, illiterate teenagers. As the cities were being evacuated, the Khmer Rouge tortured and executed the intellectuals, military officers, professionals, religious, civic and political leaders. The sick and elderly were also eliminated as they were of no value. By May the streets and roads were covered with bloated, decaying bodies. The survivors were relocated in new communes, were re-clothed in shapeless black garments, and were given nightly indoctrination lectures. Husbands, wives and children were separated as the traditional family was to be eliminated, as was all religion. To resist or complain meant torture and death; during the almost four years of terror, thousands upon thousands of Cambodians were beaten to death with hoes, bayoneted, shot, poisoned, roasted, asphyxiated with plastic bags tied over their heads, buried alive up to their necks to be eaten by red ants, tied to stakes and disemboweled, or had their necks slowly cut with the rough edge of a palm branch. Mass killings included wives quaking in line behind their husbands, awaiting their turn; infants were torn to pieces with bare hands or held by their ankles while their heads were smashed against a nearby tree. The bodies were dumped into large open graves which the victims dug themselves before being murdered. The horror of this period is memorialized in the Tuol Sleng genocide museum in Phnom Penh and the Killing Fields Memorial just south of Phnom Penh.
The work in the rice fields was grueling and the food was minuscule as the rice produced was to be exported. Consequently, hundreds of thousands perished in the rice fields from starvation and endemic disease such as tuberculosis, malaria, cholera and dysentery; no modern medicine was permitted, only herbal remedies from young, untrained female Khmer Rouge at the filthy “clinics”. Suicide was common. People staggered around like walking skeletons, existing in terrible conditions; there were no toilet facilities, and they slept in the rice fields, partially submerged in the water, with the leaches, snakes and insects all around them.
By November of 1977, the rice production was not what it was supposed to be, and the Khmer Rouge leadership reacted by purging the ranks of those whom they thought were traitors. Those under fire were either tortured and murdered at Tuol Sleng, or they fled to Vietnam. Those fleeing to Vietnam included Heng Samrin, Hun Sen, and Chia Sim who formed the “Khmer Front for the Liberation of the Motherland”. When diplomatic relations between Cambodia and Vietnam ceased on December 31, 1977, full scale war began on the common border. This persisted for a year; on December 25, 1978, the Vietnamese and many Cambodian refugees began an all-out “blitzkrieg”, and captured Phnom Penh on January 7, 1979. The next six months saw the Khmer Rouge in retreat to China and Thailand; there was a concurrent fleeing of thousands of Cambodians to the refugee camps of Thailand. From these camps in Thailand, 200,000 Cambodians were eventually resettled overseas (60% in the United States – the Diaspora).
A Vietnamese supported government headed by Hun Sen and his friends (the Peoples Republic of Cambodia), was established. The Khmer Rouge tried to rebuild itself in Thailand and China and spent the next 15 years in gorilla warfare against the Hun Sen government. Throughout the 1980’s, the western world and the United Nations continued to support the Chinese backed Khmer Rouge and put a world economic embargo on the Soviet/Vietnamese backed ruling government. In 1989, with the collapse of communism in Europe and under severe international pressure, the Vietnamese army left Cambodia. In October 1991, the Paris Peace Accord established an interim Supreme National Council headed by Prince Sihanouk and Cambodia was placed under UN mandate with an international force of 22,000 peace keepers. In May 1993, the first elections were held and after a controversial result, a coalition government was established with Prince Ranariddh, (Sihanouk’s son) and Hun Sen as co Prime Ministers. In September of 1993, Prince Sihanouk, now 70 years old, was re-crowned king with the understanding that the king reigns, but does not rule, and the country became known as the Kingdom of Cambodia. In July of 1997, Hun Sen violently ousted Co-Prime Minister Ranariddh, who had to flee to France. The rest of the world rose up in protest with the result that Cambodia’s UN seat fell vacant and all ouside financial assistance was halted. This resulted in another year of civil war with fighting in the streets and very unsafe conditions.
The second democratic elections were held in 1998, again associated with street wars between the two parties. Peace was finally restored in late 1998 when King Sihanouk arranged that Hun Sen be the prime minister and Prince Ranariddh be speaker of the House of Delegates. Ministerial positions were divided between the two parties. Things were relatively stable without open war for the next five years. In July, 2003 the third general election occurred (a five year cycle) without any bloodshed. However, there was not a pleural majority between the three parties running. It took 11 months for Hun Sen (CPP) and Ranariddh (FUN) to put together a coalition; this was a period of governmental paralysis, though fortunately not open fighting. The present situation is one of peaceful coexistance of the three parties.
[dt_hr_title tag=”h2″]The History of the Cambodian Church[/dt_hr_title]
Buddhism has been the official religion of Cambodia since the 12 th century A.D. Pure Buddhism, with its philosophical attitude to life and its high esthetic demands, is little understood and is largely irrelevant to the practical needs of the ordinary people of Cambodia. They reduced it to the simple dictum of “do good, get good; do bad, get bad”, which included their view of reincarnation. Buddhism is such an inseparable part of being a Khmer (Cambodian), that only a traitor or a social pariah would entertain another system of belief. Buddhism promotes conformity rather than individual thinking and initiative. Therefore the history of Christianity is a history of persecution and being an outcast. Catholicism was first introduced into Cambodia in 1555 by the Portugese; a French Catholic priest first translated the Gospel into Khmer in the mid 1800’s. Protestant missionaries first set foot on Cambodian soil in 1923. Mr. and Mrs. David Ellison began their work in Battambang and began the first Bible school in 1925; Mr. and Mrs. Arthur Hammond were based in Phnom Penh and immediately began translating the Bible into the Khmer language. The period of 1925 to 1955 was one of persecution and very slow growth. When the French granted Cambodia independence in 1953, Sihanouk became the head of state. In 1954, after he was presented with a copy of the recently published Cambodian Bible, he declared freedom of religion, although the Protestant Church was not officially recognized. The Bible School was transferred from Battambang to Takmau, just south of Phnom Penh, and it trained many new pastors. This began a decade of relative peace and tranquility and the Cambodian Church grew to about 700 baptised believers and 2000 adherents by 1965. But in 1965 Prince Sihanouk began his shift to the left supporting the Vietcong, and becoming very anti-American. All Christian missionaries were expelled and there was a five year crackdown on Christianity so that by 1970, there were only about 300 believers. When Lon Nol took control in 1970, there began another five years of religious freedom and growth with the emergence of many pastors and new churches.
[dt_sc_blockquote align=”center” variation=”grey”]By April of 1975, it was estimated that there were between 7,000 and 10,000 Christians in Cambodia with 3,000 of these in Phnom Penh; but on April 17, 1975, the slaughter of the “killing fields” began and over the next three and ¾ years, more than 90% of the believers and all but three pastors, (Pastor Hom, Pastor Reach Yeah and Pastor Siang) were murdered. [/dt_sc_blockquote]The miraculous survival of these men of God is wonderfully chronicled by Don Comrack in his book Killing Fields, Living Fields. At the conclusion of the reign of terror by the Khmer Rouge in January of 1979, a two year migration of Cambodians to the refugee camps in Thailand occurred. The three surviving pastors and many western missionaries began a great harvest in these camps as the refugees, now with freedom of religion, saw the hope of Christianity and the futility of Buddhism. Many of these converts became part of the 200,000 of the Diaspora who were resettled overseas. Those converts from the refugee camps who eventually had to return to Cambodia met continued surveillance, scrutiny, and harassment as evangelism was forbidden.
It was not until 1990 that Christianity was formally recognized and that Christian relief and development agencies and missionaries were allowed to enter Cambodia. In 1992, the Phnom Penh Bible School was restarted by Pastor Setan Lee with 30 full-time students. Reverend Setan Lee was one of the converts at the Khao I Dang refugee camp in Thailand who was resettled in the United States. He gained formal ministerial training in Denver, Colorado and returned to Phnom Penh with a goal of country-wide evangelism and establishing a Protestant church in every province of Cambodia. By 1994, the Protestant church had grown to about 5,000 members; however it was seriously divided and far from self-supporting. There was also a lack of theological training and experienced leaders. The formation of the Evangelical Fellowship of Cambodia in 1996 was an attempt to heal the divisions.
By 1998, there were four Protestant councils: (1) the CCF or Cambodian Christian Federation, (2) the CCEA or Cambodian Christian Evangelical Association, (3) the CBC or Cambodian Baptist Convention, and (4) the EFC or Evangelical Fellowship of Cambodia. These were all working independently without cooperation or coordination. In November of 1998, Pastor Setan Lee was able to begin a meaningful dialogue between the leaders of these four groups and they began to work together. With the assistance of Mr. Jim Groen of Global Connection International (GCI), the first pastor’s leadership training conference was held in November of 1999; conferences have been held every October since then and cooperation is more the norm.[dt_sc_blockquote align=”center” variation=”grey”]
Presently it is estimated that there are about 80,000 Christians in Cambodia and the numbers are increasing rapidly.[/dt_sc_blockquote]
[dt_hr_title tag=”h2″]Medical Conditions in Cambodia[/dt_hr_title]
Like most other things in Cambodia, medical care is generally deplorable. To understand why, one must look back at what happened during the “killing fields”. A medical school had been established in Phnom Penh in 1950 and by 1975, there were about 950 well-trained physicians in Cambodia caring for its seven million people. During Pol Pot’s reign of terror, all but 38 physicians were killed; only 20 of these remained in 1980 to try to reestablish medical care. The medical school was re-opened in 1980 and anyone with medical training was given six months in the classroom followed by one year of on-the-job training and then sent out to the cities and provinces as a “physician”. It is estimated that approximately 1,000 of these “physicians” were sent out in the last 20 years.
In 1995, the medical school began to look from quantity to quality, establishing an eight year curriculum with three years of college courses, three years of basic medical science, and two years of clinical experience. There are presently 1,000 applicants per year for 50 positions. However, the medical education is hindered by the lack of full-time faculty, a very limited library, and a physical plant that is in disrepair because of neglect during the 1975 to 1979 era with subsequent lack of funds for refurbishing. Students do not have their own books and there is very limited access to the Internet. In 1997, the medical school began nine post graduate training programs including general medicine, general surgery, OB/GYN, Pediatrics, Anesthesia, Emergency Medicine, Pathology, Pharmacology and Mental Health. All nine programs required three years of incountry training, and six months abroad, with the first graduate specialists to be available in late 2000.
Medical care is a combination of private for the wealthy minority and public for the poor majority.
[dt_sc_blockquote align=”center” variation=”grey”]All public health care workers (physicians, nurses, etc.) receive $20 U.S. per month, a wage that has not changed in 20 years. Since it presently takes a minimum of $100 U.S. per month to live, everyone must get a second job or resort to the stealing of drugs and the selling of them in the black market. The public health care budget in 2000 was only $8,000,000 U.S. to care for 11 million people.[/dt_sc_blockquote] The Minister of Health, Dr. Hong Sun Hoat, one of the few survivors of the killing fields, is a articulate gray-haired physician with a good concept of public health and what needs to be done, but with very limited funds. His goal is to establish 930 health centers in the 22 provinces of Cambodia; a health center is an out-patient diagnostic/treatment center responsible for 8,000 to 10,000 people. It is planned that there will be a hospital for every 10 to 13 health centers and at least one hospital in every province.
The present hospitals are generally large campuses of multiple buildings with 100 to 500 bed capacities. The hospitals are almost all in terrible condition because of no use or maintenance during the four years of the “killing fields”, and then limited funding during the next 20 years of political instability. The only hospitals that have acceptable facilities are those supported by foreign charitable foundations, i.e.; Kantha Bopha – a three campus pediatric hospital supported by the Swiss to the tune of $9,000,000 U.S. per year – and Calmette Hospital, supported by the French, with recent addition of a new $3,100,000 U.S. cardiac center. The remainder of the hospitals are generally run-down, filthy buildings with limited equipment, poor sanitation and inadequate medication. There are no ventilators and only two echocardiograph machines in the whole country; there are almost no pathology capabilities with most surgeries done on a clinical basis alone without any histological confirmation. There are very limited general laboratory facilities. Pharmaceutical drugs, except in special situations like in Kantha Bopha, are in limited supply and poorly controlled; although the Minister of Health is trying to change this, most drugs can be purchased without a prescription, if one has the money.
As in much of southeast Asia, food and basic care is provided by the patient’s family. Most hospital rooms have at least four beds and the family moves in to cook, feed and bathe the patient. They are usually the only ones who see the patient, except for the once daily rounds of the medical team, and must seek help in emergent conditions. There are no laundry or cleaning services and limited toilet facilities. The rooms are open air with flies and insects everywhere.
Over 50% of the population of Cambodia is under the age of 25. The life expectancy is less than 50 years of age with major causes of morbidity and mortality being infectious disease and trauma. Tuberculosis is the major medical problem in the country with up to 70% of the population in some provinces having active disease. A paucity of immunizations make tetanus, measles, typhoid, diphtheria, etc. every common. Malaria is a frequent occurrence especially in the provinces and rice fields. Dengue fever and other bacterial causes of diarrhea fill the pediatric hospital beds. Japanese encephalitis is also a common cause of pediatric hospital admission.
[dt_sc_blockquote align=”center” variation=”grey”]Prostitution has been rampant in Cambodia from antiquity with most males getting their first sexual encounter at a brothel; however, there was no AIDS until the HIV virus was introduced by the UN troops in 1993, and now approximately 4% of the population are HIV positive.[/dt_sc_blockquote] There are minimal anti-viral medications available in the country and physicians are left to treat only the complications. Most hospitals have wards of dying patients that have AIDS.
The most frequent mode of transportation is the moped. With poor roads, and no traffic control, open fractures with secondary ostemyelitis and draining wounds are the norm. With lack of sterile (let alone clean) conditions, and inadequate antibiotics, amputations are common. Amputations secondary to land mine accidents were prevalent in the past, but are less frequent now that most of the land mines have been made inactive. However, this has created a whole new culture of beggars.
[dt_sc_blockquote align=”center” variation=”grey”]The medical situation is deplorable and most of us would expect better treatment for our animals. There is a lack of knowledgeable personnel, proper facilities, modern technology and appropriate medications which will take years to correct. The situation was much better in l975; Pol Pot put Cambodia back into the dark ages![/dt_sc_blockquote]
[dt_hr_title tag=”h2″]Medical Conditions in Cambodia[/dt_hr_title]
Our first impression was surprise at the paucity of lights when we flew into Phnom Penh on Sunday night, June 4, 2000 a great contrast with Bangkok, Thailand which we had just left. The shortage of electrical power with frequent city-wide power outages over the next week, was only one of the many pressing needs of this once modern city. It was stated that prior to 1970, Phnom Penh was a beautiful city, the Paris of southeast Asia. Now it is an overpopulated place with inadequate roads, sewage system, housing and medical care to accommodate its 1.5 million inhabitants. Although there is a lot of construction occurring with many new modern buildings and homes (a testimony to the economic development fostered by foreign money), over 90% of the people live in wood shacks that we would consider slums. Over 50% appear to be unemployed. There is a tremendous gap between the few rich and many poor with an almost absent middle class.
[dt_sc_blockquote align=”center” variation=”grey”]The faces that we remember are the faces of the happy people – smiling faces. In spite of abject poverty, one has the feeling that Cambodians are happy because this is still better than the “killing fields” or the refugee camps, and there is hope as things are slowly improving. But the real hope is occurring because of the rapid growth of Christianity, the saving hope of Jesus Christ. [/dt_sc_blockquote]To be among the Christian leaders, their staff, students and parishioners, gave one the feeling that he was back in the first century Church with all of its excitement and rapid growth. Cambodian Christians are excited about the Gospel and anxious to share it with anyone who will listen. There is a hungering for the Gospel of grace and mercy offered by Jesus Christ, rather than the damning life of good works required by Buddhism. In viewing recent Cambodia history, one is reminded of Jeremiah 29: 11-13, where God promises the people of Israel that, after 70 years of captivity, He has a plan to prosper them and to give them hope and a future if they will seek Him with all their hearts. One has a sense that God is going to prosper Cambodia as the people seek Him.
As we left Cambodia for the United States, our minds were full with the many memories and images of people in need. Our hearts were filled with sorrow over the sinful nature of man. This nature that could inflict such pain, torture and hatred on his fellow man. The present day needs of Cambodia are many faceted and are economic, medical, social, and spiritual. As Americans we have been blessed with many aspects of personal and religious freedom, abundant wealth and national and personal prosperity. It is very easy to think solely of what we bring to the Cambodian people. But we also need to realize that they have much to teach and share with us.
We were particularly struck with the faces of our Cambodian Christian leaders. These men and women had hearts filled with the Holy Spirit. You would think they would have hatred and bitterness and revenge on their minds as they speak about “killing fields”. But the Lord has a different plan for them. He has healed their hearts filled with pain and suffering and replace those aches with love, joy and forgiveness.
[dt_sc_blockquote align=”center” variation=”grey”]As Americans we cry out for justice and what is fair and right. But Christ has commanded us to love one another. The Holy Spirit has filled the Cambodian church leadership with love, joy, peace and forgiveness, so that they have turned away from their anger and pain and are bringing the healing, saving message of Christ’s love to the lost. They are living examples of what God can do to change the human heart from hate and anger to love and forgiveness.[/dt_sc_blockquote] We are very thankful for the tremendous gift we have received from these members of the body of Christ. We must each pray that our hearts are filled with this divine prescription of healing. This divine healing is for ourselves, our families, our churches, and our country.