Follow up from the American family reported by Khmer Intelligence

On 14 November 2009, Khmer Intelligence published the following report:

Tragedy of an American family in Cambodia (2)

An American family who have come to help Cambodia and made big sacrifices to run a medical clinic providing basic health care to the poor, are victims of corruption and violence, which characterize the prevailing political system.. The e-mail we publish here has been circulating among their countless known and unknown friends who are deeply moved by their tragedy and revolted by the Kafkaesque situation they are facing. You can read their story by clicking at http://tinyurl.com/y8duql9

Below if a follow up from the family:
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Dear Khmer Friends,

Thank you everyone for your patience with us, considering the ramifications of our story.

If you your site could use the information in this letter to make a difference in the corruption rampant in the medical field in Cambodia, please contact me to discuss how we can cooperate. This is a bit long, but please bear with me.

We came to Cambodia to save lives, but because of our outspoken stance againt this corruption, we became targets and nearly lost our lives.

Yes, we managed to escape Cambodia, thanks to supporters of our NGO who used their personal funds and air miles to arrange a ticket. We have nothing left but our suitcases, and must start over here in the US. Cara is still unwell, and will require continued medical care for some time.

For your patience I'll provide you the details, but please be aware this is not a simple story of another assault. As they say in Cambodia, there is little random violence. There IS violence, but nearly all of it is for a reason. It's the reason for the attack that had us so worried.

The initial details of the attack are outlined in the forwarded letter below. It wasn't until a few days later that we put the pieces together to realize this wasn't random.

Since we arrived in Cambodia this past March, we had been working at a small clinic in Kampong Thom Province. At the request of National Assembly Representative from Kampong Thom, His Excellency Nhem Thavy, we were given a closed down Community Health Center. Using our own funds, we renovated and restored the clinic. We were incredibly successful, seeing up to 100 patients a day, who often came hundreds of K's and waited days to see us, as we were the only reliable and available care in the provinces. It reached the point we were getting busloads of sick people arriving daily from past Siem Reap, Kampong Cham, and kampong Channg. As long as we were spending our own cash, we were fine. We had opened on the advice and request of the Ministry of Health while awaiting our MOU to be finalized by the Ministry of Foreign Affairs. We had thought that it would be completed shortly, but as of Oct 12, the day of the attack, it had not yet been approved. We had been told by many other NGO's that a significant "donation"(bribe, specifically cash, a nice camera, or laptop) needed to be paid to get our MOU cleared, but we refused to pay. Therefore, we were told repeatedly by the MFA that our MOU wasn't good enough- basically our budget was under $100,000- too small for their % cut. We were given odd reasons, like we dated it before it was signed, then we removed the date, then it was declined because it didn't have a date. We had used the old Min of Health Logo. We used blue ink on the stamps, and red ink is supposed to be used prior to approval. Then, they didn't like our date. Then, our typeface was too small. We kept making these ridiculous modifications to appease them, until finally, "the ink on our logo was too bright". It reached the point the Secretary General Leng Peng Long, Vice President Nguon Nhel, the Assembly President and finally Minister of Health H.E. Mom BunHeng all appealed to the MFA and we still never got approved. And all this time we were still saving the lives of 100 people a day from our little clinic.

That was the big corruption we were dealing with, but not the most deadly. It was the little guys who we believe came after us. In the Baray-Santouk referral district of Kampong Thom Dept of Health, there are 19 health care centers just like ours. Almost like our, that is. They are all boarded up, shut down, and non-functioning. Some see a few patients, but not many people go to them because they have no medicine and no staff. At the Baray-Santouk Referral Hospital, there are 10 paid doctors and 37 paid nurses on staff- but me made a practice to bring by every international visitor and challenge them to find a health care worker on the grounds. Not once in 8 months was someone working there. They average 3 to 5 patients a day, and most are never given the medications they need. We would often visit there, and on occasion gave money to the patients to catch a bus to Siem Reap so they could actually get treatment- if you didn't have $50 cash, you couldn't take one of the three empty ambulances sitting there.

But it wasn't the lack of treatment and staff that was the big problem. Each of the other 18 closed down health Care centers in the District were reporting to the Regional Director Dr. Meas Cham that they were treating 900 patients a month. The medicine for these imaginary patients was being shipped there, stolen, and sold by the staff. Every week we would submit our legitimate medication requests, only to be told "we don't have any". Our patients were dying over 50 cents worth of Cipro, and we were quickly running out of our own funds to purchase medicine. We finally confronted Dr Meas Cham and his Supervisor, Dr Vao Lough Kuhn, Kampong Thom regional Director, over this issue, and were told we were going to be reported (to the Ministry of Foreign Affairs!) over our outrageous behavior.

Every time we demanded we be sent the even the basic medication that they were already listing as being distributed to us, we were told they had just run out, or that our "MOU wasn't completed so they didn't have to send us anything". We did not receive one dose of vaccines for 6 months when we were seeing over 1800 patients a month. They had run out every single month. At one point we contacted the head of the Cambodian Red Cross, HE Ho Noun, who paid a visit to our clinic. She was very impressed, and we had a big media day, but still no medicines came. Every now and then we would get a box with 10 IV's, and a few bottles of the stuff that no one could sell (Vitamin A and Birth Control Pills), but never Paracetemol or Antibiotics.

The situation was becoming critical, and we began to put more pressure on the district. We staged a visit with "simulated" visitors from World Health, who asked about why vaccines weren't being delivered. Dr Meas Cham walked out on them, so we called some friends and were arranging an actual aduitor come visit to help out. AT the end of September, we had to close the clinic. We were out of our personal money, and without our MOU, could not even apply for grants and loans. We did get some funding from the Camkids Charity (Dominique and Benita Sharpe, very nice people), but could not operate without adequate supplies. We hoped closing for a few days would put pressure on the MFA and MOH to get our papers completed so we could operate. That's when the top level of the Nat'l Assembly began to put on the pressure. It looked like we might finally get it done, and the local Min of Health would be forced to give us the required medications.

And that was precisely when Cara was attacked.

You see, a lot of people were making a lot of money off of those stolen medications. A lot of staff had very nice Camrys, and a Lexus or two, and without that extra cash, they could lose them. Most importantly, if two westerners could legitimately open and operate a clinic, and treat 2000 patients a month with almost no money, then they might be expected to improve THEIR standards a little bit.

So we were battling corruption everywhere- the MFA at the top, the MOH in the middle, and the thieving doctors at the bottom. This was never our intent- we just wanted our medicine so we could save lives.

We asked for help, and told of the corruption- asked for help from the Red Cross, from Parliament, from UNICEF and World Health, but it seems everyone has their finger in the pie, and everyone had a lot to lose by us succeeding. We were succeeding, and with a completed MOU would have the clout to get around these hurdles.

What's also implied is that many of the larger NGOs in Cambodia are aware of this situation as well- we sat through endless lectures on Child and Maternal Health from UNICEF, when it struck us that they were getting their statistics from the same people who were forging patient records to get enough medicine to sell so they could make their car payments. How many children die every year in the jungles? Who really knows, because I swear every statistic is made up by the other 18 boarded up health care centers that never actually treated patients. Take a drive up Road 6 one day, or any of the tiny villages, and spend 5 minutes visiting the little "Blue H" signs. Do you see 900 patients a month being treated there? Maybe at Sihanouk inPP or Angkor in SR, but not where these statistics are coming from. We can tell you that despite the MOH charging 28000 Riels to deliver a baby, the midwives are charging them $75, so they never come, deliver alone at home, and die a few days later from the jagged episiotomies, the inevitable blood loss or infection, or the tetanus that follows. But UNICEF doesn't see that, they just take the fabricated numbers, spend $3 million on writing the nice powerpoint report, and never see the dying children who never got the stolen tetanus shots.

Someone needed to stop us. So we got what they consider "a warning" in Cambodia. Those details are outlined below.

We are grateful we got out alive- Cara was never meant to survive this attack. We are most grateful it wasn't our children (Samantha, 13, and Moira, 10) who were injured- we don't know how we would have recovered from that.

So we hid for a week, and got a donated flight out of there. We stayed a few days in NY, then a week in Ohio to get Cara medical treatment near her family. We are finally back in South Carolina, and hope to put our lives back together. We will keep our NGO "open" long enough to recover some of the costs for getting home and Cara's medical expenses, and would be grateful for any donations to our website www.sharethehealthcambodia.org

We hope at some point to find the right people to go to with this information. As you know, Cambodia receives close to $1 BILLION in foreign aid, much of it for health care. When the world discovers NONE of that money or medicine actually makes it to the people who need it, things may change. Even telling this story puts us in more danger, but we came to Cambodia to help the people, not to buy Camrys for corrupt doctors. When Ho Noun came to visit us, the staff at Baray-Santouk heard she was coming and washed the walls in the front rooms, and hired people from the village to pose as patients so it looked like they were functional. It was a good ploy, because no one ever really checked. Somehow and somewhere, we'll find the right people who are interested in where all that money goes. Maybe then, the people who need the help can actually get it.

Several people have asked me if I'd ever consider returning to Cambodia. I say yes, with a bullet proof vest and a team of inspectors and auditors from the UN intent on cleaning up corruption. I personally saw too many children dying over 50 cents worth of antibiotics while the people that were getting these millions to care for them were laughing and sipping coffee.

We were careless in speaking openly about corruption while we were still in Cambodia. That was our mistake. When they tried to kill my wife, they didn't get the job done. That was their mistake.

James Garcia
Share the Health Cambodia

Business: Welcome to the kingdoom of ... rampant corruption and crony capitalism

Cambodia Calls

MONDAY, JULY 27, 2009
By LESLIE P. NORTON
Barron's (USA)

Checking out Cambodia's nascent economy.

REMEMBER FRONTIER MARKETS? Those in Pakistan and Vietnam, the high-octane sector of the developing world, promising even swifter growth than the more mature emerging markets?

They've been left in the dust this year as investors swarmed to so-called BRIC funds -- those that trade in shares of Brazilian, Russian, Indian and Chinese companies -- as well as to emerging-markets funds. The MSCI BRICs index has returned 53% in 2009, while emerging markets have returned 43%, and the corresponding frontier markets index, just 4.8%. (The Templeton Frontier Markets Fund is up 23%.)

Says Michael Hartnett, Merrill Lynch's global equity strategist: "Interest in frontier markets has lagged because of liquidity issues." But if enthusiasm about growth in China and almost anywhere outside the developed world gathers steam, expect new interest in frontier markets to jump.

David Wilton, chief investment officer of the International Finance Corp.'s private-equity and investment-funds department, thinks a change is already under way: "The mood has shifted noticeably from February. Now the listed equity markets have recovered, and they're thinking about investing."

The latest market to get attention is Cambodia, where a handful of investors familiar with Vietnam and Thailand are trying to set up funds. Cambodia is very poor, with rampant corruption and crony capitalism. But economic growth is robust, even if the economy is just $8 billion. Douglas Clayton, managing partner of Phnom Penh-based Leopard Capital, has raised just under $30 million and is trying to raise more; sitting on his board is markets commentator and Barron's Roundtable contributor Marc Faber.

Cambodia doesn't have a stock market yet, but Clayton believes it could by year's end. There are numerous foreign-sponsored companies, including banks and cellphone operators, though the economy is largely agricultural. The median age in Cambodia is 21, the lowest in Asia. Clayton reckons that about 70% of the population, which numbers 14 million, wasn't yet born during the horrific regime of the Khmer Rouge, estimated to have killed two million Cambodians.

"Cambodia is back open for business," says Clayton, who is applying for citizenship. "This is a failed state that's back on its feet."

Conservative investors aren't impressed. Says Peter Newell, managing director of Vontobel Asset Management: "We look for a $50 million bottom line, low leverage, high ROA [return on assets]. Can you find that in a frontier market? No. Not even in China, not easily."

David Wilton of the International Finance Corp. agrees: Investing in Cambodia may be, as he delicately puts it, "a wee bit nascent," and there are few deals to support private-equity funds. Still, Wilton concedes that the IFC is very close to seeding a fund to invest there.

Asians Uniting Against Corruption

Marwaan Macan-Markar
Inter Press Service (IPS)

BANGKOK, Jun 16 (IPS) - Cambodian lawmakers are still to offer unanimous support for a petition aimed at combating corruption that was presented to the National Assembly in mid-May. The call was a cry from ordinary people -- over a million of them.

Leading this grassroots movement was a coalition of civil society organizations (CSOs) that have been fighting graft that plagues every level of this Southeast Asian nation. By May, the activists had gotten some 1.1 million signatures out of a population of 14.2 million to support a drive to bring local anti-corruption laws on par with international standards.

There was a lot of awareness raised, with many public meetings during the signature campaign, which ran from Nov. until Apr. 2008, says Aaron Bornstein, head of the Cambodia office of the Mainstreaming Anti-Corruption for Equity (MAE) Project, which is funded by the development arm of the U.S. government. "The campaign was conducted in 19 out of the country's 20 provinces. There was urban and rural support."

"The coalition is intent on getting all political parties in the country to commit to supporting the petition before the end of the calendar year," Bornstein said during a telephone interview from Phnom Penh. "This revealed greater public awareness that even ordinary people can play a role in battling corruption. Supporters of the petition were saying, 'enough is enough'."

As a new report by the United Nations Development Programme (UNDP) confirms, Cambodia's groundswell of anger against corruption at the grassroots level is also evident in other corners of Asia, where people are forced to pay bribes to get basic services such as health care, education, water, and sanitation -- in addition to bribing the police and members of the judiciary.

Like in Cambodia, sections of the public have mounted innovative efforts to take on those who are abusing power. In Nepal, an anti-corruption CSO has tapped the power of community radio to "encourage anti-corruption activities," states the UNDP report, "Tackling Corruption, Transforming Lives - Accelerating Human Development in Asia and the Pacific."

In the Philippines, "roadwatching" has become an anti-graft activity, where adults and schoolchildren have learned "valuable lessons about citizens power and good governance" by paying attention to road construction, adds the 233-page report. "[This group] monitors road-building -- examining the original plans, then sending young people out into the field to discover what, if anything, was actually built, and if so, how well it was constructed."

"People across the Asia-Pacific region are becoming increasingly concerned about corruption, and governments are starting to react," notes the report, the first of its kind published by the UN agency. Hauling the rich and powerful before the courts may grab the headlines, but the poor will benefit more from efforts to eliminate corruption that plagues their everyday lives.

That message, in fact, was driven home by Transparency International (TI), a global anti-graft watchdog, last year. "The poor, whether in developing or highly industrialized countries, are the most penalized by corruption," revealed TI's "Global Corruption Barometer 2007." "About one in 10 people around the world had to pay a bribe in the past year; reported bribery has increased in some regions, such as Asia-Pacific and Southeast Europe."

"Corruption affects the poor most in this region; it is they who suffer because they cannot afford to pay the bribes since it eats up a large portion of their small incomes," Ramesh Gampath, co-author of the UNDP report, told IPS from Jakarta, where the publication was launched. "They have to pay bribes for services that should be their right, like health, education, water, and sanitation."

The rampant scale of corruption across Asia and the Pacific -- identified by some studies as the most corrupt region in the world -- could undermine the targets set for the Millennium Development Goals (MDGs). The latter are eight targets that government leaders have pledged to meet by 2015, including halving poverty and extreme hunger, securing primary education for all children, and reducing child mortality.

"If there is rampant corruption, the MDGs will be compromised," says Gampath.

"Corruption can occur within health services at all levels -- from grand corruption, as funds are siphoned off during the construction of new hospitals or health centers, to petty corruption as health workers demand bribes to perform their routine duties," the report reveals. "Some cross-national studies have suggested that in countries where levels of corruption are higher immunization rates are lower and levels of child mortality are higher."

Corruption in education has its own unique features besides the obvious, such as corrupt officials siphoning off funds for school buildings, "which can increase costs between two and eight times." In many countries, the report notes, "there are irregularities in the hiring of teachers, which, in the most extreme form, results in the recruitment of 'ghost teachers' or even in the creating of entire 'ghost institutions' -- with allocated salaries and other expenses channeled into the pockets of officials."

Curbing abuse through greater local community activity has produced some results in Indonesia -- notorious for being among the most corrupt countries in Asia. "There has been a shift in public perception since 2004, where people perceive that they have a role to play in fighting corruption," says Rezki Sri Wibowo, deputy secretary-general of TI's Indonesia chapter. "A strong anti-corruption [effort] has emerged in Aceh to monitor reconstruction after the tsunami [in December 2004]....Civil society groups and the public are monitoring the procurement process much more now than before," he added during a telephone interview from Jakarta. "The government's decision to revitalize the national counter-corruption commission has also helped."