Introduction

Life and death in Cambodia All seemed normal when Sath, a 27-year-old Cambodian woman pregnant for the first time with twins, felt the onset of labour. Then she began to bleed profusely. No doctor was on duty at the nearby clinic - doctors in rural Cambodia made so little money that they often supported themselves by practising on the side - and no one in her village, Phum Dok Po, had a phone, so a relative bicycled to the nearest town to secure transport to the hospital. A taxi driver in the town agreed to take Sath the 30 miles to the hospital for US$37 - more than one third of Sath's husband's yearly income. Desperate, her husband borrowed the money from fellow farmers and sent Sath on her way. After a slow and jolting journey, along a muddy, difficult road, Sath reached the hospital but she had lost too much blood. Her first child was born dead, the second survived but Sath did not. A physician consulted after about her case concluded that the bleeding likely was caused by a tear in the birth tract made worse by anaemia, a lack of vitamin A and other uncomplicated conditions that ought not be fatal in the twenty-first century. 'People get sick because they are poor,' said Dr Nicole Seguy, medical coordinator in Cambodia for Doctors Without Borders (Médecins Sans Frontières). 'And also they get poor because they are sick.' A study by the relief agency Oxfam reports that 43% of Cambodian peasants who become landless have been forced to sell their acreage because of illness, making disease the largest single factor in the loss of agrarian livelihood. The first four most frequently reported diseases of those who lost land are malaria, Dengue fever, tuberculosis and typhoid - all preventable or curable diseases.