The Shay Rebellion | Christopher Shay

Fake Drugs, Real Problems

With a fever, an upset stomach and a splitting headache, Chheth Sokha, 52, did what she always did when she felt sick — she went to the grocery store and bought some cheap medicine.

“Whenever I am sick, I always buy medicine at grocery stores, because it is cheaper than at big pharmacies,” she said.

She bought the same medicine she had purchased the last time she was sick, but this time instead of making her feel better, the medicine landed her at the Russian Hospital.

“The doctor told me that I was poisoned by the medicine. I thought by buying cheap medicines I could save money, but it was the opposite. Fake medicine cost me even more when I got worse and had to go to the hospital,” she said.

The medicine that Chheth Sokha bought was almost certainly counterfeit. The problem of fake medicine in Cambodia is a long-standing one, and despite efforts from the World Health Organisation (WHO), Interpol and the Cambodian government, it is not a problem that is easily cured.

A week ago, Interpol seized US$6.65 million of counterfeit drugs in Cambodia, China, Laos, Myanmar, Singapore, Thailand and Vietnam, but even this impressive haul will not significantly impact the global counterfeit drug market, experts say.

“It is a huge illegal business, and single events in and of themselves will be unlikely to make a dent in the world market of counterfeit drugs,” Thomas Kubic, the president of US-based Pharmaceutical Security Institute, said.

Kubic pointed to a recent seizure in Belgium to illustrate the scope of the global problem. In September, over 2,146,000 counterfeit anti-malaria and pain medications from India en route to Togo were seized. Inquiries disclosed that this was just one of four other similar weighted shipments — with an estimated total of over 10,000,000 dosages.”

Specific statistics for Cambodia are unavailable, but a 2007 WHO estimate revealed that about 200,000 people in Asia die every year as a direct result of counterfeit pharmaceuticals.

With porous borders, an impoverished population and a drug distribution system that still relies on over a thousand unregistered pharmacies, Cambodia is particularly vulnerable to counterfeits streaming in from other countries, but increased efforts by international organisations and the government have made a noticeable impact in recent years.

A Cambodian Health Ministry survey conducted in 2002 revealed that about 13 percent of drugs in the Kingdom were counterfeit, and now estimates put the percentage at around ten percent. In contrast, only about one percent of drugs in developed countries are counterfeit.

“The prevalence of counterfeit drugs has decreased. We have done a lot of education to people about counterfeited items, and the items have started to disappear in the markets,” Chroeng Sokhan, the vice director of the department of drug and food said.

But Chroeng Sokhan admitted that due to the global nature of the problem, there is only so much that can be done locally.

“Counterfeiters have a lot of money, so they can do many things. They can adapt. It’s a difficult problem to solve locally. We need Interpol support for cross-border help,” he said.

The government says it is working with its neighbours to decrease the number of fake drugs smuggled across borders of southeast Asia.

“We are taking measures to crackdown on the illegal trafficking of fake medicine. This is being done with the cooperation of authorities in neighbouring countries by increasing the exchange of information,” Sar Kheng, the deputy prime minister, said in a meeting last week.

“Even though China, Thailand and Laos refuse to admit some of their citizens produce fake drugs, what is important is that we cooperate to strengthen the border checks,” Yim Yann said.

The other key part of Cambodia’s war against counterfeits is to educate Cambodians about the dangers of fake pharmaceuticals. The government as well as drug producers have focused on educating pharmacists, hoping to create a frontline against the distribution of counterfeits in the Kingdom.

Has Aun, a pharmacist who sells medicine near Central Market, said, “It is difficult for us to know whether a drug is fake or good because they really look the same. But we have been trained on how to detect fake drugs by the drug producers and the Ministry of Health.”

Sok Serey, another pharmacist said, “The ministry’s agents examine our pharmacy at least two or three times a year. They train us how to check for expired drugs and how to check the brand names of drugs.”

The sophistication of some of the counterfeit drugs have made it nearly impossibly to tell if a drug is authentic or not. For the last five years, counterfeit malaria medicine with holograms nearly indistinguishable from the real drug have been found in the Kingdom, according to a report authored by sixteen top malaria researchers.

Tey Sovannarith, the deputy director of the technology office in the drug quality experimentation and examination department, said that when a visual inspection is inconclusive, he even needs to resort to checking the melting time of the pills in order to know for sure if a drug is counterfeit.

The counterfeit drug market has hurt the reputation of overseas drug companies in Cambodia, especially ones from China. Sok Serey said that her pharmacy did not carry any medicine made in China, because of the danger of counterfeits.

“I don’t like Chinese medicine. Sometimes it works; sometimes it doesn’t,” she said.

Chroeng Sokhan mentioned that two of the three counterfeit drug “ghost manufacturers” — fake companies that produce fake drugs — that currently produce the majority of the counterfeits in Cambodia are located in China.

What can Cambodian consumers do? According to William Mfuko, the officer responsible for essential medicines at WHO in Cambodia, because of public education efforts, all Cambodians need to is “watch TV, listen to their radio and look out for posters that warn against counterfeit drugs.”

“Most of all,” he said, “they should develop habits of consulting medical professionals for their drug needs. Self-medication is often the driving force behind counterfeit drug markets.”

Through continued education and better enforcement, the government hopes that Cambodians will become more discerning drug consumers and will learn what Chheth Sokha had to figure out the hard way.

“From now on, I’ll remember the doctor’s advice not to use medicines which do not have clear or proper brand names. Moreover, I will be really careful taking medicine, because they are double-edged swords. They are good for us only if we use them properly. But if we do not use them properly, they could kill us,” she said.

Also written by Khoun Leahkana

Voluntourism in Cambodia

Early this month World Expedition, a global adventure travel company, charged tourists AUS$1,790 (US$ 1,159) for a twelve-day tour of Cambodia, selling their tour product as a “community project,” because four of the twelve days were spent repairing a schoolhouse in Siem Reap.

Is four days work from unskilled laborers an expensive guilt trip for tourists and an onus on the local community, or can it make a real, lasting impact on both the participants and the community?

More travelers than ever are including volunteer work on their vacation itineraries, but when the volunteer tourist sector merges with for-profit tourism, critics warn that do-gooders can be duped into doing more harm than good.

Tourism where one blends vacation time with charity work, dubbed voluntourism, has boomed in the last two years.

According to a poll from Travelocity, a popular travel website, the number of travelers planning to volunteer during their vacation jumped from six percent in 2006 to eleven percent in 2007, and a 2008 survey sponsored by and Condé Nast suggests even faster growth this year with more than 55 percent of people expressing interest in taking a volunteer vacation.

David Clemmons, founder of US-based, said, “The number of participants, as measured by at least 15 Voluntourism operators… is significantly higher than [in] 2007. Some organizations are experiencing more than 100% growth.”

Volunteer tourism is nothing new, but traditionally, the sector was run mainly by church groups and NGOs. Today as interest in voluntourism grows, large, for-profit, travel companies are getting into mix, and they have a different priority — the bottom line.

There is nothing inherently wrong with commercial organisations sending volunteers, but the needs and interests of local communities should still be a concern, Rachel Noble, the campaigns officer of UK-based tourism watchdog Tourism Concern, said.

“It’s vital that the projects are not determined by market demand and provide meaningful long-term benefits to local people. Fulfilling the ‘feel good’ factor for tourists should not be done at the expense of the developmental needs of local communities,” Noble said.

Daniela Papi, the president of Siem Reap-based PEPY Tours, a for-profit tour company designed to fund a separate PEPY nonprofit organisation, is critical of many of the voluntourism opportunities available in Cambodia. She stresses the need of volunteer tour operators to be involved in long-term projects in order to know the effect of the volunteering on the community.

“Short-term volunteering is very hard to translate into positive impact… You can’t monitor the impact on the community if you only visit it three times a year,” she said.

Papi criticised companies like World Expeditions that do not give money to the community or insist that its customers do.

“There are very few situations where unskilled volunteers should come without funding to a project — especially if you’re coming just for two hours. You’re probably just taking the director’s time… Volunteers aren’t free,” Papi said. “If the companies are making money, they should give back.”

PEPY tours integrates their product with their non-profit organisation’s long-term work and requires their tourists to bring in funding, Papi said, but she admits that her organisation is not perfect and stresses that volunteer tourism is a delicate balance that requires constant self-reflection.

“You have to admit you’re going to make mistakes. You have to be willing to change. Too often, people are afraid to do that,” Papi said. “I trust organisations the will admit to the mistakes they’ve made.”

One thing all voluntourism experts agree on is that people interested in volunteering while traveling need to be discerning.

“Travelers need to start demanding that it’s done responsibly. They need to call out tour operators,” Papi said.

There are a few things that customers should look for in a volunteer vacation to ensure that their trip both helpful and fun.

First, Noble at Tourism Concern emphasized that volunteer work should take advantage of the particular skills of the tourists, language skills for instance, so that they are not taking jobs away from locals.

“It’s important that projects don’t take on volunteers to do work that could be done perfectly competently by and provide employment for local people. Our research has shown that volunteers are only too aware when their well-intended efforts are not providing any real benefit to local people, leading to unhappy locals and unhappy volunteers,” she said.

Second, be wary of volunteer tours that advertise a long time ahead of the project and are inflexible about the charitywork they will doing, Papi said. These types of volunteer tours create an incentive not to fix the problem locally, because they know tourists will come in — with additional money — to solve the problem for them.

“When you’re advertising a volunteer tour six months out, there’s a problem. What if you realize the program is corrupt or the needs are elsewhere?” Papi said.

Most importantly, a tourist interested in doing some volunteering should be sure to ask the operator some basic questions about the projects, especially about where the money is going.

Tourism Concern recommends that a person, “enquire about how they [tour operators] work with local communities, whether it’s a long-term partnership, whether they contribute money directly in support of the project and how the project is appraised.”

Despite the dangers of volunteer tours using communities as marketing ploys, Clemmons believes carefully planned voluntourism has the potential to change the very nature of travel by making people engage with local communities and think about where their money is going.

“Voluntourism may… introduce us to unprecedented forms of social entrepreneurism, change travel from a leisure activity to a lifestyle and life-purpose engagement, and shake the roots of capitalism by making it conscious and intentional,” he said.

The growing threat of drug-resistant malaria

Near the Thai – Cambodian border, one fatal strain of malaria shows signs of overcoming even the most potent drug designed to destroy it.

Artemisinin, a drug first isolated by Chinese scientists four decades ago but only recently embraced by the international community, was supposed to be the frontline medicine against malaria for years to come, and in Cambodia, it is the only effective drug against the most lethal form of malaria, Plasmodium falciparum.

“Artemisinin combination therapies are the most important antimalarial drug in the armoury of antimalarials and central to global efforts to control malaria,” Shunmay Yeung, a researcher at the Health Policy Unit at the London School of Hygiene and Tropical Medicine, said. “They are the fastest acting. They are safe and well tolerated… and can be used in both uncomplicated and severe malaria.”

But for five decades, western Cambodia has been the world’s crucible for drug-resistant malaria, and artemisinin appears to be following the same path of previous antimalarials to obsolescence. First, chloroquine became ineffective, then sulfadoxine-pyrimethamine, and more recently the parasite became tolerant to mefloquine.

But this time, if artemisinin falls by the wayside, there are no known drugs that can replace it.

“If the parasite becomes resistant to artemisinin, we don’t have another drug for treatment in the world. Artemisinin is the only one that is strong enough to kill enough parasites” Duong Socheat, the director of the National Centre for Malaria, said, “If malaria becomes resistant to Artemisinin, many in the world will die,” he said.

Amir Attaran, who holds Canada Research Chair in Law, Population Health and Global Development Policy at the University of Ottawa, echoed Duong Socheat’s fears.

“If the artemisinin drugs were lost to resistance before an alternative were found — and none is on the horizon — then there’s nothing else and malaria is untreatable. We are back to the Stone Age, basically,” he said.

Every year since 2000, the National Centre for Malaria has run tests determining the effectiveness of artemisinin in western Cambodia, and every year the drug takes longer to clear the malaria parasite from the body, indicating that the disease is quickly developing resistance.

“The drug used to take 24 hours to clear the parasite now it can take more than 72 hours,” Duong Socheat said.

A few factors conspire together to make western Cambodia the epicentre for malaria drug resistance. People from all around the region come to this area for gem mining, according to Duong Socheat. The transient population from across southeast Asia allows different strains to mix together when mosquitoes bite more than one infected person, increasing the likelihood of gene mutation.

Plus, almost all the pharmacies in the region are unregulated private providers, who are rarely properly trained and often prescribe improper treatments and dosages. One common practice is to sell cheap sachets filled with unknown drugs, which often include quinine, vitamins and artemisinins.

“It’s not a proper treatment,” Duong Socheat said, “Even the right drug with the wrong dose is a problem. When you don’t have proper treatment, dosages, or good doctors, you have contributions to resistant.”

Even if patients avoid drug cocktail sachets, monotherapy dosages of artemisinins are still widely available. Monotherapy rapidly increases the tolerance rate of the malaria parasite. Artemisin is a fast-acting, potent drug, but it needs to be prescribed with a slower partner drug to wipe out any residual malaria parasites which might be resistant to artemisinin.

“Artemisinin and its derivatives… are recommended for use in combination with other groups of antimalarial drugs and not by themselves. Thus, it is important that national policy in Cambodia be in line with the international and World Health Organisation guidelines of not using artemisinin as monotherapies. This will prolong the effectiveness of the artemisinin,” Awash Teklehaimanot, the director of the malaria program at Columbia University, said.

Currently, the policy in Cambodia does emphasize combination therapy, but experts with local experience say more needs to be done.

“A ban on the import and selling of oral artemisinin monotherapies is going to be issued, but everybody agrees that this is not enough in itself. It needs to be accompanied by enforcement, training, lots of communication and incentives to change the behaviour of providers and consumers,” Shunmay Yeung said.

The National Centre for Malaria with the help of the World Health Organization has been working closely with the private pharmacists, educating them about the importance of proper combination therapies, but with the pharmaceutical distribution system still relying on unlicensed distributors, the National Centre for Malaria faces an uphill battle in changing people’s behaviours.

Despite efforts by the National Centre for Malaria to encourage combination therapy, there’s evidence that patients sometimes avoid taking the partner drug even when combination therapy is properly prescribed. Currently, the nationally recommended therapy is artemisinin and mefloquine blister-packaged together, allowing people to avoid taking the partner drug, mefloquine, which has more adverse side effects.

“Ideally, the drugs should be co-formulated, ie both drugs in one tablet so they cannot be taken separately,” Shunmay Yeung said, “The main reason being that at a global level there has been a long delay in a good quality, effective co-formulated ACT [artemisinin combination therapy] becoming available.”

To top it all off, counterfeit malaria drugs, which contain just enough artemisinin to pass a dye test indicating they contain the drug, have contributed to malaria resistance, according to a 2006 report written by 21 of the world’s top malaria experts..

“We work with private providers in the area to make them stop providing monotherapy treatments and asking them to use combination therapy,” Duong Socheat said.

Clive Schiff, a professor at the Johns Hopkins Malaria Research Institute, emphasized the importance of the National Centre for Malaria’s success in the global fight against the disease that infects nearly 250 million people every year, according the World Health Organisation.

“It would be a global disaster to lose artemisinin… It must be used with care and in the proper manner to conserve its efficacy and to manage any signs of resistance or tolerance by the malaria parasite,” he said.

This rising threat comes at time when real gains have been made against the parasite in Cambodia. According to Duong Socheat, ten years ago more than a 1,000 Cambodians died every year from malaria, and now, about 200 Cambodians die.

But modeling done by the Mahidol-Oxford Tropical Medicine Research Unit suggests that the only way to stop a resistant malaria parasite in Cambodia is to eradicate the most fatal strain of malaria completely.

“The mathematical modeling department from our unit has modeled different containment strategies. All strategies tested reveal that the only way to get rid of the resistant phenotype is by getting rid of all falciparum malaria in Western Cambodia,” Arjen Dondorp, the deputy director of Mahidol-Oxford Tropical Medicine Research Unit, said.

Dondorp recommended a three prong attack against the disease. He stressed the need to get artemisinin monotherapies out of the private sector and replace them with combination therapy, distribute insecticide-treated bednets and repeatedly do mass screenings and treat the infected with combination therapy.

Though Duong Socheat is optimistic that Cambodia can eliminate malaria parasites in the country by 2015, Amir Attaran paints a darker picture. Though reduction is possible, he says “to talk of eradicating malaria is nonsense.”

Phymean for CNN Hero

During a visit to the Stung Meanchey Center, a school bordering Phnom Penh’s municipal garbage dump, one young student ran spontaneously towards Phymean Noun, the school’s founder, and lept into her embrace, kissing her on the cheek.

When the other students at the middle school saw this, they surrounded Phymean Noun and within moments, dozens of students were laughing and smiling as they sought her embrace. Phymean Noun’s schools have provided these students not just with occupational skills but affection and hope.

Five years ago, Phymean Noun opened the Stung Meanchey Center for children working and living near the Phnom Penh dump, and for her efforts, CNN has selected her as one of the Top Ten CNN Heroes from over 4,000 entries from 75 countries. On November 27, CNN will announce its “Hero of the Year” during a show hosted by CNN anchor Anderson Cooper. The winner will be chosen by a public vote and will receive an additional US$100,000.

Many of the children at Stung Meanchey Center still work at the municipal dump for less than a dollar day when they are not at school. Before the Stung Meanchey Center opened, few of them had shoes, let alone access to education, but Phymean Noun believed that education could be their tickets out of poverty, as it was for her.

“Without education, poverty will continue nonstop from one generation to another. I always tell them about my life to show them that they can be successful. The world can change with educated children,” she said.

Deciding to act
Before she founded the People Improvement Organization (PIO), Phymean Noun had overcome her own difficult youth. Orphaned at age 15 and left to raise a three-year-old niece in poverty, she eventually ended up landing a high-paying job at Untac. “I was successful. I had comfortable life and a nice car,” she said.

Then one day in 2002, she was walking along the riverfront eating a piece of chicken. When she finished, she threw the bones in a trash heap and watched as children scrambled over the rubbish for her scraps.

Instead of ignoring what happened, she called over the kids, sat in the grass with them and talked. They told her about their families, their daily lives and why they did not attend school.

That night, Phymean Noun tossed and turned as she thought about the kids. By morning, she made the decision to quit her job and devote herself to helping kids like the ones she met on the riverfront.

A year later, she opened a school next to the municipal dump.
“The conversations with the kids transformed my life. I saw these kids, and they reminded me of myself,” she said.
But the first two years of the Stung Meanchey Center were “tough”, Phymean Noun said. She spent over US$30,000 of her own money establishing and running the school.

In the early days, Phymean Noun had to go to the dump every day to persuade the parents to send their kids to her school, even bribing the parents with rice to let their kids attend. Today, PIO runs three schools and a vocational training centre, and Phymean Noun is forced to turn away some of the kids who want to attend – one of the things she hopes to change if she wins the $100,000 grand prize. Through the schools, PIO provides nutritious meals, uniforms, shoes and basic health care. In addition to studying basics of reading, writing and maths, the students can learn Apsara dancing, computer skills and beauty salon techniques. They have opportunities to decorate the school themselves.

Kelly Flynn, the executive producer of CNN Heroes, explained why CNN chose Phymean Noun over other contestants.
“[Phymean Noun is] an everyday person changing the world. From one moment witnessing children scavenge for her discarded chicken bones grew a commitment to educate the children…. She brought the education to them and gave them a way out. Phymean is proof that all it takes is the small effort of just one person to really effect change.”

Phymean Noun is proud of the difference she’s made and says, “Now the kids smile with hope for the future. I can see the change.”
To vote for Phymean Noun, log onto and for donations
to PIO visit their website at

As published in the Phnom Penh Post

After almost 40 years, submunitions are still a blast

During the US’s secret bombing campaign of Cambodia between 1969 and 1973, the US dropped about 80,000 cluster bombs on the Kingdom, littering the ground with over 26 million submunitions, according to Handicap International. About one third of these submunitions failed to explode resulting in more than 8.5 million explosives dotting the Cambodian landscape. Even after nearly four decades, these submunitions, or ‘bombies’, still pose a serious threat to Cambodians.

While land mines in the western part of the country have received the spotlight of the international community, the dangers of submunitions in eastern Cambodia have been largely ignored, but this is changing with an international campaign to ban cluster bombs.

Cambodia is at the forefront of a campaign to convince countries to sign a clusterbomb ban in Oslo, Norway this December. Cambodia has sent representatives to conventions on the submunition ban in Norway, Peru, Austria, New Zealand, Ireland and Laos.

“People turn to Cambodia to hear about its experiences with cluster munitions. Cambodia is sharing its history with the world,” Alex Hiniker, a communications and advocacy officer at UNDP, said.

Cambodia was the first country who pledged to sign the cluster bomb ban, which would ban the production, sale and transfer of these weapons as well as require signature countries to meet victim assistance standards and clearance regulations. Cambodia, along with Laos and Vietnam, is on of the countries most affected by cluster bombs, and victim assistance and submunition clearance up to the standards of the treaty will be costly.

“A huge part of the bus ban is to raise awareness for international donors and to show that this is still affecting Cambodia. We’ll be able to say, ‘Look thousands of Cambodians have signed this treaty’ and to share the stories of the victims with the donors,” Hiniker said.

Alex Hiniker along with representatives from Norwegian People’s Aid, the Cambodian Red Cross and Religions for Peace have been traveling around Cambodia for the last week in the “ban bus” to collect signatures to support the cluster munitions ban and record the stories of cluster munition victims.

In Kratie province, the ban bus never had to travel very far to hear from a submunition victim.

About twelve years ago, Rom Veth walked about 25 meters from her house into the forest to collect firewood. She saw her neighbours and younger brother playing with a metallic sphere the size of a petanc ball. She knew about the dangers of land mines but knew nothing about submunitions. The metal ball exploded while they were playing, killing her younger brother and one other child and leaving Rom Veth with only one leg.

She still lives in that house and is constantly worried about setting off another submunition. Even though the plot is still laden with bombies, she cultivates rice and vegetables on the land. The explosion affected her strength, and she’s not able to work efficiently. Her father called her a “burden.”

“I have no choice but to risk my life everyday,” she said.

Long Tinh, 35, a farmer in a neighbouring village, says that since the accident, no one else goes near Rom Veth’s fields for fear of submunitions.

The Cambodian Mine Action Center (CMAC) has started to remove explosives in the area, but Long Tinh and other farmers from the village say they will still avoid the area.

“Cluster munitions aren’t just an accident issue, they’re a land issue. People know where the cluster munitions are now, but they don’t use those fields. Just because accidents are down doesn’t mean it’s no longer a problem. They’re victims, because they can’t use the land,” Hiniker said.

But not every village knows enough about cluster munitions to stay away from affected areas. One village in Kratie province, Phum Thom, is still filled with submunitions, which are concentrated near a small bridge that the US bombed during the Vietnam War. Today, parents send their children down to the river searching for scrap metal.

Though the children know not to use the bombies for scrap and the local police have informed the villagers that the submunitions are dangerous, they still pick up and carry them. Two children, aged 8 and 10, enthusiastically showed us how they carefully handled bombies.

“I want to collect them [cluster munitions] in one place so I don’t confuse them for scrap metal,” Man Hoeung, aged 10, explained.

Hiniker said that one of the dangers of submunitions is their unpredictability: “You’re never sure if it’ll be the first time you touch them or the hundredth when they’ll go off.”

Keo Kunthea, 42, estimates that children in the village find about one hundred cluster munitions every year.

Hong Sophea, the senior monk at Wat Roka Kandal, when he learned about the campaign said he would help educate people about the dangers of submunitions and about the campaign itself.

“I think this campaign is very good for the people. These bombies hurt people. I will share this information with the monks and will inform lay people about this issue” Hong Sophea said.

The victims themselves, who were educated about the dangers of submunitions the hard way, were glad to hear about the attempt to rid the world of cluster bombs.

“The ban on cluster munitions is not just important to my family, but other children around the world. I feel proud. I feel happy, because the campaign prevents kids from being in danger,” Yoeun Sam En, who was blinded and lost both his arms in a submunition explosion, said.

For now, more than fifty countries have pledged to sign the treaty, but the world’s largest producers of cluster bombs are conspicuously absent. The US, Russia and China have given no signs that they will sign the ban. Many of the victims found the weapons producers responsible.

“I want to say to the governments that produce bombies that they should help take care of the victims,” Talang Taoeun, a victim who lost a leg in a submunition blast, said.

On this trip, the ban bus has collected around 400 signatures, but in total, about 16,000 Cambodians have signed a petition supporting the ban.

Penh Vidol, a Buddhist monk who is a member of Religions for Peace, said, “This country has been victimized by bombies. Cambodia is tired of war and bombs. The legacies war like cluster bombs should be eliminated.”

Drug Outreach in Cambodia

In a dark corner of one of Phnom Penh’s poorest communities, JB, a member of Korsang’s medical crisis team, disinfects and cleans scratches on a young girl. After JB finishes, the girl runs to play in the boggy trash heaps adjacent to her room.

It may not seem like it, but JB’s actions are part of the frontline of Cambodia’s battle against the spread of HIV.

Peer educators from Korsang, a local harm reduction NGO, visit Phnom Penh’s most drug-riddled communities everyday. Most of Korsang’s staff members are former drug users themselves, and they gain the trust of Phnom Penh’s at-risk communities by talking candidly about drug use and HIV risk and by providing basic medical aid.

“We come to this spot every other day so they know who we are, and they’ll be comfortable talking to us. Every time we make contact with someone, we ask if they know their HIV status. Sometimes they tell us, ‘No. I don’t know [my HIV status], but I want to,’ and we can make sure they get tested,” JB said. “Some of the people in poverty don’t even know how HIV is transmitted, what drugs do to their bodies and what options they have.”

Korsang was one of the pioneers in the politically sensitive harm reduction approach in Cambodia — a method that emphasizes engaging with individual users to curtail the harmful effects of drugs on the individual and society but does not insist on abstaining from drugs completely. In a country where cold-turkey, boot camp style treatment was once the norm and where drug addicts are still treated as social pariahs, Korsang became one of the few places where drug users in Phnom Penh were treated with respect.

Today, Korsang’s connections to the drug using community will allow it to play a crucial role in Cambodia’s new strategy to thwart the growing threat of an HIV epidemic caused by an increase in unsafe intravenous drug use.

Gordon Mortimore, a technical advisor to the HIV/AIDS Asia Regional Program (HAARP), said, “Cambodia has a very distinct problem with injections. Though the numbers aren’t large, the problem is growing, and it’s growing month by month.”

The National Strategic Plan for Illicit Drug Use, developed by the National AIDS Authority and National Authority for Combating Drugs with input from NGOs, is a comprehensive plan that focuses on harm reduction strategies. The plan has yet to receive the necessary funding for the full program, but AusAid and HAARP have both pledged financial support.

“We still have many needs… We’re looking for more support from UNAID and others. We need more support,” Thong Sokunthea, the deputy director of Legislation, Prevention and Rehabilitation, said.

The plan itself has been lauded by experts. Mortimore called Cambodia’s plan “a good example for the region,” noting that the National Plan for Illicit Drug Use ensures a coordinated so that international NGOs and civil society groups can avoid funding redundant programs and know where the funding gaps in the plan lie.

Cambodia’s new, holistic approach focuses on drug education, treatment and law enforcement and is supposed to ensure that NGOs, the Ministry of Health and police have the same goals of reducing HIV rates and the stigma of being a drug user. One key aspect of the plan is the introduction of methadone maintenance therapy, which will be available to drug-users in Cambodia for the first time early next year. Though the pilot methadone treatment program run by the Ministry of Health at Russian Hospital is an important step, it represents only part of the solution.

“Our government cannot implement this [the National Strategic Plan] without help from civil society… Drug-users don’t always feel comfortable with government officials, and Korsang has a lot of experience contacting and educating drug users. We need their support for us to be successful,” Thong Sokunthea said.

The government is relying on Korsang to run support services and make referrals for the methadone program, and thankfully, Korsang has the experience and the contacts to help.

“Methadone is requested all the time. They [drug users] tell us they want a medicine to help them quit. They’ve been waiting for it,” JB said.

Even though Korsang has been requesting the rights to run a methadone treatment program for over three years, Holly Bradford, the founder of Korsang, does not think Cambodia is far behind the curve.

“Its [the introduction of a methadone maintenance therapy] timing is good. There’s an emerging injection drug problem,” Bradford said.

Korsang may have started off small, but the organization quickly grew to fill different needs of Phnom Penh’s growing population of drug users.

“Each additional program we implemented came from the drug users themselves. They let us know what they needed,” Short, one of about twenty Cambodian returnees deported from the US who work at Korsang that are known only by street names, said.

In only four years, Korsang has grown to fifty staff members and twenty peer educators. They currently run an outreach program, a 24 hour drop-in centre, a women’s health education program, an infirmary, a needle exchange program and a music and dance program for at-risk youth, but they are about to expand even more.

With promises of financial support for seven years from HAARP, Korsang will be able to run support services for the methadone maintenance therapy in Cambodia and continue running an overnight program for street-based users, Bradford said, making it a key player in ensuring the success of Cambodia’s national drug plan.

According to Cambodian Senator Chhim Kim Yeat’s presentation at the Rights Beyond Borders conference, a regional harm reduction forum held in Phnom Penh last week, the Cambodian government does indeed recognize the importance of a harm reduction plan to ensure the continued decline in the HIV rate in Cambodia.

Chhim Kim Yeat described Cambodia’s fight against HIV as a fragile success story that could be derailed without a collaborative solution to the problem of injection drugs. The HIV rate in Cambodia has dropped sharply, from 3 percent in 1997 to 0.8 percent in 2006, according to government statistics.

“There is a window of opportunity to avoid a crisis… The extent of drugs and poverty may set back our goals,” Chhim Kim Yeat told the audience.

In order to avert an HIV epidemic, Korsang’s grassroots efforts to educate drug users and to refer people to the government run methadone treatment program will be key.

Everyday Korsang’s staff members provide Phnom Penh’s drug users with information about HIV transmission but as Tang, one of the first five staff members at Korsang, pointed out it’s not just what you do that matters, it’s how you do it.

“We make them [drug-users] feel better. They see us; we hug them and talk to them. Treating drug users as friends is what separates us,” he said.

After traipsing through the muddy alley-ways of Louksang and in the dusty tent warren of Thai Buarong — two of about twenty at-risk areas that Korsang visits — JB and three other Korsang staff members finished their rounds. During their outreach, they sat down with a drug user with blood shot eyes and calmly explained the effects of drugs; they checked in on one drug user’s baby to make sure she was still healthy, and a woman, high on yama, screamed at them, demanding medicine they did not have.

In a few hours, they will visit another two sites, and tomorrow, they will do it all again. What keeps them coming back day after day?

“You see people come alive. Day by day, when I see get them better, I feel good,” JB said.

North Korean Food for Thought

North Korea announced it would dismantle its plutonium plant, supposedly ending its nuclear weapons program for good. In response, the United States took North Korea off its list of terrorist state sponsors — and I went to dinner.

Pyongyang Restaurant in Phnom Penh is owned and operated by the North Korean government, meaning all profits are sent directly back Kim Jong-il’s government, and now that North Korea is no longer a terrorist nation, I can enjoy my kimchi guilt free.

With a restaurants in Siem Reap, Phnom Penh and Sihanoukville, the totalitarian country’s foray into capitalism in Cambodia has been a runaway success. North Korea opened its first Cambodian restaurant in Siem Reap in 2003, and it was an immediate hit — especially with the growing number of South Korean tourists and businessmen.

Largely because of Norodom Sihanouk’s ties to North Korea, Cambodia has maintained diplomatic relations with North Korea, allowing the restaurants to set up shop. Sihanouk has been a regular resident of North Korea since being ousted in 1970 and has even befriended fellow movie-buff Kim Jong-il.

Estimates of the exact number of North Korean-run restaurants abroad vary but most put the number around one hundred. These restaurants play an important role in the North Korean economy, funneling tens of millions of dollars of foreign currency into Kim Jong-il’s coffers — necessary because the North Korean won is not convertible.

North Korean waitresses from Restaurant Pyongyang entertain patrons

While some North Korean-run restaurants in China blare propaganda films and plaster Kim Jong-il’s face on every possible surface, the restaurants in Cambodia are apolitical. In the Phnom Penh restaurant, customers can sit under a painting of a tiger with a disproportionately small head and watch a flat screen playing soothing films of North Korean waterfalls.

The food at Pyongyang Restaurant is expensive for Cambodia — US$6 to $22 per entrée — but it’s top notch Korean food. The ox-tail was tender, and the kimchi was both spicy and tangy. The restaurant also sells rare North Korean products like ginseng, honey and bear bile at outlandish prices. But people don’t just come for the bile.

At eight pm, the well-coiffed waitresses wearing identical pale blue, polka-dotted dresses and four inch heels take a break from serving to sing, dance and play traditional instruments. One waitress plays the electric keyboard, while the rest take turns belting out Korean songs. After doing the show day after day, the waitresses’ twirls and arm movements are perfectly in sync with each other, and the staff never stops smiling — ever.

By nine, the clientele, which had been enthusiastically drinking North Korean rice wine, started singing Korean karaoke with the waitresses. All of the servers are slim with faces pale from white make-up. All the waitresses have gone through a strict selection process in North Korea where they were chosen based on their appearance and loyalty to the government. Most of the waitresses are from well-connected North Korean families that could face retribution if their relative escaped. Despite this assurance, the waitresses are not allowed to explore Cambodia unattended.  Somehow, this results in excellent service. Really excellent service. When I left, one grinning waitress sprinted across the restaurant to make sure she was there to thank me as I left.

Most people are not allowed into North Korea, but they can go to Pyongyang Restaurant  and get a taste of the world’s most secretive nation.