Limited understanding, limited services, limited resources: patients’ experiences with managing hypertension and diabetes in Cambodia

Abstract

IntroductionHealth system responses to the emergence of non-communicable diseases (NCDs) in many Southeast Asian nations, Cambodia included, have been insufficient. Little is known about how people suffering from such conditions behave in constrained contexts. We examined the experience of patients with NCDs as they seek care for their conditions and manage them.MethodsIn-depth interviews with 28 purposively selected patients with hypertension and/or diabetes using an interview guide to capture the trajectory followed by interviewees from the development and recognition of symptoms to adherence to treatment. A general outline of major topics to be discussed was used instead of a predetermined list of specific questions.ResultsAll interviewees had experienced symptoms for a substantial period of time, sometimes many years, before being diagnosed. Initial treatment focused on symptoms instead of underlying conditions, often at considerable financial cost. Following diagnosis, many struggled to take medicines daily for their condition and adhering to the required behaviour changes. Many resorted to complementary medicine. Lack of financial resources was a common reason to discontinue treatment. Many reported loss of income and assets such as livestock and productive land and increasingly relied on others.ConclusionIn order to assist people with NCDs in Cambodia, there is a need for a multipronged approach focusing on communities and healthcare providers. Information campaigns could focus on the timely recognition by communities of symptoms indicative of the conditions, together with instigating demand for routine screening at qualified health providers. Peer support is considerable, and locally adjusted approaches based on this principle should be considered.

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“…The case of Cambodia also underlines the importance of and the struggles around access to medicines for lifelong chronic conditions such as diabetes and hypertension in countries that are rapidly moving through the epidemiological transition while still facing a substantial burden of communicable diseases and maternal and child mortality. Jacobs et al 7 point that the public health system in Cambodia has been developed along the principles of a district model geared towards fighting communicable diseases. Health centres are not prepared or equipped to deliver appropriate long-term care for patients living with diabetes and hypertension, enabling the private sector to fill the void.…”

“…At the same time, populations have also to cope with the new epidemics of NCDs; this creates a need for appropriate and mutual adjustments, as evidenced in the papers from the Indian and the Cambodian studies. Jacobs et al 7 plea for urgent action based on the principles of the diagonal approach, 10 which would integrate diabetes and hypertension care with HIV/AIDS services, carried out in tandem with a reform reorienting the health system towards the type of care required by chronic lifelong conditions—such as a strong primary healthcare system with the capacity to implement disease management programmes and support an effective continuum of care from the community to specialised hospital care.…”