I think every volunteer (health and english teaching) faces this issue of tradition vs. modern at least once in their service. As American citizens, we grew up in a culture that values the MD degree, prescription drugs, and a certain faith in science. Often, alternative medicine is seen as a fad and not bearing up to the scrutiny that modern medicine has passed. Coming to Cambodia, we’re faced with a completely different culture.
Modern medicine in Cambodia is not entirely the same as modern medicine in America. The basics are the same in that you are supposed to have an individual that has gone to school to earn a degree. They make decisions based on facts that have been tested scientifically. Some differences are: there are very few doctors, most health professionals earned their degree after one year of studying, villagers more often visit the local pharmacy for medicine rather than a health center. Pharmacies are a major provider of modern medications to Cambodians. Pharmacies range from modern stores like U-care which provide quality drugs from countries like France and a cardboard box of a variety of medications doled out of a neighbor’s home (her provider is a son who works at a health center).
Traditional medicine is widely practiced in Cambodia. In my experience many Cambodians believe that spirits can adversely affect health among many other things like types of food you eat. There are some common practices that some people may categorize as religious, but I think these practices are also critical, from a Cambodian perspective, for their health. For example, putting food on the family altar, wearing ghost beads, being coined. Many of these activities have a superstitious nature to them and their purpose to protect general wellbeing. Horoscopes also play a large role in health. My host mother was told that this year she would get sick often and she has been sick with headache, what seems to be a strained ligament, diarrhea, and dizzyness. To counteract these illness (caused by illfortune) my mother has been through a number of blessing ceremonies in the past month. These blessings are traditional medicine in a way. In addition to blessings, my mother also visits a Khmer traditional healer. I’m not sure what the healer did to her, but she also provided a mixture of herbs that seemed to act like a hot pack and my mother also boils khmer medicine (herbs and bark) to drink each day.
Both modern and traditional medicine is used by almost every Cambodian I’ve met. In Cambodia, it almost seems like modern medicine and traditional medicine work together. My host mother spent a lot of time and money on traditional remedies, but she also takes acetaminophen for her pain. I think this causes some confusion when Cambodians opt to use modern medicine. Often, Cambodians may intrinsically trust providers of medication even though they are handed a medley of random pills in a plastic bag. This is similar to Khmer healers, whose validity is more based on lineage and reputation. On the other hand, Cambodians often distrust modern medical practitioners especially when modern medicine does not show an effect immediately or does not give the desired affect.
I think, most often, people are just confused about what works and what doesn’t. The older generation is more likely to recommend traditional remedies and Health Center staff sometimes directly contradict those recommendations. For example, after giving birth a traditional remedy is drinking urine and sleeping on a bed that is heated by hot coals. In a country that is already hot, this can be extremely dangerous if the mother is not properly hydrated. It is hard for a young woman to disregard her elders and tradition in order to follow a midwife. As a PCV, we’re taught to accept cultural practices, but also to teach Cambodians new information. The relationship between traditional and modern medicine is one of the more difficult areas to tread. How do you show cultural sensitivity and help people change simultaneously? Sometimes you can compromise. Tell the new mothers that they can practice tradition, but stay hydrated when they are on the hot bed. However, this can also be difficult because you are essentially condoning a potentially dangerous practice.
I don’t have an answer for this issue, but I think what most people would say is that if your community trusts you then they will listen. Unfortunately, it’s difficult to build a relationship of trust with every single person you encounter at the health center. And, it's hard to know how far you can push your trust when trying to change traditions.