Takeo Health Centers Focus on Travel Histories; Disregarding ‘Normal Flu’ Cases
In Takeo province, health centers are using Health Ministry guidelines to flag potential COVID-19 cases only if there was international travel involved, leaving cases of “normal flu” untested. 
TAKEO PROVINCE — The Samraung Health Center in Takeo province’s Bati district is tucked in behind the grey façade of an Acleda Bank branch and is opposite the local school. The building is decrepit with little except a large sign at the front gate to suggest it is a functioning health center. Inside, the consultation rooms and general wards were padlocked. The noticeboard has a statement from the Ministry of Health on safety measures to be taken during traveling amid the COVID-19 pandemic. Sitting alone in the only unlocked room, Yeu Chhengly is busy on his phone. The room has one table, stacked with documents, and a metal frame bed, with no mattress and a single pillow. He runs the health center. Yeu Chhengly is eager to talk about the coronavirus pandemic, which as of Friday in Cambodia had resulted in a total of 122 cases and 110 recoveries. The middle-aged man is animated about the pandemic, describing the 11 migrant workers who had returned to his commune and how eight of them had finished their 14-day quarantine period. The government said earlier this week that around 90,000 workers had returned to Cambodia in recent weeks, putting all of them in mandated quarantine. “I went to the villages myself to educate people,'' Yeu Chhengly said. ''When we go, we have the equipment and used it as much as we can. We educate people that within 14 days if they have coughs, fevers, or sore throats they should go to see a doctor and we will report to the health department.” Yeu Chhengly spoke with passion and said the checks were limited to those who had returned from abroad -- or as the Ministry of Health puts it, 'individuals with recent travel history.' The health center worker said district residents who had walked in over the past few weeks with coughs and flu-like symptoms, but with no recent travel history, were being treated as “normal.” “Some people are locals living here,” he said. “They cannot be infected because they are local, they just have the normal flu. We only report based on the patients’ [travel] history.” He admits that it is hard to make an assessment of which cases were the flu and which were the novel coronavirus respiratory disease, yet emphasized to VOA Khmer reporters that these procedures were working effectively, noting that Takeo had zero positive cases. Yeu Chhengly’s assertion can be linked to the government’s narrative that cases were largely linked to foreigners or Cambodians returning from overseas, dismissing claims that there could be a local cluster or community transmissions. In recent weeks, as countries attempt to look beyond the pandemic and plan on re-opening their economies, the availability of testing and the levels of testing needed to safely return to normality or semi-normality have been debated. This week, the Ministry of Health said it had conducted 9,792 tests since the start of the pandemic, with some 6,000 different persons having been tested so far. Of these, approximately 2,000 tests were conducted on passengers of the MS Westerdam cruise ship and the crew of the World Dream ship. In the seven-day period preceding Monday, Cambodia had conducted 883 tests, officials said, despite having the capacity to perform 600 tests a day at the Institut Pasteur du Cambodge and National Institute of Public Health. “I've mentioned many times the very important thing is testing, testing, testing,” the World Health Organization’s director in Cambodia, Dr. Li Ailan, said on April 13. She praised Cambodia’s efforts in dealing with the 122 positive cases recorded so far, but also said it needed to create its own testing strategy moving forward. The Cambodian Health Ministry has not been very clear about the country’s testing strategy. The ministry was of the view that most cases were imported, testing only individuals with travel histories, as well as those identified through contact tracing. This resulted in a spike in cases after Cambodians returned from a religious meeting in Malaysia and a large group of French tourists tested positive in Sihanoukville, after traveling to Siem Reap and Phnom Penh. After a few recent cases in Phnom Penh, Health Minister Mam Bunheng suggested that it was likely there was small-scale community transmission in the capital. Forty or so people in the capital’s Boeung Keng Kang 1 district, who had come in contact with a COVID-19-positive couple, were then tested. Earlier this week, ministry spokesperson Ly Sovann said the number of weekly tests had gone down because Cambodia had registered no new cases. Of the 90,000 migrant workers who have returned, only 410 had been tested as of Monday’s Ministry of Health press conference, seemingly resulting in zero positive cases. Additionally, the Ministries of Health and Labor intends to put nearly 30,000 garment workers into isolation for breaking the ban on leaving Phnom Penh last week during the canceled Khmer New Year holiday. On Thursday, Labor Ministry officials had reported that around 80 quarantined garment workers in Phnom Penh had shown symptoms of COVID-19 and had been tested for the disease. Cambodia, despite skepticism over the COVID-19 case tally and testing strategies, could soon have no active cases, potentially leading the administration to consider removing restrictions placed on businesses, educational activities, and the general public. Back in Takeo’s Bati district, Roveang Health Center has only a few people in a general ward, with no attending doctor or nurse to be seen. In the back of the health center, behind a rope preventing access, sat Chea Sreng who is the director of the facility. Much like his colleague at the Samraung Health Center, Chea Sreng is focused on the Ministry of Health guidelines, saying it was unwise to diverge from them. “There are guidelines that are issued by the ministry for COVID-19,'' he said. ''We check their temperature to see if they have a sore throat, body pain, coughing, and sneezing.” However, when people do come to his health center with these symptoms, he recommends COVID-19 testing merely for those with travel histories, especially, migrant workers who have returned from Thailand, Malaysia, and South Korea. Chea Sreng said doctors will check them for other respiratory diseases, like tuberculosis, but not for the novel coronavirus. All such cases, even if the symptoms were similar but diagnosed not to be coronavirus related, were entered into a report that was sent to the Health Ministry at the end of each month, he said. “Those who are without travel histories but are having such symptoms, then have the normal flu,” he said. “Only if migrant workers are having suspected symptoms should then be tested.” At another health center in Takeo, Kong Yutheavy, director of the Choan Chum Health Center, said she asks patients who have the “normal flu” to keep track of their symptoms and to visit the doctors again if their symptoms didn’t improve. And while she is still focused on cases linked to overseas travel, Kong Yutheavy did acknowledge the possibility of locally-transmitted infections, especially in hot spots around the country. “I ask them where are they from,” she said, on the phone. “If they live in Cambodia and are from Preah Sihanouk province [and have flu-like symptoms], then I will suspect them and will take their samples.”