Recently, I took a respite from my concerns about the Affordable Care Act, which I left simmering in the crockpot while I was re-visiting the Kingdom of Cambodia.

Most people visit Cambodia for a brief trip to Siem Reap to experience the magnificent ancient temples at Angkor Wat, the symbol adorning its flag. Some visit the capital city, Phnom Penh, to experience mass graves and a torture camp, prison, and execution center. Cambodia has a haunting physical and emotional landscape and an intangible something about these inspirational people that lures many visitors back.

The prolific and feared Khmer Angkor Empire that extended over Southeast Asia was transformed by years of civil or border wars and French protectionism. But the mother of all change was imposed by a native Khmer, Saloth Sar, better known as Pol Pot, in the name of creating an equal society.

Pol Pot led the communist Khmer Rouge who overthrew the sitting Khmer Republic and renamed the country “Democratic Kampuchea.” Within hours of victory in 1975, armed soldiers began herding the two million residents out of Phnom Penh. Pol Pot assured them they could return.

Instead, the Khmer Rouge razed Phnom Penh and other cities and towns. The residents were forced into the countryside to work collective farms up to 18 hours a day on meager rations. Villagers’ houses were burned to ensure they could not return.
Pol Pot destroyed anything that represented capitalism and prerevolutionary society, including hospitals, schools, Buddhist temples, and hotels. The goal was to return to “Year Zero” with a rice-based economy and a single agricultural class.

To that end, Pol Pot immediately murdered the educated and people who wore glasses or had a high forehead (signs of intellect). Others were imprisoned in tiny cells and tortured “to confess” to “pre-revolutionary lifestyles and crimes,” which usually included some kind of free-market activity. The reward for a “confession” was execution or life in a labor camp with “re-education.”

Ironically, in 1979 the Vietnamese freed the Cambodians from their twisted leader when they extended their border war. All told, Pol Pot killed 2 to 3 million – at least 25 percent of the population – through murder, starvation, or disease. Many of the dead were buried in some 20,000 mass graves, or “Killing Fields” all over the country where human remains still rise to the surface.

Despite the arrival of peace in 1993, Pol Pot’s legacy lives on. Fifty percent of the population is under age 25. Forty percent of people over age 40 have post-traumatic stress disorder (PTSD). With 95 percent of doctors and 80 percent of teachers murdered, the country is limping along to recovery with little infrastructure. Even knowing the government plays fast and loose with foreign aid, Cambodia draws more donor-based nongovernmental organizations than any other country.

Phnom Penh is growing, with new government buildings and hotels amidst the remains of once-elegant French colonial homes and burned-out buildings. Siem Reap has doubled its hotels in the last five years and boasts the best Mexican restaurant in Asia. (We preferred standard Khmer fare of rice, morning glories, and fish.)

Although medical care is free to the certifiably poor in sparsely equipped clinics, 85 percent of children are seen in five modern hospitals established by Dr. Beat Richner with private donations. His hospital in Siem Reap is flanked by 5-star hotels. People arrive on foot or three to a motorbike: a driver, a patient, and someone holding the IV bag. By 5 a.m., hundreds of people are queued up. Street vendors sell French bread and crepes or rice and noodles to those in line.

A written constitution, a three-branch government, and multi-party elections proved to be no guarantee of good government. Corruption, economic mismanagement, and lack of transparency have become part of the government fabric.

Consequently, some Cambodians have just tuned out. Fortunately, many people refuse to be miserable and are determined to overcome past and current abuses by their leaders. Some carry those little black and white composition books and are not shy about asking for help with their English so they can get good jobs. They have their own vision of a better life.

Pol Pot destroyed Cambodian society by promising social and economic equity. Expressing no regret, his last words were reportedly, “Everything I did, I did for my country.”

Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.

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