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Sunday, April 06, 2008

Doctors not nearly as diverse as the valley

Southeast Asians and Latinos underserved

By Barbara Anderson

A huge gap exists between the minority populations in California and the number of doctors of diverse backgrounds, particularly Latino and Southeast Asian doctors in the San Joaquin Valley, according to a report made public Wednesday.

Results of a California Medical Board Survey found just 3,282 Latino doctors are practicing medicine in the state and only 90 in the state are of Lao, Cambodian, Hmong or Samoan background. There are about 61,800 doctors with practices in California.

Researchers were shocked by those results, said Dr. Kevin Grumbach, director of the Center for California Health Workforce Studies at the University of California at San Francisco and principal author of the study.

"The problem is even worse than we thought," Grumbach said during a teleconference at the University of California at Davis School of Medicine.

When physicians share a language and culture with patients, they can communicate better and provide better medical care.

The survey, which used ethnic information collected from doctors when they renew medical licenses every two years in California, also shows a stark disparity between the Latino doctor work force in the valley and the patients they treat.

Only 5.2 percent of doctors statewide are Latino; in the survey region that includes the valley, only 8.1 percent of doctors are Latino.

But Latinos represent 38 percent of the population in Stanislaus County, 36 percent in San Joaquin County and more than 50 percent in Merced County, according to the U.S. Census Bureau 2006 American Community Survey.

Large numbers of Cambodians, Hmong and Vietnamese live in the valley.

Making a healthier community

There's no question the valley needs to increase the number of minority doctors, said Bertha Dominguez, education director for the UCSF-Latino Center for Medical Education and Research.

To do so would benefit the entire population, not just minorities, she said. "Overall, it will make us a healthier community."

The Scenic Faculty Medical Group has 26 doctors serving patients in the Stanislaus County Health Services Agency clinics, which provide health care to low-income and uninsured patients. The clinics have three Latino doctors, and eight other doctors have learned Spanish to try to bridge the language gap, the group said.

But there is only one Cambodian physician to focus on the county's Southeast Asian community.

"Most Southeast Asian people in the county don't have a doctor who speaks their language or understands their culture," said Marge Leopold, site coordinator for The Bridge, a Southeast Asian community organization in Modesto.

Because of the language barrier, Hmong and Cambodian patients with English-speaking physicians have limited understanding of their prescription medication. Some of the Cambodians are survivors of the Khmer Rouge genocide in the late 1970s, Leopold said.

"A lot of Southeast Asians are put on antidepressants because of the trauma they have experienced," she said. "After they have been on antidepressants, they have had side effects they don't understand because they didn't comprehend what the doctors told them."

Residency program recruiting

Peter Broderick, director of the Stanislaus Family Medicine Residency Program, said it's tougher for Latinos and Southeast Asians to get into medical school. Many grew up in poor or rural communities without access to good schools.

The county's residency program prides itself in giving culturally competent training to the 27 residents in the three-year program. Right now, it has four Latino residents and two who are Hmong, and it's always looking for Southeast Asian residents to recruit, Broderick said.

Graduates of the program are encouraged to work in the community, although there is no guarantee they will. Dr. Sa Vang, who is Hmong, will complete her residency in June and plans to work at the county's Ceres Medical Office starting in September. The other Hmong resident is in the second year.

The physician survey found 20 percent of doctors statewide spoke Spanish and more than half were non-Latino white doctors, which was encouraging, Grumbach said. But the pattern wasn't the same for Asian languages. For example, 2 percent of doctors spoke Vietnamese.

Children continue to serve as interpreters at medical appointments when doctors are not fluent in Hmong or other Southeast Asian languages, said Silas Cha, associate director at the Fresno Center for New Americans.

"When things are communicated through the young child, the young child does not understand the level of seriousness of the condition or may not even understand the condition at all," he said.
Area medical school needed

The doctor survey found minority doctors are more likely to work in underserved communities and areas with large minority populations, such as those in the valley. And they were more likely to work in primary care, such as family and internal medicine and pediatrics, than are white physicians.

But doctors, regardless of ethnic background, are in short supply in the valley.

There are 173 doctors per 100,000 residents, the lowest of any region in the state, according to a recent study by the Central Valley Health Policy Institute.

A medical school proposed for UC Merced could boost the numbers of doctors, said Maria Pallavicini, dean of natural sciences. "Certainly a mission of the proposed medical school is to train students to become physicians who will stay in the valley and reflect the face of the valley, which is certainly diverse," she said.

The UCSF health work force researchers recommended increasing minority representation in medical schools and increasing incentives for doctors to work in underserved areas. They said the state needs to invest more in the educational pipeline to prepare minority students for careers in medicine and other health professions.

Bee staff writer Ken Carlson can be reached at or 578-2321.

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Global rice reserves at lowest

Global rice reserves are at their lowest in 30 years and wholesale price of rice in Thailand has increased to $580 per tone in past three months.

Rice is one of the most important parts of daily diet in many Asian countries. People of China, Japan, India, Pakistan, Turkey and Iran are among those who at least consume rice once in a day.

The rising price of rice undoubtedly imposes hardship to many people in these countries.

Thailand and Vietnam are the first two largest exporters of rice in the world and the latest news indicate Vietnam, Cambodia and Indonesia have imposed restrictions on their rice exports to assure having enough rice for their domestic consumption.

Vietnam has reduced its rice exports, Cambodia has banned exports of rice altogether and Indonesia has levied a new tax on its rice exports.

Afzal Ali, an Asian Development Bank economist, predicts shortage of rice and its higher price could cause some social tensions and that is the main reason some Southeast Asian countries have imposes restrictions on rice exportation.

Social tensions can prove to be very dangerous, class tension destabilizes the countries and that is why Southeast Asian countries are so sensitive to the issue, he added.

The Philippines, with 58 million citizens, imports more than 2 million tons of rice annually and more than any other Southeast Asian nation is vulnerable.

The country does not have enough arable land to produce its own consumption needs and about 10 million of its population is suffering from hunger.
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Realty investors target Cambodia

PHNOM PENH, Cambodia — An old hospital was razed to make way for Phnom Penh’s tallest building — a 42-story twin condominium tower. A garbage-strewn slum became prime real estate after police evicted its dwellers to a parched rice field outside the capital.

Cambodia is experiencing a construction boom fueled by foreign investment, particularly by South Koreans, and buying and selling among the country’s few nouveaux riche — while leaving the poor majority behind.

Shopping malls and tall apartment buildings are sprouting up, transforming the capital’s landscape that once bore the charm of colonial French-styled villas but resembled a ghost town at the fall of the genocidal Khmer Rouge regime nearly 30 years ago.

Political stability and robust economic growth of nearly 10 percent have lured investors to the real estate market that has seen prices surge over the last few years — though they are still lower than in neighboring Vietnam or Thailand.

“Cambodia was sleeping for many years and now it’s waking up,” said Claire Brown, managing director of Britain-based Claire Brown Realty, who began buying and selling property in Phnom Penh two years ago.

“Everybody wants to get a piece of the action,” she said by phone. “The time to get in is now because soon it’s going to be too late.”

Prime city land prices have tripled over the last two years to $3,000 per square meter ($279 per square foot). Those kinds of returns have drawn rich and middle-class Cambodians, as well as those living abroad.

“In buying and selling land, they could get profit 100 or 200 percent a year, if they make the right bet on the right location,” said Dith Channa, the sale manager of CPL Cambodia Properties Ltd., a Phnom Penh-based real estate agency.

But the soaring real estate market is also widening the gap between the rich and the poor.

“Phnom Penh city is getting modern every day — of course for the wealthy,” said Chhorn Et, a former slum dweller now living with hundreds of others in a village in the middle of rice field about 12 miles from the capital.

“The government swept us away because they regarded us as very unpleasant for their eyes,” said the 34-year-old woman who scavenges for discarded cans and bottles to sell for a living.

The flourishing property market is also happening in the shadow of problems of land rights disputes that, in recent years, have often pitted the poor against wealthy developers with link to the Cambodian political establishment.

“We’re moving toward possibly about 10 percent of the population owning 90 percent of the land in Cambodia,” said Naly Pilorge, director of the nonprofit human rights group Licadho.

That could fan social and political unrest, she and others have warned.

The biggest projects are being funded by South Korean investors and companies, which have been the leading investors in Cambodia following the resumption of diplomatic ties between the two countries in 1997. Investment and tourists from South Korea have surged following a 2006 visit to Cambodia by former President Roh Moo-hyun.

World City Co., of South Korea, is investing $2 billion to build a “satellite” urban complex called Camko City on a 300-acre area on the northwest side of Phnom Penh. The project, the single biggest foreign direct investment in Cambodia to date, will include residential, commercial and public facilities — villas, condos, trade and financial centers, office buildings, shopping centers, hotels, schools and hospitals.

Meanwhile, at a busy corner leading up to the city’s landmark Independence Monument, an old government hospital has been torn down to make way for a 42-story condominium and shopping complex worth about $250 million. That’s going to dramatically change Phnom Penh’s skyline, where the tallest building now is a 15-story hotel.

It is going to be the first luxury residential building and tallest structure in Cambodia, said Kim Tae-Yeon, chairman of Yon Woo Inc., a South Korean developer.

Kim said the towers will have about 500 units of apartments, office space and retail shops with price tags ranging from $112,000 to $1.8 million a unit. Construction will start next month and take 3½ years to complete, but Kim said nearly half of the units have already been bought.

In recent years, Siem Reap, a northwestern town near the famed Angkor Wat ruins, also has seen frenzy of hotel and guesthouse construction for the growing numbers of tourists.

Thrilled with the boom, Prime Minister Hun Sen has said it has been made possible by the political stability he has brought. In a recent speech he warned that if he isn’t re-elected in July elections, property prices could nosedive.

“It was a threat, a dirty trick to gain votes,” said Son Chhay, an opposition party lawmaker.

Son Chhay and some human rights workers, including Pilorge of the human rights group Licadho, believe that the boom is partly fueled by people laundering money from illegal logging, drug trafficking and tax evasion by plowing the cash into the real estate market.

“This is not going to be healthy for the Cambodian economy,” Son Chhay said.

There are also concerns that the rapid price gains are creating a bubble that will eventually pop.

Eric Sidgwick, senior economist at the Asian Development Bank office in Phnom Penh, said the real estate market has been “driven by a combination of genuine demand for business-related and residential construction,” as well as a growing population, increased urbanization and speculation.

Still, there were “reasons to be concerned about the recent increase in real estate prices and the dangers of further inflating a speculation-led bubble,” he said in an e-mail. He declined to comment about any possible link between money laundering and the property market boom.

Meanwhile, the poor like Chhorn Et, the former slum dweller who was moved outside the capital, are left to cope with a stark reality in their new village, which has no running water or sewage system.

Although each family has been given a small piece of land to live on, they complained of the lack of means to support their livelihoods. They have to travel daily to the capital to do odd jobs as motorbike taxi drivers, in construction or scavenge for bottles and cans to sell to buy food.

Many of them are even too poor to afford a latrine and have to use a nearby rice field as toilet, said 37-year-old Mom Somaly, a mother of five children.

Pointing to a distant land-for-sale sign, she said “soon they may not even have a field to use as toilet any longer.”

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War reporter Jon Swain pays tribute to Dith Pran

Jon Swain was about to be shot by the Khmer Rouge when Dith Pran intervened. The Sunday Times war reporter pays tribute to the courage of his friend, who died last week

Four years after his enslavement by the Khmer Rouge, an intrepid Cambodian stumbled out of the thickly wooded jungle to freedom. His legs were wobbly. He was weak with malaria. His front teeth were broken. His face was gaunt. He was incredibly thin – but he still retained his lopsided grin.

That grin was still in place – although fading – in the weeks before Dith Pran died last Sunday in a hospital in America, his adopted home, from pancreatic cancer. He was 65. Although wan and thin, he moved on gracefully, loved and mourned by all whose lives he had touched. “This is my path and I must go where it takes me,” he said shortly before the end.

Pran’s harrowing personal tale of enslavement and escape from the Khmer Rouge in 1979 had eventually become the subject of the Oscar-winning film The Killing Fields, directed by Roland Joffé, which focused global attention on one of history’s worst genocides.

Pran was justly famous. Were it not for this former tourist guide to the fabled Angkor temples, who later became interpreter and assistant to Sydney Schanberg, a reporter for The New York Times, in Cambodia, the world’s eyes would probably not have been opened to the monstrous atrocities committed by the Khmer Rouge in his native land. In its rush to forge a new society, 2m people died in executions or from starvation, disease and overwork – nearly a third of the population.

However, Pran did more. After his escape he moved to America, where he worked as a photographer for The New York Times and spent the rest of his life speaking out about what his countrymen had been through. He also pushed for war crimes trials for the Khmer Rouge leaders – trials that are finally due to begin this year in Phnom Penh, the Cambodian capital. Pran, alas, will never see them.

“I am a one-person crusade,” he once said. “I must speak for those who did not survive and those who still suffer.”

I owe this honourable Cambodian a debt of gratitude that I can never erase. He saved my life when I was captured by the Khmer Rouge.

At the time the Cambodian war was a sideshow to the war raging next door in Vietnam and some aspects of it seemed comic. Before sallying forth every morning into the countryside to witness the fighting, we reporters would meet at the Groaning Table – an open-air cafe – for a military briefing from a charming colonel called Am Rong, whose unfortunate name was a butt of endless jokes. His military communiqués, I remember, were invariably nonsense.

The seductive wartime capital, with its brothels and opium parlours, encouraged all kinds of indiscretions and we conducted our lives as though we were characters in a Graham Greene novel; or we liked to imagine that we did.

However, the war was deadly serious. So we also took insane risks and witnessed and reported on some of the most appalling human suffering that I have seen.

In the process more than 20 of the tiny foreign press corps of about 60 were killed in a matter of months by the Khmer Rouge, who never took prisoners. And many more Cambodian journalists also died.

We loved the Cambodians, who had a disarming insouciance in the face of danger. The difference between us and the band of local journalists we hired to interpret the language, politics and culture was that they were seeing and reporting on their own country being destroyed. We, on the other hand, were reporting from the privileged position of visitors who could always bail out. For them, there could be nowhere else to go: they and their loved ones were trapped by the war and their survival was dependent on the outcome.

It was Pran who was the unacknowledged dean of this Cambodian press corps, not because of the status that his job with the venerable New York Times gave him, but because he was so unusually acute and resourceful and had unassailable integrity.

The horrors of the war had made morality a luxury that many of his fellow countrymen had long since discarded. Yet, unlike so many of the politicians and generals for whom survival and money were the ultimate objectives, Pran remained faithful to his principles. He believed passionately that the story of the destruction of his beautiful homeland needed to be told. And to that end he risked his life time after time.

I first met Pran in 1972. Although his loyalty was always to Schanberg, he was ready to give help and advice to me and all the other journalists. Never more so than on April 17, 1975 – the day of the fall of Phnom Penh.

On that same day Schanberg, Al Rockoff, an American photographer, and I were captured by the Khmer Rouge.

A squad of teenage soldiers with hate-filled eyes forced us into a captured armoured personnel carrier (APC). Pran, realising we were going to be executed, selflessly argued to be allowed to join us inside, knowing full well that without his communication skills we were doomed.

It is this story that is told in The Killing Fields. And it was Dith Pran himself, by the way, who coined the phrase “killing fields” after seeing the grim piles of corpses and skeletal remains on his desperate trek to freedom.

That was in the future. Back when Pran volunteered himself as a prisoner, there seemed little hope of escape for any of us. First we were taken to the banks of the Mekong river; then the rear door of the APC opened and a pair of Khmer Rouge soldiers, pointing rifles, beckoned us out. We knew they were going to shoot us.

Pran got out first and began to talk softly and firmly, as he always did. He told the Khmer Rouge that we were neutral journalists who had come to report on their historic “liberation”; and, after a while, our would-be killers began to calm down. The tension suddenly evaporated and we were freed.

A few days later we tried to doctor one of my two British passports for Pran so that he could be evacuated with us to Thailand as a foreigner – but we failed.

The Khmer Rouge forced him to go into the countryside – by now becoming a giant labour camp – where he somehow survived torture, starvation and a life of unremitting hard toil.

When he emerged four years later, 50 members of his family had perished. Mercifully, Schanberg had evacuated Pran’s wife, Ser Moeun, and his four beloved children before Phnom Penh fell and they were safely in America.

The first I knew of his freedom was when I received a telegram from Schanberg, who had been tortured by guilt about Pran’s disappearance and had led his own one-man crusade to trace his helper and friend.

The telegram included a personal message from Pran, patterned on a Cambodian proverb: “Hi Jon. The world is round. Now I meet you again. Pran was in bad shape, but the life is remained. Love Pran.”

I still have it. In subsequent years I saw him several times back in Cambodia.

It is a place that takes over the soul, and those who have known it at its worst are irresistibly drawn back. We revisited old spots – including, once, the place on the riverbank where, blinking in the sunlight, we had stood facing the rifles of the Khmer Rouge peasant boys, waiting for the volley of shots that would kill us.

The slight man I had known had put on weight; he had adopted American food and habits and had a New Jersey twang. Beneath all that he was still the same Pran: warm and attentive, with that peculiarly Cambodian joie de vivre and a mischievous sense of humour.

His business card announced simply: “Dith Pran – photographer”. On the other side, however, it listed information about how the Khmer Rouge had ruined his beloved homeland.

Using his survival as a tool against injustice and genocide, he became a good-will ambassador for the United Nations High Commissioner for Refugees, founded a holocaust awareness project and compiled a book of children’s accounts of growing up under the Khmer Rouge.

It is given to few journalists to make a real difference to people’s lives. Once safe in America, Pran could have retreated into the background. Countless Cambodians did. But he saw it as his duty to stop the memory of what had happened to his country fading away. That and his courage and loyalty are what made Pran magnificent.

Latterly, friends said, he had become disappointed with the way Cambodia was becoming rotten again with corruption and cruelty. His marriage to Ser Moeun had broken up and another marriage had failed.

Despite personal setbacks, he bore his public role gracefully. Right to the end he always thought there was more that he could do, according to Schanberg, who spent many days attending to his dying friend.

“Pran was a true reporter – a fighter for the truth and for his people,” Schanberg said. “When the cancer struck, he fought for his life again. And he did it with the same Buddhist calm and courage and positive spirit that made [him] so special.”

Having been diagnosed with pancreatic cancer too late for much hope of survival, Pran urged others to undergo early testing. “I want to save lives, including my own,” he said.

He had triumphed over the Khmer Rouge and outlived their leader, Pol Pot, who had turned Cambodia into a madhouse. But Pran knew deep down that the battle against cancer was one he could not win.

“Cambodians believe we just rent this body,” he said not long before he died. “It is just a house for the spirit; and if the house is full of termites, it is time to leave.”

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