By any standards Cambodia's healthcare
system is in a pretty dismal state. Reliable figures
estimate that there is one doctor per 1,700 people.
But one hospital stands out from the rest.
The Sihanouk Hospital Centre for Hope in the capital
Phnom Penh is funded by foreign donations, staffed by a
mixture of local and international medics and, unlike other
Cambodian hospitals, it offers free treatment.
But the centre has become a victim of its own success,
with demand now far outstripping capacity.
So the patients themselves have come up with a novel
system to decide who gets an appointment with the doctor - a
daily lottery.
At just seven o'clock in the morning, a crowd had already
gathered in the car park of the Sihanouk Hospital.
Some people had been waiting all night, their cooking
pots and mats piled up under a shelter near the gate.
Charb Sorn, a woman with closely cropped grey hair and a
pained expression, was one of them. She looked a lot older
than her 48 years.
"I travelled 40km (25 miles) from my village because I
heard you could get free treatment here. I don't have money
to pay at other hospitals. I have had problems with my chest
for a while now. I have a lot of children waiting for me at
home, so I hope I get to see a doctor quickly," she said.
If Charb's condition had been life-threatening, she would
have been seen by a doctor immediately.
But after an initial assessment from the medics, she was
told to rejoin the crowd waiting outside one particular wing
of the hospital.
Large crowds
The Centre for Hope aims to provides high quality, free
treatment to anyone who needs it. Dr Gary Jaques, executive
director of the centre, said word had spread.
"Sixty percent of our patients now come from the
provinces, provinces that are one or two days difficult
drive over bumpy roads," he said.
"Patients have heard about the hospital and they make
their way here, often in desperate circumstances. So it does
create a demand that exceeds our capacity to deliver and
supply. It has caused what you see here today - the crowds."
So who decides which patients will get the treatment they
need? Lady luck, apparently. It was the patients themselves
who came up with the solution.
Those waiting outside in the hospital grounds form
themselves into a big circle, and a hospital official goes
round the circle stamping today's date onto their hands and
then writing a number next to it. The numbers are copied
onto pieces of paper and put into a big cardboard box.
Then the real drama begins.
A hospital official stands in the centre of the circle,
picks up the box and begins to shake it in front of the
expectant crowd - on the day we visited it was several
hundred strong.
Then, one by one, with pantomime-like choruses of "ooos"
and "ahhs", the numbers are drawn.
It may seem arbitrary, but Dr Jaques said the lottery
system was both open and fair.
"We don't ask anything about their income, where they're
from, sex, age, race, religion. All those factors are
removed. There's no opportunity for bias because the lottery
is very impartial in that respect," he said.
Winners and losers
The Centre for Hope has plans to link up with other state
hospitals to provide training and assistance so that
standards elsewhere might be improved.
In the long run, that should reduce the pressure, but for
now the lottery is many people's best hope of affordable
health care.
"This was the first time I tried and I was lucky," said
one of the day's 10 winners we met - 43-year-old Yane.
"I'm so excited and happy. I was so busy at home, I only
came here when my condition got much worse," she said,
clutching a baby to her breast.
Now in the system, Yane will be looked after for as long
as she needed treatment.
But others were not so fortunate. Charb Sorn's number did
not come up. She sat on her haunches, her head in her hands.
"I've lost hope." she told me. "I'll have to try again.
But I only have enough money to stay here for maybe three
more days, then that's it."
As the other unlucky losers drifted away, Charb collected
her rattan mat and prepared to wait for her next chance to
enter the medical lottery.
Maybe tomorrow her luck will change.