Islanders of Koh Rong have difficulty reaching proper medical treatment on the mainland.

The nearly 1,400 residents of Koh Rong lack clean water, proper sewage and access to health services. Impoverished residents of the island, which sits 40 kilometers from the coast of Sihanoukville, relay on herbs and traditional medicine, as few people are able to cross the mainland for modern medicine.

“Rich people can afford treatment at a clinic or hospital on the mainland,” said Kou Kao, 52, a resident of Prek Svay, one of the island’s four villages. “But for those who live hand-to-mouth, when they fall sick, they only expect one thing: death.”

Boat rental to leave the island can cost between $50 and $100, he said, far beyond the means of most of the islanders, who fish and farm for a living.

Koe Som, deputy chief of Prek Svay, said malaria frequently spreads in the dry season, killing several people each year.

“A lot of people have died,” he said. “They are always late to find a boat to the mainland. Some die in the middle of the sea. Some die when they get close to the referral hospital of [Sihanoukville], because they are gravely ill from here.”

Koh Rong Commune Chief Duch Sokhom said malaria was the main problem. Some people sleep without a mosquito net. Many islanders still pray to the spirit Yeay Mao, believed to protect forests and oceans, instead of seeking medical attention.

Another problem, he said, is the water: red and odorous, it fills the wells. Islanders drink the water unboiled, making themselves ill.

A plan by the Ministry of Health, which constructed a two-room clinic and provided two healthcare workers, is failing, residents said.

“We lack almost everything, small things, such as pins, bulbs, medicine, electricity,” said one nurse, who was once forced to borrow a neighbor’s battery to power lights while assisting a childbirth.

Se Chous Sothychouth, deputy director of Sihanoukville’s health department, said he understood the problem, but added that the clinic had only been open two months and was improving. The island’s population is too far below the ministry standard of 5,000 for a larger center, he said.

Meanwhile, the Reproductive Health Association of Cambodia is cooperating to provide outreach to the islanders, helping pregnant women and raising awareness of diseases like polio, HIV and AIDS, malaria and dengue fever.

The organization rents a boat every three months, for $150 to $250, to bring medical teams to the island, but such trips have been completely shut down for the past six months, thanks to poor weather and rough seas, said Meas Chanty a program officer.

“We can’t go there,” he said. “There have been big waves and storms. It’s dangerous. We understand the problem of the patients, but doctors have to care for their own safety first.”