What does a Quebec doctor on Park Avenue have in common with a Cambodian doctor on Angkor Street? Apart from their profession, both speak and practice in French. A question then arises: How is it that, over 70 years after the independence of Cambodia, French is still used in the Cambodian medical field? Where does this relationship come from? How long will the language survive? Within the limits of this article, these questions will be answered in three steps: First, I will look at the history of Franco-Khmer cooperation in the field of medicine. Next, I will explore the decrease in the use of French. Ultimately I will demonstrate that French will remain the dominant language in the Cambodian medical field in the future.
The Khmer dynasties, which appeared around 600 BCE, used local and indigenous medicines upon settling in Angkor. However, the generational transmission of medical knowledge and practices in the national context, as well as the construction of a specific Cambodian medical profession, were strongly disrupted by the successive changes and often brutal ruptures of political regimes. Each time, these regimes prompted new social projects and power structures that shaped different health systems, public health ideologies, and a medical profession that was constantly challenged and forced to adapt to new conditions.
The protectorate with Cambodia was signed on August 11, 1863. It was the result of King Norodom I’s call for Napoleon III’s help, threatened by his neighbors, Vietnam and Thailand. Thus, modern Cambodian medicine was born from the arrival of the French, who established their Western practices on Cambodian territory. The main goal of France’s involvement was not to drastically ameliorate the public health system. However, they played a substantial role in laying down the foundation of Western medicine in the country, establishing the first hospital, L’Hospital Mixte, and creating a training program for native medical attendants in 1905.
Cambodia regained full independence on November 9, 1953, under the reign of Norodom Sihanouk. His “socialist monarchy” lasted seventeen years and was overthrown in 1970 by a pro-American regime that forced the country into war until 1975. The communist group Khmers Rouges emerged victorious, imposing a totalitarian order that intended to wipe out the past. From 1975-79, nearly two million people were killed and a terrible famine set in. The populations targeted were mainly intellectuals and members of the government. The country witnessed stigmatization of the French language, with users being punished with death. Due to this genocide, French people and intellectuals fled, causing the public health system to crumble. This is also the direct cause of the decrease in the use of French in the daily lives of Cambodians.
The medical education system had to be entirely reconstructed after the Khmers Rouges, and this effort was hampered by another decade of political instability. France invested heavily in the development of Université des sciences de la santé du Cambodge (Phnom Penh University of Health Sciences [UHS]), the oldest and most prestigious of the two medical schools in Phnom Penh, the capital of Cambodia.
Thus, the relationship between Cambodia and France has considerably changed over the years. It is only reasonable to wonder if we can envision cooperation between the two countries in the future.
Up until the 1950s, French was the language of instruction in Cambodia, but today, the use of French has drastically dropped among young people. Out of all Asian Francophone nations, Cambodia is where French has declined the most. In 2014, French was spoken by 423,000 people as a foreign language, which is 3% of the country’s population. According to the 2008 census, only 873 use French as their mother tongue.
Under the French protectorate, Cambodia had to request authorization from France to engage in partnerships with other countries. Because of its independence, Cambodia can now partner with anyone in the field of medicine. Even though France remains its first partner in Europe, new partnerships are emerging in the healthcare field. For example, the United Nations Office for Project Services (UNOPS) supports the government of Cambodia by providing procurement, infrastructure, grant management, and advisory services in the health sector. Another example is the U.S.-Cambodian relationship. Over the last 30 years, the United States has provided $3 billion in foreign assistance for health in fields such as, but not limited to, health security, education, and food security. Thus, it is important to acknowledge that local dynamics have changed significantly.
Finally, the multiplicity of actors marks the Cambodian medical environment through linguistic pluralism. With doctors being trained in French, patients speaking mostly only Khmer, and English being popular in research, interventions, and exchanges, the three languages are widely used by health professionals. However, English is increasingly being employed and favored by aspiring Khmer doctors, particularly because of the decreasing number of places available for Khmer students for exchange in France. The medical program of the International University of Phnom Penh, founded in 2002, is completely conducted in English and is becoming increasingly popular among students. Thus, French is seeing its place threatened by two other languages, and many are questioning its future in the medical field.
Despite some upheavals, French remains a used and strategic language, even though it is mostly spoken in Phnom Penh. For a medical student in Cambodia, learning French not only means accessing educational resources but also securing a training post in France to specialize. According to LePetitJournal, since 1996, more than 900 Cambodian medical and pharmacy students have gone to France to perfect their training in various medical specialties. Out of the 44 countries that France receives international students from, Cambodia is the 4th largest provider. Moreover, French remains the main language spoken in local hospitals. Therefore, doctors who train in French-speaking universities have more professional opportunities than their English-speaking colleagues.
Furthermore, by preserving the academic relations with France, Cambodia has access to many French medical resources that play an important role in the development of this sector in Cambodia. According to research published in the magazine CEOReview, in the context of a global health crisis, France has the 7th most efficient care system. This country is one of the world’s leaders in insurance and guarantees. Maintaining good relations and exchanges with France is therefore strategic for the development of Cambodia’s healthcare system. On the French side, a close relationship with a South Asian country ensures a foothold for French influence. We can truly consider it as bilateral cooperation.
In addition to the plentiful funding and opportunities offered to Cambodian students, cooperation is maintained by the physical presence of French health services in Cambodia, making France a more credible influence. The Institut Pasteur is a famous figure of this involvement. Created in 1953 and rebuilt in 1995, the Institut Pasteur du Cambodge (IPC) specializes in high-level research and training on containing infectious diseases in South East Asia. The institute actively employs 220 permanent Cambodian temporary and permanent staff, expatriates, and Cambodian and international students. In addition to research and medical analysis, it fulfills the mission of health monitoring and public health, especially in the transmission and control of diseases such as Dengue Fever or Tuberculosis. Thus, the presence of an organization like the IPC creates a virtuous circle among young Khmer-speaking people who aspire to study medicine since the benefits of this cooperation are presented to them on a local and concrete scale, allowing them to access opportunities linked to the French language.
To conclude, the French language has always occupied an important place in the implementation and management of an efficient health system in Cambodia. Although this relationship was torn apart with the arrival of the Khmers Rouges, it is still present today due to the benefits of bilateral cooperation. This cooperation is based on funding, academic exchanges, and deep involvement in the Khmer culture and society. Despite constant changes in the dynamics of Cambodian cooperation, the arrival of new actors and new languages, and the lack of interest from the youth, French still has a central place in Cambodian medicine that does not seem likely to disappear. French is still a very common language among the Cambodian elite, guaranteeing the transmission of the language even if it were to disappear from the medical world.
Edited by Malia Yee
