K.R. Ordered Medical Care Dispensed by Unqualified Illiterates
On day three of Riel San’s testimony, Judge Lavergne proved again why we need judges. Although he has an avuncular manner, he gets right to the point. And, today, the judge wanted to clear up a miscellany of details that had been lost in the witness’s prior testimony.
The jurist started with asking Riel San to provide his educational background. The witness had completed Grade Three “of the old curriculum.” When he was 13, he passed his middle school examinations, and during vacation, he took a private college course in Phnom Penh. Mr. Riel considers himself “a progressive person.” Prior to the collapse of the Lon Nol government, he had worked as a blacksmith and an apprentice mechanic under the supervision of a trainer. His duties in the latter position were in “economics,” supplying food for the mechanics’ group. After the coup d’état, he joined the revolution. Mr. San’s first revolutionary duties were as a propagandist. He “mobilized the youth to join the literary unit.” While the USA was still bombing, he also was a worker building dams. (Ed. Note: Operation Menu pounded Cambodia from March 18,1969, to May 26, 1970). About 250 workers gathered from the villages and the twelve communes worked on his site. A Chinese delegation did not attend the inauguration of the dam, but he saw the visitors’ vehicles passing the worksite one night. He once went to the Leay Baur cooperative to organize the clinic prior to an inspection by a Chinese group. Riel San identified the chief of the cooperative as Ta Kith (spelling?) who he dismissed as illiterate.
Riel San saw Khieu Samphan near an office in Chumbok when Yeay Khem, Ta Mok’s wife, had asked him to help her deliver cakes to Khieu Samphan. It was Khieu Samphan’s wedding day. Mr. Riel had “barely caught sight of him…and couldn’t see his face very well.”
Mr. Riel was in charge of purchasing medicines when he was Deputy Chief of the District 105 Hospital. He would request money from the chiefs, and then procure the medicines as required.
His brief medical lessons were taken sometime after 1975.The witness reiterated that “Sey,” the chief of the sector hospital was the trainer, and that the training days amounted to only two weeks over three months for the first session, and two weeks over six months for the second. Summarily, as Riel San had had no medical education at all before his appointment as Deputy Chief, his total medical training amounted to one month. However, he had learned how to give his parents injections when he was a youth. The witness was aware that Sey was a former nurse in a military hospital who had fled before the 1975 coup to the forest with Khieu Samphan, and then joined him in his activities. Afterwards, Sey was made head of the sector hospital. Sey’s wife took over his duties while he went to study in Phnom Penh until she ran into difficulties and disappeared. When Sey returned from Phnom Penh, he worked in the Takeo provincial town without a specific position. The witness did not know if Sey had been at the 17th April Hospital in Phnom Penh.
The military hospital was in Tram Kok, but the witness did not know whether it was under the jurisdiction of the sector or the zone. Only military could be admitted. No representatives of Hospital 22 attended District meetings. The Sector 13 hospital for the Tram Kok District (to which serious patients from the district hospitals could be referred) was at Chumbok School. The difference between the district and sector hospitals was in the gravity of the patients’ condition. There was no discrimination between “base people” and “17th April people.” Members from both classifications were referred to the sector hospital. The personnel at the sector hospital were better trained and had more effective treatment methods than the district hospitals. Example: There were no surgeries at all at the district level but a few were performed at the sector institution. Only Sey had had any in- depth medical training acquired before the revolution.
“Sen” was head of the hospital in Trapeang Ronep, Tram Kok district. There were usually five to seven medics in each commune. The one that was “more skillful in medicine” would be appointed in charge of the group under the umbrella of the commune chief. Riel San supervised all 12 commune hospitals in the Tram Kok District. Part of his duties was to visit them, distributing medicines and assessing the condition of in-patients. If he found them to be in “severe” difficulties, he would request that they be sent to the district hospital. Like all hospitals, some died at the commune facilities. They would get sick on the worksites, and sometimes be seriously ill by the time they got to the commune hospital.
The unit and village chiefs would visually assess whether someone should be hospitalized. They had the authority to refer the sick to the commune hospitals. Sometimes the patients were in such bad condition that they had to be carried. The commune hospitals had the discretion to refer patients to the district hospital. If the case was above the capabilities of the district hospital, the patient would go to the sector facility. Riel San had sent ten patients with severe dysentery to Chambok Hospital. Less frequently, patients had been transferred to the Khmer-Soviet Hospital in Phnom Penh under the authority of the chief at the sector hospital. “Old people” and “new people,” men and women—all went to Phnom Penh. Mr. Riel did not know what the level of care was in the city medical institution. He delivered the patients into the care of the Phnom Penh hospital staff (who were not from Tram Kok), along with their medical files. Once a month, Mr. Riel would get hospital reports (on the admission and release of patients), from the communes, and then he, in turn, would report to the sector hospital. He had no idea if the information went to “the upper echelon” after that.
Action plans that Riel San received dealt with the production of traditional medicines and were not political in nature. The female directors (his supervisors), were in charge of general matters including political training, but he was part of the overall management team along with the chief. Caesarean sections were not done at the district hospital but rather by a specialist at the sector hospital. Riel San and his staff had expertise in delivering babies.
The district hospital chief rotated with some of her staff to handle disciplinary problems. For example, Mate would alternate with Han. Mr. Riel elaborated that they really did not have any serious problems. The Chief instructed the staff “to adhere to high morals,” and the staff respected discipline well so no measures had to be taken.
The District Secretary made decisions on marriages, but staff anticipated the issue so matched themselves to people they knew before the orders came from on high. Thus, no one at the hospital was forced to marry someone they did not want.
Riel San stood by his OCIJ interview statement that “educated intellectuals could have betrayed Angkar because they could think.” He opined that Angkar had favoured women from “the poor peasant class.” Personnel were chosen by the District Chief. The hospital would receive a letter instructing them to take in a female staff and provide her with training. Some of these women were as young as 13. The majority did not want to study because they were illiterate. The youngest staff would not give injections, but would clean needles and syringes; the mature staff would do injections, often consulting with Mr. Riel beforehand. As they had not much experience, they would sometimes cause a reaction by pushing the liquid into a vein too early or too quickly, but he could not recollect any patients dying because of this.
The District Secretary had instructed Riel San to recruit older people from the social affairs section of the villages and communes to work with him to make traditional remedies out of tree bark and leaves. In particular, Ta Poon (spelling?) skillfully applied the art to certain diseases but then he died. A nurse by the name of Tan who also allegedly produced elixirs did not “ring any bells” with the witness. Mr. San presumed the “human gallbladder tree” used in the traditional tinctures was the basis of stories of real human gallbladders put to this use. His personnel were “only good at making serums and liquids” to mix with such as B11, B12 and calcium. There “was a daily shortage of modern medicines. When a supply came in, it would run out in a few days.” Some pharmaceuticals came from China but most were from cadre sources. (No one could read the Chinese dosage labels but Mr. Riel could decipher the necessary parts of the French ones found on fluid bottles and ampoules). In any event, the meds would only be for treatment of a few specific diseases. When a patient’s condition became serious and they had no medicine, they would refer the patient to the sector hospital which had more medicine. There was no discrimination in who would get necessary medication if they had it.
Riel San remembered the instance when raised to him of a patient that had died immediately after receiving an injection from a nurse. He exculpated her on the basis that the patient had brought the ‘medicine’ in and asked her to inject him. Its deadly qualities were confirmed when the rat and dog on which it was tested also promptly expired. Mr. Riel posited that “the man wanted to die, like everyone else.”
Judge Lavernge reviewed Riel San’s visit to Kraing Ta Chan but there was little more materially that he could add. “Fearful,” he had taken just a quick “glance” at the prisoners without even going in the building, so did not know how many there were. The hospital team had been instructed to spray the bushes with DDT. He was not asked to bring any medicines or alcohol with which to treat the prisoners. Mr. Riel did recall seeing loudspeakers hanging from a tree, but there was no music playing during the half-hour the men were there.
Riel San knows Don who used to be in the District Office and is now Deputy Chief of the Royal Gendarmerie in Battambang province which is part of the village police. The witness did not know if Don was ever sent to Kraing Ta Chan. He could not bring to mind Ieng Voot (spelling?) although the judge remarked that he had made a long statement about this person. Nor did the witness remember Yeap Duch or recognize the person in a still from a video documentary he was shown.
Mr. Riel said his five children were still young when he lived in Tram Kok so did not hold any official positions. He denied that his son had ever been head of the Tram Kok Youth. But he had strong ties to the regime nonetheless: His only daughter had lived with Ta Mok from age 15 to 30. She returned illiterate. She is now married and has given the witness three grandchildren. Further, Mr. Riel has a nephew, Sim Han, who was a commander of a regiment under Ta Mok.
Victor Koppe, Nuon Chea Defence Counsel, started his cross-examination with demographics but the witness was not much help. Mr. Riel did not know the population of District 105 in 1975 or 1979, although “perhaps” it was the 80,000 that counsel estimated. The witness defined the mortality rate correctly as referring to the number of people who have died, but he did not know what it was in Tram Kok in 1975 or whether it would have been three per 100,000 in 1979, as Mr. Koppe suggested. Explaining that he “did not think of death of people,” Mr. Riel was not cognizant of whether the rate was more or less before 1975 than after. Before 1975, he was not aware of dysentery. He did not know how many died of the disease after either 1975 or 1979. The President interjected that the witness did not have to answer any more of this line of questions, that, notwithstanding Mr. Koppe’s protestations to the contrary, they were repetitive.
Riel San felt that the level of medical skill after 1975 was similar to that before1975, although he was unable to comment on what sort of training the doctors and nurses at the sector hospitals had been given. From medical manuals, he had gleaned that medics used the same treatments but “with a differential between levels of treatment.” eg. Aspirin was prescribed for aches in both time frames. There was not as much difference in treatment levels between the rich and poor pre-1975 as one would expect as the poor did not have to pay for their care.The village chief would write a letter to certify the person’s poverty, and there would be no bill. The rich paid. But, Mr. Riel used very few traditional meds before 1975 because modern medicines were available from pharmacies then.
Mr. Riel attributed the five deaths a day from dysentery to malnutrition and too much hard labor. He had observed how his in-patients got swollen bodies and then died. Mr. Koppe tried to testify himself that dysentery was not caused by malnutrition but withdrew it as soon as he had vocalized the comment and as the Co-Prosecutor was getting up. Counsel tried to draw the witness out on his knowledge that the motivation behind Angkar’s plans for irrigation canals would be so the water would be clean. Mr. Riel added that they also dug wells and ponds for the same reason. The relationship between clean water and eradication of dysentery was not lost on Riel San. He related the problems that were caused when people on worksites would relieve themselves near the water and the excrement would make people sick.
When someone died, hospital staff would call relatives to come and pick up the bodies. If they did not, some bodies were cremated and some were buried in a nearby compound about one kilometer from the hospital. The witness did not know where Hospital 22 disposed of their human remains.
Mr. Riel’s hospital had successfully treated malaria patients back to full health. Those they could not help, they sent to the sector hospital. There was no necessity to spray for mosquitoes around the hospital because it was located in a field away from any forest area. Ta An had made a request to the District Secretary to deploy their spraying services at Kraing Ta Chan.The witness found it difficult to gauge the effectiveness of the DDT they had used, but admitted the prisoners would profit from it as well as the staff even though they were not instructed to dose inside the buildings. He knew quite well from his medical education sessions that an infected female mosquito, “and only a female mosquito,” transmitted the malaria by biting.
It “was rather far” to Kraing Ta Chan from the hospital, maybe more than the six kilometers to which Mr. Riel had previously testified. He had never had anyone sent to Krain Ta Chan. He reiterated that, in the latter part of the DK era, his medic Han had been arrested by militia and taken there where Mr. Riel saw her during his spraying trip. He repeated that he did not know when she had been released, but she had come to see him in1979. It was a short visit for her to pick up rice. She did not speak of the security center at that time, but mentioned that she “had been implicated along with Kong.” As Han’s native village was not in Takeo, he knew of no relatives who could say whether she was alive. The witness cleared up that Ta Hanoi (whom he had met at Kraing Ta Chan) was named “Geer” (spelling?) not Dung. He did not recall a “Sat.”
Riel San did not go to a meeting in the forest at which it was announced that soldiers from the Second Lieutenant rank and above, and government officials at deputy chief level and above, where not to be purged. Directions on purging were also promulgated at a commune-level meeting, but the witness could not remember when. Mr. Lysak objected to Mr. Koppe implying the month and year, at which point the opposing counsel conceded and rephrased. Mr. Riel placed it before or during the evacuation of Phnom Penh. He claimed to be the hospital representative at the meeting presided over by Ta Chhim with all the village and commune chiefs in attendance. No one wanted to sit close to the District Committee because they were afraid of them “like a tiger.” They were issued instructions “to monitor evacuees as to whether there were ranking officers or ranking soldiers.” No specific guidance was directed at Mr. Riel personally.
After the break, Mr. Koppe grilled the witness on the apparent inconsistency in his testimony.
Riel San had said he was representing the hospital at the 1975 meeting but he was not appointed
to the post until 1976. Mr. San then admitted to going to two meetings, both chaired by Ta Chhim, one before 1975 and one after. At the time of the first meeting, he attended as part of a contingent of “progressive males and females.” He had no particular authority to do so. Ta Chhim reiterated his speech that the evacuees “were everywhere,” and the Lon Nol officials and military needed to be purged from the lot of them. Mr. Riel was not given specific instructions because he worked at the hospital, and it was the commune and village chiefs that had to implement policy.
Riel San knew people who were targeted were executed because his brother-in-law and uncle had been taken. He pointed out that Ta Chimm had used the word “purged,” not “executed.” Mr. Riel personally had not witnessed any executions of soldiers.
Mr. Riel had not heard the term “re-education” nor comprehended what it meant. He did not know that Kraing Ta Chan’s official name was “Re-education Office 105.” Neither was he aware of a distinction between “minor” and “serious” offences. He could establish that a few offenders had returned from prison (not “re-education”), but most did not. After the evacuation, in every district and village meeting, the cadres spoke about identifying the Vietnamese and the Kampuchea Krom. Riel San does not know for sure what happened to them, but all the targeted families and their belongings disappeared. He had heard nothing about them possibly being expelled to Vietnam.
Riel San had neither access to the Revolutionary Flag magazines or, until recently, a radio. Nor was he familiar with the terms “rightist” and “leftist.” He had learned of the Cultural Revolution in China when he was young, and it had left him less than impressed.
Khieu Samphan Defence Counsel, Kong Sam Onn’s questioning revealed that the Cultural Revolution was not the sort of policy that one could expect to appeal to a vendor who ran a small business out of home, manufacturing and selling medicines even before he became a medic. Later on, the District Committee gave Riel San money to make meds. When money was abolished, he would travel to the border near Vietnam to barter pigs and other animals for the necessary materials such as camphor and B1 to mix up in remedies. Mr. Riel would make the trip twice a year, at the beginning and end of the dry season.
When Riel San was a hospital medic, he would hold a monthly training session for his staff. He would also invite in midwives to teach from their experience in delivering babies. His wife had been a midwife and he had learned from her (and other midwives he had been friendly with in Phnom Penh), and then they both had taken training in deliveries. Riel San was never promoted in his hospital job and was deputy chief until the 1979 liberation.
Mr. Koppe interrupted to request some clarification on the notification he had received a short while previously to expect another 226 statements from Cases 003 and 004. He did not understand whether this figure included the 190 statements for which there recently had been a separate warning. An anguished coda that he “(was) not saying (he) was instantly depressed but maybe (he) was,” was poignant.
Mr. Lysak enlightened the Chamber that the International Co-Investigating Judges have authorized the bulk of the statements to be disclosed now. Only a small number remain. “The good news is that the disclosure is now and not later.” Out of courtesy, the Co-Prosecutor then gave references for several documents and pages concerning Nuon Chea and Khieu Samphan statements that would be of benefit to his colleagues.
On that note, court adjourned.