To live and die in South East Asia

Death and taxes are the only things certain in life so they reckon. Well death anyway: some people never pay taxes. Where you choose to live invariably impacts on where you’re likely to die and, in some cases, how. Some expats choose to live in Southeast Asia and some die there too. Expats who choose to live in Southeast Asia can be misfits, mercenaries, missionaries or parts thereof. I mean missionary in a broader sense. Not merely proselytisers, like Mormons on bikes in Phnom Penh, but educationalists, or those who may be working in skills development or community empowerment.

But for sure it’s a region with a reputation for more than a few expats dying before their time. There can be a variety of reasons for this. Things in Southeast Asia will kill you much faster than at home, sometimes rather innocuous things.

Big Doug was a Kiwi who’d lived in Cambodia for years, right from after the civil war back in the nineties. He used to run the Rebel Guesthouse in Koh Kong City. I’ve stayed there. His business card featured Harley Davidson and the Marlboro Man, a fitting moniker as it’s a bit like the Wild West. He was diabetic, a big man morbidly obese. One day a young kid on a motorbike clipped Doug’s shin with his foot peg, cutting him to the bone. The kid’s family stumped up with some compensation by way of a cash payment. The cops brokered the deal for a fee, a perk of the job. Doug’s wound festered. He made regular trips to Thailand for medical care. The dressings were always clean but the tropical heat took its toll. When I revisited Cambodia I was told Doug was dead, blood poisoning. His wound had never healed.

One day I was sat next to a South African nurse on a bus to Battambang. We spoke about the curtailed longevity of many expats living in Southeast Asia. As we headed across the sunbaked plains of north western Cambodia, I think we concluded that expats make a decision subconsciously or otherwise, to trade the lifestyle here for a shorter time on the planet. The onset of morbidities perfectly treatable back home might mean a serious reduction of quality of life here, even death. But that trading a potentially shorter life in one of the most wonderful parts of the world was infinitely preferable to living longer in a country you no longer enjoy, like back home. It was a trade-off you were prepared to accept, and many do.

A mate of mine who lives in Thailand said that he agrees one hundred percent with this. He’s lived in the City of Angels for ages and reckons that living in Bangkok takes at least 10 years off of your life. He’d come across a recent post on a blog written by an expat. The post went something like this. Since the writer moved to Thailand in 2002, he’d been lucky enough to enjoy the company of a few expats, some retired, some working for coin or volunteering. But with a recent passing, he’d realised that every one of those friends were now dead. Suicide, cancer, motorbike accidents, one cause went unspecified, and diabetes. He was shocked that none of these people were older than 65 years, and several were in their 30’s. In addition, two more friends ‘went mad’ and two more were now alcoholics.

My mate, a keen observer of life in Thailand and not just of expats, told me that Thailand does have a reputation for the early deaths of foreigners. Mainly these are in motor accidents. Thinking on he said he’d known a journalist who got run over by a truck, a friend who got wiped out on his motorbike, and others who expired relatively young with various ailments. Only last month a colleague’s 11-year-old daughter fell to her death from the 20th floor of a condo.

There’s even a website rather morbidly dedicated to documenting the deaths of foreigners in Thailand. Suicides are common. Usually these are expat males caught up in some sordid financial wrangle with a local woman or more to the point, with her family. There’s a few expats been burned that way, some losing their life savings. The “lucky” ones may be able to re-enter the workforce and put some more money away before it’s too late. Some can wind up living on the streets in places like Pattaya. Others throw themselves from high rises, or drive headlong into a rubbish truck at high speed.

Many expats in places like Cambodia or Thailand adopt unhealthy lifestyles. There’s alcohol, poor diet and a lack of exercise. Often they don’t fill in their time constructively. It’s not uncommon to see sexpats and potential deadpats in bars before lunchtime, usually in the company of farm girls driven to cities by the lack of opportunities in rural areas. Of Cambodia with its long tropical nights, one long time expat, a Swiss paediatrician said, “you either become a readaholic or an alcoholic.”

There are motorbikes and drownings. You’d be amazed at the numbers of tourists and some expats who decide to jump into a pool and can’t swim. Of the former it seems a particular trait of late of Arabs and Russians. Then there are traffic fatalities. Southeast Asians die on the roads in their thousands every year, some foreigners too. Usually these are motorbikes but more usually scooters, the cheapest most accessible form of motorised transport. Drivers are reckless and if involved in an accident invariably flee the scene. This includes bus and train drivers, and even a couple of airline pilots on Koh Samui, except that they couldn’t fit out the cockpit windows.

The South African nurse mentioned earlier was in Cambodia researching her PhD on human trafficking. She told me of the wonders of East Africa. She had left years before and now worked as a charge nurse at a major Singapore hospital. She didn’t especially rate the standard of healthcare in Singapore. Places like Singapore are where those with money in places like Cambodia go to for medical treatment unobtainable at home.

There are limited pathology services in Cambodia for example. An expat doctor living in Phnom Penh told me the so-called laboratories are just fronts where the rich stash their cash. He told me of an Irishman who, against his medical advice, had a mole tested at such a place with fatal consequences. He’d been given a phoney report. By the time he got back to the doctor it was too late.

Pharmacies in Cambodia can be two-a-penny. Often they are clustered together. Self-medication is the rule. Cambodians tend to value volume, colour and variety as this is equated with efficacy. It’s the placebo effect for the impoverished. There’s no such thing as a controlled substance, which can lead to all sorts of related issues. Generally, use-by dates are irrelevant. Morphine and heroin are widely available and cheap.

Death by misadventure is a common occurrence in Cambodia. According to Khmer440, at least 95 expats have died in Cambodia in the first nine and a half months of 2015. Some are murdered. Some die as a result of overdoses. Some die in crashes that wouldn’t kill them in the west. Some commit suicide and many of the causes of death are never discovered, a result of local official incompetence and indifference. Many of the victims have perhaps burned their bridges back home and get into a tight spot with seemingly no way out, like the Finnish owner of Suomi Guesthouse on Street 172, found dead in his room with rent arrears. Others suffer horrific deaths, like the poor unidentified soul murdered and stuffed into a suitcase found floating in the river near Kep recently, his head poking out and his tattoo sliced off to render him anonymous.

Backpackers buy cheap heroin thinking it is cocaine with often fatal consequences. Bodies can go undiscovered in hotels for several days, making a grisly find for staff. They ride bikes drunk with little protection, and have no road sense in a country with little formal road sense. Bodies sometimes turn up in Tonle Sap, hands bound with wire their throats cut. One sexpat TEFLer with a reputation for not paying taxi girls was discovered dumped in a drain.

Don’t have a crash on Cambodian roads. Getting into a traffic accident anywhere is serious, but in Cambodia it’s particularly so. Get insurance and be prepared. An ambulance, if there is one, may refuse seriously injured patients for fear that death may prohibit paying the bill. Healthcare is rudimentary. The best hospitals are all in Phnom Penh, but even those are poor by international standards with low quality care and low paid staff trying to get by by inflating your bill.

Expat hospitals like SOS International exist across the region offering services at exorbitant rates no actual person can afford. One Australian I met was treated at one in Vietnam. Stricken with a condition in Nha Trang, he spent days in a public hospital room with a pregnant Vietnamese woman. He was so ill she had to help him to the toilet and he relied on her family cooking him food. In the end a Soviet-era ambulance drove him to Saigon where he woke in the SOS facility. The head doctor, a Dane, came in the next morning smoking a cigar. He asked which he wanted first, the good or the bad news. He was told the good news was they knew what was wrong with him, he had dengue fever. The bad news was the hospital charged US$1200 a night. “How many nights can you afford?” The Aussie replied “just one, this one,” So they moved him down the road to a guesthouse, where they treated him as an outpatient.

Rural Cambodia has health centres, basic primary care facilities usually located in villages. Larger provincial centres have referral hospitals, a mixed bag. It’s common in Cambodian hospitals for staff to double dip with “dual practice”, working in private facilities while still being paid to be at work at a public facility. Wages are low, facilities Spartan. Rich Cambodians go offshore, the poor make do. I’ve seen women post-caesarean lying on a bare bamboo slat frame in tropical heat. There’s no pillow or bed linen, and no food unless their family provides.

I once saw a dead man, a local, on a footpath in Phnom Penh. People gathered around and stared. I’m unsure how long he lay there before being collected to who knows where. An Irishman told me about an American who fell to his death from an apartment building. His body was in the street all morning because no one knew who he was or who to call. Eventually someone called the embassy.

A Frenchman killed himself, and his Khmer wife was understandably distraught. The Frenchman was a heroin addict and dealer. The police were closing in, and he hadn’t the money to buy them off, or to leave the country, besides there was his young family to consider. Another expat took his wife to inform the French Embassy. Security wouldn’t let her in. In the end security called her mother-in-law in France, told her bluntly here son was dead and hung-up.

As someone wrote, if you are living in Cambodia and if you’re unmarried or not in a relationship (or even if you are) it is probably best to have a friend or two – people you can rely on – to organise your affairs if required.

Choosing to live in one of the most fascinating parts of the world has many benefits, and can be rewarding for all kinds of reasons. An English writer living in Chiang Rai explained Southeast Asia to me as follow; “a paradox: what is good for the soul is bad for the bank account (usually) and vice versa.” He went on to say that it’s not easy doing both because the system is set up so that people either have too much time, and too little money, or too much money with no time to enjoy it.

But after several years living in Asia expats often find returning home an impossible option, even if they may think they want to. They’re just too used to the lifestyle in their adopted land. As John Le Carre once said ‘Nothing ever bridged the gap between the man who went, and the man who stayed behind’.

There may be no money either and western life is expensive. Your beautiful Khmer wife may not like it, and be lonely. They’ll also have to consider those links and networks left behind. Those friends and family who stayed will have “moved on”. Ultimately, they’ll be a certain disconnect. What once was will never be again.

By choosing to live out your days here you make certain choices about where you’ll finally wind up exiting. You should make sure you’re comfortable with your choice. Think it through, shoot it down to the bone.

This is a slightly updated version of an article that first appeared on www.michaelbatson.co.nz. Many thanks to the author for permission to reproduce it here.