Dr Nous Sarom: Operation FIRST / Rose Charities Cambodia

Sarah (N.Z.) August 2009

I spent four weeks with Rose Charities in Phnom Penh during August 2009. This was my final elective placement after doing three weeks in ED in Wexford, Ireland and four weeks of ED in Saigon, Vietnam. I am a trainee intern from Wellington School of Medicine, Otago University in New Zealand. Trainee Interns are sixth year students, having passed final exams at the end of fifth year.

I organised my placement nine months before I was due to start, through Will Grut who was extremely helpful and easy to liase with. I contacted Dr Sarom numerous times via a few different email addresses, but because he is very busy I didn't ever get a reply from him. This was not an issue however, there are usually a few students and he knows to expect them regularly.

I arrived at Chea Chumenas Hospital on my first day and it was easy to locate Dr Sarom using a note with his name written on it and plenty of hand gestures! Unfortunately there had been some miscommunication of some sort which meant there were seven elective students for the first two weeks I was there, far too many for a tiny surgical unit. Thankfully Dr Sarom made arrangements for two girls to go to the paediatric department where they did ward rounds and outpatients and I went to the Rose Charities Eye Clinic, based on the other side of the city, over the Tonle Sap River.

I spent two weeks at the eye clinic, doing clinic in the mornings, where locals drop in to be seen by Dr Vra and his wife Natalia who are the Rose opthalmologists. Firstly we would see the patients from the previous day's surgery, then would see around 150 drop-ins over the morning. Any requiring surgery would get it that afternoon usually. The unit was very small, but everyone was very friendly, and the administration man speaks great english and was very helpful. I was able to watch cataract and pterygium removals and even an upper lid plasty . I think it was actually a friend of Natalia's who paid for her surgery. I saw very advanced pathology and learnt a lot of opthalmology during my two weeks. Unfortunately Dr Vra was not at clinic much and I was mostly with Natalia who was lovely, but not at all confident in her English, so tended to just show me the slit lamp and say a few words. Obviously communication with llocals was difficult, but the Khmer people are so sensationally friendly that I had many "conversations", me speaking English and them speaking Khmer, but we seemed to understand each other! I think one week at the eye clinic would be a good amount of time to see and experience great opthalmology.

I spent two days with Impact Charity going on outreach clinic trips to places around Phnom Penh. These were great experiences I would highly recommend (Dr Sarom can hook you up). The Impact team are super friendly and loved having me come along.They thought I was much more expereinced in opthalmology than I was, so was set up with a huge group of petients with eye complaints which I tried to deal with, using a translator. Mainly I just reassured those without pathology and decided whether referral was needed in the others. If you were to go on one of these trips, I would try and organise a bit of equipment, as I only took my stethoscope which had a little torch on it, an opthalmoscope would have been handy! I also helped dispense medications on these trips, which was a fun change. These villages were great spot-the-diagnosis places, with heaps of pathology all around.

I spent the second two weeks with the surgical team at Chea Chumenas Hospital, where the pace was so slow that if it had been any slower, time would have been standing still! The team were very relaxed and fun to be with. The anaesthetist was particularly friendly and helpful. I saw thyroid surgery, hernia repairs and appendicectomies mainly. I didn't scrub into any surgeries, which I was happy with as the surgeons seemed a little irractic with their sharps and all keen to get their hands dirty. The thyroid surgery had four people scrubbed and for most of it there were eight hands in or around the incision, all popping in instruments as they saw fit! Unfortunately for me it was a particularly quiet patch while I was there, often I would arrive in the morning to find no electives booked, no acutes arrived and nothing happening at Dr Sarom's private clinic (which he is happy for students to hang out at when surgeries at Chea Chumenas are finished). Also, Operation First weren't operating while I was there either, so I didn't see any cleft lip/palate repairs which I had been looking forward to, but that's just the luck of the draw. I would definitely recommend finding out when the visiting charity Operation Rainbow are visiting and co-ordinating your visit with them, as I have heard that being with them is fantastic. I talked with Dr Sarom about how quiet it was, and he said it was because there is the Pchum Ben Festival which runs for 15 days in September. For a month beforehand everyone is very busy planning for it, so don't get their operations during this time! So I wouldn't recommend coming during August or September. There is also a water festival in November which is similar according to Dr Sarom, so it may be better not to go then either.

I stayed at Okay Guesthouse which had lovely clean rooms and super friendly staff. I negotiated a great room rate (US$10 a night for a double room with hot shower bathroom and cable tv) because I was staying for four weeks. Phaly was a staff member there and he drove me anywhere I wanted on the back of his motorbike, including to and from the hospital everyday. He was easily contactable by phone (he set me up with a SIM card when I arrived). Having a driver was really useful and I felt very safe and trusted him.

Cambodia is a sensational place to do your elective, but not if you're after an action packed placement. After a busy time in ED in Ireland and Saigon, the pace of Rose was perfect for me though! I met a girl who had a great time doing an Obstetrics elective at the national womens hospital, near Wat Phnom, which she highly recommended. There are great opportunities to travel and lovely places to see in Cambodia too, rich in Ancient and recent history.

So, enjoy your time and make the most of the amazing Khmer culture and people - they are truly incredible! I am happy to be contacted regarding an elective in Cambodia, Will Grut has my email details.

Things can be fast or things can be slow. Be warned !!

Scores of students having visited Cambodia over the years to do electives with Rose Charities and/Operation FIRST have shown that speed of activity can be very variable. At local holiday time, things can be very slow. Sarah (student) wrote of her time that 'if things got much slower they would stop' . It was holiday time (Pchum Ben) . People dont seem to have time to get sick in holidays ! Fortunately though there was the eye clinc which is always busy. (it is invariably so packed that another NGO comes in and bribes patients away to stand outside their own doors, with offerings of free food when they are have potential donor visitors from overseas coming; so that they can impress them. Its a standing joke at the clinic !) . On the other hand, activity can be very fast, as when one of the external teams visit.

It is very important to keep the above in mind. The medicine and surgery also is not highly sophisticated. Almost nowhere in Cambodia is this so. The message is really that an elective with Operation FIRST / Rose Charities is best suited for those who are interested in the 'total experience' of Cambodia, not simply to focus on medical / surgical activity. Medical Schools the world over run surprisingly different systems. Some give multiple elective periods over the whole training period, some one big elective almost as a 'reward' for hard work over the years , some ask for very focused electives. You should think carefully about what you want out of your elective. My personal view is illness and human mechanisms for coping with it are deeply integrated into the social fabric of the population, and so to try to isolate the simple procedures of our discipline and focus only on those gives a very stilted viewpoint. The counter argument however is that exams have to be passed and experience in procedures is needed to pass them. Bottom line is that it is your call, but an elective in Cambodia may well not offer what you want, so please think carefully. It is almost as disappointing for us, as it is for you, if you feel let down.