Rose Charities Students

Uganda experience - a thankyou from Andrea...

2011-12-15T08:06:00.000-08:00

September 20^th, 2011

Dear Dr. Macnab,

I am writing to say thank you for the trip with Brighter Smiles Africa I was selected for through the UBC Global Health Initiative. I am so grateful to have had the experience I did.

I immigrated to Canada in 2006 and one of the biggest reasons I turned to medicine as a career was I wanted to be able to work internationally. I have always dreamed of going to Africa, and I have a particular interest in international medical aid work. I was inspired to apply for Brighter Smiles Africa after hearing what a great training opportunity it was, and I am so happy to report that it was completely aligned with my goals and more than met all my expectations both personally and professionally.

As a student in the Northern Medical program we have an unprecedented chance to experience rural medicine both in Prince George and the outlying communities. It was so nice to see how well the Brighter Smiles program complimented what I had been taught, but it was also great to find how much it added, both on the team’s visit to Hartley Bay, and during project delivery in Uganda. (I was also very happy to have the Hartley Bay experience for my DPAS project on Aboriginal health). I was fascinated to see how the work we did in Ugandan rural communities like Kalisizo was a natural extension of what we did in Hartley Bay. So many of the health concerns and challenges the BC and Ugandan communities face proved similar, and I particularly like the way you have connected the children in the BC and Ugandan schools through your program.

Medicine is truly an international endeavor and I was very pleased to learn so much from the many health professionals you were able to connect us with in Uganda. Also the variety of the medical experience we were able to gain in the different communities we visited (Urban Kampala, Kampala slums, family practice with Dr. Emma, community clinics and hospitals, and outreach), and the inter professional time spent with the Makerere students and professors. I even had the chance to watch a variety of specialists in Kampala; and being called out with you at night to see a child with hydrocephalus was something I will never forget.

However, I really think that most of the experiences I had would have been wasted on me without the effort you put into teaching and guiding us. I am so grateful that I had someone like you to learn from; and it really helped to have you as a guide when I felt overwhelmed. What you taught me about pediatrics and international medicine was invaluable, as was the real world experience you gave us of medical ethics in a developing country. Because of the connections and history that Brighter Smiles Africa already had in Kampala and Kalisizo I was able to step into a fully functioning long-term alliance. Time is so limited for medical students and I think that Brighter Smiles Africa neatly blends the energy of a first-timer to Africa into an established collaboration with a history, local reputation, and track record of sustainability and returning volunteers.

As you know, I am going in to third year now. At the end of second year, I was starting to feel like I would never survive medicine. Being a member of Brighter Smiles gave me a new and much-needed perspective on the role of a doctor in society. I particularly enjoyed what I learned from you about kind, empathic, and integrated patient care. I am doing my full-time rural rotation now in McBride BC and I feel so much better about seeing patients in the clinic than I did prior to the Brighter Smiles Africa trip. The hands-on practical medicine that I learned in Uganda, from you and our Ugandan colleagues has guided and informed my clinical reasoning in McBride. I feel much more comfortable with what I am looking for in a clinical assessment after the opportunity to see so many patients in Africa.

I can't help but thank you as well for the opportunity to realistically assess my future goals in international medicine. Having such a broad and well integrated program really allowed me to see many aspects of global health delivery and western funding at work. I have an understanding now of how western aid is used, and what is effective and efficient and what isn't. It was so neat to see how your link with African Hearts helps them to integrate their service work in the community and support the vulnerable children in their care in culturally appropriate ways. I also enjoyed our chances to collaborate with western aid workers like the Peace Core and Rotary on the trip. Being able to participate in fund-raising for Brighter Smiles Africa in Canada before we went, and then to see the funds at work in Uganda was also a great experience, and I think I will be much more effective as a fund-raiser, and as a donor because of that balanced view.

Of course I must mention the fantastic opportunity we had to experience so many aspects of Ugandan life and culture. I really felt lucky to associate with people from so many different walks of life; from the street kids in the slum to medical students and doctors, rural community members and urban politicians, women and men, children and teens, westernized and traditional. The cultural experience was invaluable, the ideas shared amazing, and I am so grateful for everything I learned.

Some of the medical experience I garnered in Uganda I would never have been able to see in Canada, especially so much exposure to tropical medicine and third world medical concerns. We receive excellent lectures at UBC, and I felt I had the factual knowledge needed about many of the conditions I saw. But I was immensely grateful to have you there to add the clinical perspective to the theory, and underline the social relevance of illness, as we saw malaria, HIV, malnutrition, untreated congestive heart failure and so many other conditions in person.

I must also thank you for all the time, help, and encouragement you gave me over my research project. I had never considered doing research before I signed up with Brighter Smiles. Now I have written a research proposal, written an ethics proposal, applied for funding, conducted clinical research on the ground as part of a team, and am in the process of submitting results! I can't thank you enough for taking the time to teach me about clinical research, the research process, and how to interpret data. For the first time EVER I can see research as an integral part of my future career as a doctor, I never thought I had the skills to do research before this experience.

I think a great strength of Brighter Smiles Africa is that while you engage us full-time, 24/7, the program is flexible and your leadership lenient. Thank you for giving me so much leeway to become involved with social issues that I encountered that particularly interested me. I really felt like I had the best of both worlds in so many senses; full time support and direction, but the invitation to be open, creative, independently explore. Obvious highlights of the program are having so much patient contact with your guidance, seeing real global health issues first hand, participating in a truly international partnership, being constantly reminded of issues of social conscience and debating ethical conduct, and experiencing both the challenges and practical solutions of aid programs in the context of balancing Ugandan and Western culture and values.

I guess we all look for "synergy" when we work together, but as a member of Brighter Smiles and the African Hearts collaboration I really felt like I was part of something bigger, both in my personal growth and in our changing world.

Thank you.

Third Year Medical Student

Northern Medical Program (Southern Medical Program)

Bhavna writes... (May 2011)

2011-05-21T15:10:00.000-07:00

I loved my medical elective at Rose Rehabilitation/Rose eye clinic in Cambodia! I sit in clinics now wondering what I would be doing if I was still out there and reminiscing about this unique experience.

Cambodia as a country is amazing, it is full of the friendliest people I think I’ve ever met; everybody is keen to help you and make you feel welcome. This was no different at Rose Rehabilitation centre in Takhmao. It was a slightly awkward moto journey arriving there from Phnom Penh (capital city) but all the angst quickly disappeared once I saw Joanna, Sophak, Rith and the rest of the team. They were extremely welcoming, friendly and inclusive; even when there were no medical issues for me to be getting on with – Joanna always invited me to visit the rehab patients in the community to take histories, examine them etc and even teach me. She (and the rest of the team) answered my questions; always allowing time for me. It was truly extraordinary to see the healthcare running successfully with limited resources and the variety of patients that Rose Rehabilitation deal with; the immense clinical signs really tested my (limited!) medical knowledge and allowed me to see the aftercare involved in a surgical patient – something I rarely see in hospitals back at home. This was such a great opportunity to really test my clinical skills too and offer some medical tips back to the team.

I have to stress though that this is not always the case for visiting medical students – it just so happened that my visit coincided with Dr. Sarom’s (the head surgeon) visit to Australia and so I was only able to spend about a week with him. I had applied for this elective because I am highly interested in surgery and did get to see some cool cleft palate repairs, plastics and grafts but never got a chance to assist unfortunately as I believe Dr. Sarom was training a Khmer doctor at that time.

It was lucky for me that I have a keen interest in ophthalmology and so I split my time between takhmao (Rose Rehabilitation) and the eye clinic (based in Phnom penh) where I sat in the clinics for the morning and then assisted – that’s right – ASSISTED in ophthalmology surgery in the afternoons! The eye centre is run by Dr. Vra (who predominantly performs cataract surgery) and his Ukrainian wife – Dr. Natalie (oculoplasty etc) – the rest of the team are lovely however, language is a major problem. If, by chance, you speak Russian or Khmer – then great! You will be fine – but if however, you only speak English – it makes life somewhat interesting.... Of course you pick up little things here and there but you can’t really run the clinic or ask the patients much yourself – without a translator. I was lucky that Dr. Natalie was so keen to teach and wrote everything in English. She was also very eager for me to practise my surgical skills and although I’m sure I was the local attraction/entertainment at the clinic – her teaching was invaluable. The very first day there, she made me do an interrupted suture with tiny thread on a blepharoplasty . It soon progressed to me doing complete operations on my own – supervised of course. If you’re keen or even interested in ophthalmological surgery – this is the place to be, there is nowhere in England that you will get such experience at our level – it is impossible so I am truly grateful for the opportunity I had to complete my elective here. However, if you are squeamish, then I suggest maybe just attending morning clinic (start at 8am-12pm) as all the patients are under local anaesthetic only for their surgeries!

Bits of advice/ things I wish I’d known before I came:
-    Bring your own scrubs especially for eye clinic and id suggest taking your own crocs too but they all wear flip flops.
-    If you can get sterile hats then bring them too.
-    I’d suggest staying in Phnom Penh – purely as there’s so much more to do there, and it really caters for westerners. I stayed in Europe Guesthouse on Street 136, which had the perfect location and was run by the loveliest family!
-    Take a book with you to read if you’re spending time in Takhmao as everything runs on “Cambodian Standard Timing” and you do end up waiting around for patients etc. There is a medical ward there but the doctors speak only Khmer or French. Dr. Sarom is excellent and speaks good English however.
-    Getting to Takhmao – if you can arrange for the directions to be written in Khmer and find yourself a nice tuk tuk driver that will do you a deal – take it! I went with a friend of mine (Physio volunteer) from Phnom Penh via tuk tuk there and back and it came to $7 a day but I’m sure it can be done cheaper.
-    At the eye clinic – there is a nice canteen around the back where doctors and other volunteers from the opposite surgical centre eat – lovely dinner ladies and you can eat as much as you want for 2000 riel – that equates to around 25p!
-    Definitely try sugar cane juice when the lady comes around on her moto too.
-    Uniform – it’s so hot (esp. during march-may) that I wore cropped trousers, shorts, and decent tops – there’s no need in dressing too smart as everybody is pretty laid back.
-    Be prepared for things to “go with the flow” – it is not a regimented elective – which I think is good as it really allows you to immerse yourself in Cambodian nature.
-    Ooh if you’re vegetarian – learn the words in Khmer for “no meat, no fish” etc and just re-iterate that when you go to eat. I found it difficult to find vegetarian food – esp. in Takhmao but it’s understandable as it’s not in Cambodian nature to not eat meat! However, Sophak, Sokney and Joanna all made sure the dinner ladies at Takhmao had some vegetables for me; they really look after you during your elective so just remember to have fun!

Jess 'Summary of time at Chea Chumeas Hospital

2011-03-15T01:53:00.001-07:00

A Summary of Our Time At Chey Chumneas Referral Hospital

It's difficult to summarize our experience volunteering with Rose and observing physicians at the Chey Chumneas Hospital in Takmao. There were aspects that were disconcerting, such as watching a hernia repair and a total hysterectomy performed with only local anesthesia. Other differences between US and Cambodian surgical procedures seemed more comical and adaptive to the climate. Operations were performed in flip-flops, some doctors went shirtless under their surgical gowns, and every now and then the anesthesiologist would grab a bug zapper shaped like a tennis racket and swing it through the air, making a loud cracking sound as it killed mosquitoes.

The hospital itself was beautiful. Although the buildings were rather plain and poorly stocked compared to the high tech hospital rooms I worked in last year, they also seemed more inviting and family-oriented. Doors and windows were wide open, Bougainvillea blossoms surrounded most of the compound, and families took a more active role in feeding and caring for the sick. This may have been necessary, since the hospital probably doesn't have a budget for kitchens or extra nurses or aids, but it was still nice to see. Danielle and I had several talks about how the US could learn a thing or two from Cambodia about creating an environment conducive to healing. As long as that environment still includes general anesthesia.

Of course, the most inspiring part of our experience was watching the work of intelligent, dedicated people as they tried to improve the lives of others. Many of the doctors had worked longer and harder than ever would have been necessary in the US to obtain an education and competently practice medicine. While a few seemed like stereotypical type A achievers, others took the time to carefully explain complicated procedures in a foreign language to 2 clueless American girls, made room around the operating table and invited us to peak over their shoulders, let us take a few pictures for Bill to share with Rose supporters, and managed to play host to us while holding someone's life in their hands.

And then there was the Rose staff. Dr. Sarom was performing surgeries from dawn to dusk the entire time we were there for an Operation Smile initiative, but still helped us observe surgeries at the hospital in his absence. Sokny played tour guide during our trip to the countryside, showed us some of his amazing work, and let us practice our dismal Khmer on him over lunch. Rith, the office administrator, introduced us to doctors and helped find people for us to shadow. And of course our BFFs Bill and Jan went out of their way to find opportunities for us, entertained us with dinners, serenades, trivia nights, and stories from their travels, and generally spoiled us.

Despite a few miscommunications and the fact that a few of the doctors didn't seem to know what to do with us other than lose us like Jason Bourne losing an FBI tail, the time we spent at Rose gave us an incredible opportunity to observe the everyday operation of a health care system that is vastly different from the one we're used to. Our experiences were more than we'd hoped for, and probably much more than we are entitled to as an art/math grad and a premed student. We've become believers in the effectiveness of Rose, and with the help of Bill and Jan are already lining up more Rose-endorsed charities to volunteer with in Uganda and Nairobi. If any of you have cash burning a hole in your pocket and want to find a reputable charity to donate to, this one's a keeper.

Jess writes...

2011-03-01T03:13:00.000-08:00

Cambodia

During a brief study abroad in 2005, I toured a clinic operated by RoseCharities in Phnom Penh and was impressed by the efficiency and dedication of the medical workers there. In fact, this was the clinic that first sparked my interest in becoming a doctor. It was one of the few NGOs my class visited that offered both immediate and long-term relief to people struggling through the effects of poverty: immediate relief through life-saving medical procedures that would have been otherwise impossible for the clinic's patients, and long-term benefits through community outreach programs and an emphasis on improving the quality of life in Cambodia.

Even in the few short weeks we spent in Cambodia studying aid organizations, it was easy to become discouraged by the waste, and sometimes obvious corruption, that plagued well-intentioned charities, but the Rose Clinic seemed to stretch every dollar it received. As I saw firsthand in 2005, a $20 donation to RoseCharities can restore a person's sight, and $50 can repair a cleft palate or give a child the ability to walk. For more information on how to donate to RoseCharities, please see http://www.rosecharities.info/donate.htm.

The organization's efficiency can be traced to its formation, as outlined on the RoseCharities homepage:

"Founded by aid workers who were disillusioned by the waste and bureaucracy often seen in international aid, we started in Cambodia in 1998. The aim was to deliver effective, sustainable programmes directly to those in need, with minimal bureaucracy, and with transparency at every stage....We are run by volunteers, so administration costs are kept to a bare minimum, with 98% of donations going directly to support our work."

- RoseCharities
http://www.rosecharities.info/

I contacted Rose last October and asked if they'd be willing to take us in for a few weeks as volunteers, and they graciously agreed. Since then, Bill and Jan Johnston have been bending over backwards to find opportunities to put our random interests and talents to work. We started last Wednesday with a short tour of the gynecology ward in the Chey Chumnas General Hospital in Takmao, the hospital where Rose Cambodia is based. That afternoon we helped enter patient files into the computer (data entry is a rare example of a skill that Danielle and I both possess).

Thursday we traveled to the countryside with Sokny, the physical therapist on staff at the Rose office, to work with a woman who had laid in bed for 30 years after a debilitating bout with encephalitis (for more info visit the Rose Rehab page: http://www.rosecambodia.org/?page_id=12). The physical therapists at Rose have been working with her to help her gain the strength to sit up, and in order to get her hands moving Danielle brought a bunch of art supplies. We made simple shapes for her to paint in, and Danielle taught her a few strokes. Danielle and I were so absorbed in watching her work that it took a while to notice the dozen or so kids from the village in a semicircle around her, jealously watching her paint. It was a great visit. As we left, Danielle hung some of her paintings next to her bed with ribbon.

On the way back to the office, we stopped to visit a woman who had been badly burned on her legs by gasoline, and the physical therapists changed a bandage for her. Apparently a skin graft had failed to take, so there was still a gaping wound behind her left knee months after the accident. While we were visiting her, her neighbors brought another potential patient to see the therapists and placed him on the bed next to her. The man had been in a motorcycle accident and could no longer move the left side of his arm. The physical therapists assessed him and made an appointment to see him later at the clinic.

As we were about to leave, the neighbors convinced the therapists to see a woman next door who was having trouble walking. While the physical therapists did their thing, Danielle and I hung back and smiled shyly at some very friendly older women, who seemed to be staring at us. One of them started talking, half at us and half at the women around her. She then started wiping at her nose, as if to inform me that I powdered sugar on the end of mine, so I self-consciously started doing the same but she just laughed. One of the therapists translated, "She wants your nose." This seemed hysterical at the time, so Danielle and I giggled about it for a while.

After the therapists had finished their work we got back in the tuk tuk, but before we could go there was some kind of commotion. The lady who couldn't stop looking at my nose jumped into the tuk tuk and handed us each a coconut and a straw. We very gratefully accepted and drove off.

We made one last stop to see a beautiful young girl who was working with the therapists to build the strength in her arms and legs, and then we took a holiday all weekend (2 working days is long enough...)

Today Bill gave us a tour of the Rose Eye Clinic just outside Phnom Penh in the morning, and Danielle and I returned in the afternoon to observe glaucoma surgeries. We watched for 2 and a half hours as nearly a dozen patients underwent the 20-30 minute procedure. It was one of the most amazing things I've ever seen.

I may move to Cambodia when I'm a doctor just so I can operate in flip flops

More to come on what we've been doing with our play time in this wonderful country.

Posted by Jess at 2/21/2011
The rest of Jess' blog

Living costs - elective

2011-02-15T07:36:00.000-08:00

Brian asks... ": I was just wondering if you could give me an estimate of living costs and perhaps an average amount that is spent on living there for two weeks? Thank you very much".

Reply "Hi Brian:

I can give you some rough estimates but please don't hold me to them!

Guest house accommodation ranges from around $10 to $20 -- there is a guest house very close to the hospital which is clean and spacious and includes hot water, a/c, etc for $10 per night. However - Takhmao is fairly quite and rural, most students end up moving to Phnom Penh which is about 15-20 mins by tuk-tuk.

Food can be very cheap if you are ok with local food (Cambodian food is actually really good) - beer is cheap - around $1 to $1.50! If you prefer western food you'll end up paying more obviously. Here is a menu from a pretty good restaurant recommended by Lonely Planet - this would be 'middle range', if you eat at street stalls it will be cheaper.

http://www.frizz-restaurant.com/frizz-menu-khmer.html

Tuk Tuk to and from Phnom Penh to the hospital is around $4 each way -- crazy price considering you can get to Saigon for $8 - but that's westerner prices. If you ride a moto (motorcycle w driver) it is cheaper - $1.50 to $2.00 but you are strongly advised to wear a helmet, if you can bring one with you.

I hope this helps -- this is all my personal experience. Rose is not accountable if you find your own experience to be different.

~Jan "

___________

Directions to the Rose Charities / Rose Rehab Cambodia / Operation First / Kien Khleang / Chea Chumneas

2010-08-31T00:03:00.000-07:00

1) For: Rose Charities Sight Center (Eye Clinic): Kien Khleang: See www.rose-eye.info and look at the CONTACT page. There is a link there to a map

2) For Operation FIRST / Rose Rehab Cambodia / Chea Chumneas etc... Takhmau, Kandal See. www.roserehab.org and look the ABOUT US section

Judith - Univ Basel. Summer 2010.

2010-08-25T06:01:00.000-07:00

I just came home from my travels in Southeast Asia and I want to thank you. You might remember that I spent July with Rose Charities in Chey Chumneas and then I went travelling with my boyfriend for a bit in Cambodia and Vietnam.
This month at the hospital was truly amazing, even more amazing than I had expected it to. Surely sometimes sad and depressing, but the work these people do just throws you off the chair (if you say that in English too...). The kindness and friendliness of these people is just outstanding. I can't even describe how privileged I feel to have been able to see and experience that, everything about it: the medical part, the cultural part, everything. Not just Joanna (who is doing a WONDERFUL job) but everybody there is just amazing and I loved my month there.
I guess I just want to say thank you for having given me the opportunity to participate. I feel very lucky to have been there!

Vietnam Elective

2010-03-19T10:34:00.001-07:00

'J' writes...

The Vietnam elective I did was well organized though I learned little medicine (and more about the culture). It was also tough coming to terms with the fact that they had incredible resources but didn't in all cases have the education or compassion to use them as we might be used to.

I worked at Cho Ray hospital in Ho Chi Minh City (Saigon) http://www.facebook.com/l/71c4c;www.choray.org.vn/eleccourse.asp. The elective was set up directly through the hospital; they charge a small fee but you will have a locker and meals provided if you are in the Emergency room. The patients mostly speak Vietnamese, some English. Depending on the length of the elective, you'd do a few weeks in the ER and then a few in infectious disesease/paeds/etc. as desired. There is suturing, ultrasounding, intubations, and recusses in the ER. You can't really take any histories since even the forms are in Vietnamese (even though I was told the hospital was run in English). [I think I first heard about this from this website http://www.facebook.com/l/71c4c;www.thelancetstudent.com/2008/01/25/viva-vietnam/ which I discovered through googling "vietnam medical student elective" or the like].

Forgive my cynicism; I should say that I've done electives in 4 countries and have seen quite a variety of settings. I move to engage in sustainable placements in which I am able to leave something behind (eg. teaching the ABCs to medical students in Cambodia) as opposed to simply being an observer or a 'taker.'

That said, this may be an appropriate elective for someone who speaks Vietnamese, really wants to manage a lot of head trauma with few resources, or to understand the medical culture of an inner-city hospital in Vietnam. You may see some interesting pathology but much of it is similar to what you probably see at home. Experiencing HCMC is well worth the trip, though I'd caution you to set low expectations for learning at Cho Ray.

Electives in Bolivia

2010-01-22T11:13:00.000-08:00

We have the possibility for a limited number of electives in Santa Cruz Bolivia. Some Spanish is necessary. The electives are hospital based. Accommodation etc will be at the students expense. One of the hospitals may ask for an attendance fee, but it would be possible not to include this one. Contact us if you are interested, and in plenty of time. RoseHQ@aol.com

Accommodation

2009-11-05T13:21:00.000-08:00

You will not have any problem in Phnom Penh finding accommodation. There is lots of it at all prices but places come and go so its best to ask around and / or look on the internet or contact student(s) who have recently done electives in Cambodia

There is an $8 per night guest house almost opposite Chea Chumneas Hospital in Takmau. However Takmau is a bit out of the way of main Phnom Penh life (and opposite end of town from the Eye Clinc), so some students prefer to stay in town.

.. otherwise.. click on link below

A short synopsis of cheap guesthouses in Phnom Penh (good as of Feb 2009)

Dr Nous Sarom: Operation FIRST / Rose Charities Cambodia

2009-10-22T17:56:00.000-07:00

Sarah (N.Z.) August 2009

2009-10-20T22:21:00.000-07:00

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 !!

2009-10-20T21:50:00.000-07:00

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.

Motor accidents are bad in Cambodia !! Be very careful about travelling there...

2009-07-22T07:59:00.000-07:00

Warning to all studens and travellers in Cambodia

Car / vehicle crashes are common and are usually bad, especially outside of Phnom Penh and other towns (where traffic makes traveling speeds slower). People drive too fast and nearly always in rickety, badly maintained vehicles which would be banned from the roads in many other countries. Dont get trapped into being in a dangerous driving situation. Tell the driver to slow down, even pay him to do so, and if he does not, then get him to stop the vehicle and find another. Ask around before you go with any particular driver. Overland taxi's overcrowd their vehicles (putting up to 8 or 9 people in small cars). Dont use them !! If you have to, pay for the whole vehicle and insist absolutely that they drive slowly. Crashes at speed will kill you ... !!

Sarah writes..."About 30 mins in we had a bit of a reality check, there was a crowd gathered as we came to an intersection, which almost always means one thing…an accident. We drove past slowly to avoid the crowd and I was just waiting to see something I didn’t want to see...the people involved in the crash. Luckily there was no people there, just the aftermath from the bikes…one was ripped in half, the front wheel completely missing, there was debris everywhere and a fitting reminder of what can happen, especially if not dressed appropriately…a pair of thongs were the only sign of the driver. We all fell silent as we passed and I was glad to be driven by girls that were very careful with their speed, a bit different to the young boys around town."

3 persons die every day from road traffic accidents in Cambodia.

Road traffic fatalities have doubled over the last three years.

Traffic increases by more than 10% every year.

Cambodia has the second highest road traffic fatality rate (number of fatalities/10,000 vehicles) in the

region. This rate is ten times higher than in developed countries and twice as high than the ASEAN

average6.

18% of road traffic casualties reported in Cambodia occur in Phnom Penh.

People aged between 15 and 24 years old account for 48% of casualties although they represent

only 24% of the population.

Males account for 71% of casualties, although they account for only 48% of the population.

Motorcyclists account for the large majority of casualties (76%), followed by pedestrians (9%) and car

users (7%).

Students14 represent the largest group of casualties (22.5% of casualties), followed by workers

(22%) and vendors/small businesses (18%).

In total, more than 4% of casualties die either at the scene of the accident or of their injuries

later (an average of 17 fatalities per month).

In total, 65% of casualties suffer from head injuries.

- 9% of them are considered as severe15.

- 80% of casualties suffering from head injuries are motorbike users. Among them, only 4.39% are

wearing a helmet at the time of the accident.

A higher number of casualties occur on Saturdays and Sundays17, especially during night time.

Nighttime accidents are responsible for 39% of casualties.

Two peaks of casualties are observed: at noon and at 9 pm.

Alcohol/drug abuse is responsible for 15% of casualties.

In total , human error is responsible for more than 90% of casualties.

Motorbike-motorbike collisions are responsible for 36% of the casualties, followed by motorbike-car

collisions (25%) and motorbike-pedestrian collisions (6%).

- 6% of motorbike casualties fell alone.

- An average of 3.6 persons are involved and 2.1 are injured in each accident.

More tips from Jessica.. what to wear etc

2009-06-02T10:30:00.000-07:00

Thanks so much for all your information. It's really helpful. I just had a few things that came to mind to ask - what did you wear at the hospital? I'm presuming it's going to be very hot and I think raining quite a bit too so just wondered how smart I need to be etc. Also, did you need to wear proper shoes (e.g. closed toe) or were sandles acceptable?

I arrive in Phnom Penh in 2 weeks time so I'm very excited.

June 1 at 4:08pm

Hi Ella,

I wore pants or capris at the hospital, a short-sleeved shirt, and my short-white-coat. It doesn't have to be too dressy though jeans or shorts would be inappropriate.

Do bring your own scrubs as they probably won't have any for you. You can probably wear sandles - many of the Cambodians do - but from a safety perspective, close-toed shoes are always best. You are your own boss in that department. It does get hot no matter what you are wearing!

Jessica writes ... (May 09)

2009-05-18T21:56:00.000-07:00

To answer your questions: I wasn't able to communicate that well with patients. Hand gestures and basic words ("pain" "lay down" "okay?") helped a lot. I thought my french would come in handy, but very few other than the anaesthetists (who train a bit in France) spoke it.

At the eye clinic, there were lots of cataracts, glaucoma, and sometraumatic eye injuries. In Dr. Sarom's clinic, the patients usually hadgeneral complaints - sore stomach, chest pain, trouble breathing fatigue - or they had appendicitis or an orthotrauma that required surgery. Also saw a c-section, a hydrocele repair, and a thyroidsurgery . The rest was cleft-lip and palate surgeries with operationsmile, and one from dr Sarom's clinic.

Somtimes the volume of patients could be quite low. That is why Will and I suggest asking him to help you connect with other departments at the hospital,like pediatrics, or to go to the eye clinic at other times.

In Cambodia, I did travel a bit. The first weekend was a holiday sothere wasn't much at the hospital. I went to Shianoukville (nice, iftouristy beach)/Kampot (small quiet place, not a lot to do but interesting caves nearby)/Kep (nice beach and seafood) to the south.went on my own but met other travellers along the way (on the bus) thatI hung out with a bit. I was lucky that Operation Smile was in PhnomPenh for about 1.5wks while I was there. I got pretty heavily involvedwith their operations and when they took a trip to Siem Reap, I joinedin

Jessica UBC . May 2009

2009-05-15T06:53:00.000-07:00

I got back from my trip in mid-April; 4 weeks in Cambodia with ROSE and another 2 weeks in Vietnam (working at Cho Ray Hospital in Ho Chi Minh City). This wasn't the first time I've done electives overseas, as I've spent time in Northern India and Nepal as well.

That being said, even very underdeveloped countries do sometimes have quite advanced resources. You'll find that Phnom Penh is a hotbed of NGO activity, as well as other international partnerships. The larger hospitals do have things like CT and probably MRI, although the hospital that Dr. Sarom works at (and his private clinic) I think only have x-ray.

For some of my time in Cambodia, the pace was pretty slow. Dr Sarom let me join his colleagues at the public hospital or in his general practice clinic, so that I could observe the 1 or 2 surgeries that happened each day. If you've scrubbed into the Operating Theatre in your medical school career already, you'll note quite a few interesting differences. As well, what the anesthetists can do without fancy monitors or ventilators is pretty impressive. The surgeries are quite similiar in many ways, but you'll see innovative use and sterilization of what were once considered disposable instruments (having been recycled hundreds of times).

Doctors definitely get creative; my time in Cambodia was quite quite slow at times, but the part that was very busy was the 1.5 weeks where Operation Smile happened to be in town. They were using all western, shiny new equipment and most of the doctors were from the west as well. This wasn't representative of the local style of doing things at all, however we encountered lots of problems when trying to mesh all the imported, Western equipment (and styles) with the existing infrastructure in the Cambodian ORs. My time in Vietnam was far busier, so just because of the volume of patients, I learned a lot more tips about using observation or alternate equipment to achieve the same result as something more complicated, because even though the resources like MRI were availalbe, it was just easier to do it the quick way. Many of these things are similar to what one would learn doing Rural Practice in Canada, so I know they'll be useful in my future.

I stayed in Okay Guesthouse. It's in the Lonely Planet guide. Cheap, backpackery. A single room with A/C and cable TV with hot shower was $12/night. It will be cheaper with two of you.This was about 15 minutes walk from the riverfront area, on a fairly quiet stretch, and quite easy to get a moto, book a bus tour, rent bicycles, and there was a decent restaurant where you can socialize with other travellers.

I also tried the Bright Lotus which was more expensive, not as friendly, but a bit cleaner. It is in the riverfront area, and was about $16/night for a single room. Many of the western-style restaurants are in this area.

- I did not take post-exposure prophylaxis; I would have travelled home if I got a needle stick; that being said, the pace was very very slow. Even though I tell you that, it may be still slower than you think. Typically, I would go to the Dr. Sarom's private clinic in the morning, see a few patients with him [i might examine them, but he would do all the talking in Khmer, and give me a brief rundown of the history in English], watch one surgery at the hospital, and then generally hang around the clinic most of the day; I think asking to do some peds with him is an excellent idea

- as far as rural practice, I think you are right that it will be easier to set up once you are there; Dr. Sarom has lots of contacts and may be able to help facilitate this

- i didn't bring gloves; if you prefer a particular type, you should definitely bring them; surgical gloves are available if you scrub on any procedures, tho they may not have your exact size; in the clinic, I just carried around hand sanitizer, and we would glove only for blood/fluid/etc. contact [i.e. "universal precautions"]. I should say I am comfortable touching patients at home even if they are HIV/HepC positive so long as there are no fluids, etc. Some people always where gloves when they examine people, but as long as you are washing your hands often, I feel like I can do without. If you really like gloves, bring a few boxes! You can usually buy them at drug stores.

- I brought a fair bit of US cash and some traveller's cheques; if you bring traveller's cheques, you can't really use them - you'll have to exchange them at a bank. There are many banks and ATMs are all over Phnom Penh - they dispense US dollars. You'll get small change in the local currency (riels) which is good for negotiating cheaper rides at the market. 1 USD is 4000 riel everywhere. It's sort of a fixed rate that doesn't seem to flux with the global markets. They will laugh if you try to use US coins - I know, I tried it! P.S. only the really upper-scale hotels and shops seem to take VISA.

-don't know how your are planning to get around; tuk tuks from Phnom Penh to Dr. Sarom's place take about 40 minutes and cost 3 to 5 dollars depending on your bargaining skills; a moto would be about 2 dollars. it's worth buying a full helmet (a north-american style full face one is about $15-$20; brands like Index and Apex are pretty good) - on a moto you'll save money, get much faster thru traffic, and save your noggin. Sometimes, I was able to get rides home from the other surgeons and anesthetists, so make friends!

-if you don't have your VISA yet, you might try the e-visa service online. it's pretty easy and allows you to skip the longer lineup at the airport. http://evisa.mfaic.gov.kh/e-visa/vindex.aspx

Comment on the above (from Will) : One comment about speed or slowness of things hapening: It can be very variable. Like Jessica says, when a group is in town things get a lot faster. Operation FIRST/Rose Charities is an organization which, as well as operating locally, focuses on linking specialized groups from overseas who come into the country and share their expertise within the Ministry of Health system (thats very important for he country and often overlooked by some expats.) The next 'group' will be an ear surgery mission in the next month, and following that a teaching group from the Chinese University of Hongkong. When these groups come, the general pace tends to pick up considerably, often to frenetic levels ! The second thing is that the eye clinic (the other side of town) is almost always very busy all day. You can always retrat to it. Doing some paeds and other disciplines is a very good idea. Some of the students who report the best elective experiences did quite a bit

Bottom line, is that its hard to predict exactly what you will do and see. You have to be flexible (just like you were Jessica) and open to opportunities etc. Also though, be clear about commuication. If it seems like no more is going on for the rest of the day, ask if this is the case. Cambodian culture is very poite and you will probably not be told (ie not to offend) if actually there is not much further going on. It can mean you will hang about the rest of the day till you work it out for yourself !
I think, Jessica, you made the point too when we met that in your view the elective is better for those really into seeing how other cultures work and how they intergrate and operate their medical / surgical systems. It does not guarantee steady, regular day by day hands on experience. It can and does happen, but predicatbility is variable. We get students from all over the world and find that actually elective philosophies vary. Some do just one elective, others, electives every year. For these latter ones particularly it may be more appropriate for those 'electiving' in their earlier years, where techniques are newer in the experience spectrum. But then its even hard to say that for, when the specialized teams come (or in the Rose Charities Cambodia Eye surgery unit, where the mics have teaching heads) you may get a lot of hands-on experience.
So think carefully about what you want to get out of your elective.

And please keep on writing back to Rose Charities www.RoseHQ@aol.com so we can keep updating this site.

A very very big thank-you to Jessica, for such wonderful feed-back. I know its going to be read and prove very useful by many !

Jessica (UBC)

2009-03-06T23:58:00.000-08:00

Jessica now in Cambodia. See her ongoing blog

Suzanne. University of Cardiff. October 2008

2009-01-22T21:57:00.000-08:00

(..click on each page below to enlarge)

Comment: A great report Suzanne. Many thanks. A good tactic if things get slow at one center is to head up to the RoseCharities Eye Clinic at Kien Khleang. It is the busiest of its type in Cambodia and operations go on almost every afternoon (when other centers can get quiet). There is so much untreated eye disease in developing countries, that any experience that trainee doctors in that area could be of huge benefit in the future.

Mindy (Wright University, Ohio, USA)

2008-07-17T22:02:00.000-07:00

"...the Cambodia trip was wonderful! We all had such an amazing experience and a truely incredible trip! It is trips like this that change your life, I wish everyone I know could have an experience like it."

(Mindy did her elective with FIRST-RoseCharities in April 08)

Katrina (University of Glasgow, UK)

2008-07-03T12:15:00.000-07:00

"Arrived in Phnom Penh on Monday (30th June 08) and started my elective with Dr Vra on Tuesday. Having a great time so far, seeing lots of unusual presentations and operations. Thanks for setting this up."

All the best
Katrina

Jonny (cont.)

2008-03-20T16:40:00.001-07:00

Hi Will,

In the end I just did two weeks at Chey Chumneas as I needed to return to the UK earlier than previously envisaged. It was a fantastic experience though. Dr Sarom got me in on a few surgeries and I spent some very valuable time with the paediatrics department as well as a day with on the general medicine ward. I am returning to Cambodia in the summer where I may well spend a few days with the mental health team.

Thanks very much for your encouragement and support. I will write blog my experiences soon.

Best,

Jonny

Jonny. (UK). 4th March 2008

2008-03-03T22:53:00.000-08:00

Hi Will,
Just a quick note to say that I've had my first day at Chea Chumnas. Dr Sarom has been very welcoming. I scrubbed in for an operation this morning which was a fantastic experience. I've hooked up with a couple of other med students from London and will also probably be joining one from Australia.
Best wishes,
Jonny

Tom Wolfenden: Brighton & Sussex Med.School UK

2007-09-28T07:25:00.000-07:00

I’ve had a brilliant time here in Phnom Penh and especially at Chey Chumnas. Life here is pretty relaxed, but once adjusted really enjoyable, you certainly get more from the experience if you just go with the flow. Initially I was a bit concerned about being on my own out here, but staying in Phnom Penh has allowed me to make so many friends out here. Dr Sarom has been a star, relaxed and easy going and always keen to point you in the direction of another department if you’re not enjoying where you currently are. I’ve spent time in both surgery and paeds now. Despite being really keen on surgery, it is paeds which I enjoyed the most. It’s certainly been a great learning experience. All the doctors on the paeds ward speak good English, which is something that can’t always be said for other departments. Yesterday I ran my own paeds HIV clinic. A pretty daunting task at first, but by the end I was quite happy ordering investigations and writing prescriptions for anti viral drugs (all done through a translator, my Khmer still isn’t quite up to scratch!). All the kids I have met have been amazing, they’re so well behaved.

During my stay in PnP I have been staying at teh Bhoddi Tree guesthouse. It is opposite Tuol Sleng, which is probably the most famous of Pol Pots prisons. Over 17 thousand people were “processed” through there, and indefinitely ended up going out to the killing fields. The actual guesthouse is so charming, it is set back from the road surrounded by a patio garden with large tropical plants sheltering you from the sun. Even if you don’t stay here it is a nice place to go for a quick coffee or a smoothie. The staff here are great, really accommodating and will bend over backwards to help you out (even organising sim cards for mobiles). Prices here can range depending on your budget, you can live it up with air con and an en-suite for around $23 dollars or settle for a fan and shared shower for around $12. The way I worked it out was I got them to do me a deal as I was spending a more prolonged period there compared to the majority of their guests. There are plenty of mottos outside the guesthouse to take you wherever you want and generally they speak fairly good English. Expect to pay around a couple of to get to the hospital in the morning and a dollar back. If you don’t use berrang mottos then you can certainly arrange your fair for cheaper, but they will be a walk around a corner from teh tourist hot spots.

PnP has a really large ex-pat community probably as a result of the number of NGO’s operating out of here. Consequently there are some really great places to go meet people away from the hassles of flower sellers and beggars. If you fancy a bagel and a coffee for lunch why not go check out the Garden Centre (on st57), Java (nr independence monument) or The Shop. All have loyal regular customers and the food is really just what you need if you’re tired of noodles and rice! In the evenings I’ve been eating in a plethora of places, from venders selling noodles on the street, to quite extravagant restaurants and sushi bars. There is a place to cater to everyone’s needs and budgets. Road 63 is a good one to go exploring in search of food, both berrang and Khmer eat here alike.

After super if you’ve had too much chili in your noodles then you would probably want to go and wash it down with a few glasses of Angkor (the local brew). There are loads of ex-pat bars where you don’t get any hassle like you can in Siem Reap or over the boarder in Thailand. I’ve been frequenting Equinox and Rubys wine bar fairly often. Another place to go meet people is Gasolina, there they have regular dance and martial arts classes in the evening. I’ve been going to Capoiera (a brazilian non contact martial art) its something that I would never do back in the UK, but has been really good fun and I’ve met so many friends there. Good bars to watch the sun set are Guesthouse number 9 at lakeside and Snowy’s bar on the other side of the river.

The hospital is pretty relaxed and you can normally take Friday afternoons off. As a result the weekends provide the perfect opportunity to get out of the city and go exploring. If you come to Cambodia you must go to Siem Reap to go the temples at Angkor. There are regular bus and boats, or if you don’t fancy 6 hours in a bus there a regular half hour flights. I bought only a day pass on Friday evening which entitled me entry to the park after about 4ish, which allowed us to go and see the sun set over the temples. We then got up early the next day to watch dawn break over Angkor Wat, if you make the effort it is one of those moments that will stay with you for the rest of your life. There is a real aura about the whole place at this time in the morning. Siem Reap is a rapidly growing town as a result of the numbers of visitors going to see the temples, I stayed at the Merridean purely because it was one of the nearest to the temples, but there are cheaper options in town. The nightlife in Siem Reap is pretty good, and there is a great bar called Angkor What? along a strip of bars and restaurants known to the locals as bar street.

We also have had weekend excursion to Udong, to see yet more temples. After which personally I was a bit templed out. SO the following weekend we went to Kep and stayed on the hill, just below Veranda bungalows. Kep doesn’t really have a beach as such, so we took a short boat ride across to Rabbit Island. It was pretty peaceful and we had the beach to ourselves.

Overall I’ve had such a great time out here, if your prepared to go with the flow and be outgoing you’ll have an amazing time here. If anyone wants to know more about what clinical skills/experiences I think I have gained from this elective please drop me a mail. My address is t.p.j.wolfenden@bsms.ac.uk

Tom Univ. Sussex & Brighton (UK) Med School

2007-09-19T13:10:00.000-07:00

All is going well here in PnP. Now adjusted to the pace of life and going out more and more in PnP exploring and finding various places where to go out and about, so could write a pretty good blog entry I feel. There is certainly a big ex pats/NGO scene here at night.

Have got till the end of this week in Surgery then next week am transferring across to Paeds. So will have totalled 3 weeks at Chey Chumnas.

I can show Joseph around if he wishes on the 25th, I'll still be staying at teh Boddhi Tree if he wishes to also book in there.

Jesal (Univ. Birmingham, UK). Elective May 07

2007-08-04T11:46:00.000-07:00

Hi Will,

Sorry about the delay in writing to you - I've started final year now, so everything is a bit hectic! I just wanted to say thank you on behalf of all the girls for helping us to organise the placement with ROSEcharities. It was a great experience for us, we had a terrific time and we learnt a lot!

If you want me to write on the blogsite or anything, I'd love to do that.

Thanks again,

Jesal and group

Jesal. Univ. Birmingham. May 07

2007-05-14T13:07:00.001-07:00

..We're in Cambodia at the moment and are really enjoying been at Dr Vra's eye clinic!! I think I've seen more signs here in one morning, than I did after being at a eye hospital in England for a week! So thank you for helping us in organising the placement..

Trudy. Univ.Sydney

2007-03-18T12:21:00.000-07:00

blogCambodia Elective Report

Cambodia is a South East Asian country of roughly 15 million people. It is a country that has a legacy of human suffering and devastation. During the 3yr rule of the Khmer Rouge 30% of the population was slaughtered in a horrific ‘auto-genocide’ and many more died in the following years due to disease and malnutrition. Once an Asian centre for Medicine, after the Khmer Rouge regime the numbers of doctors fell to less than 50. Cambodia has since made much progress - they have achieved peace and had a sustained economic growth. The percentage of the population living below the national poverty line has fallen to 35%. However, in a setting of poverty, sex work, overcrowding, lack of infrastructure and lack of health funding, Cambodia’s health situation is poor. Communicable diseases, especially TB, HIV, STIs and malaria, dominate all age groups accounting for 83 per cent of all disease burden. About 11% of the population is below the minimum level of dietary energy consumption. Nearly half of all Cambodian children are malnourished, and one in eight dies before their fifth birthday, largely due to preventable causes.

Spending our time in the city of Phnom Penh we weren’t made as aware of these statistics however we did see a lot of patients suffering from the consequences of TB, HIV, malaria and leprosy infections. Hopefully this will begin to change as the healthcare for Cambodian people becomes a priority on a national and international stage.

One thing that struck Courtney and I was the huge number of hospitals and medical and public health clinics both in Phnom Penh and in rural areas. While their condition and service availability might be less than adequate and, granted, the clinics never looked to be open, signs of healthcare are certainly always visible. There are also plenty of billboards explaining normal paediatric milestones, promoting safe sex and raising awareness about malaria and bird flu.

We spent our first two weeks at Kien Khleang Rehabilitation Centre Ophthalmology Clinic which is in the north of the city. It is assisted by Rose Charities New Zealand. There is only one ophthalmologist on staff, Dr Hang Vra, and every morning he sees approximately forty patients. He is assisted by a very capable team of people including several local medical students who spend their weekdays working there and then go to university on weekends. We spent mornings in clinic with Dr Vra who constantly tried hard to include us. The hospital/clinic is small, especially to contain the huge numbers of patients, but comfortable. Patients seem to come enmasse, maintain some system of order and struggle through a series of steps that take them inside and outside seeing different people. They start on the verandah where their visual acuity is tested and written on a small square of paper. Next they wait to see Dr Vra. Generally the door to the clinic was full of people trying to see what was going on inside. After that they have their intraocular pressure checked on the other side of the room, wait outside for their dilating eyedrops to work, push their way back in for another check with Dr Vra and then see the pharmacist to get their medications. At times there were several people fighting for the one chair, but generally they seemed to have an understanding of some kind of order. We saw a good range of eye diseases and Dr Vra would let us use the slit lamp and the ophthalmoscope. The main condition by far was cataracts, but there were also many cases of corneal scarring, glaucoma, fungal and bacterial conjunctivitis, pterygiums and retinal diseases such as retinitis pigmentosa in quite young adults. Many patients would include us in their consultation, turning to us and launching into a lengthy story in Khmer, to which we’d just smile nicely and nod. Dr Vra’s most commonly used phrase was “they’ve come too late, that eye is gone already”. Most patients seemed to accept blindness as part of their life. For many however Dr Vra had the joy of being able to restore their sight or prevent its further loss. In a noisy, stressful and often tedious environment he seemed to take constant satisfaction from this. He often remarked that the other eye clinic just next door didn’t do good quality surgery and quite a few people turned up to see him with an eye that couldn’t be saved due to botched surgery. We found it sad that this can become so widely known, even by word of mouth in the general public, and yet the place is still allowed to run.

Lunch consisted of us going to a small local place with the Optometrist and one of the med students or struggling through interesting food shopping experiences with the small shop owners who spoke no English and didn’t seem to have the ability to get their message across any other way.

After lunch we would join Dr Vra in surgery. While we weren’t able to get involved we could look through the microscope and watch the surgery or watch the anaesthetist prepare the next patient. We became quite knowledgeable of the procedures involved in a cataract operation or a trabeculectomy for glaucoma. Probably the most exciting surgery we saw was an evisceration of an eye which involved cutting out the iris and then scooping out the lens, vitreous humour, retina and choroid. We became used to those little unique differences in surgery such as wearing thongs and washing gloves with saline between patients instead of changing them.

The rest of our time was spent at Chey Chumneas General Hospital in Takhmao which is about 20mins to the south of the city. The hospital consisted of several buildings spread out over quite a large site. The grounds were dusty and quiet and it often seemed like nothing was happening. The general surgery block was always crowded of a morning with the patients and their extended families. Our main contact there was Dr Nous Sarom who is a maxillofacial/reconstructive surgeon and works for FIRST - Rose Charities Canada. He was very friendly and helped us organise a simple timetable for our stay before introducing us in each section. This made things much easier since they all knew to expect us. He also gave us keys to his office which was a nice spot to keep our valuables and go for a cup of coffee. FIRST have their own building and operating theatre and you could definitely see the benefit the international funding has had. We saw some really interesting post-reconstructive surgery patients of Dr Sarom’s on the first day there but after that he had no surgery scheduled. It was harvest time in Cambodia so families don’t book in for elective surgery. We were looking forward to seeing cleft palate surgery so it was a bit disappointing and if you were choosing this as a surgical elective then this definitely isn’t the time of year to go. Instead we divided our time between the Children’s Mental Health Centre, the Children’s HIV clinic and General Surgery.

The Children’s Mental Health Centre was a really well run service and consisted of a very friendly, multidisciplinary team of people who all spoke very good English. We were able to sit in on the early development assessment clinics and assess and play with babies and small children who had a variety of neurodevelopmental delays. Most of these children had a past history of tuberculous meningitis. Every Tuesday they have an educational day for special needs children since there are no schools that offer this and we joined in on one of these. It was interesting to see that it was these children who accepted us more openly and naturally than at any other people during our trip. On Thursdays villagers from a rural province are brought in for their children to see the doctors. We were able to sit in on the consultations with the children and their parents. The children had a range of disorders but most common were epilepsy, mental retardation and personality disorders. In some cases we were shocked by how many difficulties of various kinds the mothers or grandmothers live with every day.

The paediatric HIV clinic was another good experience. The mothers were all very keen for us to play with their children and quite often a woman would lead her children to us so we could talk and play with them. This was harder than it sounds since we didn’t speak their language but the children seemed to like us. Almost all the children there were infected with HIV from their mothers during birth. We found it strange that the children all presented with varying degrees of skin infections, respiratory infections and malnutrition while their mothers all looked perfectly healthy. Generally the children were happy and relatively well despite having TH4 counts of around 1%. Most were there for a checkup and review of their antiviral medications. Occasionally a child would look quite skinny and unwell and we found it quite sad to see this. The life expectancy of most of the children would be approximately 18yrs. One little girl had been an inpatient for a month due to severe diarrhoea and malnutrition and she was still the skinniest, tiniest 4yr old I’ve ever seen. Several doctors working at the clinic spoke good English and were really keen to tell us everything despite it slowing them down so much that they’d only get through 2-3 patients in a morning!

It was quite a trip each day from Phnom Penh to Takhmao so for 1 week we stayed at the comfortable guesthouse across the road. On most days there wasn’t much to do after about 2pm so it was good to have our room so close. However it is a part of town where tourists aren’t common and we found the stares, limited restaurant options and lack of spoken English quite difficult. We would recommend staying in town and travelling out each day.

In all we had a great time. The medicine wasn’t very hands on and I suppose you could say that the learning opportunities for serious medicine were limited however we definitely gained an insight into the lives of the Cambodian people and got to see a little of the hardships they face in accessing and financing adequate healthcare. As to the standard of healthcare, because all our time was spent in charity assisted clinics we found it to be excellent. I suppose in the government hospitals and clinics it may be a little more sub-standard. We also overlapped with some other med students from NZ and enjoyed spending some time with them. I would never knock back an opportunity like this, to spend a month getting to know and understand a complex city like Phnom Penh.

Some points for future students:

* Don’t expect it to be a completely surgical elective if you go Jan-Feb

* Take your own scrubs

* Short sleeves are good because it’s oppressively hot but dress modestly.

* Mosquitoes aren’t as much of a problem as guidebooks say they are (at least not at this time of the year)

* Even as 2 females, we felt safer than we usually do in Sydney. We never had a problem.

* Contrary to some info, there are now ATMs in Phnom Penh. They dispense USD and are very reliable. Bring money in small denominations ($1, $5) and expect to deal in a mixture of riel and USD.

* The food is really nice, there are countless little family-run restaurants to eat at and they’re safe and cheap.

* Tuktuks are great transport for 2 ppl, just agree on a price first. Drivers will often arrange to come back for you in the afternoon.

* Get the 3 day pass for the Angkor temples, start early and take your time

* Visit Capitol Guesthouse for ideas for weekends

* Eat, stay or both at the Boddhi Tree opp Tuol Sleng Museum for a week, it’s really lovely.

* Internet is very available and cheap.

* All guesthouses supply linen and towels.

* Learn some Khmer - I found numbers and ‘no thankyou’ to be the most useful

* Remember to bargain, it becomes a lot easier once you get used to what things should cost.

* Have a chat to some of the kids that are selling things - they can be annoying but they’re still kids and some love an interesting talk and their English is almost the best you’ll find.

* Phnom Penh grows on you, it really does!!! There’s something really nice about it, just give it some time.

For more info contact me on strudel75@hotmail.com

Trudy (Univ. Sydney)

2007-01-23T11:21:00.000-08:00

Hi will,

just a quick one to say that courtney and i have been here for 1 week

now. have been with dr Vra at the eye clinic for that time. having a

great time. have met wendy, sean and dave. going to siem reap this

weekend and then swap to work with dr sarom after that.

will be in touch,

Trudy

Luke. Univ.Adelaide

2007-01-10T19:15:00.000-08:00

Hi Will,

I have finished my elective and left Cambodia already (im in vietnam). The elective was great and Dr Sarom seemed happy with us, especially with the accounting and patient record systems anne set up.

We had a great time in Cambodia, did a lot of travel too. We are now working our way up the coast of vietnam.

thanks for helping me sort out the elective, and if you ever want me to get in touch with other students or write something for you id be happy to

thanks again

Luke

Malcom. Univ. Oxford UK

2007-01-05T21:55:00.000-08:00

See www.studentbmj.com/issues/01/07/life/243.php for full article.. excerpt below..

.....Dr Sarom, the ROSE surgeon, taught and performed surgical procedures in the basic, but adequate, operating theatre. We would often have to be the scrub nurse and assist at the same time; as time went on we were able to help more and more. After we had seen and assisted at several of the cleft lip operations, Dr Sarom declared, "Next time you be surgeon!" Dr Sarom supervised me closely as I operated, his stepwise teaching paid off and the results were impressive. The buzz from completing my first operation was heightened when the little girl thanked me a week later. "Now I am pretty," she said.

I became familiar with the tropical diseases that I had previously heard about only in lecture theatres. Though the medical ward was an incredible learning environment, with late stage everything and full of florid clinical signs, it was hard not to get frustrated by the lack of resources. The country ran out of insulin during our stay, the strongest analgesic available was pentazocine, and the availability of x ray equipment was a luxury. The variation in the training of the medical staff was more difficult to cope with. The concept of ensuring the airway and protecting the cervical spine after trauma was alien to most doctors, and it was unsettling to see patients' lives put at risk from such simple oversights.

We went on several outreach visits to regional hospitals. In an Italian run emergency hospital near the Thai border, I gained first hand experience of the horror of landmine injuries. A demining truck had driven over an antitank mine after being told that the route was clear of mines. We treated the two passengers, one whose spleen had shattered, the other with several broken bones. The driver had been killed instantly. The wards of these rural hospitals were full of the limbless......

Debbie. Univ. Brisbane. Australia

2007-01-05T14:03:00.000-08:00

...

Cambodia is a
beautiful country. During a trip out into the one of the villages with
Dr Sarom I had the chance to see some most amazing sights... nothing
likie anything I would ever encounter back home.
I've also had the chance to see some of the sadder sights of the
country, including many amputee cambodians. A constant reminder of the
tragic history of the nation
There are many differences between the medical procedures here and
those I have observed back in Brisbane. It is interesting to see the
application of limited resources in very ingenious ways.

I am very much looking forward to the Operation Rainbow Mission. I
believe I will get to see a lot, and have an enormous potential to
learn...

Helene. McGill University. Montreal. QuebecHi Will and Josephine!

2007-01-05T13:54:00.001-08:00

Hi Will and Josephine!

We left Cambodia two days ago, we had an amazing time over there, working with Dr Sarom. He found a place for us to stay near the hospital which was really great.

Wwe did go do some drawings with the kids in the mental health center nearby.

As for the shopping for the auction, we bought some very nice silk scarves, about 20. The shipping was kind of complicated, so we did not buy anything more, it would have been too big or too heavy. Let me know when and where you want me to send them once we come back to Canada.

Thanks a lot for everything, Helene

Kate. Univ. Otago. NZ

2007-01-05T13:49:00.000-08:00

Hi Will,

Just wanted to write an let you know all is going really well here in

Phnom Pehn. I've been working with Nous Sarom for the last couple of

weeks and he has been really fantastic to me and the other students (Tom

and Emily ). Nous has gone out of his way to help us and has been very

generous with his time. I've been able to do a bit of surgery with Nous

as well as visit other NGOs at Chey Chumneas like Children's Mental Health

service and HIV/AIDs ward which I've found really interesting (or should I

say eye-opening!?). I'll hopefully join Dr Vra at his clinic next week and

then spend some more time at Chey Chumneas.

Just to keep you in the loop, I've had to change my flight back to NZ so

unfortunately I won't be here for the Rainbow mission (I was going to be

present for the first 2 days). My medical school elective administrator

has informed me that, despite writing the that my elective quater finished

on the 19th of November, I'm actually required to be back in NZ on the

13th of November to sit distinction examinations and be present for prize

giving. I'm disappointed not to have the extra time here but

unfortunatly that's the way things have worked out.

So all going well here and a big thanks for co-ordinating things here for

me!

Cheers,

Kate Romeril

Emily. Univ. Bristol. UK

2007-01-05T13:43:00.000-08:00

Hi Will,

Tom and I arrived in Cambodia a week ago Saturday.

Sarom very kindly picked us up from the airport and

settled us into a guest house in the city for the

weekend. We had a great time exploring and then on

Monday morning we went with Sarom to Siem Reap. He was

going up there to take part in a Operation Smile

mission and we went along to see how it all worked and

to assist in theatre. It was a shame we missed

operation rainbow, but at least this was on similar

lines. It was a realy interesting week.

Sarom was very keen for us to see the temples, so we

took the Friday off and stayed the weekend to do it

all properly - absolutely amazing!

We've just had our first day at Chey Chumnas - some

surgery and then attending a funeral party with

Sarom(apparently they have parties for people at set

years after they have died - very sureal!)

So all in all it is going brilliantly and I just

wanted to thank you for all your time and effort.

Also, I won one of the six royal college of surgeons

elective prizes, so thank you for your input with

that. Very chuffed, and the money will come in handy!

Sarom is going to organise for me to see a few post-op

patients.

Anyway, I hope all is well in Canada (if you are

there!). I will send an update soon

Best wishes

Emily

Olivia. Univ.Liverpool.UK

2007-01-05T13:38:00.000-08:00

Dear Will,

I just wanted to write to say thankyou so much for enabling me & Christina to have such a fabulous time on our elective in Cambodia this summer. We had fantastic experiences with Dr Vra & Dr Sarom. It didn't matter that the New Zealanders were there when we were there as it actually meant that we could see more and Dr Vra could see more patients whilst Dr Sabiston could explain a few things to us. I only wish we had arranged to spend more time at the eye clinic & Chey Chumneas!

I have sent a donation to Rose Charities UK, which I hope will be useful and can be spent on the brilliant work done in Cambodia.

I know that you have forwarded a few requests for information from other students to Christina & I would be happy to do the same if that is helpful.

Again, thankyou so much.

Regards,

Olivia Mort

4th year medical student

Liverpool University

Wendy. Univ. Sydney

2007-01-05T13:04:00.000-08:00

Hi Will and Theresa,

Thank you both for your replies.

I hope my initial email was not too dramatic. The first few days here

were quite emotional as this is my first real experience of a

developing country and there was so much of the unfamiliar to adjust to.

I should add to my initial observations that the section of Chey

Chumneas dedicated to Operation FIRST shows obvious benefits from the

contributions and linkage with ROSE charities. Dr Sarom's ward and

operating theatre are in much better condition than those of the

general surgery dept. He was pleased to show me the newly renovated

operating theatre and ward, the anaesthetics and monitoring equipment

which had recently been sent from Hong Kong as well as the TV in the

ward which was recently donated from New Zealand.

Dr Sarom gave me a quick tour of the Operation FIRST facilities but I

actually spent my first morning mostly in the general surgery dept.

And while their wards are extremely run down, their operating theatre

did seemed reasonably well equipped.

I have spent the past two days with Dr Vra and his staff at the Kien

Khleang Rehab Center. It has been such a privilege to watch them work.

In the morning Dr Vra's consultation room is bustling with a steady

stream of patients, with up to four or five consultations occurring

simultaneaously in the same room. But there is distinct order to the

ebb and flow of people. A basic test of visual acuity is performed

outside before the patients are sent to see Dr Vra or one of his

medical assistants. After the initial consultation the patient may be

sent to another side of the room to pick up medications, to be

measured for artificial lenses or to receive other pre-operative care.

Dr Vra has a very warm and easy manner with his patients. He also

remembered to give me explanatory asides now and again as I watched

him perform his examinations.

The afternoons at the Rose Eye Clinic are dedicated to surgery. It was

amazing to watch Dr Vra's deft and steady skill up close as he

performed a series of lens replacements for patients with cataracts.

This was the first time I'd ever seen someone getting stitches on his

eyeball!

Even more extraordinary was watching a removal of a pterygium (tumour

of the conjunctiva). The operation involved a graft of the conjunctiva

from one region of the eyeball to another to cover the excised area.

An unbelievably delicate and precise procedure! I never would have

though it possible.

Tomorrow I'll finally get a chance to explore Phnom Penh. Though Dr

Vra's staff have already taken me to a couple of lovely restaurants by

the Mekong River for lunch.

I'm having a wonderful time here.

All the best,

Wendy