Friday, September 28, 2007

Tom Wolfenden: Brighton & Sussex Med.School UK

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

Wednesday, September 19, 2007

Tom Univ. Sussex & Brighton (UK) Med School

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.

Saturday, August 4, 2007

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

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

Monday, May 14, 2007

Jesal. Univ. Birmingham. May 07

..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..

Sunday, March 18, 2007

Trudy. Univ.Sydney

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

Tuesday, January 23, 2007

Trudy (Univ. Sydney)

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

Wednesday, January 10, 2007

Luke. Univ.Adelaide

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

Friday, January 5, 2007

Malcom. Univ. Oxford UK

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

...
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!

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

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

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

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

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