Accommodation

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

Sarah (N.Z.) August 2009

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reply

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)

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

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)

Jessica now in Cambodia. See her ongoing blog

Suzanne. University of Cardiff. October 2008

(..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.