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
Monday, May 18, 2009
Friday, May 15, 2009
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 !
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/
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 !
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