Bhavna writes... (May 2011)

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!

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.