CAMBODIA 2007 - Ozonoff' Report
Carlene and I spent almost three weeks volunteering on the staff of Angkor Children’s Hospital in Siem Reap, Cambodia in January. I worked and taught in the Radiology department and she worked with the support staff helping keep the patients and their siblings content while waiting to be seen.
Siem Reap is a small colonial town built around an old French Quarter and would be just another village if not for its location about a mile from the Angkor ruins. This remnant of the Angkor Kingdom (ca 800-1400 A.D.) was discovered by French explorers in the 1800s and has been rediscovered by the tour industry. This has resulted in several miles of extravagant hotels resembling Palm Springs or Miami Beach – tourists fly in, visit the ruins for a day or two and fly out. The hotels have every modern touch, air conditioning, huge pools, lush landscaping, etc., and are located at the north end of town. But the old town, a mile away, where we lived and worked, is something out of the early 1900s.
The hospital was built and is supported by a US foundation (Friends Without A Border). It was built in the French colonial style in 1995, with screened porch type wards. Some of the equipment is very modern, some (like the x-ray machine and darkroom) are relics of the pre-1950s. The staff is Cambodian but the official language is English, which all the staff have to learn. Volunteers (like us) visit for weeks or months at a time and help out in the wards with clinical practice or teaching; many volunteers have come back for as much as seven years in a row. We met physicians, physiotherapists, nurses, computer specialists, business managers, public health workers and others from the US, Italy, Holland, Australia and elsewhere. Its mission is to train Cambodians who travel there from all over the country for weeks or years of training, so they can return home to practice modern medicine and public health. (Interestingly, there is a rival children’s hospital in the new part of town, established by an eccentric Swiss doctor who is said to run it as a self-centered fiefdom without significant teaching programs, and the two hospitals have nothing to do with each other: this modern-style building is the one most tourists see, while we were at the one in the old part of town.)
We stayed at a French Colonial style converted mansion guest house owned by the hospital, but about a 25 minute walk away down a dirt road. Its advantages (free room, two meals a day, laundry, and socializing with other volunteers) were balanced against its drawbacks (no air conditioning -- so it was over 90 degrees in our bedroom despite two fans -- no hot water – but a cool shower felt good at close to 100 degrees the first week, and a walk to the hospital and back for lunch at noon, then repeat for the afternoon from 2 to 5 PM.).
But the walk was fascinating, along dirt roads thick with refuse, chickens, motorcycles, burning rubbish, naked or barefoot children, dogs, pigs tied to motorcycles, people cooking along the roadside, motorbikes with infants seated in the front holding onto the handlebars with 3 or 4 other passengers behind (helmets? – you can’t be serious). Traffic was wild, with the two stop lights and the one way roads only “suggestions” that no-one observed, and since so much of life was lived on the sidewalks you had to walk in the street, and believe me, pedestrians were the lowest form of life. But I think we learned more about life on the walk to the hospital. The town center was filled with small restaurants and pubs and the crowded central covered market. The food was wonderful, all eaten outside in the warm evening air, and incredibly good and cheap (typical: beer, wine, spring rolls, two curries, and dessert cost $ 12 for two). We ate everything, despite the kitchens that it was best not to look at too carefully, and never had a day of illness (our secret: two pepto bismol tablets every morning).
Over 300 patients crowd in when the gates open in the morning, and if not seen by 5 PM they stay overnight on the hospital grounds in mosquito net tents and hope to be seen the next day. Only the most ill are admitted to the two 20 bed open wards, where the parents sit and sleep on the beds with the children. (The beds are metal frame with wooden slats covered by woven reed mats: the space the patient takes up has a linoleum slab and a torn sheet segment.) Extended families are common, and since there is no food service they are given basic supplies and cook it themselves on grills next to the wards or buy it from food stalls on the street. Siblings and patients wander through all the wards, most barefoot, some without any clothes. All are incredibly patient and uncomplaining. Carlene’s job was helping entertain them by folding origami animals or cuddling those babies without mothers.
The medical staff is 5 or 6 full time Cambodian pediatricians and about the same number of Cambodian resident-equivalents, augmented by specialists like me as volunteers (ophthalmology, developmental pediatrics, orthopedics) and pediatric residents from Brown Univ. and other programs. The Cambodian doctors grew up with civil war and repression – the one I worked with had his father and four brothers killed by the Khmer Rouge – spoke Khmer, learned French to attend medical school, and English to practice in the hospital. All realize that many diagnoses will go untreated for lack of specialty surgeons, equipment, or money. I saw many cases of congenital heart disease (we had a modern ultrasound machine) that couldn’t be sent to Singapore for surgery (no money) and so would eventually die, although a team had come down and made plans to fly 100 of them to Korea for surgery. I now know where my charitable contributions will go.
The patients typically presented at a late stage of disease, having been treated in their villages by local healers. TB, soft tissue abscesses, hydrocephalus, land mine amputations, malaria, hemorrhagic dengue fever were common. There were many HIV positive children, some with full-blown AIDS but most asymptomatic. There was a daily outreach run to the countryside to make sure the HIV patients took their medication, and the health worker we accompanied to really primitive stilt house villages counted all the pills to make sure they had been taken.
All in all, it was a sobering, uplifting, and exciting experience. If any of you are interested, let me know, or look at the website: Angkor Hospital for Children.
Mike and Carlene