Written by Christina Kinnevey, MD, Fellow at Kaiser Permanente Napa-Solano Community Medicine & Global Health…
Written by Chuong Dang, MD PGY3 at Kaiser Permanente Oakland Pediatrics Residency Program on a Global Health rotation with Project Angkor in Cambodia.
We departed from San Francisco Airport on 12/29 early morning, transit flight in Taipei and arrived in Phnom Penh, the capital of Cambodia on 12/30. We picked up our supply boxes (about 30-40), applied for expedite visa at the custom then were on our way to the hotel via buses. It was free time the first evening in Phnom Penh; we went to the Russian Market to buy some personal goods in preparation for the trip. It was a surprise to me that the U.S. dollar is accepted almost everywhere we traveled to in Cambodia.
The second day, the program organized a field trip to the infamous Killing Field, where the old Khmer Rouge regime executed and massacred tens of thousands of people during 1976-1979 coup. This place taught us to value peace and to condemn war or any crime/ideology that is against humanity. In the afternoon, my room-mate and I visited the Royal Palace, where the king of Cambodia is living. It is a cluster of beautiful temples, palaces, and landscapes that embody the Khmer culture and architecture. They are very deeply influenced by Buddhism and Hinduism. We then walked about 1.5 miles to the Central Market where some souvenirs were purchased. We headed to the hotel and attended the Count Down party for the New Year which was organized at the central area of the capital. It is truly a great experience to be able to take part in this party during this time of the New Year in Cambodia, not the same experience I used to have in the States.
The third day, we checked out of the hotel and travel to Kampong Cham as our clinic will be at this province. The travel distance between Phnom Penh and Kampong Cham is about 120 km. With the highway system in Cambodia this trip normal took more than 3 hours. We did stop at one of the famous Buddhist temple midway to Kampong Cham to meet with the students who were studying at the temple. The Project Angkor team also donate books, library supplies, laptops, and money to the students and the local library at the temple. We spent about 1/2 hours at the temple before continuing our journey to the final destination to Kampong Cham. After checking in our hotel, we had an orientation at the clinic site, which is a local provincial hospital about 0.5 miles away from the hotel. The overall plan for the day did change after we discussed with the local health officers regarding the work flow of the clinic in the morning. We also met up with the group of Cambodian medical students who serve as interpreters during our clinic time in Kampong Cham. They are the young students in their last year of medical education from an English medical school in Phnom Penh the Project Angkor has the opportunity to work with every year. Everything is ready for us to start the first day of clinic in the morning. That night we spent some time to discover the local of Kampong Cham.
The 4th day of this trip was the First day of clinic: We are among the people that arrived at the hospital earliest in the morning, about 7AM. There were about 100 people already there at the hospital waiting to see us. The hospital helped us to put up some tents (wedding tents) that can house more than 300 people at a time. Our pediatric clinic was cleaned up since last night but there was almost nothing ready. It is an abandoned building which was innovated by the aid of USAID fund several years back, I have the impression that the building has not been used before. We spent the rest of the next 2 hours speedily made things ready. We attended the opening ceremony before the clinic started. As the first day went, we have seen more than 50 patients among 700+ total. Lunch was provided at the hospital. It was a busy day at the clinic but very self-fulfilling. My patients varied between common cold to worried well, pneumonia, skin abscess and HSV infection, but most of them carry the appearance of severe undernourishment and stunted height. Due to the fast pace of this clinic, the residents (2 of us, including me) were on their own–not much of attending supervision. At the end of the clinic we even participated in a rapid response (adult) for one of the patient who was waiting under the sun and suffered from heat stroke and collapsed on the ground. She was stabilized by oral hydration and simple cooling procedure such as fanning and water cooling with ventilation by the pediatric team! That night, we had a dinner invitation by a NGO group who happened to be in Kampong Cham at the same time. It was a great time to be together with other volunteers and programs.
The second day of the clinic was very busy day. When we arrived at the hospital in the morning there were more than 200 patients waiting at the tents, this along with the hot weather (much warmer than the other day) made the day really hard and long. It was a very exhausting but fun day as we were also able to order for some minimal labs and X-ray which were not the case the day before. I was thrilled to also perform a suturing procedure for a child who endured an accident that caused a laceration (through-through) at the left side of his nostril. At the end of the day, though very tired, I felt like I did something in helping the underserved population at Kampong Cham; overall it was a great day.
We started our third day in Kampong Cham with a 1.2 mile walk up the Mekong River shoreline to visit the famous Bamboo Bridge. It was a beautiful sunrise on the river! We took the Tuk-Tuk back to the hospital and start the 3rd day of the clinic. In the morning, total number of patients was more than yesterday morning but our pediatric department was not too busy today. We saw a total of 80+ patients mostly in the morning. I also ended up admitting a child with pyelonephritis to the local hospital for IV antibiotics. That day I was totally exhausted since I was affected by acute gastroenteritis symptoms after I tried some new food at a local restaurant. I went back to the hotel earlier, took a long nap after the clinic and went to have dinner late that night. Tomorrow will be better I hope!
I felt better on the 4th day in Kampong Cham and ready to see patients. My stomach was still sick hence I was careful not to each much of solid food today. We arrived by tuk-tuk and started to see patient at about 8:15 AM. The total number of pediatric patient today was about 120+. Today I arranged another admission for a baby who is about 9 months old to have her non-reducible umbilical hernia to be surgically corrected. We were able to arrange a free surgery for the child in Phnom Penh but the cost of transportation and hotel stay were not free; hence I did a small fund raising campaign for the child and we got about $260 for her parents to go to Phnom Penh for the surgery. I felt extremely pleased with the process. After the clinic we arranged a boat tour on the Mekong River during the night for which I would not consider so much fun since it is quite treacherous boat tour on a great river without much lighting, lots of flying bugs, and no life vests! After the boat tour, we had dinner at the local restaurant. I chose to walk along the river shore alone, enjoying Kampong Cham by the Mekong at night time.
The fifth day of clinic is also the last day. Our breakfast was at a noodle house by the hospital. The local noodle was one of the best I’ve tried. They are much cheaper and more delicious compared to the fancy restaurant we used to eat by the river side. Again we started the clinic at about 8AM. My first patient was the child with umbilical hernia that we arranged the surgery for. After discussing with her husband, the mother took the child back to the clinic today in order to proceed with the plan for surgery in Phnom Penh. I gave the family the money and sent them to Phnom Penh, wishing them luck. The clinic was only half day today. But we have seen about 100+ today. In total, there were about 500+ patient visits throughout the past several days among 3 of us. We had lunch together after pediatric clinic, took some pictures together. We had some free time back to the hotel until the closing dinner as a big team of Project Angkor together. We will check out tomorrow. I will also have another 3 days in Cambodia before returning back to the States. It was a very fun and meaningful time that I spent in the past week in Cambodia. I will definitely be back if time allows.
This is the first time I have ever been in Cambodia and it turned out to be one of the best 10 days of my life. I love Global Health from the bottom of my heart hence trips like this truly make my dream come true. During this short rotation, although I did not gain much medical knowledge but I am confident to say that the experience here cannot be purchased by money or be achieved via any type of training in the US. Ten days in Cambodia not only taught me the culture and history of Khmer people via visiting multiple historical and heritage sites, but it also gave me the opportunity to meet with many people that I am sure will serve as key persons for my future plan regarding global medicine in Southeast Asia. My hope is to build a bridge in form of pediatric care and education in developing countries, especially in Southeast Asia. This rotation, along with other global health experience in the past and near future during my residency, surely gave me the crucial tools to achieve that goal. Thank you for supporting me.