|
International Child Health Section: Articles
Phnom Penh, Cambodia
Submitted by Dina Kulik
During my international elective in Cambodia, I spent mornings at the National Paediatric Hospital (NPH), the main children’s hospital in the capital city of Phnom Penh. While at NPH, I was exposed to relatively modern health care delivery and great teaching from motivated educators. The physicians at the hospitals in Cambodia are eager to explain their delivery of care, and are interested in finding out more about the care given in Canada. Cambodians speak mainly Khmer, but physicians also lecture in French, and occasionally in English. I found that most teachers and residents were keen to practice English when given a chance.
I had the opportunity to teach at rounds and teaching sessions. This was gratifying. Like medical education in Canada, paediatric residents and medical students rotate through NPH, and present at rounds. I was asked to aid the medical educator and teach physical exam skills. I was able to cross barriers posed by language, and the relatively male-dominated system, in order to provide useful services, both clinically, and educationally.
While at NPH, I was saw myriad diseases and conditions that I am usually never exposed to. Most of my time was spent on the Infectious Disease Ward, seeing patients with Dengue and Malaria. However, the Diarrhoea and Dehydration Ward became increasingly busy with each week as more gastrointestinal viruses were being passed around.
I learned that children will often be brought to the hospital only once they are very ill because families cannot afford to pay for their treatment. I saw cases of dengue hemorrhagic fever progressing to end-stages before a child was brought to hospital. I saw cases of children presenting with end stages of hepatitis, pneumonia, malaria, pleural effusions, intestinal perforations, and injuries sustained from motor vehicle accidents. In addition, and perhaps most sadly, I saw the consequences of delayed care even when the patient was brought to hospital in a timely manner. The family must come up with the money to pay for investigations and medicines, and without those funds, the patient could end up waiting for care. It was not uncommon to hear stories of families that had gone into debt borrowing money from loan sharks to pay for the care of other family members.
I found that many families would seek the services of the pharmacist prior to coming to hospital, as this is more affordable. However, Cambodian pharmacists do not receive the same type of rigorous training as Canadian pharmacists. It was not uncommon to see cases of overdoses, medication interactions, medications given for the improper reasons, and other medication errors as prescribed by the pharmacy. This approach to treatment sometimes had devastating outcomes for patients.
I also spent a substantial amount of time working on the HIV/AIDS Ward. On this ward, more than ten patients are treated at a time and stay for inpatient care. All patients were receiving good quality antiretroviral treatment as well as antibiotics and antifungals as needed. Most importantly, they were all well-cared for. The hospital also provides a great outpatient department for HIV patients, and I spent time with those physicians as well. It was eye-opening to see how many children were in orphanages as a result of HIV/AIDS in their family.
I did volunteer work with Action to End Exploitation (AEE), a non-governmental organization (NGO) that works to teach English to victims of human trafficking and sexual exploitation. Unfortunately, the sex trade is still alive and well in Cambodia. On numerous occasions, I saw children and women being solicited for sex. AEE reaches out to children who have parents that work in, or own, brothels. I taught a class of children aged 7 to 16 years. They were great: fun, energetic, intelligent and thoughtful. When there was limited medical work to do at NPH, I helped teach sexual education and English. The children I taught inspired me. Working with them was a rewarding part of my trip. I felt that I made a difference in these young people’s lives.
After teaching at AEE I would head to another hospital in Phnom Penh, Calmette. I wanted to round out my knowledge of how the health care system in Cambodia functioned. Though Calmette is an adult hospital, they do care for many children, especially the many children that come in post-MVA. I saw many cases of stroke, pneumonia, bowel disease, MVA, TB and other diseases such as tetanus.
Cambodia is a beautiful country. The people I met were warm and inviting; they wanted very much to convey their culture to me, as well as talk about their families and their lives. My work was interesting and informative. It will be incredibly useful for future international work and patient care in the Greater Toronto Area.
Posted: March 2009
|
|
