|
International
Child Health Section: Articles
Nisha
Thampi
Angkor, Cambodia
I volunteered at the Angkor Hospital for Children (AHC), an
NGO-based hospital that cares for children and adolescents in and
around the
province of Siem Reap, Cambodia. This formal capital has been at the
epicenter
of the growing tourism industry due to its proximity to the
UNESCO-protected
Angkor temples, built by Hindu and Buddhist kings one thousand years
ago. As a subspecialty
resident in Infectious Diseases, my
primary role was as consultant. The hospital was capably run by local
physicians, many of whom had also trained abroad and were considered
among the
best paediatricians in the country. The hospital administration had
identified
medical education as a priority, and so part of my experience involved
bedside
teaching opportunities, strengthening physical examination and
documentation skills,
formulating differential diagnoses and disposition, and participating
in daily
teaching rounds in the inpatient and intensive care units. I
had worked in Cambodia as a medical student, so I was
excited at the prospect of returning to the country with a more
polished set of
skills. I had been wary of infection control issues, having found a
scarcity of
resources at other hospitals in the country, but at AHC there were
clearly
efforts to mitigate the spread of community-acquired and nosocomial
infections,
including a 4-bed ICU with individual isolation rooms and a bustling
emergency
room with alcohol-based handwash at every bedside, and 2 isolation
rooms in the
inpatient unit that were, at one point, each occupied by a child with
Methicillin-resistant Staphylococcus
aureus (MRSA)-associated abscesses and another with AIDS and
active
pulmonary tuberculosis. Although
my
primary role was as consultant and educator, I learned a lot from
colleagues in
managing cases of tetanus, meliodosis, advanced HIV and tuberculosis,
profound
anemias and neonatal respiratory distress with limited diagnostic and
therapeutic resources.
I was also impressed
by the strong commitment to medical
education, with daily didactic seminars, bedside teaching rounds and
grand
rounds every Friday, to which I had been invited to present on
antimicrobial
resistance, which had been an emerging concern at the hospital with
significant
rates of MRSA and multi-drug-resistant gram-negative organisms. Given
the Microbiology’s
sophisticated diagnostic capabilities, I also developed an antibiogram
that
looked at the incidence of organisms isolated in blood and
cerebrospinal fluid
over the previous 12 months to better inform the development of an
empiric
antibiotic policy for the hospital.
The medical system is still recovering from the decimation
brought on by the Khmer Rouge regime, during which all but 20
physicians were
killed or fled the country. Previous Hillman award-winners have
addressed this
conflict period in their reports, and it is indeed remarkable how much
of
Cambodia has been rebuilt over the last 30 years – paved roads in the
cities
and some parts of the countryside, a health care system that is seeking
to become
self-sufficient (at Angkor Hospital for Children, there remains only
one
foreign-trained physician among the senior staff), and a judicial
system that
is finally addressing some of the worst crimes in the country. I have
been
inspired by the resilience and commitment among staff to their
education and
patient population. One physician described the travel between his
village near
Siem Reap to the capital, Phnom Penh, for his medical studies during
the 1990s:
"The bus ride took 3 days (it nows takes 5-6h) because the roads,
having
been destroyed by the Khmer Rouge, were riddled with landmines, and
sometimes
the soldiers would stop the bus to question people or steal our
belongings."
My time at AHC was insightful,
instructive and
inspiring. I met wonderful health care professionals who are working
hard to
transition this place from a centre of competence to a centre of
excellence –
no easy task in a resource-strapped setting. Posted:
March 2011 |
|
