Stories From the Field:

CAMBODIA

Mobile Medical, Dental, and Surgical Clinics in Battambang, Cambodia

Tina Tam, RN

Tina Tam, RN, Staff Nurse on Lunder 10 Hematology/Oncology Bone Marrow Transplant Unit, was granted a Travel Award to volunteer in Cambodia. Tina spent a week setting up clinics and providing primary, urgent, and surgical care to poverty-stricken patients in and around Battambang, Cambodia.

Cambodia is still in the process of rebuilding after its five-year civil war and genocide, which ended in 1970. Not only did the war leave Cambodia poverty-stricken, it also contributed to the current shortage of healthcare providers. During the war, intellectuals (including doctors) were deemed a risk to the new governing group, the Khmer Rouge. Therefore, many were imprisoned and executed. The goals of the Cambodian Health Professionals of America’s (CHPAA) mission was to "deliver healthcare services, promote education and social well-being to the underserved in Cambodia."  A large team of medical and non-medical volunteers, from both the United States and Canada, took part in this year's mission. In addition, CHPAA recruited medical and English student volunteers from Battambang and Phnom Penh universities to act as translators, assist with crowd management, and triage patients. In return, the students were provided with scholarships, mentorship, and clinical experiences.

A large main clinic was set up at a local hospital in the province of Battambang to provide medical, surgical, and dental care. In addition, two remote clinics were set up in nearby rural towns. Over the course of the week, approximately 3,000 patients were examined, treated, and educated.

Patients heard about the clinics through local radio, television stations, and word of mouth. They travelled from near and far, waiting long hours under tents in the hot sun for the chance to be seen by a doctor. For many, it would be their first time seeing one. Additionally, if a patient could not get one of the “tickets” handed out early in the morning for a clinic appointment on their arrival he or she would camp outside overnight to try again the next morning.  With an average income of $750 a year, most of the patients of this country could not afford the luxuries of health and dental care. In one memorable case, we treated a mother with a deep gash in her right cheek, and her one year-old baby with a tear on his left ear at the remote mobile clinic. They had been in a motorcycle accident without helmets on. They came from a local clinic, because the doctors there had stopped suturing their wounds when “they ran out of money to pay for the service.”

As a nurse, I was able to utilize my clinical skills to triage patients, assist in surgical procedures, provide wound care, and educate students and patients. Some of the cultural barriers of care occurred when we triaged and assessed the patients. We had to differentiate if the patients’ chief complaints were current issues, or if they were just reciting their complete medical history. We found it helpful to spend more time talking to the patients, asking appropriate questions to draw out their chief current complaints in order to treat them safely and appropriately. Another challenge was the limited time we could spend with patients and the inability to provide follow-up care. For example, we were only able to give a few weeks of medications to chronically ill patients with diabetes, hypertension, and pain not knowing if they would be able afford to purchase more in the future. I had to constantly remind myself that even though we were only providing temporary relief and comfort, it was still important and much appreciated by the patients.

CHPAA is also an ambassador for the LN-4 Prosthetic Hand Project. We encountered many citizens, of all ages, who were missing hands and/or limbs due to landmine explosions and other kinds of horrific accidents. Over thirty patients were fitted for and given prosthetic hands. One patient had had both of his hands amputated after being electrocuted while working, many years ago. With his new prosthetics, he could eat with utensils, write, comb his hair, shave, carry items, and perform other daily activities again. The joyous smiles and tears on these patients' faces were priceless. This was undeniably one the most memorable parts of the entire mission.

After the mission, all the volunteers were surveyed to compile ideas and suggestions for the future. There are continued debriefing sessions amongst the members and it’s board to find solutions to improve future medical missions. I hope to continue volunteering with this wonderful organization. It is an understatement to say that the trip was a humbling, enlightening, and rewarding experience. I have gained so much more than I gave. Due to the limited resources available, I was able to challenge myself and work creatively throughout the mission.