Health is the key focus of my time in Cambodia. Over the last week I've had the chance to visit a few facilities in NW Cambodia, talk with patients and staff, and view first-hand some of the challenges which await me...
On arrival in the remote Banteay Meanchey province it's clear this is a long way from the bustling metropolis of Phnom Penh, or indeed the 'khmer lite' of Siem Reap. This is the 'real Cambodia': poor, underdeveloped, and very rural - challenging territory indeed.The dirt road north is bumpy, hazards include wandering herds of oxen and water buffalo, and the dust is choking - though I shouldn't complain as come the wet season it's an impassable mudbath. Happily tarmac is promised which will greatly improve access for the people here; sadly for me it's unlikely to be finished in the next couple of years.
An hour north of the regional town of Sisophon, the sleepy rural village of Thmar Pouk lies on the watery plains stretching to the Thai border. This is the remote north-western corner of Cambodia, and the referral hospital here will be my main base for the next two years.
The hospital here is best described as 'basic' - a huddle of low-lying buildings with stark wards and sparse support facilities, built around a volleyball pitch and outdoor cooking area. Unexpectedly, the largest group of patients have respiratory conditions. I was told things are improving here, but it still looks pretty rudimentary - no consistent water or electricity supply, wards certainly not modern, spacious or particularly clean (think 'ïnfection control nightmare'), and basics such as drugs in pretty short supply.
On the positive side, there is a well-respected lead doctor, and already they have a promise of funding for a much-needed paediatric ward, so one of my jobs is to make sure this actually gets built. Interestingly, the money is coming from the US military - why would that be?
On the way back to Sisophon is the village health centre at Svay Chek, another eye-opener. Cleanliness here is even more of a challenge, and the IT infrastructure is limited to a rather imposing old Olivetti typewriter. However, there are trained midwives delivering babies here, and a TB outreach programme - there's definitely hope.
Part of my role will be to help improve the system for referring patients between local health centres and hospitals. Mercifully, I will be encouraging people to access care rather than trying to limit it, as I was having to do back in the UK. The chief explained that a well-meaning Christian group in Thailand donated the centre's ambulance to help transfer patients, but there was no provision for diesel - so unless patients can pay for fuel they stay where they are.
In fact, there was a sobering theme of well-intentioned but useless help - the Japanese had funded the health centre's water supply, but the cheap tank didn't work properly. Meanwhile the kindly-donated lab equipment sits firmly in its box as there's insufficient electricity to run it.
In contrast, we travelled south of Sisophon to the new flagship hospital at Mongkol Borei, an altogether more successful gift from the people of Japan. Whatever the motives for the donation, it's clear why this is where visiting dignitaries are directed. Beyond the bright signs and topiered hedges are shiny new wards and equipment, and also impressive systems such as health records and plans to introduce networked health information - good luck with that...
Not that it's perfect - away from the gleaming front, we wandered round the side of a stagnant pool to the deserted ophthalmic ward, and on to the shabby children's unit, with roof but no walls, rickety beds pushed tightly together, all kids on the ubiquitous drips, and toilets firmly locked (presumably to keep them clean).
Overall, it's clear some things will take some getting used to. Alison, my nursing advisor colleague, noted how few nurses there were - partly, it would seem, as all personal care such as feeding, washing, and emotional support is provided by family members - or if not possible, neighbours, or the gardener - a rather different approach from what we are used to.
One story in particular revealed some of the challenges ahead. The orthopaedic ward was full of young lads smashed up either on the roads or in the fields (more to come on road and occupational safety I'm sure!). Several had impressive bits of mechano-like metalwork sticking out of them ('external fixators'), keeping the bones in the right place. Most of the guys were recovering well, so we asked why they stayed in hospital. The doctor explained that they couldn't afford to pay the deposit on the kit so needed to stay - otherwise unscrupulous private clinics would remove and sell them on, leaving no equipment for future patients.
Altogether a fascinating week - I think I'm going to be busy.
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