Cambodia: Kdam Ha Village Medical Clinic

One of our goals for this trip had been to use our knowledge and skills, to help the local people that we meet. Through some contacts in New Zealand, we were able to link up with a lady called Adono who works as a missionary in Cambodia, working with the Girls Brigade. They run an organisation called Village Works (http://www.villageworks.com), in the small Baray village in central Cambodia, more or less halfway between Siem Reap and the capital, Phnom Penh. Village Works provides work for the local women, where they weave and sew handicrafts. At the same time, they are able to break out of the poverty cycle that sees so many women head down the wrong track.

Near Baray is the even smaller village of Kdam Ha, about 15mins off the main road. The Girls Brigade have been running outreach classes teaching English to the local school children, and with the help of Adono, we were invited by the village chief to run a medical clinic for the villagers.

Kdam Ha is about as rural as it gets. A rutted dirt road, wet with the tropical rain, leads through rice paddies to traditional Cambodian wooden houses on stilts, complete with cows, chickens and goats, and villagers peering out to see what these foreigners are up to. The village marketplace consisted of a couple of stalls selling packaged goods, and 3 ladies sitting in the centre on the dirt; one selling fish, one raw meat, one vegetables. There was a pagoda (temple) with reclusive monks, and a small school, where we were to conduct our clinic.

News of our clinic must have traveled fast, for as our white van (which looked as foreign as we did amongst the dirt road, ox-drawn carts and bicycles) drove along the road towards the school, we were followed by a stream of potential patients.

The local fish lady

The local BMX bandits - you gotta pull the bike cos it ain't got no chain

Ladies waiting to be seen by Dr Andrews

Village kids waiting to see the doc

Typical village house, no running water, just one well.

We came with our textbook knowledge, a year and a bit of experience as a house surgeon and three years of nursing,  and a box of various medications that we thought we may need (mostly antibiotics). Knowing that we certainly weren't going to be changing the world, or anything heroic given we had no IV access, imaging or other diagnostic tests at our disposal, we set about as village GPs, seeing patients who came to us with various complaints. Some had never seen a doctor before.

For the medically minded - there was a lot of basic stuff: UTIs, discharge, dehydration, lots of what sounded like sciatica and arthritic knees (from the charming old ladies who have carried water from the well to their homes for the past 70 years). In the more exciting category would be being asked to separate a boys legs that had been fused from birth (like that was going to happen on the desk in the schoolhouse!), TB, some paediatric congenital heart disease, Dengue, big tumors. It was great for history taking practice (through an interpreter), as that's all we had to go on. 

Even diagnosed some Myasthenia Gravis - a middle-aged lady with ptosis, inability to elevate her eyes, diplopia, change in speech, which were fatigable. The diagnosis was confirmed when she pulled a small pill bottle of pyridostigime, and she told me she saw a doctor in Vietnam who did some tests and gave her the pills to take. We were then able to work out how much pyridostigime she was on (which was way too small a dose anyway) and upped her dose a little, encouraging her to see a local doctor for ongoing management. It made me realise just how lucky we are in the developed world, for the management of such chronic conditions.

At the end of our time in the village, we ran a public health seminar, covering basics from what we had seen were the main health problems the locals encountered, including hygiene, the need for clean water and to drink adequate amounts of water when working in the hot sun. We had brought toothbrushes which we gave to all the villagers, and taught the children how to brush their teeth. The kids had never used a toothbrush before, and the looks on their faces when the toothpaste foamed up in their mouths was hilarious - they didn't know what to do!