Experiences abroad

As I have mentioned in previous blogs, I spent 2 and a half weeks while in Cambodia working at the Children’s Surgical Centre, part of Kien Khleang National Rehabilitation Centre. If you haven’t already, check out their website at www.csc.org

This was one of the greatest experiences in my life. I got to see some really amazing things while I was there and these things really helped put things into perspective and I would like to share some of these in this blog.

Firstly, check out the website to see what this place is about. Basically while I was there I was working with the one physio there and treating all the post-op patients on the two wards, as well as assessing some pre-surgical patients. Now when I say wards, they are pretty much two rooms with several beds (pretty much just a piece of plywood on a steel frame) and as many patients as they could fit (plus their family members) piled in like sardines. There would maybe be 20 patients in each room that would be no bigger the size of the library lecture theatre where we had most of our seminars this semester. It was extremely overcrowded, pretty filthy, and stinking bloody hot. There was not an awful lot in terms of medical supplies either (well by our standards). There is also a small consultation room maybe 5m by 10m. This got really crowded at times. The surgical theatre is about the same size as the ward, maybe a little smaller. There are three surgical beds set up, and at any given time, up to three surgeries being performed within this close proximity.

This is probably one of the best facilities available in Cambodia. Especially to the Khmers as it provides completely free consultations, surgery, and short term rehabilitation (they don’t have to bribe anyone at all!). I was able to walk into surgery basically whenever I wanted to. I was able to get as close as I wanted, take pictures or videos as long as I didn’t get in the way of the surgeons. Pretty amazing stuff. There are teams of surgeons that come from around the world to volunteer there time and skills most of the year round. This is the brilliant thing about this facility. It is encouraging self-sustainability through empowering the Cambodia people to continually learn and practice surgical techniques. This is unlike a lot of organisations and charities in Cambodia and I would assume other third world countries.

I was able to see and treat a range of patients, lots of these having conditions that just simply would not be seen in Australia. The major thing I saw was fractures. Most of these occurred from motorbike accidents, the occasional one from falling out of a tree or farming. Now these were not acute fractures like we see in Australia. These were all anything from 6 months to 6 years post fracture. Health care is not necessarily free in Cambodia. Everyone who sees you, you must bribe if you want any treatment. One of the reasons people don’t go to see a doctor when they break their leg. Other reasons are lack of transport, qualified medical staff, or facilities. So they might go and see a traditional Khmer healer. They might rub some herbs on your broken leg and off you go on your merry way.

So there were lots and lots of patients in ilizarov frames (which were all reused many many times). Another condition I got to witness that is unheard of in Australia was acid burns. This is very horrific, and a form of torture. I saw a lady who had her scalp avulsed and lost one of her eyes from an acid burn. There were many children who had burns when they were younger from various sources, and had formed contractures and secondary bony deformities requiring extensive surgery. These secondary deformities are simply unheard of in Australia. This was truly an incredible thing to witness first hand. Yet I don’t think I heard a single Khmer complain once about their ailments once.

Other conditions were; quadriceplasties, THR, a young girl with an osteogenic sarcoma of her mandibular (this was terminal, the tumor was about the size of her head), subluxed wrists and patella, meningoencephalocoele, and club feet. I viewed several surgeries including; eye surgery, external fixations, skin grafts, amputations, an exploration of an elbow (the patient turned out to have fracture off his lateral epicondyle. His arm was fixed in 900 to give him some function), and many others.

So a lot of these patients required post-op physiotherapy. I was also involved with pre-surgical consultations. The surgical team would often send a patient for pre-surgical assessment of for example ROM. I was also involved with assessing the odd child with poliomyelitis. One really enjoyable thing I got to do was remove or cut windows into several young children’s casts that they had after external fixation was removed. This was pretty challenging as the children were all rather intimidated by a strange white man coming after them with this old noisy rather large saw. No matter how many times I tried to explain to them in Khmer that there would be no pain (we learned some basic Khmer words and phrases while we were there), the kids were often crying and screaming. Not to mention that this was performed outside due to the mess it caused, in stinking hot and humid conditions to an audience of about 20 or 30 other patients and family that gathered around to see what was going on. A great experience.

So there you have it, a brief summary of my experiences while at the CSC. I encourage you all to volunteer some of your time, knowledge, and skills internationally in a country that is far worse off than ours as it truly is one of the most rewarding things you can do. This experience has completely changed my perspective on lots of things in life, not just physiotherapy. It has certainly changed my approach for many clinical situations in the future, given me many ideas for treatment and management with little or no equipment or resources, as well as putting several things into perspective (standard of health care, facilities, qualified allied health staff, level of knowledge and skills of allied health staff, medical conditions and complications, and probably most of all how others can suffer through great adversity and simply deal with it without complaint).