Emergency Care Course, Cambodia

Its great to be back in Cambodia again. This is my third trip here, and I think I have more fun every time I come as I get to know more and more people. When I arrived back in Battambang, I immediately was able to reconnect with friends and pick up where I left off.








Monday and Tuesday were part of Chinese new year, and although Cambodians are not Chinese, its provides a good excuse to now show up for work... because after all, China is close to Cambodia - so why not? I worked in the office and prepared teaching sessions on chest pain, ECG review, and how to use an AED. There is now a video on you tube detailing how to use a defibrillator in Khmer... the only one I know of. 

The hospital was relatively quiet, but we had a few interesting cases. There is still a reluctance to engage on the part of the Cambodian doctors. It becomes a game to get them interested in bedside learning without having it appear that you are actually teaching them. There is a huge fear here of looking like you don't know what you are doing; so much in fact that people will actually leave the hospital on the premise of some same excuse to avoid having to deal with a difficult patient. I am seeing some improvements, however, and people are starting to use things from prior lessons. 

 Last time I was at Battambang hospital, I had 3 doctors and a room full of nurses show up to my lectures. This time I had 23 physicians, almost all of them in the hospital. I was thrilled with the turnout.


In contrast to India, it has been very difficult to find "sick" snakebite cases in Cambodia. This is because most patients go to traditional healers and get a salad mashed up and put on their skin instead of antivenom. The sick ones die, and the ones that eventually go to the hospital are going to survive regardless of what you do for them. This poor 19 yo man stepped on an unsuspecting cobra and got bit in the foot. He had a very mild local reaction and didn't require antivenom. In a severe case, he would start having hypersalivation, intense stomach cramps, and progressive muscle weakness and paralasis requiring intubation and mechanical ventilation. There are many of these cases every year in Cambodia... but again, most of them die before they make it to a proper hospital. 

 I am now back in Phnom Penh with the rest of my team - 5 in total with about 25 local staff. We are putting on 4 day emergency care course with workshops for some 65 doctors. In the past we had a mixed group of doctors and nurses, but due to cultural peculiarities, this didn't work out because doctors refuse to ask questions and participate in front of nurses, likely because many of the nurses know more than they do and they are afraid to look stupid.

One of the work stations will be chest tube insertion. They make special mannequins for this, but they cost thousands of dollars. Instead I went to a 9 local hardware windows to collect various baskets, tubing, hose, tape, etc to try to construct an artificial chest wall with foam padding over the top. We'll see how it works. Hopefully better than nothing. 

 We met with the local nurses and doctors that will help us translate and facilitate small groups. This is a staff of about 20. We didn't have the chest tube mannequins made yet, so we had them practice on cardboard boxed. Kind of ghetto, but it got the point across. They had lots of fun stabbing the boxes and acting out the part of sick patients. 

 One the key skills we are teaching them is how to deal with femur fractures in trauma patients. We wanted to see what they had been using for traction splints, and to no great surprise, they had not been splinting them at all! Rather than showing them some expensive piece of equipment we use in the U.S., I made a traction splint out of PVC pipe, rope, hose, cloth, and some fittings. It has a pulley system in it, and it actually works as well as any expensive device I've ever used in the US!

 We went out for dinner at the Foreign Correspondents Club (FCC) last night, which is about as much of a tourist joint as you can get. It was used by reporters to send reports back to the U.S. and U.K. during the Vietnam war. I now displays many awesome B&W photographs from the war on the walls... and has cheap beer. On our way home, the tuk tuk driver asked if we wanted to go dancing. One of our team, a perpetually dancing individual, said, "sure, why not?" We were then, to our surprise, taken to one of the coolest night clubs I had seen! This was in a back alley, in the middle of no where. The stage lighting alone would have paid to build an entire emergency department! There is a very small subset (<1%) of ministers, building owners, and people who made out very well after the Khmer Rouge stepped down after peace negotiations with the Vietnamese, that had tremendous wealth despite this being a relatively poor country. I'm guessing they keep this club open, along with the local Range Rover, Mercedes, and Cadillac dealer. Curious.