By Peter S. Smith, MD
While hematology-specific programs are still in the implementation process, HVO has established programs in both pediatric and internal medicine. Peter S. Smith, MD, Professor Emeritus of Pediatrics at Brown University and longtime ASH member, participated in two tours of training in Cambodia, most recently in November 2006. He describes his experience below.
This was my second tour to Angkor Hospital for Children (AHC) in Siem Reap. Both times my assignment was to teach pediatric hematology and oncology to junior residents at AHC with the option to also supervise and consult in the Outpatient Department and the Inpatient Service. Lecture hours dealt chiefly with hematology and oncology with some pediatric rights issues integrated when the situation presented related ramifications. During the four-week assignment, I gave eight one-hour lectures covering a broad spectrum of topics, including iron deficiency, bleeding disorders, white cell disorders, and a selection of common childhood cancers and leukemia. I also observed and discussed general pediatric cases seen by the residents assigned to the OPD.
Almost all of the topics I taught were case-based, which gave the audience the opportunity to read texts out loud and practice their English while learning the subjects through questions, answers, and discussion. Their speaking ability ranged from almost unintelligible to practically flawless. Even though their speech was grammatically correct, most of them had strong accents, making it difficult to understand them—particularly when there was background noise. I asked them to repeat their statements often several times, which they did patiently, using various permutations of pronunciations until I grasped what was meant.
These young physicians were outgoing, courteous, enthusiastic in their participation, and endowed with a good sense of humor. They arrived on time, were patient when I had time-consuming technical problems with the projectors, asked good questions, and had a good fund of medical knowledge. I quizzed them orally on a preceding subject covered in my talks, which revealed to me what they had understood and retained, or what was unclear and required further discussion. These didactic sessions were my major contribution to this site. The subject matter was new territory to the house staff and required the concentration made possible by the dedicated classroom recently built for that purpose.
My contributions in the OPD were less effective, since the majority of clinic visits were for common pediatric complaints and managed well, or better, by trainees familiar with the environs, traditions, and above all, the language. Much of what I could offer was instruction in tertiary pediatrics, particularly with regard to the diagnosis and treatment of cancer. I also consulted on difficult or complex cases in hematology-bleeding disorders or severe anemia, such as thalassemia. Ward rounds were a lesson in advanced morbidities, including diseases I had rarely, if ever, seen: severe malnutrition, tuberculosis, severe congenital heart disease, typhoid fever, minimally treated thalassemia major, and many others. In this setting, I was learning more than instructing.
However, having said that, I believed that this generation of residents could adequately care for a number of curable cancers in children that would respond well to treatment provided it could be informed by attention to detail, possible risks, and more advanced imaging. The most common malignancy, acute lymphoblastic leukemia with good prognostic features, could at least be partially treated at AHC. It is expected that children will present with malignancies now that there is overall longer survival of children in developing countries.
My living conditions were basic but inexpensive. The volunteer coordinator of AHC, Sun Sopheary, a gracious English-speaking young man, greeted me at the airport and brought me to a guest house he had found and recommended. It was across the street from the hospital, and it was equipped with a bathroom, air-conditioning, large, recently-installed windows, and a furnished dining area on the first floor. The owner was very friendly, greeting me every morning with joined hands and bowed head.
Since the day’s agenda hardly changed, I required little orientation. HVO provided me with a comprehensive orientation packet with a wealth of helpful information, including the Cambodia Program Description and the Guide to Volunteering Overseas. The Guide was a model of clarity and practical advice that presented a vivid chapter on "Teaching How to Teach," which both explained the emphasis of HVO and served as a model of down-to-earth wisdom on what works best in teaching trainees.
My experience was another memorable trip to a pediatric hospital that continues to offer dedicated and high-quality free care to thousands of children from a growing catchment area. A volunteer going to Siem Reap will be impressed by the gentle and hard-working staff attending to those throngs of kids and their families or providing for the many needs of the very sick. Physicians and nurses will see severe diseases and marvel at how many patients improve and go home. The atmosphere in the hospital is cheerful and enterprising, and the volunteers will feel respected and appreciated for their contributions, however modest they may appear.
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