University of Leeds 2018

Medical, Cambodia Phnom Penh

Wren, JoshuaI chose to undertake my elective in Cambodia because, to me, it still felt unexplored.

I knew very little about the country — aside from its civil conflicts and the Angkor Wat temple. But I came to love it.

One of my main medical objectives was to learn how healthcare is conducted in a developing country. The Work the World team worked closely with me, tailoring my placement to my interests.

They arranged experiences in surgery and paediatrics, and community medicine in the form of a Village Healthcare Week.

I undertook my clinical elective across two hospitals, and one health centre in the more rural Takeo Province of Cambodia.

Both hospitals were in Phnom Penh, Cambodia’s capital city. They were mostly state funded, but thanks to their large patient base, they still needed input from international charities due to lack of resources.

Wren, JoshuaI spent most of my placement in the surgical departments of both hospitals. My role was primarily observational, but during one night shift I scrubbed in and assisted the surgical team.

My main aim for my elective was predominantly to gain confidence. Confidence to take the initiative and meet my own learning targets. Confidence in my communication abilities, particularly in a country where the population do not speak English as a first language. And confidence in my own clinical abilities and knowledge.

Another of my aims was to understand the similarities and differences between the Cambodian healthcare system and the NHS. I wanted to develop a greater appreciation of UK healthcare resources, and understand the measures staff were forced to take in an underfunded low-resource system.

The experience in the surgical department highlighted the ingenuity required to perform operations with limited resources.

Wren, JoshuaDrills used in orthopaedic surgery were those you would find in a toolkit in the UK. Very few patients received general anaesthetic, even fewer receiving sedation and pain relief.

Even the most basic pieces of equipment, such as bandages, were washed and reused.

I noticed that there was more of a focus on achieving a successful operation than effective recovery. Thus, I reflected on the importance of performing any procedure with future impact on the patient in mind.

My placement in the rural health centre (during the Village Healthcare Week) was particularly eye-opening.

I took histories; assessed patients and then took appropriate action, all within a badly underfunded and under-resourced system.

There were multiple cases where patients were prescribed Penicillin for basic joint pains. The health centre simply did not stock anti-inflammatories or basic analgesia.

It seemed patients assumed they would receive a prescription when visiting the centre. There was a unspoken yet palpable pressure on doctors to prescribe, whether necessary or not.

Wren, JoshuaOn the wards I delivered informal teaching sessions to Cambodian medical students regarding history-taking and presentation skills.

My week in the village was special also because of the people I met. The family we stayed with were incredibly welcoming and some of the nicest people I have ever encountered.

The food in the village was fantastic, and each afternoon we took a day trip that was uniquely hilarious and fun.

I travelled with two other members of the house. We became very close over the course of the week. I highly recommend you undertake Work the World’s Village Healthcare Week!

I undertook the last of my three placements at a paediatric hospital. I was based in the surgical and emergency departments.

The hospital was established and part-funded by a charity. That meant available resources were significantly better than my previous two placements.

Wren, JoshuaLaparoscopic surgical techniques were frequently available, and doctors from around the world attended the hospital to assist and train the Cambodian staff.

During my six weeks in Cambodia, I fell more and more in love with the country and its people. Most people that I passed in the street smiled and said hello.

I became close with the Work the World team in the house, spending time talking about all manners of things.

I went out of my way to try all forms of Cambodian food, no matter how spicy!

The entire team made me feel exceptionally welcome and I considered them family by the end of my elective. I also became close with my housemates, going on many weekend trips with them.

Our first trip as a group was to Koh Rong Samloem. It was a lively weekend, but relaxing at times.

Wren, JoshuaFor our next trip, we travelled to Kampot. Despite the weather, we fully explored the countryside and took a boat trip down the river as we watched the fireflies.

I went on a solo day trip to Oudong Mountain Temple. I negotiated a good price with a tuk tuk driver and off we went. It was picturesque and a somewhat spiritual experience for me.

One experience that will always stick with me is my final weekend trip. Most members of the house were heading home, so I decided to go on a solo trip to Battambang. It had been recommended to me by one of the members of the Work the World team.

This was the first time I had travelled alone, staying somewhere by myself. I was initially very nervous. However, when I arrived at the hostel I felt immediately welcome and eager to explore.

I started by travelling to Phnom Sampou (a large mountain temple) and the bat caves, out of which millions of bats fly to feed at sunset.

I went on a cycle of the countryside the following day before a self-led architecture tour of the city centre.

Wren, JoshuaThis trip increased my self-confidence enormously. I arranged transport and accommodation for myself, researched the area and planned and arranged activities for the entire weekend.

This was only a small part of my elective, but the experience helped me to grow as a person.

Reflecting on the entire elective, I can certainly say it met my expectations and I achieved all of my aims.

During my six weeks, I was granted an invaluable insight into the Cambodian healthcare system and I learned all about the similarities and differences between Cambodia and the UK.

I returned with a fresh perspective on the NHS and a greater appreciation for the work that it does.

Wren, Joshua

Furthermore, I believe that I have returned a more confident individual, with a clearer idea of which direction I want to take my medical career.

I will use this newfound confidence both in my medical practice and educational journey, but also in my day-to-day life. It grants me a greater purpose that I will carry with me throughout my life.

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