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Dr Monica Joyner, Mary, Cathy & Dr J Bleicher at Radang |
Monday, 10 October 2011
Farewell to Dr Monica Joyner, Plastic Surgeon
HIV Service and the Warehouse at Sihanouk
We were at the Sihanouk Hospital Center of Hope for another interesting day. We started off by meeting with the manager of International Volunteers named Sideth and the Hospital administrator, Dr. Gerlinda Lucas, a Medical Doctor from the Phillippines who had experience in Hospital Administration from working in Hope Worldwide Hospitals in Afghanistan and Russia. She was very impressive with her knowledge of operating a hospital system and she had very strong objectives around keeping the hospital in operation until funding kicked back in January 2012.
We were taken by Sideth to the department of nursing education where we were introduced to Mr. Horn Hong (known as Hong). He is in charge of nursing education for the hospital. We spent some time with Hong learning about the educational needs for wound care and he booked us to do two lectures to the nurses- one on Tuesday and one on Thursday.
Hong first took us to meet a nurse who works in the HIV clinic. One important service the hospital offers is the availability of life-prolonging antiretroviral drugs (ART) for patients living with HIV/AIDS. More than 2,800 HIV positive patients are currently being treated by the hospital. We saw many young men and women attending this clinic. Several young women looked to be in the end stage of the disease and were given beds to lay down on, oxygen masks were in place and their sweet little children sat beside them on the bed. This was heart breaking. The nurse from this clinic will take us to the city hospital on Thursday with a reconstructive surgeon.
Hong then took us on a tour of the Warehouse to view the donated supplies sent by charities. There were several large boxes of medical device materials that had just come in and we worked with Hong and the warehouse staff to sort through the supplies, pull out the wound care dressings and supplies, and identify as many of the medical devices as possible. We were struck by the fact that while it is essential for this hospital to receive supplies, the supplies were sent all mixed together and spread in the box. There were no labels indicating what the products did and it was apparent that the staff did not know what many of the products were used for due to the language barrier and the lack of wound product knowledge.
They took us over to the shelving area where they had very neatly categorized and placed boxes of wound care supplies. Again, there was a similar situation that while they had boxes of some wound care dressings, they were not sure as to how they would be used. We went through many of the supplies and reviewed the indications for use and Hong took notes for follow up. We discovered products for continence care (two step cleanser and skin protectant). We instructed Hong as to how they could use these products. It became blatantly clear to us that there is a disconnect between the warehouse and the surgical clinics regarding products. The warehouse staff are unaware of the products types and usages and the staff in the clinics are therefore unaware of what they have available to them. We hope we can somehow narrow the knowledge gap here.
We then saw several boxes of ostomy products that were all mixed up between four large boxes. There were products which had been donated representing all main ostomy company brands. None of the boxes were organized and there was a lack of understanding as to where and how these ostomy products would be used and applied. We offered to come and organize and label the ostomy products by type of ostomy , size and coordinating products. We will also develop a "Product Selection Tool" for the use at this Cambodian hospital.
We were then introduced to the Surgical Charge Nurse, Sam Oeun and she gave us more information on nursing care of wounds. We had the opportunity to see one of the staff nurses change the dressings on a woman who had been in a moto accident and sustained an acute , traumatic wound to her left knee. Much attention is given to sterile procedure and technique when doing dressing change due to many patients have multi resistant bacteria. Surgical patients are put in isolation when they come to the surgical clinic and wound swabbing identifies many with resistant organisms. MRSA, VRSA, EBSL is rampid here mostly due to the fact that antibiotics in Cambodia can be bought in the local drug store with no prescription and people self medicate at a very early age. Isolation rooms are identified with a sign taped to the door. Sam Oeun told us that they always wash there hands when they leave the room, but when we inquired if they washed their hands upon entering she said they do not. We reviewed the principles of handwashing with Sam Oeun - "wash in and wash out". We explained that resistant bacteria is on everything including chairs in the waiting room, IV poles and other equipment. Infection control techniques, or lack of them was identified to us by Dr. Haerner as a huge problem in the clinics. What is also interesting was we noticed most nurses wear masks all the time (the same mask through out the day). Hong told us that this started during the H1N1 outbreak last year when they heard on the news they should wear masks. Of course, they are wearing the wrong masks and do little to protect them from the transmission of bacteria or virus, but education to get them to stop wearing them has been futile. Because there is a shortage of these masks they wear them all day from one patient to the next, unknowingly putting themselves at risk and their patients.
Sam Oeun explained to us the many wound care cases they see in the clinic. It is typical for woman in the country side to care for their wounds. For woman who have fungating breast wounds due to breast cancer the typical treatment for odor control is to crush charcoal and apply it directly to the wound. They continue to do this everyday until there is a thick crust of charcoal over the breast. If and when they seek treatment at the clinic, the staff are unable to remove this adherent charcoal crusting and they perform a mastectomy. She said many of these woman are young.
Cleansing solutions used in the clinic are a mixture of 3 teaspoons each of Hydrogen Peroxide, bleach and vinegar in 1 litre of Normal Saline. This solution is used to clean infected wounds. Betadine is mixed in water in a bowl to soak infected/dirty foot wounds. Hydrogen Peroxide and normal saline are used in the OR to irrigate and cleanse wounds. Honey from the country side is used on wounds and they find it very effective in healing. Any honey is used and usually bought in the local market. Gauze is also bought in the local market for the clinic and sterilized in the autoclave.
The temperature outside was extremely oppressive. Shade and clean drinking water are needed by everyone. We are preparing for our wound care lecture tomorrow.
We were taken by Sideth to the department of nursing education where we were introduced to Mr. Horn Hong (known as Hong). He is in charge of nursing education for the hospital. We spent some time with Hong learning about the educational needs for wound care and he booked us to do two lectures to the nurses- one on Tuesday and one on Thursday.
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| Cathy and Mary with Mr. Horn Hong, Nurse Educator |
Hong first took us to meet a nurse who works in the HIV clinic. One important service the hospital offers is the availability of life-prolonging antiretroviral drugs (ART) for patients living with HIV/AIDS. More than 2,800 HIV positive patients are currently being treated by the hospital. We saw many young men and women attending this clinic. Several young women looked to be in the end stage of the disease and were given beds to lay down on, oxygen masks were in place and their sweet little children sat beside them on the bed. This was heart breaking. The nurse from this clinic will take us to the city hospital on Thursday with a reconstructive surgeon.
Hong then took us on a tour of the Warehouse to view the donated supplies sent by charities. There were several large boxes of medical device materials that had just come in and we worked with Hong and the warehouse staff to sort through the supplies, pull out the wound care dressings and supplies, and identify as many of the medical devices as possible. We were struck by the fact that while it is essential for this hospital to receive supplies, the supplies were sent all mixed together and spread in the box. There were no labels indicating what the products did and it was apparent that the staff did not know what many of the products were used for due to the language barrier and the lack of wound product knowledge.
They took us over to the shelving area where they had very neatly categorized and placed boxes of wound care supplies. Again, there was a similar situation that while they had boxes of some wound care dressings, they were not sure as to how they would be used. We went through many of the supplies and reviewed the indications for use and Hong took notes for follow up. We discovered products for continence care (two step cleanser and skin protectant). We instructed Hong as to how they could use these products. It became blatantly clear to us that there is a disconnect between the warehouse and the surgical clinics regarding products. The warehouse staff are unaware of the products types and usages and the staff in the clinics are therefore unaware of what they have available to them. We hope we can somehow narrow the knowledge gap here.
 |
| We found boxes of mixed medical supplies from charities |
We then saw several boxes of ostomy products that were all mixed up between four large boxes. There were products which had been donated representing all main ostomy company brands. None of the boxes were organized and there was a lack of understanding as to where and how these ostomy products would be used and applied. We offered to come and organize and label the ostomy products by type of ostomy , size and coordinating products. We will also develop a "Product Selection Tool" for the use at this Cambodian hospital.
We were then introduced to the Surgical Charge Nurse, Sam Oeun and she gave us more information on nursing care of wounds. We had the opportunity to see one of the staff nurses change the dressings on a woman who had been in a moto accident and sustained an acute , traumatic wound to her left knee. Much attention is given to sterile procedure and technique when doing dressing change due to many patients have multi resistant bacteria. Surgical patients are put in isolation when they come to the surgical clinic and wound swabbing identifies many with resistant organisms. MRSA, VRSA, EBSL is rampid here mostly due to the fact that antibiotics in Cambodia can be bought in the local drug store with no prescription and people self medicate at a very early age. Isolation rooms are identified with a sign taped to the door. Sam Oeun told us that they always wash there hands when they leave the room, but when we inquired if they washed their hands upon entering she said they do not. We reviewed the principles of handwashing with Sam Oeun - "wash in and wash out". We explained that resistant bacteria is on everything including chairs in the waiting room, IV poles and other equipment. Infection control techniques, or lack of them was identified to us by Dr. Haerner as a huge problem in the clinics. What is also interesting was we noticed most nurses wear masks all the time (the same mask through out the day). Hong told us that this started during the H1N1 outbreak last year when they heard on the news they should wear masks. Of course, they are wearing the wrong masks and do little to protect them from the transmission of bacteria or virus, but education to get them to stop wearing them has been futile. Because there is a shortage of these masks they wear them all day from one patient to the next, unknowingly putting themselves at risk and their patients.
Sam Oeun explained to us the many wound care cases they see in the clinic. It is typical for woman in the country side to care for their wounds. For woman who have fungating breast wounds due to breast cancer the typical treatment for odor control is to crush charcoal and apply it directly to the wound. They continue to do this everyday until there is a thick crust of charcoal over the breast. If and when they seek treatment at the clinic, the staff are unable to remove this adherent charcoal crusting and they perform a mastectomy. She said many of these woman are young.
Cleansing solutions used in the clinic are a mixture of 3 teaspoons each of Hydrogen Peroxide, bleach and vinegar in 1 litre of Normal Saline. This solution is used to clean infected wounds. Betadine is mixed in water in a bowl to soak infected/dirty foot wounds. Hydrogen Peroxide and normal saline are used in the OR to irrigate and cleanse wounds. Honey from the country side is used on wounds and they find it very effective in healing. Any honey is used and usually bought in the local market. Gauze is also bought in the local market for the clinic and sterilized in the autoclave.
The temperature outside was extremely oppressive. Shade and clean drinking water are needed by everyone. We are preparing for our wound care lecture tomorrow.
Sunday, 9 October 2011
Happy Canadian Thanksgiving from Phnom Penh
We would like to wish all of our family and friends a very Happy Thanksgiving. We want to share some of the delectable food from a Phnom Penh night vendor - a very interesting Thanksgiving feast.
Love from Mary and Cathy
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| Mmmm, snake kebabs! |
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| Not a snake person? There were a wide variety of bugs to choose from! |
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| The cockroaches were very crunchy! (and in case you were wondering......they don't taste like chicken) |
Love from Mary and Cathy
The Sihanouk Hospital Center of Hope, Phnom Penh
Our Introduction to the Sihanouk Hospital Center of HOPE
The Sihanouk Hospital Center of HOPE, has been open since 1996, and provides a center for education and clinical training of medical professionals, while providing 24-hour health care to thousands of medically underserved people at no charge.The hospital is staffed with nearly 400 people, the majority of which are Cambodian and have received medical training at the hospital. The hospital, managed by HOPE worldwide, is one of the busiest in the country and sees 350 patients daily and more than a million patient consultations have been completed since 1996. One important service the hospital offers is the availability of life-prolonging antiretroviral drugs (ART) for patients living with HIV/AIDS. More than 2,800 HIV positive patients are currently being treated by the hospital.
Patients enter the hospital system through the Outpatient Clinic or Emergency Room. The medical and nursing staffs manage the majority of patients since only the most serious are admitted to the medical ward. The hospital is a member of MEDICAM, the membership organization for Non Government Organizations (NGOs) active in the health sector of Cambodia.
Across the street from the Sihanouk Hospital Center of HOPE is a for-profit Medical/Surgical Clinic.Patients who come to this clinic must pay privately for their medical or surgical service under three levels of payment which were termed as Level A, Level B and Level C which is based on income.
The driver from Sihanouk picked us up at 0800 and took us to the main campus. We went up to the International Volunteers office and a manager escorted us to the department of Nursing Education. We met a Nurse Educator by the name of Hay who welcomed us to the hospital. She was involved in wound care and she offered to take us over to the Medical/Surgical Center to see some patients who had been admitted with wounds.
While we were in the operating room, Mary was shown around the surgical floor by nurse Hay. They have 6 rooms and seven beds. One room is for VIP (very important people aka people with money). One isolation room with a young girl of 16 years who broke her leg in a moto accident (very common here in Phnom Penh). She had an external fixation device and a leg wound that had just closed. She was MRSA positive which is also very common as they have trouble controlling the spread of it in the surgical area because of the close proximity of patients and the less than adequate infection control techniques.
Once Cathy and Dr. Joyner returned from the OR we met with Dr. Cornelia Haerner, a general surgeon who has dedicated her service to the Surgical Centre and the Centre of Hope for 12 years. We were able to observe minor surgery on a gentleman who originally had an abdominal abcess, resulting in septicemia, ICU stay and ultimately an open abdominal wound. Dr. Haerner had previously attempted to close the defect with a mesh and had success for a short time before it reopened again. Today she removed a small amount of scar tissue proximal to the wound and the sutures beneath it which was the cause. She sutured the area closed. To dress the wound a 4x4 gauze was laid over it and a sugar solution poured over top. More gauze was used as a secondary dressing and tape. The sugar solution is made at the hospital by the nurses. It consists of boiling 1 litre of water and then letting it cool to a warm temperature. 1 kilo of sugar is then added to the water and dissolved. More sugar is added until the appropriate viscosity is achieved. It is stored in what looks like a clear 500 ml saline container and used with no expiration date. We were told the sugar solution for wound care is effective in controlling bacteria due to its high osmolarity. We found this very fascinating and somewhat perplexing, considering it is a sugar solution that is left at room temperature and used on wounds to the last drop. We wondered about bacteria growth in the bottle but we were assured that the osmolarity of the solution killed the bacteria. It was then we realized that all our knowledge regarding advanced wound care products would have to be suspended because they have very little technology and supplies to work with and our knowledge of wound assessment and infection control would be shared with our colleagues here in Cambodia. Dr Haerner recommended that we keep things very basic.
The Sihanouk Hospital Center of HOPE, has been open since 1996, and provides a center for education and clinical training of medical professionals, while providing 24-hour health care to thousands of medically underserved people at no charge.The hospital is staffed with nearly 400 people, the majority of which are Cambodian and have received medical training at the hospital. The hospital, managed by HOPE worldwide, is one of the busiest in the country and sees 350 patients daily and more than a million patient consultations have been completed since 1996. One important service the hospital offers is the availability of life-prolonging antiretroviral drugs (ART) for patients living with HIV/AIDS. More than 2,800 HIV positive patients are currently being treated by the hospital.
Patients enter the hospital system through the Outpatient Clinic or Emergency Room. The medical and nursing staffs manage the majority of patients since only the most serious are admitted to the medical ward. The hospital is a member of MEDICAM, the membership organization for Non Government Organizations (NGOs) active in the health sector of Cambodia.
Across the street from the Sihanouk Hospital Center of HOPE is a for-profit Medical/Surgical Clinic.Patients who come to this clinic must pay privately for their medical or surgical service under three levels of payment which were termed as Level A, Level B and Level C which is based on income.
The driver from Sihanouk picked us up at 0800 and took us to the main campus. We went up to the International Volunteers office and a manager escorted us to the department of Nursing Education. We met a Nurse Educator by the name of Hay who welcomed us to the hospital. She was involved in wound care and she offered to take us over to the Medical/Surgical Center to see some patients who had been admitted with wounds.
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| Dr Monica Joyner and Cathy outside the hospital |
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| Sign in Hospital Foyer |
We walked across the street to the clinic and it was very hot. A guard was outside the clinic door monitoring the people who entered and left the clinic. We went up to the Surgical Center and it was full of activity. We learned about a young girl who had sustained a large acute traumatic wound to the outside of her knee ad leg as a result of a tractor collapsing on it. Dr Joyner and Cathy went into the operating room where a Cambodian Orthopedic surgeon performed surgery to drain infection as well as do a skin graft. He took skin from her thigh and grafted the wound very carefully. Once the skin graft was sutured into place he immobilized the leg using casting material , bandaged with gauze and wrapped the leg and instructed the bandages to be left in place for five days before changing.Resources are very precious and so every bandage was placed with care - and there was certainly no waste.The operating room team worked very efficiently together. We will follow up with this patient after the weekend.
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| Treatment Room in Surgical Clinic |
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| Cathy, Ready for the OR |
While we were in the operating room, Mary was shown around the surgical floor by nurse Hay. They have 6 rooms and seven beds. One room is for VIP (very important people aka people with money). One isolation room with a young girl of 16 years who broke her leg in a moto accident (very common here in Phnom Penh). She had an external fixation device and a leg wound that had just closed. She was MRSA positive which is also very common as they have trouble controlling the spread of it in the surgical area because of the close proximity of patients and the less than adequate infection control techniques.
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| Mary and Surgical Clinic Nurse outside the clinic |
Once Cathy and Dr. Joyner returned from the OR we met with Dr. Cornelia Haerner, a general surgeon who has dedicated her service to the Surgical Centre and the Centre of Hope for 12 years. We were able to observe minor surgery on a gentleman who originally had an abdominal abcess, resulting in septicemia, ICU stay and ultimately an open abdominal wound. Dr. Haerner had previously attempted to close the defect with a mesh and had success for a short time before it reopened again. Today she removed a small amount of scar tissue proximal to the wound and the sutures beneath it which was the cause. She sutured the area closed. To dress the wound a 4x4 gauze was laid over it and a sugar solution poured over top. More gauze was used as a secondary dressing and tape. The sugar solution is made at the hospital by the nurses. It consists of boiling 1 litre of water and then letting it cool to a warm temperature. 1 kilo of sugar is then added to the water and dissolved. More sugar is added until the appropriate viscosity is achieved. It is stored in what looks like a clear 500 ml saline container and used with no expiration date. We were told the sugar solution for wound care is effective in controlling bacteria due to its high osmolarity. We found this very fascinating and somewhat perplexing, considering it is a sugar solution that is left at room temperature and used on wounds to the last drop. We wondered about bacteria growth in the bottle but we were assured that the osmolarity of the solution killed the bacteria. It was then we realized that all our knowledge regarding advanced wound care products would have to be suspended because they have very little technology and supplies to work with and our knowledge of wound assessment and infection control would be shared with our colleagues here in Cambodia. Dr Haerner recommended that we keep things very basic.
Friday, 7 October 2011
The Leprosy Hospital - Kein Khleang Center
The Horror of Leprosy
More than 213 000 people mainly in Asia and Africa are infected with Leprosy, with approximately 249 000 new cases reported in 2008.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. Leprosy impacts the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes.Leprosy manifests with a skin lesion - single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common and with definite sensory loss, with or without thickened nerves. Leprosy is also diagnosed with positive skin smears. Sensory loss is a typical feature of leprosy,
Leprosy has afflicted humanity for centuries. It once affected every continent and it has left behind a terrifying image. When M.leprae was discovered by G.A. Hansen in 1873, it was the first bacterium to be identified as causing disease in man. Treatment for leprosy only appeared in the late 1940s with the introduction of dapsone, and its derivatives. Leprosy bacilli resistant to dapsone gradually appeared and became widespread.The drugs used in WHO-MDT are a combination of rifampicin, clofazimine and dapsone for MB leprosy patients and rifampicin and dapsone for PB leprosy patients. Among these rifampicin is the most important antileprosy drug and therefore is included in the treatment of both types of leprosy. Treatment of leprosy with only one antileprosy drug will always result in development of drug resistance to that drug. (Source WHO, 2011)
Our trip to the Kein Khleang Center was extremely profound in understanding the far reaching implications that this disease has on the Cambodians. The Kien Khleang Centre was opened in January 2000 and operates as a free national referral centre for patients with leprosy complications as well as an outpainet centre providing free consultations for suspected leprosy. The center offers surgery (debridment of wounds, release of tendons and amputations), physiotherapy, medical management of the disease, food and child care. We met a family with three small children while we were at the centre who were intrigued by our camera and the instant pictures we were able to produce.
Our tour of the center enabled us to meet many patients. The loss of sensation in the hands and feet leads to serious injury such as the patient we saw who burned his hand, and did not seek treatment leading to infection and the loss of his fingers. Many of the patients had plantar ulcers. This is due to the neuropathy in their feet.
The Centre provides them with healing sandals but many patients only where them in the home because of the stigma associated with the sandals when they are out in the public. We couldn' t help but think of the similarities we face a home with our diabetic population and the lack of compliance to wear off loading footwear at all times. The Centre has a prevention focus providing patients with examples of proper footwear they can purchase at the market and gloves to protect their hands. Treatment of plantar ulcers includes twice daily soaking of feet in water for 20 minutes and then the application of cooking oil to decrease the dryness and cracking to the feet. In front of the Centre there were rows of wooden benches with bowls of water and several patients soaking their feet.
The Center has iron bed frames with wooden slates. Woven bed mats are used instead of a mattress and sheet. Clients stay at the centre for 40 days for treatment, education and rehabilitation. We wondered how these patients could tolerated lying on a wooden bed for 40 days, but it was apparent that there is no other options. This is such an extreme dichotomy to Western health care where there is a strong emphasis on patient comfort. We take for granted the ability to do laundry and disinfect mattresses. There is such a lack of resources here in Cambodia for health care.
We learned that many Cambodians have leprosy and are unaware that they have this chronic disease. Signs and symptoms present as aching joints or small skin discolorations that are dismissed as the flu or normal skin abnormalities. The loss of feeling in hands and feet are not understood by these people and injuries are treated at home. We were told by the Director of the Centre that many Cambodians self amputate fingers and toes at home because they are unable to get transportation for help or do not understand implications of the disease.
.
In 2010, 250 leprosy patients received treatment and 114 underwent surgery at the Kien Khleang Rehabilitation Centre. 259 leprosy patients were treated as outpatients. Because of much needed funding that was received last May the Centre Director was able to do a contact survey to go to homes of suspected families exposed to leprosy. Due to this survey, 100 people were discovered to have leprosy and treated successfully.
The deformaties caused by leprosy creates a stigma that erodes the confidence and abilities of patients and their families, thus denying them equal access to education and income-earning opportunities. The Centre helps patients continue to be productive members of society by providing them with loans and education to set up small business or provide skill re-training.
When we left the Centre we asked the Director what he needed to support the sustainability of the program. He stated he needed people to come for 3 - 4 months to provide treatment such as surgery and wound care. He needed supplies, such as gauze, self adherent wraps, cling and wound contact layers.
We thought of how a few resources could make a difference in the lives of people with leprosy in this country; a treatable disease that impacts the confidence and income earning potential of so many Cambodians, many who are unaware that they have the disease.
More than 213 000 people mainly in Asia and Africa are infected with Leprosy, with approximately 249 000 new cases reported in 2008.
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, an acid-fast, rod-shaped bacillus. Leprosy impacts the skin, the peripheral nerves, mucosa of the upper respiratory tract and also the eyes.Leprosy manifests with a skin lesion - single or multiple, usually less pigmented than the surrounding normal skin. Sometimes the lesion is reddish or copper-coloured. A variety of skin lesions may be seen but macules (flat), papules (raised), or nodules are common and with definite sensory loss, with or without thickened nerves. Leprosy is also diagnosed with positive skin smears. Sensory loss is a typical feature of leprosy,
Leprosy has afflicted humanity for centuries. It once affected every continent and it has left behind a terrifying image. When M.leprae was discovered by G.A. Hansen in 1873, it was the first bacterium to be identified as causing disease in man. Treatment for leprosy only appeared in the late 1940s with the introduction of dapsone, and its derivatives. Leprosy bacilli resistant to dapsone gradually appeared and became widespread.The drugs used in WHO-MDT are a combination of rifampicin, clofazimine and dapsone for MB leprosy patients and rifampicin and dapsone for PB leprosy patients. Among these rifampicin is the most important antileprosy drug and therefore is included in the treatment of both types of leprosy. Treatment of leprosy with only one antileprosy drug will always result in development of drug resistance to that drug. (Source WHO, 2011)
Our trip to the Kein Khleang Center was extremely profound in understanding the far reaching implications that this disease has on the Cambodians. The Kien Khleang Centre was opened in January 2000 and operates as a free national referral centre for patients with leprosy complications as well as an outpainet centre providing free consultations for suspected leprosy. The center offers surgery (debridment of wounds, release of tendons and amputations), physiotherapy, medical management of the disease, food and child care. We met a family with three small children while we were at the centre who were intrigued by our camera and the instant pictures we were able to produce.
 |
| Mary with Dr. Monica Joyner |
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| Cathy with children who's young mother was afflicted with leprosy |
The Centre provides them with healing sandals but many patients only where them in the home because of the stigma associated with the sandals when they are out in the public. We couldn' t help but think of the similarities we face a home with our diabetic population and the lack of compliance to wear off loading footwear at all times. The Centre has a prevention focus providing patients with examples of proper footwear they can purchase at the market and gloves to protect their hands. Treatment of plantar ulcers includes twice daily soaking of feet in water for 20 minutes and then the application of cooking oil to decrease the dryness and cracking to the feet. In front of the Centre there were rows of wooden benches with bowls of water and several patients soaking their feet.
The Center has iron bed frames with wooden slates. Woven bed mats are used instead of a mattress and sheet. Clients stay at the centre for 40 days for treatment, education and rehabilitation. We wondered how these patients could tolerated lying on a wooden bed for 40 days, but it was apparent that there is no other options. This is such an extreme dichotomy to Western health care where there is a strong emphasis on patient comfort. We take for granted the ability to do laundry and disinfect mattresses. There is such a lack of resources here in Cambodia for health care.
We learned that many Cambodians have leprosy and are unaware that they have this chronic disease. Signs and symptoms present as aching joints or small skin discolorations that are dismissed as the flu or normal skin abnormalities. The loss of feeling in hands and feet are not understood by these people and injuries are treated at home. We were told by the Director of the Centre that many Cambodians self amputate fingers and toes at home because they are unable to get transportation for help or do not understand implications of the disease.
.
In 2010, 250 leprosy patients received treatment and 114 underwent surgery at the Kien Khleang Rehabilitation Centre. 259 leprosy patients were treated as outpatients. Because of much needed funding that was received last May the Centre Director was able to do a contact survey to go to homes of suspected families exposed to leprosy. Due to this survey, 100 people were discovered to have leprosy and treated successfully.
The deformaties caused by leprosy creates a stigma that erodes the confidence and abilities of patients and their families, thus denying them equal access to education and income-earning opportunities. The Centre helps patients continue to be productive members of society by providing them with loans and education to set up small business or provide skill re-training.
When we left the Centre we asked the Director what he needed to support the sustainability of the program. He stated he needed people to come for 3 - 4 months to provide treatment such as surgery and wound care. He needed supplies, such as gauze, self adherent wraps, cling and wound contact layers.
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| Cathy and Mary with the manager of the clinic |
We thought of how a few resources could make a difference in the lives of people with leprosy in this country; a treatable disease that impacts the confidence and income earning potential of so many Cambodians, many who are unaware that they have the disease.
Veterans International Cambodia
Land Mines: The Ongoing Impact on Cambodian People
Land mines were laid in Cambodia from the mid 1980's to mid 1990's by the Vietnamese forces and subsequently the Cambodian Government. Today Cambodia has one of the worlds worst land mine problems and the highest amputees per capita of any country. Over 25,000 Cambodians have lost their limbs due to land mines. (source : Lonely Planet Cambodia, 2010)
We met with Dr Joyner, Plastic Surgeon and headed off with a driver to the Veterans International Cambodia. We went to the rehabilitation department where we were greeted by a physiotherapist and staff. We went into a large room which was filled with parents and children. Many of the children had cerebral palsy and were being given physiotherapy. Some children had limbs missing as a result of coming into contact with a land mine or experiencing a traumatic accident. Several children were born with club feet and were being fitted with special shoes and splints. Many of these children experienced small pressure ulcers and were treated with betadine and gauze mainly because that was all that was available to treat them.
The physiotherapist took us to see the area where the prosthetic limbs were made. Cambodian people who were skilled in the trade of making the prosthetic limbs worked diligently on forming artificial legs , feet, arms and hands. They crafted rubber into hands and made every effort to make the limb as real looking as as possible. They were focused and hard working. We met with several more patients- one woman who was learning to walk on her artificial leg, and a child that was being fitted for leg splints due to a deformity. Despite their hardships, they all had a big smile for us.
Land mines were laid in Cambodia from the mid 1980's to mid 1990's by the Vietnamese forces and subsequently the Cambodian Government. Today Cambodia has one of the worlds worst land mine problems and the highest amputees per capita of any country. Over 25,000 Cambodians have lost their limbs due to land mines. (source : Lonely Planet Cambodia, 2010)
We met with Dr Joyner, Plastic Surgeon and headed off with a driver to the Veterans International Cambodia. We went to the rehabilitation department where we were greeted by a physiotherapist and staff. We went into a large room which was filled with parents and children. Many of the children had cerebral palsy and were being given physiotherapy. Some children had limbs missing as a result of coming into contact with a land mine or experiencing a traumatic accident. Several children were born with club feet and were being fitted with special shoes and splints. Many of these children experienced small pressure ulcers and were treated with betadine and gauze mainly because that was all that was available to treat them.
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| Cathy and Mary with the physiotherapist at Veterans International Cambodia |
The physiotherapist took us to see the area where the prosthetic limbs were made. Cambodian people who were skilled in the trade of making the prosthetic limbs worked diligently on forming artificial legs , feet, arms and hands. They crafted rubber into hands and made every effort to make the limb as real looking as as possible. They were focused and hard working. We met with several more patients- one woman who was learning to walk on her artificial leg, and a child that was being fitted for leg splints due to a deformity. Despite their hardships, they all had a big smile for us.
We also saw the area where wheel chairs are made for people in need. While there were many wheelchairs that looked quite decrepid but new wheelchairs were being newly crafted. There were paintings on the wall that depicted people without limbs walking with a crutch - or wheeling in a wheel chair- but they were depicting getting on with life. What stuck us is that the Cambodian people were making their own prosthetic limbs and wheelchairs. They were not being imported.
When we walked back to the main entrance we saw posters demonstrating what different kinds of land mines left from the war (Khmer Rouge) looked like. As we left the building we saw a large metal statue of bugs bunny- only there was a twist. Bugs had a prosthetic leg and was holding a land mine. This statue was built by the company who made the machines to detect land mines in a effort to educate children not to touch them if found.
The impact of land mines was very apparent. It was haunting.
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| Bugs Bunny with a prosthetic leg and holding a land mine |
Wednesday, 5 October 2011
Wednesday, October 5, 2011
We had a long sleep to catch up and then met with the Plastic Surgeon Dr Monica Joyner for a briefing on the hospitals. We will be meeting Monica tomorrow morning to make the trip to the Leoprosy Hospital and to work with the staff there in the wound care program and meet the patients.We also met a nurse anaesthestist from the United States who is working in the OR at the Hospital of Hope in Phnom Penh as a volunteer for two weeks. They performed a nephrectomy surgery today. We are still very thirsty from the long flight and have been searching for bottled water and drinking as much as we can.
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