A Tale of Two Hospitals

Recently, I was able to go on a tour of two of the hospitals in Siem Reap.  One is the Angkor Hospital for Children (AHC) for which Thea's husband, Eugene works at.  Several of us volunteers arranged to meet with him for a tour of the place.  AHC, if you recall, is the hospital I passed by on my first day here when I was just walking around.  The founder of AHC is famed Japanese photographer Kenro Izu who came to Cambodia between 1993 and 1996 to photograph Angkor Wat and the surrounding ruins.   Like so many others, during his visit, he was moved by the tragedies that had fallen on the country and in particular on the children.  Thus, in 1996 he formed the foundation Friends Without A Border (FWAB) with the goal of building a hospital to treat the children.  With the international exposure of his photography, he was able to gather interest and funding from a network of donors and in 1999, AHC was opened.

In short, the hospital was actually much more impressive than I had expected.  There is a large waiting area outside where parents wait with their children for the triage station.  From there, they are directed to the appropriate departments.  Over 400 kids are seen each day and so one might think it would take a long time to get seen.  However, we had seen a 12 year old child - Pahl - the day before and we were suspicious of tuberculosis based on a 3 month history of fever and cough with no response to antibiotics.  The kid looked emaciated as well.  On the morning of our visit, we had ordered a motobike (scooter) to come pick him and his mother up and bring them to the hospital.  They were in the waiting area when we arrived.  By the time we had finished the tour, he had been seen by the doctor who agreed with the possibility of TB, had received a PPD shot, and was on his way to getting his blood work and chest X-ray done.  I was quite impressed with the Cambodian doctor we chatted with as well.  The AHC welcomes foreign doctors to come in as volunteers and even hires a few as part of the staff.  As part of the deal, they have to see patients with their own Cambodian doctors so that they can receive Western medical training.  This Cambodian doctor was sharp enough to also suspect atypical pneumonia (mycoplasma pneumonia, aka "walking pneumonia") - a fair diagnosis to consider.  Later in the afternoon, we got the call that they saw the chest x-ray and it was bad enough to be considered diagnostic for active TB, so they were starting him right away on a TB treatment regimen.  His entire visit was about 3 hours.  The time to diagnosis was another 4 hours.  Total time was 7 hours.  Not bad at all for a free children's hospital.

In addition, while on tour, we got to visit the microbiology lab.  I was shocked to even see a microbiology lab, but also excited at the possibility that I might actually have a place to send kids like Pahl for testing if it's actually needed.  At this lab were two Brits, Kate and Chris who were sent here by Oxford University to study the epidemiology of infectious diseases in Cambodia.  (By the way, "Oxford University" is SO much fun to say in a British accent.  Go on, try it...OXfuhd UniVUHsity.  Right??)  So anyhow, this is all very fascinating to me because before my trip, I tried to look up some statistics regarding what kinds of infectious diseases to expect here.  The usual third world country lists of diseases comes up: HIV, TB, malaria, cholera, dengue fever, etc.  The only problem is that nobody really ever has any confirmed statistics as to how prevalent they really are.  And I've begun to wonder because Pahl is the first patient I've encountered where I've suspected TB at all. I've only seen one probable case of malaria, one case of cholera, and no known cases of dengue fever.  Perhaps it's just the area I'm in, or perhaps it's not the right season.  But really, it's just because the diagnostic services here are so poor that no one really knows.  No one's actually taken sufficient interest in this region to come in with proper diagnostic testing to confirm the diagnosis of anything so most diagnoses remain as only "suspected".  The only thing I can say is wildly rampant here is rhinovirus - the common cold.  So anyhow, Kate and Chris were sent here by...Oxfuhd Univuuuhsity...to study the prevalence and distribution of infectious diseases.  Need to setup dinner sometime with them to ask them more about their experiences.

It's also worth mentioning that the AHC has an open air kitchen in the "backyard" of the hospital.  The guardians or parents of the child patients can go there and pickup a "food basket" from a small supply room.  The food basket contains numerous food items such as leafy green vegetables and rice.  The parents are then educated on nutrition and what kinds of foods to prepare for their kids at home.  They can they cook food for their child in the kitchen and eat with them.  Other areas in the hospital are created to allow kids who are healthy enough, to play with coloring books and various toys that they normally don't encounter at home.  The notion is that most Cambodian kids don't learn how to play which is a vital part of cognitive development.  Thus, a big part of the public health effort by the hospital is to teach them how to engage their minds in their "playing".  It's hard to say how much effect it's having on the population, but I like that the hospital has identified factors beyond illness that affect the well-being of a child, and make efforts to address them, or at the very least bring it into the public awareness.  So all in all, I was pretty impressed by the AHC.   It was free, clean, well-organized, efficient, and staffed by diligent and competent healthcare professionals.  Then we went to the Siem Reap Provincial Hospital.

Angela is a second year internal medicine resident who is a volunteer at another program and was working at the SRPH.  She was on the tour with us and offered to take us around her hospital to see the contrast.  This hospital is where everyone else (e.g. adults) goes when they need medical care.  As we walked onto the hospital grounds, the contrast was already obvious.  First of all, I couldn't even tell we were in a hospital.  It was just a collection of drab decaying buildings with no visible indication that this was a place to come to get healed.  We first walked through a long dark hallway (no electrical lighting) into the maternity ward, which was just a narrow room with rows of vinyl covered mattresses on flimsy metal frames.  The checkered floor was gray from soot and dirt.  Passing by the rudimentary bathrooms, one can detect the pungent smell of old urine wafting out.  In fact, it's nearly impossible not to smell it.  People, presumably the families of mothers lined the hallway and stared blankly at us as we walked by.

We then went back out to the courtyard and walked to the ICU.  On the way we passed by a sign that pointed to our left and said "Laboratory".  About 25 meters away was a decrepit yellowish-brown building standing in its own corner of the courtyard.  I commented that I'd be interested in seeing the lab, but Angela replied, "Oh, I don't know why that sign is there.  I went over there one day and there's nothing in there."
"What do you mean 'nothing'? There's no staff there?"
"No, I mean there's literally nothing in there.  It's an empty building."
"@#%&??!!"

So then we arrived at the ICU.  I think "hell" would not be an inaccurate term to describe the conditions. Quite frankly I cannot think of single place I'd rather not be at for an eternity.  The dirty beds were filled with unwashed and sometimes unclothed patients.  I did my best not to look but I'm fairly certain some of them were sitting in their own waste.  As soon as you walk through the "door" the filth in this place mounts an all out assault on all five of the senses (not that I dared to lick anything there mind you).  The walls behind the bed are lined with old metal pipes that branch off to a valve and pressure gauge above each bed.  They were built for oxygen delivery to the beds, and appear to have been built more than 50 years ago.  Apparently, 20 years ago was the last time they were actually functioning.  Now they just provide a place for patient families to hang up and dry their clothes.

During our visit, I realized we hadn't encountered any doctors.  Angela explained that there are no doctors left in the hospital by noon time.  They are so poorly paid that they leave after a couple hours in the morning and go to their own clinics somewhere else to earn some more money.  I think I may have seen two nurses there the entire time.  And the cherry on top of this lovely hospital sundae?  The patients actually have to pay to get a bed here.  I heard a story from a friend about a brother of some Cambodian he knew who got into a motorbike accident and went to this hospital.  He couldn't pay for a bed so he sat on the ground with a head injury from the accident.  With the head injury, he couldn't remember where he lived or who his family was, so he sat on the ground for 2 days while medical staffed passed by.  He eventually died right there on the filthy hospital floor without receiving the slightest bit of medical care.  This, by the way, is a government funded hospital.  A government that has obviously decided that there are bigger priorities than a marginally clean hospital in the middle of one of its most visited cities.  And to be treated there costs money that many Cambodians don't have.  No money, no treatment.  Life and death is often very black and white in this part of the world.