CAMBODIA – After 15 years, the Handover of the Surgical Center in Battambang
EMERGENCY arrived in Battambang in 1997 to provide treatment to victims of antipersonnel mines. With 8 million landmines scattered throughout, Cambodia was one of the most contaminated countries in the world – and the district of Battambang one of the most heavily mined of the region. Local authorities entrusted us with approximately one acre of land on which to build a specialized hospital in order to provide medical and surgical treatment, free-of-charge, to patients in a country where public healthcare was essentially nonexistent.
During the Pol Pot regime, doctors were systematically murdered. They, with other professionals, had been perceived as a threat to the extreme ideology of the agrarian revolution; some did manage to flee to neighboring countries and others escaped to find their way to Europe. The few who somehow survived and remained in Cambodia worked in private facilities, which were simultaneously very expensive and utterly ineffective.
About one year after our arrival, EMERGENCY opened a hospital in Battambang. The floor space was over 2,000 square meters and it housed an accident and emergency department, examination rooms, 3 operating theaters, 3 inpatient wards (with a total of 106 beds), an intensive care unit, a physiotherapy department, laboratories and a blood bank, a radiology department, a pharmacy, offices and service rooms, and a school for the younger patients.
Since the very beginning of its work in Battambang, one of the chief commitments of EMERGENCY’s international staff has been training the local staff in order to convey not only medical and nursing knowledge, but also to transfer technical, organizational, managerial and administrative skills. The catchment area for the training extended beyond the hospital’s immediate vicinity; there was coordination of specialized training courses and internships for physiotherapists, nurses and surgeons at the University of Phnom Penh. As local staff was taking more and more responsibilities, the international staff gradually reduced direct participation.
From its inception, the hospital became the primary referral center of the entire region for surgical emergencies and for treatment of patients injured by landmines. As time passed, the hospital’s services were expanded to include plastic and reconstructive surgery and traumatology. Road accidents had become a new health crisis in Cambodia, as in all developing countries.
We worked to provide solutions to the country’s evolving needs, investing in resources to train local staff in novel techniques and interventions and furnishing the center with the necessary equipment.
During our 14 years there, over 110,000 people received free, effective treatment at the hospital in Battambang.
The need to rethink our intervention in a country which has deeply changed:
During the passing years, we witnessed Cambodia’s transformation from a country brought to its knees by war into a fully developing country. The quality of life has improved, the university system has begun to teach new skills, international aid has increased, and new public and private health facilities have been opened throughout the country.
Given this situation, and considering the results obtained by the hospital as it grew toward operational autonomy, two years ago we asked local authorities to provide concrete support in the management of the hospital.
Our hospital represented essentially the only center that offered specialized trauma care in a province with a population of one million. EMERGENCY worked to negotiate with the Cambodian government, seeking recognition of the important role of this hospital, requesting that the Ministry of Health take appropriate responsibility and allocate funds toward the program, and provide support for our provision of training for the surgeons and doctors specializing in surgery in a 3-year course and an internship in trauma management to be provided by EMERGENCY.
The Ministry of Health was uncooperative in its response: in spite of the fact that the ministry had consistently expressed recognition of the value and importance of the work carried out by EMERGENCY, the government elected not to tangibly support the activities of the Surgical Center.
We cannot continue to fund and manage the hospital without the cooperation of the Cambodian authorities. It would not be a wise use of the resources entrusted to us by donors; funds and resources can be put to work elsewhere, where they are sorely needed.
The Program Handover:
A Japanese foundation contacted us recently upon receiving news regarding our intention to transfer the hospital in Battambang to the Cambodian authorities, and expressed interest in maintaining the continuity of the program.
After discussions with the Cambodian Ministry of Health, we decided that the Handa Foundation would take over the management of the Surgical Center from EMERGENCY. We will attend to this process during the months to come.
Our logo will no longer be on the hospital’s facade, but its gates will continue to be open to people who need treatment. And patients will continue to receive treatment from skilled medical and technical practitioners that EMERGENCY trained for many years.
Leaving to the care of others a hospital that EMERGENCY created out of nothing, with great commitment and sacrifice, is bittersweet and familiar. We went through the same process seven years ago, when we turned over the Surgical Centers of Erbil and Sulaimaniya to the Iraqi authorities.
Those hospitals continue to provide an irreplaceable service to the population of Kurdistan. In an essential way they continue to serve as models of the “EMERGENCY hospital”.
Good luck Battambang.
By Pietro Parrino
If only landmines were a piece of ancient history, buried in the distant past, no longer destroying lives, amputating limbs, causing untold deaths and injuries. But one glance through patient records at the EMERGENCY Surgical Center in Battambang, makes you realize that mines pose an ever-present threat to the safety and security of the Khmer people.
On November 16, 2010, an explosion of anti-tank mines in Battambang Province caused one of the largest number of deaths in recent history: A tractor driver towing a trailer behind him with thirteen farmers, all of them related, rode over an unexploded mine; his weight alone was not enough to trigger an explosion, but the combined weight of the group seated behind him did. Although the driver was spared from injury, all thirteen people aboard the cart died instantaneously – among them, a 1-year old girl.
The area where the tragedy occurred was the site of a Khmer Rouge base until 1993. Battambang Province remains one of the most heavily mined in the country and ranks among the highest mine and UXO casualties in Cambodia. So perhaps it came as no surprise to EMERGENCY staff when, on February 27, 2011, two victims of landmine explosions were admitted to the center within hours of each other.
Rom is 27 years old, a husband and father of two children. He was working on his uncle’s farm, plowing with a tractor in the rice field when he heard an explosion and blacked out. He was transported directly to EMERGENCY and was treated for his injuries.
The rice field where Rom worked had been plowed just three years before. Before that, when a forest of trees was cut down to make way for the rice field, a mine had exploded, injuring a number of workers. After the accident, CMAC (Cambodian Mine Action Committee) visited the farm to file a report and to search for further unexploded ordnances.
The farm is located in Poom San Sep district, “thirty villages” in Battambang province. It is an area that had seen fighting during the Khmer Rouge regime; in fact, Rom’s uncle is a policeman and had fought at the time.
Fortunately for Rom, his injuries were not as extensive as they might have been; he did not lose any limbs. However, his right arm was badly injured. He says that he is now afraid to return to work because of the possibility of more mines. He would prefer to go into another line of work instead.
Srey, only fourteen years old, had just started to plow the soybean field with a handful of other people. They were working at Cabana, a community farm located near a military post in Samlot district. Srey had worked in this field before, and no warning signs were seen anywhere indicating the possibility of mines in the area.
The mine exploded without warning, she fainted and cannot recall much else. She was first taken to the local health center, where nothing could be done for her. Soon after, she was transported to Battambang, a three-hour drive away, where she underwent amputation of her right leg. She also sustained shrapnel injuries on her right arm and face.
Because she is no longer considered a child, Srey does not require a chaperone as do the other kids on the ward. Her parents are at home and come to visit once or twice a week. Her eight brothers and sisters attend school, but Srey quit because she was unable to keep up with the other students. Instead, she was sent to work in the fields. When she recovers, she expects to return to the field once again…
By Amit Janco
CAMBODIA Ophthalmology screening at the Battambang Hospital
The Eyes of Cambodia
International opticians reached the Battambang Hospital, busy for more than a month with the diagnosis and care of illnesses that are resolvable with medicine or glasses.
Almost a year after the expedition to Panjshir (in Afghanistan), here I am in Cambodia, at the Surgical Centre of Battambang. Heat and terrible humidity, houses and hospital immersed in the tropical green, and yet here are cleanliness and efficiency that stand out amid the chaos of an Asian city.
A couple of days to overcome the effects of jetlag and to set up our room with the instrumentation generously given to us in Italy, and then I start the eye screening program.
In the preceding days information about the program was posted on signs written in the Khmer language and hung on the gates of the hospital.
A silent crowd was waiting for an examination in front of those gates at five in the morning on the first day. Since it is not possible to perform more than twenty-five exams in a day, the staff saw to distributing the number of reservations based on order of arrival. After a little while it was discovered that some were selling their own reservations. To avoid speculation we were forced to stamp the hands of the first arrivals: a practice that would embarrass us more if we ignored the fact that this is common in Italy and elsewhere, in clubs for example.
In addition to the outpatient consultations, immediately are added requests from local staff and advice for patients recovered from trauma and injuries--very frequently treated in this hospital as it is becoming the trauma care centre of reference for the entire region.
EMERGENCY already makes use of the collaboration of a local ophthalmologist for urgent ocular surgical interventions. With him we discussed and agreed upon a common task.
Typical Pathologies of Poor Countries Due to Climate or Malnutrition
The objective of our mission is to diagnose ocular pathologies and vision problems. Ocular diseases for those in poverty follow similar patterns everywhere: here, as had happened in Panjshir, we find corneas ruined by forces of dehydration, climate, systemic diseases, and malnutrition. Then, there are cataracts resulting from exposure to sunlight without protection, from malnutrition and from ill-advised use of cortisone medications, mainly of local production.
The “fundus oculi” exam demonstrates that under these conditions, the population is biologically much younger than individual age and there is not the frequency of retinal pathologies typical in the West caused by hypertension, diabetes, and vascular pathology in general.
Instead we find ocular traumas of every kind, consequences of AIDS and TB that involve the ocular area in addition to many refraction defects: myopia, hypermetropy, and astigmatism. These latter conditions are probably the effect of scarce familiarity with corrective lenses, perhaps the legacy of the recent history of Cambodia. Under Pol Pot's regime, wearing glasses was perceived as a sign of intellectualism, an expression of challenge to the principal revolutionaries of the Khmer Rouge.
Well-timed use of adequate optical correction is the objective that we want to reach, mainly for the benefit of the children: good vision guarantees the possibility of study, of qualified work, and above all, of cultural renewal.
By ELENA GIRALDI
Translated by Elizabeth Meihaus
Edited by Sonia Kamath