Operations

In  January we had a friend to stay with us from the UK who is a Doctor

and she  did Voluntary work in the same hospital as Angela before returning

to the UK end of March.Sue was happy for us to reproduce a blog entry

of hers detailing an experience in the hospital:
 
A few weeks ago we had a visiting surgeon at Stung Treng Hospital. Dr
Heng is from Cambodia but has lived and worked in France for over 30
years since the Khmer Rouge time. Now he has retired he still lives in
France but spends time in Cambodia, helping out at some of the more
remote hospitals doing operations that the existing surgeons do not
have much experience with. There is only one doctor here who performs
surgery, he does everything including the obstetrics. Until last year
he was the doctor responsible for surgery, about 6 months ago there
was a reshuffle and he is now the obstetrician. I think post-graduate
training here is a bit different. There are only 6 doctors here in
total and one of them is currently away for 3 months being trained to
do surgery. The anaesthetics are given by the two nurse anaesthetists
Sethyl and Chansopy. Both are very experienced and been doing
anaesthetics for about 15 years after training for 2 years in Phnom
Penh. If the surgeon is away then the nearest hospital is in Kratie, a
2 and a half hours drive away. Luckily the section rate is very low
and they only do approximately 2 sections a week. The hospital
delivery rate is increasing rapidly, in 2010 it was approx 600 and in
2011 it had increased to over 900. Most women in the rural areas will
deliver at home with a traditional birth attendant but there is a
drive to encourage them to go to the health centres or hospitals where
there are trained midwives.
 
Anyway, the week before Dr Heng was due to come Angela made some posters;

 
   
Roughly translates as 'Do you need surgery?'
Goitres
Hernia
Cysts
Come to Stung Treng Referral Hospital
week of 20 - 24 February or phone this number (which was the surgeons mobile).
 
She distributed them to the health centres, pharmacies and put a few
up in the market. We were a bit concerned that no one would come but
on Monday morning there were several patients waiting for assessment.
 
On Monday the surgeons assessed the patients and started operating on
Tuesday. In 3 days Mr Heng performed 8 thyroidectomies, 4 hernia
repairs, a hysterectomy, a hydrocele, a caesarean section, an
appendicectomy and an incision and drainage for an abdominal wall
abscess. Not bad considering a 3 hr lunch break seems to be obligatory
here. By Friday all the surgical beds were full and we were running
out of drugs and syringes. Two of the hernia repairs were children
which they would not have done if Sue had not been here.
 
  Quite a few women had enlarged thyroid glands which they have put up
with for many years, as they cannot afford to travel to Phnom Penh for
surgery. This lady was the most dramatic, in her 60's she said that
she had had a goitre for 20 years.

 
   
Permission obtained for the use of this photo from the patient
 
  
There is no histology lab to examine the specimens but they were
always taken into recovery for the patient and relatives to have a
good look at!

 
 Imagine having to carry that lump around in your throat!
 
 
Recovery takes a bit of getting used to here. As soon as the patient
opens their eyes they are handed over to the care of their relatives!
There doesn't seem to be any recording of any observations once the
patient has left the operating theatre and certainly no administration
of pain relief in the recovery ward. The theatre staff are also the
surgical ward staff but the patients relatives stay with them and
bring them in food and do most of the basic care. Drugs for the day
are given to the patients daily in a plastic bag with little
explanation of what they are for and when they should take them.

 
Thankfully there were no post-operative complications. As most
patients stay in until their sutures are removed the ward round on
Monday was quite long with a record 25 patients. Most have now gone
home and we are left with our usual mixed bag of about 10 emergencies.