It’s No Holiday in Cambodia

The province of Kratie, on the banks of the mighty Mekong River, to the north of Cambodia, is home to more than 300,000 people, many of them surviving on just a dollar a day. On one week in October, 3,000 of those people visited the local hospital, some travelling for five hours or more by bus, bike and foot, for free eye checks, surgery, glasses and hearing aids, all courtesy of Cambodia Vision, its sponsors and a team of dedicated volunteers.

Kratie Referral Hospital is an overwhelming place to wander around. The health system, of course, is nothing like what I’m used to in Australia. As one person explained, the doctors do the medicine, the nurses make sure things are running smoothly and the families take care of the patients, fanning them through the long sweltering days and nights, holding IV medicine and saline bags high, washing and feeding them throughout their stay.

Standards of hygiene are low with hospital rubbish piling high on dusty grounds that turn to mud in an afternoon’s belting rain. The odours are suffocating. The hospital’s one ophthalmologist, Dr. Sokhan Heng, explained to me that frequent changes to funding for medical procedures meant that sometimes eye surgery is affordable for the poorer people in the community and other times not. Right now, at $65 per cataract, it’s the latter, which means Dr. Heng and the Cambodian people are heavily reliant on the support of NGOs like Cambodia Vision.

Sometimes I think we get more out of it than they do, you want to change the world and make it a better place and this is just a small step…

Interestingly, Dr. Heng said Cambodia Vision’s visit to Kratie Province last year had helped by both providing free eye care to over 3,000 people (including 433 cataract procedures) and increasing awareness of the eye care services available at the hospital. This, in turn, had brought more patients in to see him during the year. On an average month, he now performs about 40–50 cataract surgeries and sees 150–170 patients in the outpatient department.

Providing cataract surgery is just part of the job for Cambodia Vision. The group, which consists entirely of volunteers who pay their own way – from airfares and accommodation through to meals and insurances – has become a well-oiled machine over seven years of operation.

A small contingent always travels ahead of the main team to prepare for the clinics; thoroughly scrubbing down wards vacated by the hospital and setting up equipment. Once the main team arrives there are just a few hours remaining before hundreds of patients descend on the hospital grounds to have their vision and hearing restored. It’s the same every year, such is the need, and the demand for sight.

Rooms allocated by the hospital are organised into stations so patients can flow through registration on to eye checks, testing and then the dispensary.

Patients who require surgery are seen by the GP before being moved across to the anaesthetics rooms, which as you’d expect, flows on to the surgery. Unless they are from the local area, patients sleep over at the hospital on mats supplied by Cambodia Vision, and the following morning have their eye patches removed, their eyes checked and medications explained. Each patient is given a post-op kit, complete with medications. This year, thanks to a new sponsor, they were also given a bag of rice.

Cataract patients who have to travel far to get home also receive US$5 to pay for the journey. During their stay, lunch and dinner vouchers ensure no-one – neither patient or family member – goes hungry.

Finding Ways to Work

This year, like all years before, the Province’s inconsistent power supply caused havoc. Even before the clinic opened, during the set-up process, a sterilising unit blew up due to the erratic supply.

Surgery too, was delayed on day one, with regular power outages shutting down the equipment. “It’s impossible to operate with the power going on and off,” explained Dr. David Ng. “If the power is out, the microscope won’t work – if you have an instrument in the eye at the time, you can’t see if it’s safe to remove it.”

Fortunately, Cambodia Vision has an electrician on board. For the first few days, Campbell McKellar is on the run, moving from one electrical problem to another. When he’s not fixing power, he is in the dispensary grinding lenses, a skill he has picked up by since joining the group. “The power supply here is a major problem,” said Campbell. “The hospital doesn’t have anyone qualified to work on it, so they often ask me to fix problems that have been happening for months. I found one doctor randomly pulling wires from the source, trying to work out how to get things working.”

Having got the steriliser up and running, Campbell turned his attention to the main power supply. “Thida Yang (Cambodia Vision official) put calls out to senior ministers to stabilise the power, and in the meantime, I appointed someone to sit under the mains box. They were instructed to flick the switch every time it tripped,” he said. “It’s make-shift, but it worked.”

Making Progress

Despite these delays, on the first day of Cambodia Vision’s clinic, 33 patients were operated on, 70 hearing aids were fitted and hundreds of people received prescription spectacles, ready-made spectacles and sunglasses from the dispensary. Using ageing equipment owned by the Kratie Referral Hospital, Betty Katsogiannis and her team managed to produce a total of 344 prescription spectacles across the week-long clinic (90 pairs on one day) and dispense thousands of ready-mades.

In post-op on day two, the first 33 patients sat quietly in a circle on the floor waiting to have their eye patches removed and their eyes checked. Most looked stunned by their new vision, still cloudy from the operation. A few needed to be fitted with hearing aids before they could receive instructions about taking care of their eyes during the healing process.

Dr. Chris Brown, who has been part of the Cambodia Vision team since it was established in 2007, said the first surgeries had gone well. “I’ve been to many places many times and always the first day is a bit problematic. Yesterday was more problematic than most with the power shortages but overall things were very good. I’ve seen the patients today and most of them are very happy… overall I’m satisfied with the first day. This is a very small group compared to what we usually see – today we will see around 70 patients.”

Asked what he gets out of his trips with Cambodia Vision, Dr. Brown said, “I’m addicted to it, it’s really satisfying, it’s lovely and it’s always a big contrast to Australia where it’s still a great operation but people don’t have the visual problems they have here. So it’s great to know that people who may slowly go totally blind are being visually rehabilitated.”

Dr. Audrey Murugesan was also part of the founding team. She said the first Cambodia Vision team was very small and focused on pterigiums, a surgery that she continues to provide to the people of Cambodia while her colleagues perform cataract surgeries. “It is time consuming surgery but I don’t mind doing it, I’m here to help. There is a much greater prevalence of pterygium here than in Australia, I think because the people spend all of their time outside in the sun from childhood; the dust and dirt might also have something to do with it.”

For the first time in her career, Dr. Murugesan removed a pterygium in a surgery alongside a Cambodian doctor who was delivering a baby by caesere an. “I felt pretty uncomfortable about doing it but the doctor was very calm, and the baby boy was born within 10 minutes. I tried to give him the space he needed but I couldn’t help but look up when the baby was born!”

The young mother was wheeled into the anaesthetics room where eight patients lay waiting for cataract or pterygium surgery. Her baby was handed to the father who carried his little boy out into the bright sun to be introduced to the extended family. Another baby was born by caesiarean in the same surgery later that day.

Dr. Murugesan said the opportunity to be part of Cambodia Vision from the beginning was incredibly rewarding.

“You see these people and they are so poor, and they do so well and they see so well after surgery and it just makes you feel so good. Sometimes I think we get more out of it than they do, you want to change the world and make it a better place and this is just a small step. Everyone has something to offer – if we all gave just 5 per cent – whether that’s our time, our talent or our money, the world would be a better place. Giving – you just can’t put a value on that.”

The sentiment was the same, no matter who I spoke to from the team. Back in the optometry area, Vision Eye Institute practice manager Philip Lu was assigned to A-scans for cataract patients. This was his first trip as a volunteer. “Day one was pretty intense. The line of patients just kept building and I was really aware that they were all there, waiting for me.” By day two, that line had become the norm for Philip, who methodically and gently worked his way through each patient, part of a process to ensure the very best vision can be achieved for these people who have so little.

Similarly, optometrist Marlene Xiao who was on her first trip to Cambodia, said she was feeling a little nervous. “I’m used to being in my own room, knowing where everything is. Once we get going (with screening) I think I will be alright. But there is the added pressure of knowing there is a line of people waiting.” By mid-way through day one, Ms. Xiao looked comfortable in her new environment, working with the help of a medical student to screen patients using an eye chart simplified for use with people who cannot read.

Optometrist Sue Ang quietly works her way through hundreds of people who have queued patiently for hours to have their eyes checked and vision tested. After four trips to Cambodia, she is well seasoned and instrumental to the patients’ smooth passage through eye testing and checks. “My job now is essentially logistics – making sure the team is working effectively, relieving staff, moving patients through the system. This is a steep learning curve for young optometrists – I’m careful to only bring along grads with three or more years behind them – it is such a fast paced environment, you need to have the right combination of clinical skills and life experience so you can make fast, effective decisions.”

Returning Independence

A brief meeting with an 89-year-old man who’d just had his eye patch removed after cataract surgery illustrated to me, just how much Cambodia Vision gives back to these people.

The frail man sitting in front of me had been a village leader until he was evacuated by Pol Pot in 1979. With Thida Yang translating, he told me he had lost everything. Since then, to earn a living, he had advised people on property, however since losing his sight he had been unable to work. He said he was very dependent on people around him, living with his son and relying on his daughter to provide care. The man told me that after cataract surgery his vision was still blurry but clearer than the day before; understandable given the swelling caused by extra capsular cataract surgery necessitated by the inconsistent power supply. He left the hospital with his vision returning and hearing aids fitted, his future – and the future for his family – looking just a little brighter with his renewed independence.

Melanie Kell travelled to Cambodia to work with and write about the work of Cambodia Vision. She was funded by mivision.