The people of Cambodia are beginning to see the benefits of work undertaken by Khmer Sight Foundation (KSF), an international charity established in 2015 with the help of the late Dr. Kim Frumar, an Australian ophthalmologist. The charity has grown thanks to the help of his partner Teresa De Leon, along with Sean Ngu – KSF co-founder and the Cambodian Secretary of State, and Sunil Shah – Ophthalmology Consultant and International Medical Lead for KSF.
With only 32 local ophthalmologists to aid a population of 15 million, KSF is taking a two-pronged approach to tackling eye disease in this developing country. Firstly, through charitable missions and secondly, by training local Cambodian doctors to help create a sustainable future for the country.
Cambodia is a country with an ancient history and more recent violent past. The majority of the population lives in rural provinces with little to no access to basic healthcare. At present, there are an estimated 180,000 blind Cambodians, and a further 10,000 lose their sight each year. Of these cases, 90 per cent are either treatable or preventable.
KSF plans to run 18 missions during the next year, each lasting one week, with different international ophthalmic teams. There is currently a backlog of approximately 30, 000 Cambodians who require cataract operations. So far 120 optometrists and surgeons have been recruited from the UK, Germany, Italy, Austria, Singapore and India. The first mission took place in April 2017 with a team of optometrists, junior doctors, anaesthetists and ophthalmologists from Manchester and Birmingham, UK. A total of 400 patients were seen in clinic and 200 patients received operations.
Working with Local Medical Students
KSF arranges provincial screening with the help of local volunteers and Cambodian medical students. This involves identifying those with eye conditions that may be amenable to surgical intervention. Patients who earn below $100 USD per month are eligible. These patients are then transported to the capital by the charity to the hospital, with bus journeys that take up to ten hours. At present the missions take place in the Preah Ang Duong Hospital in Phnom Penh. Here, local volunteers take a brief history and undertake simple tests such as blood pressure, blood sugar and visual acuity.
Ophthalmologists and optometrists work side by side in the clinic to see all the patients from the provinces, with local volunteers supporting as interpreters. Patient with dense cataracts or pterygium obscuring their visual axis are consented for surgery here. Of course, there are many other ophthalmic cases such as glaucoma, refractive error and corneal scarring which are the causes of the patients’ poor visual acuity. There are also more obscure presentations such as cerebral tumours, thyroid eye disease and cataracts secondary to systemic disease that present in clinic, at a much more advanced stage than would be found in the developed world. At present, KSF is unable to present any solution to some of these conditions. The primary route of action is to refer these patients to local hospitals for further investigation and management. As the charity continues to expand with the help of sub-specialists, KSF will be able to provide more management options.
Biometry and ultrasound facilities are available for use in the hospital. Patients often have same-day procedures and sleep overnight in the hospital to have a post-operative check the next day. They are provided with steroid eye drops and written information in the Khmer language explaining post-operative management. After six weeks, local teams visit the provinces to carry out further review.
The operating theatre is modern, air-conditioned and well equipped with space for four operating tables to run at once. KSF has received a lot of charitable donations from many pharmaceutical companies and as a result has a full range of IOLs, iris hooks, viscoelastics and vision blue. The theatre itself has four phacoemulsification machines available for use. Due to the maturity of cataracts encountered, small incision cataract surgery (SICS), a low cost form of extracapsular cataract extraction which results in a self-sealing wound has been employed. For patients undergoing pterygium procedures, autologous blood is employed as a sealant, proving advantageous in resource-poor settings.
Developing a Sustainable Model
International teams provide lectures, wet lab sessions and hands-on surgical experience to Cambodian trainees under supervision during the mission week, which are well received by local doctors. Additionally, KSF is currently working with the Cambodian government on the construction of a super-facility, where charitable missions can continue to provide services and local ophthalmologists can be trained. This centre will also house a new school of optometry and act as the centre for postgraduate ophthalmology trainees. Local enthusiasm for the missions has been overwhelming thus far, with visits from HRH Princess Norodom Buppha Devi of Cambodia, international Embassy representative and meetings with HRH Prince Sisowath Tesso of Cambodia.
Express Your Interest
KSF runs on the goodwill of volunteers and is constantly in need of optometrists and ophthalmologists to lend their expertise. The missions are seven days long and take place in Phnom Penh, the country’s capital. Comfortable accommodation is provided by the charity and the team is usually lodged together in a hotel. It is worthwhile extending your trip if possible to make the most of visiting some of Cambodia’s many historical sites.
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