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Where to, lady?!

February 20, 2009

I wrote earlier, a bit of a justification for doing international electives. I’m always uneasy thinking about planning them, fearful of taking away and not giving back. But I can’t fight my interest and I’ve tried to develop reasonable expectations, based on my past experience and reports from peers.

So, where am I going?

Cambodia – Rehabilitation Plastic Surgery (Paediatric, Reconstructive), Chey Chumneas Referral Hospital‎, Takhmau (suburb of Phnom Penh) – 4 wks

What luck! When thinking about where to do an international elective for my fourth year, I found it impossible to search by a program’s characteristics. I asked classmates, read forums, and googled like crazy to find a program that would be a good fit. I started thinking about language. It’s a huge barrier. I have not superb, but a decent ability in French. Looking at French-speaking countries, Cambodia came up. Even though French is no longer prevalent there, coming across it in this way had me start learning about the country. One of the poorest in the world, it joined the UN around the same time as Nepal. And like Nepal, it has a slower pace of life, a perception of high degree of corruption, a turbulent and violent political history, and main industries of tourism and textiles. There is a great need for aid in the post-Khmer Rouge Cambodia. More importantly, there’s a group working there that seems to be making a small impact, in a big way.

Operation FIRST in Cambodia is a continuation of a ROSE charities outreach. A dedicated local plastic surgeon, Dr. Nous Sarom, heads the effort to provide surgical care to those with cleft-lip and palate, acid (and other) burns, injuries from land mines, and other disabilities.Corresponding with the Canadian (Vancouver)-based branch, I learned that there were strong ties between Vancouver and Phnom Penh, including the fact that Dr. Sarom has spent time training at BC Children’s Hospital. Colleagues tell me he is a keen teacher with great English!

Reading the student blog, written by those who’ve already completed their time in Phnom Penh, I was impressed. While some of the time I spend there may include surgical assists, brushing up on my surgical anatomy, and eye care at the Ophthalmology clinic, I am to be flexible. I expect engaging in public health tasks and being “an extra set of hands” to be my main job description. Accordingly, I’ll  keep a very open mind and take the self-directed approach more often than not. If I am able to assess patients for surgery, hone my surgical skills, learn to better manage  pre- and post-op patients, and/or become more familiar with ophthalmological examination and common conditions, that will be a great benefit. Again, working in a less-affluent environment,  I’m still worried about the language divide, but this being a procedural elective, I’ll have less. Plus, I have a whole month to pick up some Khmer.

It will be a challenge to come to terms with the existence of acid burn attacks, and to . I don’t expect heartwarming moments, or just how much of a difference I will make. As every learning experience, I’ll be taking away more than I give. But what I take away, I will give back and back and back again, I hope.

Vietnam- Emergency Medicine, Cho Ray Hospital, Ho Chi Minh City – 2 wks

I was a bit leery about this one. I really wanted to apply what I learn in Cambodia to another context, but I was worried about language and afraid of being pushed to do things I’m not qualified to do. I heard that an elective at Cho Ray can be a valuable experience. My French is decent, but only the older generation use it according to a Vietnamese classmate of mine. Speaking with other students who’ve done the same elective, I learned that all the charts and rounds are conducted in English and histories of patients are not as involved as in the West. In The Lancet Student, Alan Huynh describes his experience at Cho Ray, reassuring us fearful of language barriers that there will be adequate help and inclusion.

There are going to be a lot of MVAs. The Vietnamese do love their motorbikes. I have a feeling I’m going to get to  practice my full neuro exam aplenty, learn a lot more about resource allocation/triage, and speed up my suturing and other procedural skills. According to Trang La, there will be ample opportunity. Hopefully I can build on what I learn in Cambodia, dealing better with Plastics-type presentations in the ER- I’ve read that acid attacks are unfortunately common in both countries. I hope by the end of it to gain enough Vietnamese to introduce myself, conduct a physical exam (“please open your mouth,” “breath deeply,” “lay down,” “does this hurt?,” “where is the pain?,” “do this [action],” “relax”), and ask for help. I want to see how triage works in one of the busiest ERs I’m likely to encounter, and how to best stabilize neuro and internal trauma patients prior to surgery. Maybe I can even exchange teaching with the Vietnamese medical students with whom I will work.

and a little layover in Hong Kong – readjusting – 2 nights

A friend of mine did a Habitat for Humanity project in El Salvador. Surrounded by overwhelming poverty and an otherwise marginalized population, they did what they could to help build community and infrastructure. When it was time to leave, the group leader had them move out of their basic accommodations (houses constructed of adobe, bahareque [cane and mud], tin, and cardboard) and into a fancy hotel in one of the bigger cities. Doing this in a foreign country helps one debrief , and step away from the experience to reflect on it.  The theory is that it will be easier to return to privileged society, without having as difficult a time adjusting to the profound wastefulness and X of home.

So, I’ll be spending two nights in Hong Kong on my way back. I had a weirdly long layover anyway, so I decided to extend it by a day, rather than sit for 10 hrs in the airport. I’m hoping to eat as much different food as possible in this time, ride the superb underground (I have a strange technofetish for efficient transit systems; see: Berlin)

Have any travel tips? Know of good guest houses in Phnom Penh and HCMC? Leave a comment, please! I’ll probably publish a budget and more info about accomodations and how the electives go, once I’m there. Thank heck for 50cent/hr Internet cafes, otherwise this trip would be cold-turkey abstinence for my serious addiction.

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