By Tessa Collier, Undergraduate Nursing Student

Today, the undergraduate nursing students went back to Hope Hospital here in Phnom Penh while the graduate nursing students went on home visits in the area. This morning eleven students and our three professors piled into the hospital van with several huge, military green duffel bags full of supplies to donate to the hospital. Dr. Massie led a Memorial Day themed devotion en route. When we arrived, we walked into the lobby to take a group photo with all of our donations. I have noticed that so many people want to take photos with us, and I have not encountered that on previous study abroad and mission trips I have been on.

Our group of eight students split into two, and we were led on a tour of the hospital. We were informed that Hope is known throughout the country for providing excellent care, and Cambodian nursing students love having the opportunity to learn at the hospital. Our guide explained to us how the hospital used to take pride in providing completely free healthcare to its recipients but decreased funding has forced it to start charging (albeit minimally) for services. We were led through the different departments, such as the Emergency Room, a minor procedure room, and Radiology. These are among the few of the only air-conditioned rooms in the entire facility. Instead of indoor waiting rooms, patients wait outside because the sun kills Tuberculosis. We walked through the beautiful courtyard with a large mango tree into a clinic and the lab. We finished our tour by visiting the medical and surgical wards on the second floor. Each ward has about 12-13 beds; there are no individual patient rooms. If a patient needs privacy while a procedure is performed, curtains are pulled around his/her bed. There are no patient care techs or nurses aides. Family members help move the patient from stretcher to bed and are taught by the nurses how to help in managing the care of the loved one. Coming to this hospital also makes me realize how much we waste in America’s hospitals. They do not dispose of chest tubes or other small things that we usually take for granted.

We dropped off five students to shadow local doctors and nurses. Two other students and I followed Dr. Massie, Dr. Taplin, and Dr. Wofford to the medical and surgical wards to look at charts. Charts here are still done through card copies. Dr. Taplin told us that every hospital in the country is required to chart in either English or French (two of Cambodia’s official languages, after Khmer); this particular hospital uses English because it was founded by English speakers. In the medical ward, Dr. Taplin opened the chart of a patient with abscesses in his spleen. They had found growths of what are called Burkholder’s pseudonomas (a term that was not even in Stedman’s Medical Dictionary) which is a type of bacteria common to this region. We then looked at the chart of another patient with Cirrhosis who had come to the hospital with ascites, which is fluid that has shifted into the abdomen. The doctors had just finished performing a paracentesis, draining 1.5-2 liters of fluid from the man (this is the maximum amount that can be drained per day.

We then went to the surgical ward where Dr. Taplin went over the chart of a woman who underwent a mastectomy to remove a huge tumor that had been growing for three years. She had not had access nor the education to wellness check-ups or cancer prevention that we have in the States. At this point, the woman was put on palliative (comfort) care because there is nothing more that can be done for her. There is no chemotherapy in this country. People who have the money can go over to nearby countries, such as Singapore, for treatment, but for the poor there is no such luxury. Dr. Taplin, Dr. Massie, and Dr. Wofford led the three of us students in a discussion about how care differs in this country compared to the States. Again, this hospital is known for providing quality care. So while there are many differences between the two systems, just because they do things differently here does not necessarily mean that it fails to provide great care to patients. It was a very informative and thought-provoking discussion.

We later regrouped with the other five students and went to lunch at Flavours Restaurant, where we went for dinner our first night here. We are now preparing for our nine-hour drive to a province called Poipet tomorrow where we will set up clinics.

Today (Thursday, 5/25) was the fourth day of our trip, but with travel was our second full day in Phnom Penh, Cambodia! After spending yesterday exploring the city and learning more about the history, we were going to engage in the community around us through a variety of ways. Following breakfast at the hotel, our group of fifteen split into three different groups. One group went with a Social Worker to do HIV home visits and another group went to a local hospital to assist with check-offs for their staff. The group I was with was six of us going to a local school through the organization Freedom’s Promise. At the school we would be holding a clinic for Well Child Checks.

As we arrived in the area with the school, the van dropped us off across the street and walked through a small street, similar to an alleyway. The bleak reality of these peoples’ living conditions shook me. Small rooms, which consisted of little more than dividing walls and a cover were homes for families. Running water and simply a place for trash were non-existent. After walking along the row of homes, we were then in the area with the school. It consisted of several classrooms, an office, and a library. A teacher directed us to their covered play area with tables and chairs to use for our clinic. Lauren and I, both nursing students, set up to do height, weight, vital signs, and an eye chart. The two Doctorate of Nursing students, Kim and Paige did thorough assessments. Dr. Wolford and Dr. Massie were assisting anywhere and everywhere – from aiding in assessments to helping prescribe to keeping kids entertained as they waited.

A health issue noticed in nearly every child was tooth decay. This may seem somewhat insignificant to us and an easy fix, but for these kids it can be so much more. If further decay occurs, they could end up without teeth or an infection. While the United States has fluorinated water to help prevent this, these children come from families without running water (and Cambodia’s water isn’t drinkable, much less fluorinated). For the most part, brushing their teeth isn’t a priority. A toothbrush here costs $1, which seems insignificant to us. Yet, for many of these families, that is a day’s wages – not to consider the need for toothpaste or the lack of access to clean water. This simple issue made me realize even further how we take so much for granted back at home.

Dr. Wolford, a pediatric nurse practitioner, made an important point at the beginning of the day. She said that “Kids were kids, wherever you go.” This simple statement eased some of the nerves about not speaking the same language, as I found this reminder to be so true. Smiles, laughter, and even many games are so universal. Even if it was after a little misunderstanding, we learned their games as they did cartwheels over a string made with rubber bands. They learned limbo and we played their version of jump rope. As they waited for the next part of the assessment, Lauren and I were taught some of the shapes in Khmer. We sang “Head, Shoulder, Knees, and Toes” and taught some boys how to flip a half full water bottle to make it land correctly and cheered after many attempts for each of us. These kids were full of joy, despite their circumstances and I think that was the most powerful part of the entire experience.

Today was my first day in Cambodia. My group and I woke up early, had breakfast, and walked through the city to the river. Most notably it was hot, and I sweated a lot. The city was pretty and the people were nice, so that made the heat slightly more bearable. Later on in the day, I went with a group to visit the S-21 prison museum. S-21 was first a school before the Khmer Rouge took power. The Khmer soldiers decimated the school and turned it into one of many torture camps used by the Khmer Rouge during the Cambodian genocide. Their prisoners were held in hardly livable conditions, tortured daily, then killed slowly and painfully after they had given confessions to crimes they never committed. In each of the buildings, there were pictures of the prisoners and the cells they lived and died in.  The whole experience was hard to swallow, but I forced myself to look at the pictures, the torture devices, and the bones of the prisoners. I forced myself because it’s easy to look away, to not think about it and forget it happened – especially to an American. However, I see it as the least I can do for the people who can’t look away, and who can’t forget no matter how hard they try. They people who died there had no rights, no freedom, and no say in what happened to them, but I believe they have a right to be remembered; and I believe that it is our duty to remember them and the injustice of the Khmer Rouge so that those injustices will not be repeated. I think S-21 is a perfect example of what the Khmer Rouge did to Cambodia: destroy education, replace it with misery and death, and then leave it to be forgotten. There was a monument constructed at S-21 declaring that the information there is the right and property of humanity as to not forget the cruelty we are capable of.