Siem Repeat: Back to Cambodia

In just three short months of travel, we have witnessed some incredible sights:  sights that have inspired us, sights that have challenged our understanding of the human condition, sights that have reaffirmed feelings that we already had but had never quite bolstered by personal experience. In particular, I keep finding my mind drifting back to Cambodia and its people, whose recent history (and resulting poverty) moved us in ways that can’t easily be described.

As I mentioned in an earlier post, the Khmer Rouge-driven genocide that took place there in the late 1970’s claimed the lives of nearly every doctor and medical personnel in Cambodia, leaving the country today with only 3 doctors for every 10,000 Cambodians, and a lasting and obvious impact on the health of its people. Needless to say, medical care in the country is extremely rudimentary; medical personnel are generally poorly trained and infections are diagnosed by a patient’s symptoms rather than by proper tests, leading to misdiagnosis and inappropriate or delayed care. One day as we were walking through downtown Siem Reap, Scott and I passed by a single-story concrete building on the side of a dusty road with “Emergency Room” painted above the open door. The room was completely open-air, with no glass on the windows, and we could see an IV drip attached to a person lying just on the other side of the window frame. Sadly, I found myself being thankful that I had the means to fly to Bangkok or even the U.S. in the event of an emergency – and at the same time realizing that this was a place that could really benefit from whatever help trained people are willing to give.

As I neared the end of my PhD work this past July, I found myself doing some serious soul-searching as to why I had embarked on medical research in the first place. Many (or most) PhD students choose a subject area to dedicate 6 or 7 years of their lives because they simply love the subject matter and can’t imagine doing anything different – it’s something that makes them excited to get out of bed in the morning, and it’s often the last thing they think about as they fall asleep at night (I speak from the personal experience of my fellow PhD friends back in Boston). However, as the years of my PhD work ticked by, I found my feelings towards microbiology and research diverging more and more from my fellow students in that way; while they were getting more engrossed in their research, I kept struggling to figure out how to use the knowledge we were gaining in ways that could more directly affect those people that our research was supposedly helping. I certainly don’t mean to indicate that one of these ways of thinking is better than the other; we need dedicated researchers to make advances in medicine but at the same time we also need people further down the pipeline to search out populations in need, address where they are falling behind in medicine, and see that healthcare is brought to those places in an appropriate and sustainable way.

Indeed, one of the pitfalls of modern medicine (and a major reason that malaria has still not been eradicated, in fact) is that many diseases are neglected by modern research on the basis that those diseases no longer exist in the countries with the money to fund the research. Therefore, the so-called neglected diseases that disproportionately affect the world’s “bottom billion” never get the attention or funding that they deserve. (Although malaria is far from being called a “neglected disease” in the world of research, the fact that it has already been eradicated from wealthy countries has contributed to its being under-funded for many years.) Along the same lines, often the treatments and diagnostic tests that are available for disease treatment fail to reach the developing world either due to simple lack of training or equipment. How do you keep a vaccine refrigerated in the middle of an African village that has no refrigeration, for example? Other times, it is the sheer cost of a treatment that is the constraint. For example, my PhD research focused on characterizing the immune response to the bacterium Shigella flexneri  – a dysentary-causing microorganism that is 100% treatable and curable with a simple course of cheap antibiotics (the type of antibiotics that I’m currently carrying in our medicine bag all over Asia, in fact). You might be surprised to learn, then, that Shigella causes over 1,000,000 deaths each year, mostly in children under the age of 5, and almost entirely in developing countries. So even for the diseases for which we have treatments available, there is a severe lack in the bridge between the biomedical research that has developed these treatments and methods for getting these treatments into the hands of people who need them the most. This, I finally discovered (perhaps my most important discovery of all my PhD work?), is where my interests in microbiology lie: how do we apply our current knowledge of the field to getting treatment to those populations that most need the care?

Back to Cambodia, 1 out of every 15 children living there dies before the age of 5, and as you now might guess, these diseases are often preventable and treatable (…in fact, many of them are due to Shigella).  These numbers are difficult to grasp, frustrating, and left me wanting to do something about it. As many of you probably know, I was really interested in doing some kind of volunteer work related to my PhD while we were on this trip. So I did a bit of online searching before we arrived in Cambodia and discovered a place called Angkor Hospital for Children (AHC), a charitable hospital in Siem Reap, Cambodia that provides cheap ($ 0.25) or free healthcare to children living in Siem Reap Province. The hospital staff is 98% Cambodian, with a heavy reliance on foreign, medically-trained volunteers to provide training to the Cambodian staff. Therefore, another facet of AHC is to strengthen Cambodia’s health infrastructure by training doctors and rural government health workers.

While we were in Cambodia, we visited AHC and were floored by the mission of the hospital and by how well-run the facility seemed to be. By the time we left, I knew I wanted to apply to work there. So I sent off my CV and cover letter and am now happy to let you know you that I will be serving as an advisor to AHC’s diagnostic laboratory for one month!!! I will be helping them with the daily work of running their lab tests, but more importantly, my job will be to try to identify shortcomings and areas for improvement in their current diagnostic tests and assist with training of current lab staff. I’m extremely excited for the opportunity to further their mission and also to learn more about the current state of diagnostics in developing countries. (According to the list of available diagnostic tests that the volunteer coordinator already emailed to me, there are almost no microbiological tests currently being performed at the hospital – pretty amazing considering the importance of correct diagnoses for treating infectious diseases, the type of diseases that disproportionately affect impoverished populations.)

If you’re interested in reading more about AHC, their website is:

https://angkorhospital.org/

They are always interested in medically-trained volunteers, if you’re interested in living in Cambodia for a month and helping out the hospital (…with the bonus being that Angkor Wat will be in your backyard!). Scott and I will be living in Siem Reap from Jan. 31- March 1, if you find yourself in the area around that time. We’re very excited to see what this opportunity brings and feel so incredibly grateful to be once again returning to a country that captured our hearts and reminded us why we are really on this crazy journey in the first place.

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