Malcolm Finlay describes his time in the "heart of darkness"

You know a country has been through a rough patch when you can tell where the border is from the air. As I flew over the Thai border into Cambodian airspace the ordered irrigation of the fields below turned to a haphazard patchwork, the tarmacked highways to dirt tracks, well built houses to thatched shacks.

Before the Vietnam war Cambodia and Thailand had been economically comparable. Cambodia was seen as idyllic by most visiting Westerners. But then as the Vietnam war spilt over into its neutral neighbour, the Khmer Rouge was able to gain a foothold. After a prolonged civil war this band of ultra extreme Marxists succeeded in turning Cambodia into a living hell, instigating a mass genocide in which nearly a quarter of the population was killed.

During this period Cambodia was nicknamed "the heart of darkness." Only four doctors survived. The emancipation of the country by the Vietnamese invasion in 1979 led to further civil war. Peace finally came in 1998 after the country's second election. It is only in the past few years that Cambodia has become a viable elective destination, and the years of bloodshed have shaped the country as it is today.

Cambodia is a country slowly coming to terms with its past. Like most Westerners, I associated the country with the Khmer Rouge, Pol Pot, and landmines. I had heard of the killing fields. Friends had mentioned the great temples of Angkor as a forgotten wonder of the world. When asked why I wanted to go there, I said that I wanted the excitement of travelling to somewhere no one else went to, to a forgotten land, to practise medicine on the front line. I wasn't disappointed.

Landmine injuries were everywhere

I had haphazardly arranged to do plastic surgery with ROSE, a rehabilitation surgical organisation, on the understanding that once in Cambodia I'd sort out visits to other hospitals. It was with ROSE that I spent the majority of my time, the rest was split between HOPE, a general medical and surgical charity hospital, and the Calmette, Cambodia's only teaching hospital. The burden of disease is as you would expect in any poor country, but there is the added tragedy of traumatic injury. Landmine amputees are everywhere; it is not uncommon to see double amputees from two separate mine injuries.

"Now I am pretty"

Dr Sarom, the ROSE surgeon, taught and performed surgical procedures in the basic, but adequate, operating theatre. We would often have to be the scrub nurse and assist at the same time; as time went on we were able to help more and more. After we had seen and assisted at several of the cleft lip operations, Dr Sarom declared, "Next time you be surgeon!" Dr Sarom supervised me closely as I operated, his stepwise teaching paid off and the results were impressive. The buzz from completing my first operation was heightened when the little girl thanked me a week later. "Now I am pretty," she said.

I became familiar with the tropical diseases that I had previously heard about only in lecture theatres. Though the medical ward was an incredible learning environment, with late stage everything and full of florid clinical signs, it was hard not to get frustrated by the lack of resources. The country ran out of insulin during our stay, the strongest analgesic available was pentazocine, and the availability of x ray equipment was a luxury. The variation in the training of the medical staff was more difficult to cope with. The concept of ensuring the airway and protecting the cervical spine after trauma was alien to most doctors, and it was unsettling to see patients' lives put at risk from such simple oversights.

We went on several outreach visits to regional hospitals. In an Italian run emergency hospital near the Thai border, I gained first hand experience of the horror of landmine injuries. A demining truck had driven over an antitank mine after being told that the route was clear of mines. We treated the two passengers, one whose spleen had shattered, the other with several broken bones. The driver had been killed instantly. The wards of these rural hospitals were full of the limbless.

We gained a rare insight

Though medicine is the raison d'être of the elective, the cultural experience is just as important. Living and working with Cambodians, we were able to gain a rare insight into their lives. The Khmers were always generous and kind and eager to include us. Volleyball is the national sport, and after surgery the staff and patients gather outside to play. The games were often a testimony to the skill of prosthetists and to the determination of the amputees. We would often play a hard game against below knee amputees, who exhibited incredible agility and resolve.

Anatomy helped with our diet

The Cambodian cuisine is a mixed bag. Dishes vary from the exquisite (clam with Thai basil), to the exotic (fried terrapin with green peppercorns), to the downright weird (deep fried tarantula) and disgusting (blood clot noodle soup). A good knowledge of anatomy comes in handy when deciding what to eat. Having said all this, my bowels worked perfectly throughout. Perhaps it was the rice heavy diet, perhaps the doxycycline, but I think that the Cambodians are so scared of their own food that they make sure they cook it very well.

I found my elective an unparalleled learning experience. The medicine was incredible, we were looked after superbly by our hosts, and we were able to experience a country and a life which very few Westerners get the opportunity to do. Furthermore, I can never be out done on "what is the most disgusting thing have you ever eaten?"