Malcolm Finlay and Nicholas Sheppard spend their elective in a former paradise

Before the American war in Vietnam spilt over into Cambodia the country was seen as a paradise. The countryside was lush and spectacular mountains surrounding the flood plain of the Mekong river defined the country's borders. The temples of Angkor were and are still among the most breathtaking ancient monuments in the world.

Cambodia still retains many of its charms, but the recent horrors now lend a black backdrop to this beautiful country. The Khmer Rouge has surrendered and disbanded, a democratic monarchy is now in place. The population is tasting peace for the first time in over 25 years and the process of rebuilding this shattered nation has begun.

Cambodia is the most undeveloped nation in south east Asia, with over 80% of the population living under thatched roofs. Few have access to clean water. Subsistence farming is the norm and industry is confined to the few cities. Most of the population are uneducated, but now schools are available for most children and the standard of higher education is improving, albeit slowly.

Medicine in Cambodia

The population have only limited access to health care. Two systems run in parallel, that of the government and the non-governmental organisations (NGOs). Though both are nominally free of charge, in the government system corruption is rife. The state salary of US$30 (£21) a month forces doctors to charge patients for treatment; drugs and medications must be bought separately. The free NGO hospitals, staffed by a mixture of expatriates and Cambodians, are therefore overwhelmed, their resources stretched to near breaking point. Private clinics are found only in Phnom Penh, and cater for expatriates and the few wealthy Cambodians.

Cambodia suffers the diseases of the developing world. The HOPE medical director summed up the situation: "Everyone here has TB and malaria." HIV and hepatitis B and C are increasingly common. Cambodia was declared free of polio two years ago, but reports of new cases of acute polio in the north of the country are often heard. However, the legacy of 25 years of civil war gives another dimension to the medicine. Landmines maim and kill daily; there is said to be at least one landmine for every man, woman, and child in the country. Rehabilitation of the limbless is a massive undertaking, several prosthetic and orthotic charities are struggling to cope with the sheer numbers affected.

Securing placements

Elective attachments are easily secured as most hospitals are delighted to have an extra pair of hands to help out. Though you can see much in the government hospitals, the real experience is to be had with charity organisations such as ROSE, HOPE, or Emergency. Once in Cambodia it is relatively simple to organise time in other organisations in order to broaden your experience of the country. Contacts are best made by email.

Getting there

There are no direct flights to Cambodia from the United Kingdom; you have to travel via Bangkok. Flying from Bangkok to Phnom Penh, though expensive, is by far the safest and easiest way into Cambodia; visas are issued on arrival at the airport. Overland journeys are lengthy and uncomfortable and recommended only for the truly hardened traveller.

Getting around

Cambodian roads are claimed to be marginally better than the roads in Afghanistan and Angola. Most national highways are paved only sporadically; the 300 mile journey between Phnom Penh and Battambang, Cambodia's second city, can take up to 12 hours. Travel outside Phnom Penh is mainly by four by four trucks. Internal flights have one of world's worst safety records, overland may be slow and uncomfortable, but at least you're likely to arrive eventually. The "train" service is barely operational and not recommended.

Issues for the medical student

Cambodian visas can be obtained at the airport on arrival, otherwise they must be obtained at the embassy in Bangkok or Saigon. If staying for more than one month it is vital to get a business visa, which can be extended. It must be extended to become multiple entry. We were caught out and needed to buy another visa when we took a long weekend in Vietnam. Vaccinations recommended for Cambodia include rabies, typhoid, Japanese encephalitis, and tetanus. Malaria prophylaxis is highly recommended for travel outside Phnom Penh.

Over the past two years the security situation has improved dramatically. Risks to personal safety now stem chiefly from the appalling traffic, though travelling after 10 pm is not recommended as banditry is still sporadic. Landmines are not a danger if you keep to the towns and roads. Nightlife in Cambodia is limited. Though Phnom Penh has quite a few good bars full of expatriates and travellers, nightclubs are seedy affairs heaving with prostitutes. Karaoke is both ear shattering and hugely popular; you will often be dragged to karaoke bars by the Cambodian doctors after work.

In Cambodia you can see and experience in relative safety medicine usually only found in the field of war. Cambodia is therefore a perfect elective destination for those hoping to work in zones of conflict later in their careers. The hands on experience available and the sense that you are really doing some good all adds to our recommendation for an elective in Cambodia.