Planning your elective - Cambodia
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.
>ALL PHOTOS AUTHORS
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.
ALL PHOTOS AUTHORS
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.
ALL PHOTOS AUTHORS
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.
Malcolm Finlay, final year medical student, University of Oxford
Email: mcfinlay@hotmail.com
Nicholas Sheppard, final year medical student, University of Oxford
Email: getdownshes@hotmail.com
Mark Wilson, author of The Medics Guide to Work and Electives Around the World
Email: Mark@medicsworld.com
www.medicatravel.com
studentBMJ 2001;09:217-260 July ISSN 0966-6494
