Rehabilitative Care in Cambodia

Disabilities come in many forms, but more often than not affect those in society who are the most vulnerable: children and the elderly.

Disability in a developing country such as Cambodia is akin to disease because of its appalling effects on life. While in developed countries the disabled are embraced ever increasingly into society, the process may be far behind or non-existent in developing countries. The suffering disabilities cause is enormous. Disabilities have the potential to destroy social integration, happiness, economic productivity and quality of life.

The majority of physical disabilities can be assisted or even eliminated by relatively cheap procedures and techniques such as surgery, medicine and/or prosthetic devices. In the same way as polio vaccination programs insure a population against that disease, so do proper rehabilitation programs insure against the social misery of disability.

Surgery is commonly the starting point for a considerable proportion of the procedures. Unfortunately, surgical projects in developing countries unjustly tend to inspire a negative reaction with donors. The concept is of large expensive, non-sustainable high tech units soaking up the limited health resources of a developing country, performing complex operations for a limited elite. However, this is not the case at CSC.

Rehabilitative surgical procedures are cheap and sustainable.  Surgery at CSC is cost equivalent to the treatment of many infectious diseases; around US$35 - 200 per operation. The surgical techniques are passed on with simple training to local surgeons.

The surgical model at CSC was originally inspired by the immensely successful cataract removal programs developed for the blind over the last 30 years. The cataract operation is simple, rugged, cheap, trainable, has a high success rate and enormous benefit (to be able to see again!) for the patient. The CSC system applies these principles to as many other rehabilitative surgical techniques as possible with the overriding consideration: “will this procedure improve the quality of life of the patient?"

In addition to cataract and other ophthalmic surgery, the procedures now done at CSC include cleft lip and palate repair, tendon transfers for polio victims, club foot repair, plastic surgery (for leprosy & trauma), skin grafts for burns, tissue contracture releases for acid burn victims, oculplasty and skin tumour removals, orthopaedic procedures, and traumatic amputation stump remodeling (eg: for landmine victims).

 

These procedures are vitally important to the disabled person. A child born with a cleft palate in a country like Cambodia has a dismal outlook. He/she will not go to school, marry, or find a job. They will be stigmatized and probably malnourished. A repair, however, free at CSC, will take 45 to 90 minutes and utterly change his/her life.

With surgery a polio victim who is only able to crawl along the ground will be able to walk, a land-mine victim be able to be fitted with a comfortable functional artificial limb to enable him/her to work again or look after her family, a woman whose neck is fused to her body from an acid burn will be able to move her head again and eat normally.

CSC Surgical Program
CSC implements and trains its rehabilitation surgery techniques in Kien Khleang National Rehabilitation Center, in Cambodia. A rugged, highly functional surgical unit is housed within buildings loaned by the Cambodian Ministry of Social Affairs, Veterans and Youth Rehabilitation (MOSALVY).

There are two sections: ophthalmology, and general operating rooms. These run separately but combine as a central unit that is the hub of a network now involving six other provinces but with the future goal of covering the entire country.

Around 3000 rehabilitative surgical procedures are performed per year at CSC. This number is increasing both at Kien Khleang and at provincial locations, as trainees are being taught to carry out procedures.

 

Trainees are selected from the provinces and patients either assisted at their local hospital (if the standards are acceptable) or at the base unit at Kien Khleang.

All staff are Khmer, with the exception of two full time expatriates and expatriate volunteer surgeons and medical students.

Expatriate volunteers provide training to local staff in order to ensure the self sustainability of the centre in the future.

 

The Beneficiaries
The beneficiaries are the disabled people of Cambodia, their families, and the Cambodian health system, especially the professionalism of its personnel.

The disabled tend to fall into several general groups.

  • Children and adults with cleft lip and palate.
  • Children with Meningoencephalocoeles (MECs)
  • Children with birth defects, polio deformities, club feet, malformed limbs etc.
  • Land mine injuries including traumatic stump remodeling needed for the fitting of prosthetics.
  • Other orthopaedic problems such as mal-union of old fractures
  • Burns, including victims of deliberately inflicted acid burns
  • Slow growing skin tumors (most of which without treatment would kill the patient)

For each of the groups above rehabilitation surgery has dramatically life-improving effects.

MEC patients who have received treatment at CSC.  They can now live a normal and productive life.

The costs

Surgical procedure costs include materials and drugs, local staff salaries of the health personnel, and 1 - 2 days patient aftercare. These are approximately USD $35-200 per operation. However, for every patient operated upon there are approximately many more seen for consultations where surgery is not required, and are given drug treatments or supplied with dressings.

 

Maintenance costs include transportation to the outreach program. CSC runs three 4 wheel drive vehicles (purchased locally, second hand) for patient transport and travel to outreach programs in the provinces. Appalling roads in Cambodia results in high maintenance. Other maintenance costs include maintaining the supply and purification system for water piped from the Mekong River.

Routine running costs include electricity, communications (phone and e-mail), teaching materials (books etc), wages for around 40 local staff, including support people (cleaning, maintenance, administration and security).

All of the above accomplished for a base running cost of approximately USD $20,000 per month testifies to the grassroots efficacy of the program.

Needs
The greatest need is for ongoing contributions to everyday running costs. CSC is looking for sponsors who will donate funds desperately needed to maintain the program in its present form.

Donations could be directed to specific needs, such as equipment or salaries for Cambodian nurses and nurse trainees. Donations may also be directed to specific case types, such as children with cleft palates, MEC patients or acid attack victims.

 

Capital cost of items are also needed:

  • Vehicles: secondhand 4WDs can be purchased in Cambodia for approximately USD $5,000 to $10,000
  • A second operating microscope, approximately USD $5000
  • Refurbishments e.g.: ward improvements, patient and family waiting and overnight areas, washroom facilities.

Donations are accepted in-kind or in cash to fill needs for surgical instruments, medications, and ophthalmic equipment.

Contacts:

ROSEcharities USA
Children's Surgical Center (USA Overseas)
Jim Carmichael, Secretary
PO Box 2545
Kodiak, AK 99615
USA
Fax: +1 (208) 545 4525
E-mails: ROSEcharities@USA.com

Children's Surgical Centre (Cambodia)
Dr Jim Gollogly, M.B., FACS, FRCS(C)
CEO, Children's Surgical Centre
Executive director, ROSEcharities Cambodia
Executive director, ROSEcharities USA
Kien Khleang National Rehabilitation Center
Phnom Penh, Cambodia
Telephone: +855 12 979 214
E-mails: rose@online.com.kh

Children's Surgical Centre (Hong Kong Overseas)
Dan Tagliere
 DTagliere@MacauLand.com
phone +852 2525 4777