Volunteering with the Cambodia healthcare outreach programme

The charity, Camps International, offers volunteers the opportunity of a lifetime to travel to far-flung parts of the world and to put their skills to good use helping local communities. Joyce Skeet, a practice nurse from Horsham, West Sussex took her expertise to Cambodia and reports here on her experience

In November 2013 I joined a group of practice nurses to volunteer in Cambodia with Camps International (CI).¹ This trip had never run before and was set up following the success of CI's Healthcare Outreach Programme in Kenya. Very few of the team had met before arriving in Cambodia, and it turned out to be a very skilled group with 18 nurses specialising in diabetes, chronic disease management, cardiology and acute care, family planning, midwifery, triage and travel medicine, plus a teacher from New Zealand and my husband, who is a retired civil engineer.

To publicise the healthcare programme I built a website,2 and set about fundraising. I decided to swim the equivalent of the distance between Holyhead, UK and Dunlaoghaire, Ireland which is 68miles (109Km) or 4,360 lengths of my local swimming pool — and I raised £2,370. I also requested old prescription glasses from friends, family and patients, and hundreds were donated, which were shipped out to Cambodia for me by Boots PLC.

We arrived in Cambodia, met the team, were briefed on the history of Cambodia and then introduced to two voluntary groups who we would be working alongside, Build Your Future Today (BFT) and Cambodian Diabetes Association (CDA).^3,4 Just before we left the UK, Camps International had informed us that the Public Health Department had refused any short term medical volunteering programmes access to public clinics in Cambodia, because incorrect treatments had been given by foreign volunteer groups in the past. This meant that our group would now only be able to undertake educational sessions on general health in schools, on nutrition, women's health and health screening with the diabetes team, all with the aid of translators.

We stayed in Camp Beng Mealea, about two-and-a-half hours north east of Siem Reap. Our accommodation was in wooden long houses, with mattresses on the floor, mosquito nets, composting toilets and cold showers. Our food was prepared and cooked in the camp kitchen by a local family, and there was a thatched eating area. There was great camaraderie among the group with everyone wanting to get involved.

Robert, my husband, helped with the building of accommodation for the teachers at the local primary school, put a plan together for a water filtration system for the school and helped with the painting in an orphanage in Siem Reap, which was exhausting work in the hot climate but gave him a great sense of achievement.

HEALTH EDUCATION

We nurses divided into teams of five or six, all of us nurses with a variety of skills, and we were taken out daily by minibus to either local primary schools, rural diabetic clinics or on home visits. It could take over two hours to reach very rural villages on bumpy mud roads with makeshift bridges. All of us had taken out many donated items of knitted teddies, baby hats, cardigans, gloves and bootees, toothbrushes and paste, condoms, dressings, first aid kits and much, much more which we gave out to the local people.

On school visits, we taught the children hand washing and teeth cleaning. Water was collected either from a pump or a pond and in one school we had a fish swimming in the water bowl! We used bottled water for teeth cleaning and found that many of the children already had gum disease, which was a concern. Toothbrushes and paste was given to as many as possible as many of these children had never owned a toothbrush before.

The teams doing home visits saw many pregnant women at all stages of their pregnancy. When problems were identified, the women were referred to hospital by the midwife. There is no public transport in the rural areas so this would entail a trip on the back of a motorbike or a truck. Most healthcare in Cambodia is given with an audience, and the family planning discussion drew a large crowd — especially for the condom demonstration.

DIABETES IN CAMBODIA

The Cambodian Diabetes Association was set up in 2000, and the Siem Reap branch established in 2010 by Professor Lim Keuky. It is a non-profit making organisation relying on donations and fund raising to fund its activities. Lorraine Fraser-King, the deputy director, arranged for our nurses to work alongside her team in the mobile clinics screening for diabetes and hypertension. We worked with a translator registering everyone who attended, checking their blood glucose, blood pressure, height and weight. Many were identified with diabetes, hypertension, anaemia, dehydration and other minor illnesses, and referred to see the attending doctor.

Many Cambodians live below the poverty line, struggling to survive on less than $1 a day, therefore cannot afford transport to healthcare clinics or medication if prescribed, so many had walked long distances or travelled by motorbike to attend.

One of our nurses set up an exercise class with resistance bands for those waiting to be screened, which by the big smiles of the participants was very popular. All those identified with a chronic disease will be followed up regularly by the CDA team when the mobile clinic next visits.

Many diabetics attend the clinic in Siem Reap and links with the local Paediatric Hospital have been set up so newly diagnosed Type 1 patients can be followed up. Some of us worked in the clinic, checking feet and giving nutritional advice through a translator.

There is much speculation as to why Cambodians are developing diabetes in their late 30s, as most are small, slim and active due to a traditional lifestyle working in the rice fields: about 70% of their diet consists of refined rice. There are suggestions that the increased numbers may be due to more plentiful food supplies following years of starvation in the late 1970s when the country was ruled by the Khmer Rouge, which systematically killed many of its people. Professor Keuky presented a paper on the subject at the IDF 2013.

All too soon our outreach programme was over. Everywhere we went we were met with smiles and grateful people, which was a very humbling experience, considering how basic the conditions were in local schools, homes and clinics compared with what we are used to. I made new friends with similar interests and I will certainly return and would encourage other practice nurses to consider volunteering as it is such a rewarding experience.

REFERENCES

1. Camps International. http://www.campsinternational.com/projects-abroad/healthcare-volunteering-cambodia

2. Joyce Skeet's Cambodia trip website. Available at: http://joyceandrobertscambodiatrip-2013.weebly.com/

3. Build your future Today Center (Cambodia). Available at: http://www.center-bft.org/program.php

4. Cambodian Diabetes Association, Siem Reap Branch. Available at: http://www.cdasiemreap.org/

5. Public Radio Internation. Khmer Rouge may be partly to blame for diabetes in Cambodia. http://www.pri.org/stories/2014-01-29/khmer-rouge-may-be-partly-blame-diabetes-cambodia