Medical care in Cambodia has made great strides in recent years, particularly with the opening of new facilities—such as the Sunrise Japanese Hospital—and the introduction of advanced technology and equipment. However, there is still a long way to go before the Kingdom comes up to par with some of our bigger neighbors.
The number of surgeons in Cambodia, for example, is still extremely low. Estimates place the figure at 200, not counting specialists, who number around 50. The lack of access to neurosurgery is particularly problematic, as road accidents are common in Cambodia and often involve head injuries. In 2013, about 62 percent of road accident fatalities succumbed to head injuries, as disclosed by an advisor for Medical Teams International during an interview with the Phnom Penh Post.
To discuss the state of Cambodia’s medical sector, B2B meets up with Dr. Kee Park, a Harvard University Paul Farmer Global Surgery Scholar and Consultant Neurosurgeon at Preah Kossamak Hospital. Since 2008, Dr. Park has devoted his life to teaching neurosurgery residents in developing nations through the Foundation for International Education in Neurological Surgery, the World Federation of Neurosurgical Societies and the Cambodia Neurosurgical Support Project.
B2B: In what areas is the medical practice in Cambodia gaining ground?
Dr. Park: About 68 percent of health care spending in Cambodia is private, i.e. “out of pocket.” This reflects the relative underfunding of public healthcare system. The net effect being the disproportionate preferential development of the private system over the public system. In other words, the system is providing better quality and improved range of services for those with financial means. A trend that does not bode well for the less fortunate in Cambodia.
B2B: What is driving these trends?
Dr. Park: The rising economy and the demand for better health care by those that can afford it and the lack of political will to prioritize social services such as public health care.
B2B: What areas need to be addressed more urgently?
Dr. Park: One area that requires urgent attention is a system to regulate quality of health care workers. For example, licensing and credentialing of healthcare workers along with strict enforcement reduce the chance of medical harm. A good example is the HIV outbreak in a village near Battambang last year which was traced to an unlicensed health care worker using improper sterile techniques for injections.
The wide availability of unregulated medicine is another area that can be improved for obvious reasons.
B2B: How would you assess current diagnosis standards in the Kingdom?
Dr. Park: Again, the distinction should be made between private vs public facilities where quality and ability are in stark contrast. In the best private facilities, diagnostic capabilities are sufficient for most common conditions. For example, multiple private CT and MRI scanners are available in Phnom Penh although the quality of interpretation and image acquisition can vary widely, again drawing attention to the need for training standards.
B2B: What’s a traveler’s and resident expatriate’s exposure to risk in Cambodia?
Dr. Park: Besides the usual risks for travelers and expats such as diarrheal diseases from bacteria and parasites and tropical viral diseases like dengue fever, injuries can be potentially life-threatening especially if they occur in the provinces. Cambodia effectively does not have a trauma system, including an ambulance system; therefore transportation to a suitable facility may require several hours.
B2B: What areas of specialization do you think Cambodia is in great need of and how could this be met?
Dr. Park: The number of specialties with in-country training has increased dramatically recently. Neurosurgery residency started four years ago and plastic surgery started just this year. Understandably, the number of specialist is not enough to support sub-specialization yet. As previously mentioned, quality and safety needs more attention. This can be done by each professional society by implementing minimum training requirements, certification of competency, and sanctions when necessary.
B2B: Could you tell us more about the Cambodia Support Project? In what specific ways is your team of doctors equipping local medical practitioners?
Dr. Park: The goal of the Cambodia Neurosurgery Support Project is to come alongside Cambodian neurosurgeons and provide assistance and expertise when needed. The Cambodian Society of Neurosurgeons was only established a few years ago, and support from the international community of neurosurgeons can be very helpful in improving standards in neurosurgical care, training and research. We also helped in acquiring new equipment such as a surgical drill and operating microscopes. We also support with organisation of educational symposia and annual meetings in Cambodia. When we brought to attention the disparities in access to surgical care in the provinces, the Society has chosen to address this issue by training general surgeons to provide life-saving emergency neurosurgical care at the provincial level.
B2B: In your experience teaching Neurosurgery in Cambodia, what specific areas do you find local residents to be strong at. For what areas do they need more support?
Dr. Park: The neurosurgery residents are without exception some of the brightest and most talented young people in Cambodia. Most of them are fluent in English and French and, of course, Khmer. Some of them also came from modest homes as well as very challenging environments which has a way of broadening their empathy and imparting strong sense of social responsibilities. It has been an absolute pleasure to be mentoring them. If there is one area I would point out as needing attention would be the culture of accepting substandard quality within the medical community.
B2B: What are some of your own learning experiences in equipping local medical practitioners, and how would you advise those coming over to prepare for practice here?
Dr. Park: One thing I have learned is to walk alongside the Cambodian colleagues and support their efforts to improve quality. The other is the realization that health care is an ecosystem with interdependent components; efforts to improve the system are far more successful and sustainable than focusing on one aspect. For example, teaching a highly advanced surgical technique without addressing anesthesia, nursing, equipment maintenance, supply chain issues and financing concerns will likely fail to make lasting changes.