Pediatric Clinic In Phnom Penh

[Urbano Bozman]

Butat the time in Phnom Penh, no surgeons were available to operate on children under 5 years of age. And if the tumor could be removed, there were no facilities in the region to provide additional cancer treatment such as chemotherapy and radiation.

Flash forward ten years and Schroeder is now an assistant professor of pediatrics and global health at Duke University. She has also established an innovative pediatric cancer unit at Bugando Medical Centre in Mwanza, Tanzania, where she is making a real dent in survival rates by trying more holistic approaches to patient care. Schroeder and her team make sure that patients and their families are guided and cared for throughout the entire journey of diagnosis and treatment.

Haglund, a world-renowned expert in treating epilepsy and cervical spine disease, also serves as volunteer coordinator for the Foundation for International Education for Neurological Surgery, assigning teams of medical personnel to work in underserved communities around the world including in Uganda, Ecuador, Rwanda, and Kenya.

In response, she and Chao launched a non-profit called the International Cancer Care and Research Excellence Foundation(iCCARE)to help families with healthcare costs. They were able to raise enough money to pay for the cost of medications and chemotherapy administration for all children coming to Bugando Medical Centre.

With this new data, Schroeder tried something new: a patient navigator program. With iCCARE support, she hired a patient navigator to guide patients through their hospital experience, educating them on what cancer is, what their diagnosis is, and the importance of beginning and completing the treatment. The navigator helped identify potential new patients early in their hospital stay, assisted with ordering the proper diagnostic tests, and serving as a communication link between the families, and medical providers.

Schroeder was proud of the change in these numbers. But there was still so much work to do. Over the past few years, as resources have allowed, she has continued to build on the services offered to patients. Her team opened a hostel near the clinic, similar in concept to the United States based Ronald McDonald house, where families can stay while a child is treated. They have formed partnerships with other non-profit groups to cover full chemotherapy and supportive medication cost, expand the hostel services, and enroll all patients in health insurance plan.

Another Duke University medical student, Kunal Goel, also conducted a project in Mwanza over the summer. He worked on adapting and programming a mobile health application to guide treatment for Burkitt's lymphoma.

PHNOM PENH, Sept. 5 (Xinhua) -- The China-backed neonatal care project had not only helped reduce child mortality, but also strengthened the capacity for medical staff in Cambodia, Nhip Angkeabos, director of the state-run National Pediatric Hospital of Cambodia (NPH), told Xinhua in an interview.

Through the project, China had donated 13 types of medical equipment as well as medicines to the NPH, he said, adding that about 20 NPH doctors and nurses had been sent to the Hunan Children's Hospital for professional training for Newborn Intensive Care Unit and Pediatric Intensive Care Unit.

The director added that the training was focused on pediatric medicine, pediatric surgery, neonatal treatment, critical care and emergency medicine, imaging medicine, laboratory techniques, pediatric nursing techniques and hospital management.

"The project had not only helped modernize our hospital, but also given us bigger possibility to save children," he said. "It had also contributed to improving knowledge and technical skills for our doctors and nurses."

Angkeabos said the cooperation between the two hospitals had also helped enhance the comprehensive ability of the NPH in hospital management, clinical diagnosis and treatment, quality care, and department construction.

Following his successful trip to Cambodia in March 2005 to perform heart surgery on children with congenital (present at birth) heart disease, Dr. Jonathan M. Chen again led his group to Cambodia earlier this year under the auspices of the Surgeons of Hope Foundation. The trip undertaken by Dr. Chen's team of doctors and nurses from NewYork-Presbyterian Hospital (both Weill Cornell and Columbia campuses) was part of a larger initiative in which pediatric heart surgery teams from developed countries help to build surgical expertise in Cambodia.

In addition to Dr. Chen, the team included Dr. Alejandro Torres, a pediatric cardiac catheterization specialist; Dr. Stephanie Levasseur, a pediatric echocardiography specialist; Kevin Charette, a pediatric perfusionist; Dr. Johanna Schwarzenberger, a pediatric cardiac anesthesiologist; Jillian Kirkpatrick, a pediatric ICU nurse; Dr. H. Michael Ushay, a pediatric intensivist, and Ellen Moquette, a pediatric catheterization nurse.

The group took on 12 cases in five days, with the procedures performed in The Children's Pavilion, the three-year-old pediatric unit of PPHC, which serves more than 240 Cambodian children a year at no cost to their families. Upon their arrival, Dr. Chen and his team had to use a hefty dose of ingenuity to perform the catheterizations, since the hospital's catheterization lab - undergoing renovations - was only a dirt floor. "We thought to ourselves, 'There's got to be something we can figure out,'" says Dr. Chen.

The team sent Dr. Torres and one of the nurses to nearby Calmette Hospital, a very under-equipped facility, according to Dr. Chen, where they borrowed an orthopedic X-ray machine that could provide still images of the heart for the catheterizations. Under normal circumstances, the procedure is performed by a cardiac catheterization machine that provides moving images of the heart. "It (the X-ray machine) was like a Jalopy to the cardiac cath machine's Ferrari," Dr. Chen says.

To make up for this lack of sophisticated imaging, "they did some wild things," Dr. Chen recalls. "Stephanie (Levasseur) had a video function on her digital camera and took videos of sequential X-ray stills during the catheterization procedure. This enabled Alejandro (Torres) to properly size and deploy the catheter device." Thanks to this makeshift method, doctors determined that three children had operable hearts. "Otherwise, we would have had to pass them over," Dr. Chen says.

The cases this year were more complex than in 2005. Five children from a hospital with no operating room in the town of Siem Reap (which houses the ruins of Angkor Wat) three hours north of Phnom Penh arrived for treatment with a variety of complicated problems. One had Total Anomalous Pulmonary Venous Return (TAPVR), a congenital heart defect that usually kills babies as newborns. Due to abnormal development of the fetal heart during the first eight weeks of pregnancy, the vessels that bring oxygen-rich (red) blood back to the heart from the lungs in TAPVR patients are improperly connected. But this child, says Dr. Chen, did not have the pulmonary venous obstruction that usually is a part of TAPVR, a blessing that had enabled him to survive. The New York team performed a catheterization and then a complex operation to repair the TAPVR.

One of the incremental improvements in 2006 was the addition of two more junior Cambodian surgeons to the team. The teams used a combination of English, French, and hand signals to communicate. "Teaching the Cambodian surgeons wasn't unlike teaching residents or fellows here," says Dr. Chen, who instructed one on how to close a Ventricular Septal Defect (VSD), a hole between two chambers of the heart. (The septum is a wall that separates the heart's left and right sides; a defect between the heart's two lower chambers (the ventricles) is called a ventricular septal defect.) Says Dr. Chen, "He was surprised I asked him to do that."

All of the members of Chen's team donate their time and use vacation days to pursue these trips. Chen noted that one of the most important things the team could leave the Cambodian doctors and nurses were skills they could use. "It's never about the number of cases you do."

In February 2005, under the auspices of the Surgeons of Hope (SOH) Foundation, Dr. Jonathan Chen led a group of nine cardiovascular specialists to the Phnom Penh Heart Center where they helped doctors there diagnose, catheterize and operate on children with congenital heart defects. In addition to Dr. Chen, the team included William E. Hellenbrand, MD, Chief of Pediatric Cardiology at NewYork-Presbyterian Hospital, and Charles S. Kleinman, MD, chief of perinatal cardiology at NewYork-Presbyterian. Also included were: Kevin Charette, a pediatric perfusionist; Dr. Johanna Schwarzenberger, a pediatric cardiac anesthesiologist; Jillian Kirkpatrick, a pediatric ICU nurse; Dr. H. Michael Ushay, a pediatric intensivist, and Ellen Moquette, a pediatric catheterization nurse.

The group took on 23 cases in five days, where Dr. Chen operated with the Cambodian surgeons on nine children in all. The procedures were performed in The Children's Pavilion, the two-year-old pediatric unit of PPHC, which serves more than 240 Cambodian children a year at no cost to their families.

Current estimates suggest that 100,000 children in Cambodia suffer from heart disease, and probably one-tenth of those are in need of critical cardiac surgery. Faced with this overwhelming demand and working on a very tight schedule, Dr. Chen and his colleagues immediately prioritized cases. First, they identified those children who would benefit most from a single procedure. Next, they prioritized the cases they believed might become inoperable within several months before a team of European physicians would arrive. Finally, they determined which operations would be low-risk enough that proper follow-up care could be administered, and straightforward enough that they could be replicated by the Center's own surgeons. "All of this is so PPHC can become a self-sustaining hospital that can really help these kids," Dr. Chen said, underscoring the strategy of the SOH foundation to establish hospitals in less-developed countries and train local medical staff to provide the highest quality care.

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