In 2002 Beris Bird RN Traveled to:
Cambodia
Beris Bird RN
Ms Bird's IAHPC Travelling Fellowship was made possible by an unrestricted donation by Mundipharma (Australia)
Highlights
The purpose of the visit was to set up a surgical rehabilitation unit for leprosy patients in Phnom Penh under the auspices of the Order of Malta, and the government's leprosy control program.
The aim was to enable the patient to be self-caring and capable of independent living - good palliative care principles!
Click photo to view larger image
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Dying of AIDS
This man was dying from AIDS – alone and unattended in an abandoned ward.
He was screaming with abdominal pain and the doctor had only panadeine to give, which the patient could not swallow. He had been given an injection of atropine – probably by the doctor who came occasionally to give drugs for tuberculosis. His pain was not helped! |
Report
Cambodia is a country with a past that is horrific. Many thousands of people killed, executed or 're-located' during Pol Pot's regime. Terror, torture, pain, despair, hunger, suffering is part of every family's memories and they certainly know the reality of death. There have been no trials, no justice following the genocide and Cambodia is very obviously missing a generation - there are so few older people to be seen. People talked to me of their inability to trust, to hope, to plan for the future.
If you take time, people will talk, and it does seem to help them to be able to share their memories with someone who will take time to listen. Our tourist guidebook expresses the present state of Cambodia better than I can! " The Cambodian people deserve justice after so much suffering, but it could be argued that the nation would be better served by a truth commission that cleanses a nation's soul without seeking revenge"
And now, they face the scourge of AIDS.
AIDS dominates the medical scene, but the focus is on trying to provide antiretrovirals for those newly diagnosed. The suffering and despair of those dying of AIDS is largely ignored. The way people have to die is hard to watch, especially when there is so little available to help them. With no free government medical care, these families have to pay for everything themselves, and so there is pain, there is suffering, which in the more affluent countries can be avoided.
Palliative care programs are beginning and already there are two very simple hospices run by the Catholic church. The patients are lovingly cared for, but there are too few beds. The general hospitals are finding that many of the AIDS patients who come for help cannot be discharged as they have nowhere to go. Most are very poor and live in rented rooms. The rules for a rented house state that a person cannot die there - by law! So the street is often the only option. Many patients have found their way to an abandoned ward at the back of one of the hospitals, and there they find a bed, and a little medical help. The Catholic agency has provided a doctor who attends once weekly to visit patients who are without family. Some drugs are given and some care provided through the employment of two Cambodian ladies.
Two non-government agencies have applied for funding for hospice beds, and confidently expect their applications to be successful. The main aim is, at first, to provide accommodation, rather than trying to practise palliative care with its commitment to holistic care, although this would be the long-term goal.
There are very many agencies, Christian organizations and non-governmental organizations working in Cambodia, all trying to do something to help. Millions of dollars are being poured into Cambodia, and this alone has sent corruption spiralling out of control. There appears to be little communication or co-operation between the agencies and it is very hard to get accurate information about the projects being planned or supported, including, of course, palliative care.
Morphine in Phnom Penh is only available at designated pharmacies and is very expensive. Oral morphine is not available except through one agency. The cost and the difficulty in obtaining supplies prejudices against its use and it is certainly not available in government hospitals.
Next year, we will be returning at regular intervals to continue with the leprosy surgery, and so it is possible that I could become more involved with the established hospices and in teaching the volunteers about AIDS and basic nursing care.
With such an emphasis on AIDS, cancer patients and their needs are not considered, nor, in fact, known. Statistically, one would assume that the incidence would be the same in Cambodia as in other countries. There is no radiotherapy available and only very simple chemotherapy - and at a price! Patients commonly present with advanced cancer and die with much pain and suffering
In Cambodia, as in other developing countries, it is difficult to see how the principles of palliative care can be appropriately, and helpfully, developed. But maybe the challenge is to simply try?
Submitted by: Beris Bird RN December 2002
