Training the next generation of Cambodian paediatric specialists
Dr Um Khemuoy is training to become Cambodia’s next generation of paediatric specialists, so children requiring respiratory treatment can access the care they need.
In Cambodia, there are only two doctors for every 10,000 people (WHO, 2014). Only a fraction of these trained doctors are paediatric specialists, meaning children requiring specialised treatment for illnesses like cancer, HIV, or a cleft palate cannot access the paediatric specialists they need, leaving them undiagnosed and untreated.
“In our country there are many children who have trouble breathing. I can see as an organisation, and as a country, we need to continue improving our care available to these children and as a respiratory specialist I have the capability to help them.” – Dr Khemuoy, respiratory specialist doctor, AHC
As one of three paediatric teaching hospitals in the country, AHC is developing its own cohort of specialist doctors to address the unmet child health needs in Cambodia. AHC’s fellowship programme offers sub-specialty training to middle-grade doctors in eight paediatric specialties, including paediatric neonatology, oncology, surgery, microbiology, and respiratory medicine.
Dr Khemuoy began her medical career at AHC in 2017. After completing three years of medical residency training at AHC, she decided to begin her sub-specialty training in respiratory medicine. She is now entering her second year of the three-year training curriculum and is joined by AHC’s other paediatric respiratory specialist, Dr Kong Sokchinda, who will complete her fellowship training this year. The two are visited by over 60 patients every month who require treatment for their chronic respiratory illnesses.
Champey is one of Dr Khemuoy’s patients and has been receiving regular treatment for the past two years. The five-year-old girl has chronic bronchiolitis that requires her mother, Arun, to bring her daughter to the hospital every month for treatment. She described the difficulties of living with a child with a chronic illness, “My daughter cannot behave like the other children in our village,” said Arun, “She cannot play outside without coughing and then she often misses school, which means I have to stay home to care for her.”
Like so many of AHC’s patients, Champey comes from a poor family that has limited access to healthcare in their rural community, forcing them to travel to Siem Reap, or further to Phnom Penh, for respiratory treatment. Every month, Champey and Arun travel over three hours by bus from their small rural village in Kulen Mountain to AHC.
Most of the patients we see have chronic illness so they need to visit AHC regularly for treatment. But their care is a full time job, the parents sacrifice a lot of their time and money to look after their child.” – Dr Khemuoy
Arun explained that Champey previously had serious trouble breathing at least once per week that would require them to travel for treatment, costing them a lot of money, to the point where they could not afford to buy clothes for their family. “I did not think we would find any treatment that would work for my daughter,” said Arun, “I even began to think she may not survive.” Arun said that the change in care and medication at AHC has meant Champeys symptoms only return once every month or two, and is hoping for continued improvement.
Watch Dr Khemuoy’s story:
Respiratory care is essential during the COVID-19 pandemic. AHC treats some of the most at risk patients, like Champey, whose already vulnerable respiratory system would be overwhelmed by the coronavirus. Fortunately, Cambodia has escaped a full outbreak of the virus to date, but an outbreak would be catastrophic to an already fragile health system. AHC is preparing for a potential outbreak by training staff, patients and caregivers correct hand hygiene and infection prevention and control, along with strengthening the health systems by filling the gaps in specialised paediatric care.
Dr Khemuoy receives respiratory training and mentorship from paediatric pulmonologist Dr Michael Wall, from Oregon Health Sciences University Hospital in the US. Dr Wall has been volunteering at AHC for over seven years, visiting the hospital every year to train Dr Chinda and Dr Khemuoy. He meets with them weekly, over video conferencing from his home in the US, to discuss patient cases and have one-on-one training sessions.
Due to the global pandemic, international medical volunteers like Dr Wall have been unable to visit AHC in person, resorting to training and mentorship remotely.
Over the years, Dr Wall has been a main driver of AHC’s respiratory programme development, helping initially develop and then rewrite the training curriculum multiple times. “When I first came to AHC I would spend most of my time just trying to help residents move mass numbers through OPD, with one or two lectures scheduled,” said Dr Wall, “Now my time is spent solely teaching respiratory medicine with Dr Chinda and Dr Khemuoy, giving us time to dig deep into cases and understand how and why children in Cambodia are developing these issues.”
Today, Dr Khemuoy continues to receive support from senior AHC medical staff and international experts in her day-to-day patient care and self-directed learning. As part of her training to become a respiratory specialist, Dr Khemuoy is completing a retrospective research study that will focus on respiratory care in the Cambodian setting, calling upon her experiences throughout the fellowship programme. She also plans to update AHC’s guidelines for respiratory care after she finishes her fellowship and becomes a qualified respiratory specialist.