Cambodia Otology Fellowship

24 May 2016

Cambodia is a country of 15 million, still recovering from the genocide under the Khmer Rouge in the 1970s. Most of the medical profession, together with the rest of the educated population, was executed - the fortunate few fled - leaving a country with a lack of senior doctors to train the new cohort of juniors that are enthusiastic to improve the countries medical services. Ear surgery provision in Cambodia is scarce at best with no local resident otologist providing complex mastoid work. Occasional international visiting teams provide outreach ear camps for a few weeks a year but, whilst valuable, these are inadequate to provide the country with sustainable future services. The current fellowship was therefore established as a new approach to humanitarian ENT surgical provision, to bridge that educational gap and provide the essential training for local Khmer surgeons.

Chronic active mucosal otitis media presented more commonly than cholesteatoma, so initial teaching concentrated on tympanoplasty techniques. We achieved our aim, with the local doctors being able to operate unassisted by the end of the first fellowship (96 tympanoplasties were performed together). 34 mastoidectomies for cholesteatoma were also performed, largely front-to-back following the disease since pre-operative CT was rarely available and cost prohibitive, and the concept of second-stage procedures unrealistic as our patients would return to their remote villages. Mood is continuing this work by teaching and developing the local Khmer doctors mastoidectomy techniques.

The main referral pathway is through ‘All Ears Cambodia’, (www.allearscambodia.org), an NGO established by Glyn Vaughan, an audiologist from Charing Cross Hospital. It proved a mutually beneficial arrangement. They provided pre and postoperative audiology, plus postoperative mastoid cavity care at four centres around the country. In return, they have a point of referral for ear patients, and the fellow contributes to a teaching programme for their audiology students.

 

For the fellow:

This is a fellowship for post-CCT Otologists, ideal (but not limited) for those looking to further their skills prior to a Consultant appointment. The duration of the fellowship is about 6 months and works very well tagged with a second 6- month fellowship in a developed country, such as Australia (Charlie continued on to the Graham Fraser Memorial Fellowship in Sydney and Mood will continue on to Perth). In such a brief report it is difficult to emphasise the impact this experience can have on competence and confidence, raising both surgical and managerial skills to a whole new level. Charlie regularly dealt with much more extensive disease than he'd been exposed to in the UK due to its late presentation, without the backup of preoperative CT scans or intra-operative facial nerve monitoring. Regular remote support and advice from Matt was welcome, to discuss approaches to difficult cases. Learning how to manage a team and getting them to work to the best of their ability was challenging, especially in a different culture. It was a fantastic exercise in self-restraint, service organisation and workforce planning.

 

The Practicalities:

Phnom Penh is a rapidly developing metropolis: the large tourist and ex-pat communities are served by a range of bars and restaurants, plus a number of gyms. For those with families, child-care is readily available, and nice apartments are easily available to rent. Cambodians are a warm, smiling and friendly people and Charlie never felt uneasy or threatened. The post funds one return flight and a wage that more than covers living expenses. Taking leave is straightforward, allowing travel further afield to sites such as Angkor Wat.
 

Summary:

This is a unique fellowship for post-CCT Otologists with an adventurous spirit. The transition from trainee to independent practitioner is a big step and this experience has proved to be a perfect bridge between the two.

 

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