Improving Surgical Care in Cambodia

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Orange County Register December 28th, 2017 Section B-1

Improving Surgical Care in Cambodia
by Elliott Brender, MD, FACS

My name is Dr. Elliott Brender.  I am a Retired Clinical Professor of Surgery at the University of California Irvine School of Medicine.  I’d like to talk to you about something very important to me, surgical care in Cambodia.  You may wonder why I as a non – Cambodian I have an interest in this; so let me tell you my story.

In 2008 I received a letter from the People to People Ambassador Programs regarding my joining a surgical delegation to Cambodia and Vietnam.  Our mission was to evaluate the surgical care currently being provided and to get involved in helping to improve care in both nations. The letter mentioned 3rd Field Hospital, the hospital I was stationed at during the Vietnam War.  In addition the trip departed on November 2nd, exactly 37 years to the day when I departed for my tour of duty in Vietnam.  The flight departed at 10:30pm the EXACT same time as well.  The coincidence was too great for me not to go.  Although I was more interested in seeing the changes that occurred in Vietnam, I had never been to Cambodia and we did get to visit Angkor Wat, something I wanted to see in my lifetime.

We were asked to bring donations such as old textbooks, journals, and any other materials that might be of use to the local surgeons.  In the early 90’s I had produced a videotape entitled “Avoiding Complications during Laparoscopic Cholecystectomy.”  This videotape was a collection of major errors made during laparoscopic cholecystectomy.  I feel watching someone else make a mistake and learning what to avoid is far better than making that error yourself.  I converted the videotape to DVD, burned multiple copies and brought this as a donation.  Interestingly since my video presentation of these errors it was strongly suggested that everyone STOP VIDEOTAPING.  You were creating damning evidence against yourself.

I was amazed at the progress I saw in Vietnam and was shocked by what I saw in Cambodia.  My DVD’s were worthless for Cambodian doctors because in 2008 there was no laparoscopic surgery in Cambodia.  Walking through the Toul Sleng Genocide Museum and the Killing Fields, learning of the 1.7 million Cambodians murdered by the Khmer Rouge brought back memories of my own family’s slaughters by the Nazis during World War 2.  I wanted to do something meaningful for the Cambodian people.

Hernia is an extremely common problem and the current repair technique involves the use of mesh so there is no tension on the repair.   With 30 years of experience and connections I knew I could obtain mesh.  I also could obtain antibiotics, suture material, and other surgical supplies, all badly needed.

So in 2009 I returned with suitcases full of donated supplies.  I personally did multiple hernia operations and taught my techniques to the medical students and staff.  I also gave a talk to the Cambodian Surgical Society on “Hernia and its Approach in the 21st Century.”  In addition Sen Sok International Hospital had obtained laparoscopic equipment.  So we set the equipment up and did the first laparoscopic cholecystectomies ever done in Cambodia.

The next year I attended the annual American College of Surgeons meeting and I went around to the surgical suppliers to see what I could obtain in donations.  Laparoscopic instruments, an insufflator, more mesh, and suture material was obtainable from multiple vendors so I again returned with donated materials.  Dr. Gunther Hintz, president of the NGO Medicorps supplied me with a 501c3 form allowing me to obtain additional donations from charitable organizations.

I returned again in February 2011 this time lecturing on “Diagnosing the Acute Abdomen.”  I performed more hernia surgeries, more laparoscopic cholecystectomies and helped a Cambodian colleague with a patient with a perforated cecum secondary to lymphoma requiring a right hemicolectomy.   I had decided to donate my colorectal equipment I had from my practice sitting in a bin in my garage so it was learned that my specialty was colon and rectal surgery.  I was asked if I knew about complications from hemorrhoid treatments and was shown shocking pictures of damage as a result of improper hemorrhoid treatment.  Severe narrowing of the anal canal was occurring making it almost impossible for patients to have a bowel movement..  I was asked if I knew how to correct this.  The answer was yes but there wasn't enough time left for me to start on this new problem.
So I again returned to teach techniques for repair of anal and rectal damage secondary to improper hemorrhoid treatments and lectured on "The Proper Care of Hemorrhoids."  I was able to teach a handful of students the proper techniques but I realized there was so much more that needed to be done and on each trip I had only a limited time to teach what I knew
I had presented my experience to the Department of Surgery at the University of California Irvine School of Medicine Department of Surgery and published my experiences in the Bulletin of the American College of Surgeons December 2010    A great deal of enthusiasm was generated as a result of my presentations .   What Cambodia could really use is a training program in General Surgery to properly teach medical students and established surgeons current proper surgical techniques.  The question was how to accomplish this?
A surgical residency program located in Cambodia to train Cambodian surgeons would be ideal.  But this goal will take time.  In the United States it takes 5 years to fully train a surgeon.  In order for Cambodian doctors to work in the United States they must take and pass the ECFMG exam.  This is a multipart exam and costs $2600 which is prohibitive to most Cambodian doctors.  Another issue is once trained in the USA they do not return to their home country.  Training in their own country makes much more sense.
So in 2017 we established the Dr. Brender's American Surgical Clinic at the Khmer Soviet Friendship Hospital.  We rotate R5, R4, & R3 junior surgeons to Cambodia to run the clinic.  They are supervised by senior FACS surgeons to insure quality surgery.  We have a senior full time surgeon to oversee the clinic as well.  Rotations are between 2 weeks & a month for residents, longer for supervisors if desired.
We see patients Wednesdays from  2pm to 4pm & Saturdays from 9am to 1pm at the Outpatient Surgical Clinic.
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We established Surgeons for Cambodia, Inc., our own 501c3 non-profit corporation whose mission is to accomplish these goals.  We are also an Association as per Cambodian government regulations.  We work in association with Americares and MAP-Ethicon to provide state of the art equipment.
We need donations to continue doing what we do. 

I have set up a PayPal account for charitable donations.  I hope you will contribute to this great endeavor.  Your donation is tax deductible.  Just click on the Donate button.
Cambodians need quality surgical care and adequate training is a must.  We provide supplies, instruments, & surgical training.
Thank you for your time and generosity.                    
Elliott Brender, MD, FACS.

Subpages (1): Getting This to Work