慈濟傳播人文志業基金會
Free Clinic in Cambodia

Wars, natural disasters, and poverty have hollowed out Cambodia in the past half century. Medical resources, among other things, are sorely scarce. The first large free clinic hosted by Tzu Chi was like a sweet rain in the arid medical landscape of this Indochinese nation.

A volunteer holds the trembling hands of a dental patient to give her courage.  Lin Ling-li

They’re so very poor that I worry about them. What can they do when they fall ill?” asked Dr. Soo Lin Hoe (蘇聯和), of Malaysia. He had just participated in a Tzu Chi free clinic held in Cambodia in March 2017, and he was referring to destitute Cambodians and the scarcity of medical resources in the nation. He has been a practicing doctor for 25 years and has successfully tackled the most severe or baffling of diseases, but faced with the lack of even basic medical necessities in Cambodia, he felt completely powerless.

“We brought ultrasound equipment, but we weren’t sure whether to use it,” Dr. Liao Kuan-fu (廖光福), a gastroenterologist from Taichung Tzu Chi Hospital in central Taiwan, also lamented. “Even if the ultrasound revealed a terminal condition in a patient, what could the patient do about it?”

Liao recalled an experience during the free clinic. On the screen, the ultrasound machine showed that a disease had already spread throughout the body of a Cambodian patient, so Liao advised him to go to a large hospital for treatment. The patient replied calmly, “I can’t afford the transportation. I’m not going to a big hospital.”

Five countries joining forces

In March 2017, members of the Tzu Chi International Medical Association (TIMA) from Singapore, Malaysia, Vietnam, and Taiwan traveled to Cambodia and joined forces with the local Samdech Techo Voluntary Youth Doctor Association (TYDA) in providing a three-day free clinic held at Chamkarleu Referral Hospital and Bosknor Primary School in Kampong Cham Province.

Back in June 2016, Taipei Tzu Chi Hospital had offered to donate to TYDA some dialysis machines that it had scheduled to retire. After evaluation, TYDA declined the offer because they would not have been able to properly maintain and repair the machines. In November that year, TIMA Singapore donated wheelchairs and hospital beds to the association.

TYDA is a non-governmental medical group comprised of more than 4,500 members, 500 of whom are physicians. The group rotates monthly free clinics throughout the provinces of Cambodia. Aware of Tzu Chi’s work in providing care around the world, the association expressed a desire to collaborate with the foundation. The result was the joint free clinic that took place from March 10 to 12, 2017.

Chamkarleu Referral Hospital, one of the venues, was quite old. It had no air-conditioning and lacked basic medical equipment. The buildings were dusty and infested with flies and mosquitoes. To prepare the site for the clinic, an advance Tzu Chi team from Singapore arrived on March 7, three days early, and set to work. They installed a power generator, air conditioners, and dental air compressors. They cleaned up the place, and in particular they carefully scrubbed the walls of one room, sealed the windows, added five portable surgical beds, and transformed the room into an operating room.

In the afternoon of March 10, TIMA members from Singapore and Malaysia ran a half day clinic. They served 247 patients in internal medicine, surgery, dentistry, ophthalmology, and Chinese medicine.

By the morning of March 11, the full complement of the TIMA delegation was in place and ready. They split into two groups: One group continued seeing patients at Chamkarleu Referral Hospital. The other joined a TYDA group for an opening ceremony at Bosknor Primary School before starting their medical services there.

A volunteer carries an elderly patient out of a clinic to take transportation home.  Chen Xie-ming


It was already hot at eight o’clock in the morning. People had arrived at Bosknor Primary School for the free clinic on oxcarts or motor scooters. They sat quietly in the seats that had been neatly lined up on the campus and waited for their turn to see the doctors. The Cambodian people were friendly; when they saw Tzu Chi volunteers, they immediately broke into humble and amiable smiles.

The operating room at this venue was really just a space formed by encircling drapes. Dr. Chien Sou-hsin (簡守信), a plastic surgeon and the superintendent of Taichung Tzu Chi Hospital, and Dr. Ye Tian-hao (葉添浩), also a plastic surgeon from Taiwan, took this make-shift operating room in stride. They deftly and calmly operated on five patients in three hours, while young Cambodian physicians looked on to learn from the two experts.

Chien later talked about one of the more difficult operations that day. A tumor had grown in a patient for a very long time, becoming entangled with some nerves. Chien had to conduct the surgery extremely carefully and avoid making big incisions. “Since surgical instruments that simultaneously cut and cauterize tissues were unavailable to us, we couldn’t use general anesthesia. We could only anesthetize locally, and we had to apply the anesthetics very precisely to prevent bleeding from getting out of control.”

Fortunately for the patient, he did not need to worry about those issues and precautions. He needed only to show up to be served. Were it not for Dr. Chien, he very likely would have spent the rest of his life living with the tumor.

Dr. Chien’s mother had just recently passed away. Her funeral was held on March 8. He would really have liked to spend more time with his father through this sad time, but he knew that the sick people in Cambodia needed him more. So he set out with his team members on March 10.

“Every time I operated on a patient, I felt as if Mom was talking to me. I believe that she’d have approved of my Cambodia trip,” Chien said. His father was actually glad and proud that he had gone to help the less fortunate.

Many local people seized the opportunity to see a doctor at the first Tzu Chi free clinic in Cambodia. Hong Wen-qing

 

Local helpers

Many young physicians and medical school students who were members of TYDA volunteered at the site too. They assisted with tasks such as taking blood pressure readings, ushering patients to their doctors, conducting health education, assisting dentists, and sterilizing instruments.

Cambodian dentist Sreng Heng had organized 45 dental school students to help at the venue. They learned to assist dentists and sterilize instruments.

All six dental chairs were occupied. Some patients had never seen a dentist in their lives and knew practically nothing about oral hygiene. It was therefore not surprising that they had dental problems. After the free clinic, they could finally smile and rejoice—their pain and discomfort had been relieved. They pressed their palms together and bowed to thank their dentists.

Vorn Chanchivoan would soon become a full-fledged dentist. He said of his experience at the free clinic, “It brought me great joy when patients happily thanked me.” He had done as much as he could to save patients’ teeth. He had also taken the opportunity to teach his patients proper dental hygiene routines. At his invitation, friends of his had worked in the free clinic as well. “More than 90 percent of Cambodians are Buddhists, and we all take pride and pleasure in helping others,” he added.

Young volunteers abounded at the Cham-karleu Referral Hospital venue too. Some ushered patients, served tea, soothed patients, or did whatever else needed doing. Others served as interpreters between doctors and patients, translating between Cambodian and Chinese or between Cambodian and English.

Hu Mei-ling (胡美玲), a Tzu Chi volunteer in Cambodia, pointed out that she and her fellow volunteers had assembled a group of interpreters who could speak English or Chinese when they had previously helped conduct Tzu Chi rice distributions for needy people. For the free clinic this time, many young people called on their friends to help with interpretation. Some of them even got their whole families to take the three-hour ride from Phnom Penh, the national capital, to take part.

Local Cambodian volunteers help patients take vision tests. Hong Wen-qing

 
 

The hospital site

At Chamkarleu Referral Hospital, the exam rooms for internal medicine and Chinese medicine were in a tent, where temperatures soared to 37 degrees Celsius (99 degrees Fahrenheit). A mobile air-conditioner kept the space more comfortable, but it broke down on the third day. In its place, two industrial-grade electric fans kept the place less stuffy, but not much cooler.

Doctors sweated as they saw patient after patient, but the long lines waiting to be seen never seemed to get any shorter. Dr. Lin Chin-lon (林俊龍), CEO of the Tzu Chi Medical Mission and a cardiologist, walked from one area to the next, checking on how things were going and helping out where he could, including joining in consultations.

The lines at the pharmacy were long as well. Su Fang-pei (蘇芳霈), Wang Zhi-min (王智民), Chen Xing-ji (陳幸姬), Chen Hong-yan (陳紅燕), and four Vietnamese nurses staffed the pharmacy. This team was hardly adequate for the large crowd, and dispensing drugs kept the team hopping.

“Mebendazole [an anti-worm medication] for five days and multivitamins three times a day for two weeks. Should we really give out so much for a patient?” Chen Hong-yan asked Su Fang-pei to double-check.

“The prescription says the patient is 48 years old and weighs 15 kilograms [33 lbs],” replied Su, pointing to the prescription. She was overwhelmed with sympathy for the patient and could barely keep her tears from falling. But she knew she had no time to cry now. She had more pressing matters to attend to.

Destitute Cambodians cannot always eat their meals on a regular schedule. This 48-year-old patient, for example, might have been in almost constant hunger while the worms and parasites inside her sucked up what nutrients they wanted, depriving their feeble host of even the most basic nourishment. Considering that, the two pharmacists didn’t question the prescription anymore. They dispensed everything that Dr. Tang Kiat Beng (陳吉民) had prescribed for this cadaverous patient.

Two local volunteers, center, interpret for a doctor and a young patient. During the free clinic, nearly a hundred local volunteers interpreted for care providers from Taiwan, Singapore, Vietnam, and Malaysia. Chen Xie-ming

 
 

Make them laugh

In the Chinese medicine area, Dr. Nai Keng Hak (賴金和) of Malaysia saw a woman with a face of woe. The woman complained that she had had pain in her back and waist for 30 years. Nai concluded after examining her that she was suffering the consequences of not having received proper rest and care after a childbirth. Sure enough, her son was exactly 30 years old.

Nai suggested through an interpreter that she eat black bean and ginger soup to help alleviate the pain. The trouble was that the woman could not even afford three regular meals a day—how could she possibly fork out money for this recommended diet? She did not even know what black beans looked like.

In response to the recommendation, she just shook her head. Dr. Nai took out three moxa sticks, lighted one of them, and held it close to her knee cap. He was treating her with moxibustion therapy, a kind of fire acupuncture. “One stick stands for ten years,” Nai said to her. “Three sticks stand for 30. After all three sticks are burned out, your pain will be all gone.” The woman finally broke into a smile.

“We’re here at the free clinic for just three days,” Nai explained. “That’s not enough time to give the patients much help. Many people fall sick because they are unhappy, so I try to ease their minds and make them laugh—one of the best therapies around.”

Nai, 70, has seen countless patients in his long medical career. Experience has taught him how unhappy minds can lead to illness and led him to use humor to supplement medication.

Nai also saw a 57-year-old patient whose husband was blind. Their oldest son and his wife worked in Thai-land, leaving two children for them to care for. Their three other sons worked in other provinces and came home just once or twice a year, if at all.

The woman helped look after a cow for its owner, who, instead of paying her for her service, gave her a promise: If the cow gave birth, the owner would keep the first calf and she would own the second one. As a result, she worked not for pay but with the hope that she might one day come into possession of a cow. At first she would see to it that the cow could graze properly, but she later found out that all around them the fields were dotted with dry grass, and the situation was even worse during the dry season. The animal ended up being nothing but skin and bone.

Two years had gone by since the woman had started caring for the cow, and it had not yet given birth. All the woman had gotten for her time, effort, and trouble were aches and pains, and she complained as much to Nai.

“I’ll give you a shiatsu massage,” Nai said to the woman, who was 13 years his junior. “If you’d like, you can curse me or hit me as if I were your son.” That remark dissolved the frown on the woman’s face and made her laugh. She opened up to the volunteers and told them about the things that had been bothering her.

 

TIMA surgeons operated in this makeshift operating room, originally a recovery room in Chamkarleu Referral Hospital. Volunteers had converted the room into a temporary operating room by cleaning the walls, sealing the windows, and adding air-conditioning.  Xu Zhen-fu

 
 
 

The doctors

The large number of patients completely filled the time slots on the schedules of Drs. Tang Kiat Beng, Liao Kuan-fu, Soo Lin Hoe, and Chang Heng-chia (張恒嘉). They had to see patients non-stop.

The portable ultrasound machine that Liao had brought from Taiwan proved to be of great value. With it, the doctors were able to get a much clearer view of patients’ conditions and make more accurate diagnoses. For example, it helped identify cases of terminal cancer and active pulmonary tuberculosis. Patient Sun Heak, 48, came to have his feet checked. He walked with a limp, and he thought that he had a foot problem. Further examination with the ultrasound revealed heart valve problems too.

Drs. Lin Chin-lon and Chang Heng-chia consulted and recommended that Sun Heak go to a big hospital for treatment. Sun Heak was worried, but not so much about his illness. He was more concerned about the cost of transportation to and from the hospital. TYDA and Cambodia Tzu Chi volunteers rose to the occasion: The latter would take care of transportation while the former took care of his health. Sun Heak was relieved.

In the operating room, surgeons dealt mostly with patients with cysts, tumors, and warts. The room was really nothing but a makeshift space that volunteers had improvised shortly beforehand for use in the free clinic. Though they had done their best to make the space suitable, they could not keep the omnipresent flies out and lighting was insufficient. Despite that, the surgeons plugged away, giving their all without the benefit of advanced surgical instruments, such as Harmonic scalpels that can simultaneously cut and cauterize tissues. Five surgeons completed 126 operations in two and a half days.

One patient had a two-inch tumor on his neck and a huge one on his elbow. His case challenged the patience and skill of the surgeon, Dr. Chien Sou-hsin. “Dr. Chien calmly adjusted the surgery to whatever situation that he needed to solve,” recalled Dr. Lin Wei-you (林威佑), of Yuli Tzu Chi Hospital, eastern Taiwan. “He finished the operation beautifully. There was just minimal bleeding throughout the procedure.”

This was Lin’s first involvement with a TIMA international free clinic. “When we solved patients’ problems and saw the joy that spread over their faces, our fatigue evaporated.”

 

A patient cheerfully thanks the doctor after receiving care at the Chinese medicine clinic.   Zhang Li-yun

 
 

We’ll be back

On the heels of a protracted civil war that had lasted over 20 years, Cambodia was afflicted in 1994 with droughts and floods, making food supplies severely scarce in the nation. The Tzu Chi Foundation sent water pumps and food to Cambodia from 1994 to 1997, but then political turmoil in the country forced the foundation to halt further aid.

Tzu Chi’s connection with Cambodia was reestablished more than a decade later because of Yoshikazu Shaku. Shaku fled his native Cambodia during the civil war and later became a businessman in Japan. He first encountered Tzu Chi in Singapore in 2007. One year later, following a visit to Tzu Chi headquarters in Hualien, Taiwan, he began training in Singapore to become a certified volunteer. He received his certification in 2010.

His love for his home country and his father eventually led him back to Cambodia to look for his father. He witnessed the poverty there, and he took pity on the destitute. In 2011, he invited David Liu (劉濟雨), then CEO of the Singapore Tzu Chi chapter, to give a series of talks in Cambodia. This inspired some local people to join Tzu Chi.

Though there are currently fewer than ten certified Tzu Chi volunteers in Cambodia, they helped pull off the large-scale free clinic mission in March. It was a feat that impressed even Dr. Chien, a veteran of TIMA international events in many countries. In three days, 2,880 patients were served in ophthalmology, internal medicine, surgery, dentistry, and Chinese medicine. In the ophthalmology clinic, patients also received free eyeglasses if they needed them.

Despite the large number of people served, the volunteers knew that for every patient that they had treated, there were probably many more suffering Cambodians who needed medical care but had no access to it. Dr. Lin Chin-lon said, “TIMA has developed very well in the Philippines, Indonesia, and Malaysia, where poor people can usually get medical care, but the same can’t be said of Cambodia. There’s still much we in Taiwan can do for this country in the future.”

Dr. Chien Sou-hsin urged TIMA members to do what they could to help this country, and he made a promise to Hsieh Ming-hsuan (謝明勳), head of Tzu Chi Cambodia, his wife, Hu Mei-ling, and their fellow volunteers in Cambodia: “We’ll definitely be back.”

Summer 2017