It has been less than a year that I have been practising as a surgical oncologist in Central Hospital, but I have been living in Phnom Penh for the past four years as a Christian missionary. Before moving here, I had been practising oncology for the past 30 years in the Philippines. I had my surgical training in a government hospital in Manila and a short surgical fellowship at the Pacific Presbyterian Hospital in San Francisco, California. During the course of my practice here in Phnom Penh, the following are my sad observations regarding the medical system:
• There is no obvious quality medical standard for all practising medical personnel (doctor and nurses).
• The medical and nursing curriculums are inadequate to meet international standards.
• There is no internship program to transition medical students to private medical practice.
• Domineering, materialistic attitude and lack of compassion of most medical personnel.
• Religious beliefs and superstition without scientific or medical basis form the foundation of most medical and surgical decisions.
• Lack of ongoing research on some medical problems and issues affecting the community.
• Lack of training institutions or training programs on some essential specialties (there is only one cardiac interventionist and one nephrologist in the whole Phnom Penh area).
• Lack of a governing body that determines the competency and regulates the behaviour of most medical personnel.
• The government hospital that should be giving the best medical and surgical treatment is in a deplorable condition in terms of staff competency.
• Lack of competence in handling medical and surgical emergencies in different hospitals.
• Lack of governing bodies that classify clinics and hospitals in terms of their facilities and competencies in handling medical and surgical cases.
• Develop medical and nursing curriculums that will meet the international standards.
• Create a governing body that will determine the competence and skill of medical students who just graduated from medical schools and regulate the behaviour and competencies of most medical and nursing personnel.
• Establish a governing body that will classify health care facilities into a primary, secondary and tertiary, depending on their competencies and facilities in handling patients, and would limit hospitals from admitting patients according to their classification.
• Give qualified students, medical and nursing personnel an opportunity to be trained abroad in different medical and surgical specialties with the agreement that after the training they would come back to Cambodia to trained other students and medical and nursing personnel.
• Develop a residencies program for tertiary hospitals in different medical and surgical specialties and subspecialties.
• Create a network of medical emergencies services among hospitals.
• Create medical facilities and hospitals that specialise in certain medical and surgical conditions, eg, an orthopedic hospital, a heart centre, a cancer centre, a hospital that handles traumas etc.
I hope and pray that changes in the medical system will come soon. But on the other hand, I am fully aware that it will take a lot of political will to change this system, because the problems are deeply rooted.
Demosthenes C Reyes, MD
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