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Foreign surgeons prove tireless

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Facial surgeon Dr Hans-Dieter Pape (left) and consultant surgeon Eugene Tragus. Photo: Craig Miles

Facial surgeon Dr Hans-Dieter Pape (left) and consultant surgeon Eugene Tragus. Photo: Craig Miles

Since 2009 we have done 30 open heart surgeries and by the end of this trip we would have hopefully done 35

Angkor Hospital for Children consultant surgeon Eugene Tragus doesn’t hesitate to describe German volunteer surgeon Hans-Dieter Pape in glowing terms.

“He’s a star in Germany,” says Tragus. “A quiet gentleman, an excellent surgeon and a humanitarian. It would be a great loss without him.”

Pape is a 79-year-old facial surgeon who treats cleft lips and palates. He hails from Cologne and works in Siem Reap for two weeks every year.

He’s one of many surgical volunteers who visit Angkor Hospital for Children annually.

Cleft lip is an opening in the upper lip, between the nose and the mouth. Normally it would close by itself when the child is an infant.

Cleft palate, on the other hand, is an opening in the roof of the mouth, which didn’t close and requires complicated surgery.

Pape treats both and is constantly teaching the Khmer surgeons when he is at the hospital.

Two Khmer surgeons are now able to properly repair a stage one cleft lip, which is a less severe type. On his most recent trip in December, Pape was training them to treat more severe types.

“It’s as difficult as any other special surgery,” Pape says. “You need a lot of experience, but the surgery is usually successful here. The surgeons here are very good.”

Pape usually treats 15 to 20 patients when he’s in Siem Reap and generally operates on two to three per day. Each operation usually takes one to two hours.

Pape says he enjoys seeing the children happy after surgery.

“To see the children leaving the hospital with a nearly fine face is what I enjoy seeing most.”

Pape first started volunteering at the age of 70 in 2001.

“I’ll keep doing it as long as I can,” he says. “As long as my fingers will let me.”

How the Angkor Hospital for Children opened is remarkable. It opened in 1999 after the NGO Friends Without a Border was founded by Kenro Izu in 1996.

As a travel photographer, he came to Cambodia to take pictures for his Light Over Ancient Angkor series during 1993 to 1996.

According to AHC director of public relations Sinketh Arun, Izu visited a provincial hospital and a child died during his visit. There was insufficient medical care which proved fatal. “The child was the same age as his daughter, so he thought this could happen to her,” Arun says.

“On the first day of the hospital opening, not many children came; only about 10. But every year, the number of children increases all the time.”

She says now in the mornings before the hospital opens, parents bring their sick children and wait outside. Nurses scout the 300 to 500 children who are usually there to find the ones most in need. “Many come with common problems so they see the nurses. The worst ones are taken straight to a doctor.”

Arun says volunteers are an important part of the hospital and provide valuable teaching to the Khmer staff. “When we begin we were looking for volunteers, but in the last five years we haven’t looked for any.”

The chief surgeon at the hospital is Sar Vuthy. He is one of three Khmer surgeons at the hospital. He says orthopaedic, neurological, cleft, heart and head and neck surgeons come from around the world at various times of the year to lend their expertise and teach the surgeons. “In the past 10 years, we have mainly learnt through the volunteers.”

There’s Desmond Brown, a paediatric orthopaedic surgeon from Boston who comes regularly every January and also gives lectures at the National Paediatric Hospital in Phnom Penh.

In February and March, Gregory Zemenick from Michigan, a  general orthopaedic surgeon, visits.

Iwata Mashumi from Japan, a head and neck doctor, comes three times a year for one week. He treats patients with tonsils, tumours, sinus and jaw problems.

Then there’s Sriram Shankar from Singapore. I spoke to him at the hospital, and he said in 2010 he and his team came in March, April, September and December, but he wants to do six trips a year.  He specialises in heart surgery. He’s been coming to Siem Reap for seven years and in the beginning wanted to complete simple closed heart surgery, while teaching the Khmer surgeons.

In 2009, Shankar made headlines by completing the first open heart surgery at the Angkor Hospital for Children.

“We had no choice,” he says. “We had close to 1000 patients who were on the waiting list, for valve or congenital surgery.

“Since 2009 we have done 30 open heart surgeries and by the end of this trip we would have hopefully done 35.”

Shankar says his aim was to mainly train one Khmer surgeon so that they could become an expert at it and be able to pass on their skills. This surgeon is Vuthy.

“I’m excited to be working with him,” Vuthy says with a twinkle in his eye. “But it’s not easy to learn from him, sometimes I want to quit.”

Shankar says: “I become a monster when I get into my gown but I don’t impose things on people I don’t impose on myself.”

As there are such a small number of surgeons in the hospital, Shankar says the Khmer surgeons have become multi-skilled instead of specialising.

“It’s a huge thing lost in the developed world,” he says. “The surgeons here multitask so well. Nowadays in the Western world they train everyone like a robot and I think that’s terrible.”

“We challenge ourselves,” Dr Vuthy says. “We need a variety of skills to deal with all patients because we only have three surgeons in the hospital.”

Angkor Hospital for Children certainly thrives on the help and input by the volunteers.

Before the hospital opened, statistics published on the AHC website show that one in five Cambodian children died before the age of five. Today, the ratio is one in 15.

But, as Shankar says, “everything is a step”, which is certainly indicative of present-day Cambodia.

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