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Engineering change in Cambodia
21 March 2016
UNSW Biomedical Engineering student Ojasvi Chavali reports from rural Cambodia where he and 16 fellow UNSW students are volunteering at local hospitals. In a country whose healthcare system is still ravaged by the after effects of the Khmer Rogue regime, Ojasvi helped bring ailing medical machines back to life.
Families torn apart
“It’s impossible to forget,” Chum says. “They took my brother and they took my father. Pol Pot took them both.”
His hands shake in defiance and anger and the tension in the room is palpable as he tells me what they said to him. “They said, ‘to kill you is no loss (to the Khmer Rouge) and to spare you is no gain.’ I have never been so scared or angry in my life.”
This is Chum Siphorn’s story, an X-ray operator who has worked at the Koh Kong Referral Hospital in rural Cambodia for 27 years. I am volunteering at his hospital as a biomedical equipment technician. Along with a team of 16 other UNSW Biomedical Engineering students, we are here to help fix broken equipment in rural hospitals across the country.
Visibly shaken by the remembered atrocities committed in his beautiful country, I give him a hug and a glass of water, and wait as he composes himself. “Aug kun (Thank you) brother, I am okay now,” he sighs and then smiles at me.
The stuff of horrors
Kampuchea (Cambodia in Khmer) was caught in a proxy war between the US and the USSR during the Cold War. “In the 1950s, Kampuchea had a very strong economy,” says Chum, “but during the Vietnam War, America bombed us over and over. They destroyed rural Kampuchea, and everyone either ran away or died. We turned to the Khmer Rouge because we thought they would save us. We were so wrong.”
What followed was the stuff of horrors. Between 1975 and 1979, the Khmer Rouge regime, led by Pol Pot, attempted to create an agrarian utopia free of family ties, religion, education, property and foreign influence in Cambodia. In their attempt to reboot society, over two million people - a quarter of Cambodia’s population at the time - were killed. They focused on wiping out the educated classes – doctors, lawyers, engineers, teachers, accountants – who were perceived as ‘threats’ to the regime.
One of the tour guides at the Cheung Ek killing fields near Phnom Penh describes the legacy of the Khmer Rouge. “They destroyed hospitals, banks, educational institutions and lot of infrastructure,” he says. “Because of the Khmer Rouge, 75% of Kampuchea’s population is under the age of 30. How is Kampuchea meant to recover?”
Healthcare was hit hard by the regime. After the Khmer Rouge was finally overthrown by the Vietnamese army, there were only 25 doctors, 28 dentists and 26 pharmacists left in the whole country! In subsequent years, and right up to today, healthcare has suffered from insufficient funding, inadequate medical equipment and a lack of trained personnel. Healthcare providers often practice without certifications using dysfunctional equipment.
A recent surge of foreign aid (from countries such as the US, France and Korea) has provided some relief however, and on my first day in the hospital the director, Dr Laison, takes us on a tour. As we walk along the dusty corridors, the abundance of trained medical personnel is heartening. “In one year we are now able to treat between 4,000 and 5,000 patients in this hospital,” says one of the nurses.
It is also good to see so much equipment – almost 80% of which has been donated by the US and France – but secondhand equipment can be old and prone to malfunctioning. Dr Laison tells us that much of the equipment has been in use for over 15 years and every department has broken equipment with no one skilled to fix it.
He is thrilled that we have come to help.
The doctor of machines
Later, as I’m exploring the hospital, I hear someone calling: “Bong bong! Khnom maasen ban haa!” (Brother brother! My machine has a problem). It is a nurse from the Surgery Department. “I am trying to change the oxygen settings so that it gives me 500ml/h, but it is only giving me 400ml/h,” she says.
I pull on my latex gloves and unscrew the back panel of the machine. I suspect a leak in the oxygen pipe as the barometer itself looks fine. I ask the nurse to release oxygen from the tank into the machine and within seconds, as predicted, I hear a hissing sound – a definitive indication for a leak. I clean the connection and reseal the pipe onto the machine, and as I screw the back panel back on, the nurse tests the settings. She grins - the problem is fixed!
Right then I realise how apt it is that I’m working in a hospital. I feel like a doctor – a doctor for machines.
For the next few weeks, Jeevan Shikharam, Vincent Fang and I (the team of students assigned to Koh Kong Referral Hospital) repair broken and malfunctioning medical equipment. We fix surgical lamps, and dentists’ chairs; negatoscopes, curing lights and centrifuges; suction pumps, pulse oximeters, anesthetic machines, oxygen concentrators and more!
We practice commonly used English words in the afternoons, and in the evenings we read from storybooks like Rapunzel.
We also develop operation manuals for the nurses and involve Sophal, a local biomedical equipment technician trainee, in the troubleshooting and repairing process. “Your Khmer is very funny,” he chuckles. “It’s sometimes hard for me to understand, but watching you check the maasen (machines) helps me learn a lot.” We are making a difference. We see it in the smiles of the hospital staff!
Urm…how does the toilet work?
The cultural immersion goes way beyond the walls of the hospital. As part of the homestay agreements between Engineering World Health (one of the organisers of this trip) and the hospitals, we are quartered with some of the hospital staff and their families.
I am living with Chum and his family. Apart from his wife, mother-in-law and three kids, he also supports three cheerful 15 year old girls (Kim Seang, Dina and Lis) whose families live in remote villages in the mountains surrounding Koh Kong. They live here so that they can go to school and hopefully university after they finish high school.
Living in rural Cambodia is amazing but there are some challenges. There is no electricity so it is pitch black as soon as the sun sets (although this does means the stars are fantastic!) Another peculiarity is the bathroom. I’ve never seen anything like it! The toilet is just a hole in the ground and the only other feature in the room is a bucket of water. This functions as a flush, toilet paper and a shower! The incessant whir of insects and the neighbour’s chickens also take some getting used to. The chickens are by far the best alarm clock I’ve ever had – I guess the lack of a snooze button makes them super effective.
A rich and gratifying experience
I feel so fortunate to have the opportunity to live with this Khmer family. They are so friendly and even bought me a bicycle so I can get to the hospital more easily. The language barrier is no barrier at all - we communicate in a hilarious mix of broken Khmer and sign language.
To reciprocate their kindness, I start a small English and Mathematic class for Chum’s kids and the girls that live with us. We practice commonly used English words in the afternoons, and in the evenings we read from storybooks like Rapunzel.
“Thank you bong (brother) OJ for teaching us Anglais (English)”, they say, but I just want to thank them after every reading session! Facilitating their learning of English and Mathematics has been extremely gratifying. It’s incredibly satisfying to know that I’m making a real difference to the Cambodian community in multiple dimensions.
- Ojasvi Chavali, Third year Computer and Biomedical Engineering Student
Interested in joining the UNSW Chapter of Engineering World Health? Learn more about this group by emailing EWH.
UNSW Engineering would like to thank the New Colombo Mobility Plan for their sponsorship and support of EWH Summer Institute students. Thanks also goes to The Graduate School of Biomedical Engineering which supplied gear that was later donated to the hospitals.