When the Khmer Rouge seized power in Cambodia in 1975 they reset the hands of history. To make a clean break with their nation’s history, the first year of party’s rule would be known as Year Zero.
In medical terms, Year Zero was cruelly apt. Part communist, part nationalist, the Khmer Rouge were isolationist, suspicious, and favoured economic development through unrealistic agricultural targets. In order to achieve these goals a million city dwellers were sent to agricultural zones, and the already meagre resources of the nation – human, economic, educational, and material – were squandered.
Medical specialists were treated with suspicion and either banished or executed. By the end of the regime, only two or three doctors were left in the country. This tragic period of Cambodian history had many deleterious effects, including on the Cambodian medical and healthcare system.
When Dr Robyn Devenish, a Medical Laboratory Scientist, visited Cambodia in 2001 after answering a call to help build a pathology lab there, she soon came to understand the significant medical challenges facing the nation.
“After Vietnam took over Cambodia, many of the doctors were taught in Vietnamese or sent to Russia to train. And the old medical text books were in French.”
But it wasn’t just the state of the educational infrastructure that was a problem, the labs were extremely rudimentary.
“When I got there, I realised there were a lot of haematological diseases they didn’t know about, and nothing was known at all about quality control.
“In Australia we have machines to do a lot of the work, but in Cambodia everything was done manually. The blood films were terrible, the staining was terrible, and a lot of wrong results were going out.
“They were trying to count the red blood cells manually, there was no computer system for record keeping, these were the technical and methodological challenges. After a year we managed to buy an analyser which was great.”
Misdiagnosis was also rife. Not because of any individual shortcomings, but because of the poorly funded infrastructure and historic burden of Cambodia’s history.
“There was a lot of misdiagnosis. Because there weren’t the tests available there that we have here. Haemophilia was often mistaken for polio. Thalassemia was also overlooked, doctors being taught that it was a strictly Mediterranean condition.”
Not only did misdiagnosis have tragic medical outcomes, it could also be expensive and heart-breaking for families seeking answers and treatment.
Doctor Devenish illustrates the problem with the example of a 14-year-old girl who was sent to hospital to die, doctors believing she had leukemia.
“This girl actually had autoimmune haemolytic anaemia, not leukaemia. They were giving her more transfusions, which was making her condition worse. Once we were able to properly diagnose the condition and treat her with steroids, she was better within a week.”
Another inspiring moment for Dr Devenish arrived six years after her arrival, in the form of a Cambodian haematologist who had been trained in France. To have someone to refer cases to was a great thrill.
The building up of a medical group able to take Cambodian health forward has been a great development for Dr Devenish.
“A lot of lab technicians were sent to Royal London Hospital, as well as to Malaysia and Thailand. There’s been a lot of progress with quality control, but there’s still a lot of help required.”
After a six-year absence from Cambodia, as Dr Devenish looked after her mother in Australia and had her own health concerns, she plans to continue in her quest.
“The progress has been terrific but there’s still a lot of work to be done there. In Australia, 80% of childhood leukaemia’s can be cured. In Cambodia most of those will be fatal because they don’t have the right diagnostic tests and therefore the right treatment prescribed.”
Now in her 70s, Dr Devenish also hopes to pass the baton onto Australian scientists and pathologists to help pursue the fantastic projects she has been involved in.