Craziness at the Royal Phnom Penh Hospital

Healthcare continues to improve in Cambodia but there’s still a long way to go. This is my story of craziness at the Royal Phnom Penh Hospital.

I’ve always had heavy periods that left me slightly anemic. This July though, my normal period lasted for nearly a month. I knew I was anemic. Normally easy activities left me completely winded. This was much worse than the normal mild fatigue. Going up a flight of stairs felt like running a mile. It was time to get help.

This all happened during study abroad so I called the university’s insurance provider, International SOS (ISOS).  They have a team of doctors and nurses on call 24/7 so I chatted with a nurse first and then a doctor. Both agreed I should seek treatment but where do you find reputable treatment in Phnom Penh?

They immediately set up an appointment for me in the gynecology clinic at the Royal Phnom Penh Hospital.  The great thing about ISOS is they set things up so you just go. The hospital was expecting me when I arrived and the bills were already pre-paid. They warned me that, while the doctors at the Royal Phnom Penh Hospital were qualified to diagnose me, they felt the standard of care was below Western standards. I was to tell the hospital staff that insurance had not approved payment for treatment (even though it was preapproved).

I quickly learned what ISOS meant. An old Thai doctor diagnosed me. I think he was in his late 60’s, early 70’s. He probably had a career in Thailand and then came to Cambodia in his retirement. He seemed very knowledgeable and competent.

The nurses, however, were completely another story. You know how nurses take basic measurements when you arrive? Things like height, weight, blood pressure, pulse… Well, the nurse clearly didn’t know what she was doing. She asked me to step on the scale and took my weight.

Then she asked for my height. As an American, I know my height in feet and inches – not centimeters. I know the conversion 2.54 centimeters to the inch but I was too tired to do the math in my head so I told her I didn’t know my height in centimeters. She just stared at me blankly and asked for my height again. So I told her, “Five feet six inches and there are 2.54 centimeters to an inch.” She just stared at me blankly.

The scale had a device to measure height. So I pointed at it and suggested she measure my height. It took her a minute to figure out how to use the device but she finally had my height in centimeters. Then it was blood pressure time. She put the cuff on me but then had issues with which hand the pulse device should go on.

The nurse that “assisted” the gynecologist was comical. I think the elderly Thai gynecologist spoke some Khmer. During my examination, I’d hear him ask the nurse for something followed by clattering of metal instruments in a metal tray, followed by a second request for the same thing, more clattering, and finally what I think translated into “That one!” This happened repeatedly during the examination.

Then I was sent for an ultrasound and blood work. An aid escorted me to the fourth floor for the ultrasound. She dropped me off in a changing area and came back to get me a few minutes later. The ultrasound technician was competent. One really nice thing was the ultrasound images were also projected onto a screen that faced me so I could watch. After the ultrasound it was back to the women’s center.

The girl who tried to draw my blood must have been a trainee. Firstly, the room was difficult for her to work in. There was a curtain dividing one side from the other. On the far side of the room, pregnant women were having ultrasounds. The side for blood work was very narrow. So narrow that my knees almost touched the wall in front of me. I was seated in a swivel office chair with a cabinet to my left. There was nothing to keep me from falling out of the chair if I felt woozy.

She got out the equipment and made a pile on the top of the cabinet but then seemed pretty flustered about what to do next. Before she put the tourniquet on, she palpated for veins and decided to use the ones in the back of my hand.

The procedure for drawing blood is different in Asia than in the US. In the US, when the phlebotomist sticks you, she lets the first vial fill up passively. When it’s full, she pulls it off and replaces it with another. The needle is designed to do this without removing it or getting blood everywhere. In Asia, they use a regular syringe and pull the plunger up to draw blood. When the syringe is full, they remove the whole thing and inject the blood into vials.

So back to the nurse. She missed the vein in the back of my hand and tried to suck blood out of my tissues unsuccessfully for what seemed like an eternity (probably about 30 seconds). She got about 4 ml and then asked if I was in pain. When I told her I was, she stopped pulling up on the plunger and threw the needle away. Then she apologized and told me she had to get someone else because she was only allowed to “try” once (Thank God). Fortunately, the next nurse knew how to draw blood. I can’t imagine those people trying to install an IV line.

In all the hubub, I missed lunch and it was getting late. No food plus anemia and stress equals a splitting headache. The next bit of craziness at the Royal Phnom Penh Hospital was the waiting area. The pediatric clinic is next to the women’s clinic and they share a very open space with lots of hard surfaces. Kids run and scream like they’re on a playground (no exaggeration here). All that noise bounces off the hard tiles like a massive echo chamber.

In between each step (initial intake, doctor exam, blood work, ultrasound, final consultation with the doctor) I sat in that crazy waiting area. By the time they asked me to wait for my bill, my headache was so bad I was nauseous. I explained this to the nurses and asked for a quiet place to wait but they wouldn’t listen. After five minutes, I told the nurses I was leaving. The could call me when the bill was ready.

I found a relatively quiet spot and called the insurance company with my test results. The recommended treatment, a blood transfusion, is possible in Cambodia, but not safe. I didn’t need any convincing when they said they’d send me to Thailand for treatment.  I’d had enough of the craziness at the Royal Phnom Penh Hospital.

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