NCI Cambodia – is it just a dream?

According to the Health Stratergic Plan 2008-2015 of the Ministry of Health, the stardard of care improvement of non-communicable diseases like cancer has been and will be one of the top priorities for Cambodian government.

Cancer treatment in Cambodia has advanced remarkably since the opening of  Marie Curie Oncology Center in  Preah Bat Norodom Sihanouk Hospital, formerly known as Cambodian-Russian Friendship Hospital.  Dr. Eav Sokha, Head of Department, claimed that his department has a good database management system for collecting cancer database of all patients admitted to his department for cancer treatment and care with proper follow up. Dr. Sokha explained, however, that this database does not cover all cancer incidence in the whole Cambodia due to the outflow of many cancer patients to other asian countries.  He added that Cambodia needs its own ‘National Cancer Institute’ for the three main objectives. First, with its standard quality of treatment and care, this NCI will be the referral center for all cancer cases in Cambodia. This will make possible the second objective which is nationwide cancer registry and epidemiology study, as well as its own research studies.  Last but not least, NCI will contribute to producing more experts in cancer-related fields by becoming a major cancer training center.  This will in return expand Cambodian cancer network through the distribution of young generation specialists in various cancer peripheral centers in some major provinces in Cambodia.

”That sounds like a great thing to think about, ” claimed some Cambodian and foreign colleagues, but ”Is it just a dream?” they questioned Dr.  Sokha and themselves.

The answer is NO! NCI Cambodia is not a dream but a dream-comes-true!

Supported by the government and a very powerful and smart leader, working together with his core team consisting of brilliant and committed experts in the field, it goes without saying that this great project will see its future very soon.

To be continued…

Visit to Pathology lab at AKS hospital

From April 26 to May 2, 2009, a group consisting of Prof. Dr. Piet Pattyn, Prof. Dr. Claude Cuvelier, and Dr. Monirath Hav paid a visit to Pathology Department of Norodom Sihanouk Hospital (formerly known as Hopital d’Amité Khmero-Sovietique or AKS). The purposes of the visit are:

1. to better understand the current situation of the hospital and the Pathology lab itself in order to be able to establish a vision and a feasible stratergic plan for the lab;

2. to comment on what can be immediately improved in the lab so that it can function more effectively;

3. to provide the lab with some facilities it needs urgently in its routine operation; and

4. to train the Pathologists with some new techniques to handle macroscopic specimens.

On the first day, the delegates had a meeting with the Director of the hospital and some other people involved in the project. They discussed the current and possible future collaborations.

Later on the same day, the delegates visited Pathology Department of AKS. Prof. Cuverlier, Pathology Training Program Director of Ghent University, stayed and worked in the lab for one week, together with his Cambodian student, Dr. Monirath. There, they provided a one-week training/assistance to local Pathologists both in macroscopic specimen handling and microscopic diagnosis. They have equipped the lab with one cabinet for slide storage and one multi-functional printer for administrative work. This donation has been approved and made possible by Prof. Pattyn, Head of Gasto-Intestinal Division of Ghent University Hospital and  Promoter of the current project “Creation of Reference Center for Gastro-Intestinal Tumours in Cambodia.”  In addition, the lab received a box containing 3,000 cassettes for routine processing of specimens.  This has been contributed by Prof. Dr. Patrick Pauwels, Head of Molecular Pathology Unit of Ghent University Hospital. The team also spent a few days in Siem Reap province observing Pathology situation there and creating possible future network with Siem Reap Provincial Hospital for referral cases.

Besides working in AKS Pathology lab, the team also visited another NGO-run Pathology lab and a private lab in Phnom Penh, namely Sihanouk Hospital Center of HOPE and Phnom Penh Institute of Pathology, respectively. We have also met Dr. Cornelia Haener, Deputy Director and Surgical Director of Center of HOPE, and created possible future network for referral cases from Center of HOPE  to AKS hospital. Dr. Monirath, the prospective Pathologist at AKS hospital, has agreed to help the Pathology lab at HOPE center with some numbers of referral cases free of charges. We ended the discussion with the same idea and commitment concerning re-organizing regular meetings among Pathologists from different labs as well as multi-disciplinary discussions between Pathologists and the clinicians. The purposes of re-organizing these meetings and discussions are to (1) exchange experience and knowledge on difficult cases; and (2) improve patient’s management guidelines/practice.

During our stay, we also guided a tour of AKS hospital and the lab itself to a group of Belgian tourists who were interested in our project. Seen (on the left) in these photos, is Dr. Meng Hong Pan, a retired Cambodian Pathologist who lives in France but regularly contributes his time, efforts and resources to improving Pathology practice in Cambodia.

Choosing Pathology as Spciality in Medicine

One of the many challenges medical students may face is the choice of subject in which they want to specialize. When this comes to mind, i guess most students will first ask themselves the following two questions:

(a) What subject am i best at?
(b) Will i be able to earn a good living from specializing in that particular subject?

The above two questions are, of course, good questions to ask ourselves before making such big decision. My experience, however, was far different. My choice of spciality, which is Pathology, has been greatly influenced by the answers to the following two questions instead of the above two.
(1)
- Does my country/community already have enough capable human resources in that speciality? or
- Are there going to be any added values or benefits to my society/community if I choose to specialize in this field?
or
- I am going to make any positive change in my community if i choose this specialization?
or
- Is my community/society/country in need of human resources in this specific branch or speciality?

(2) Do I want to choose the subject/speciality because I really love it? Or is it just because i have been told that this speciality will earn me a lot of money?

Now, let me tell you briefly about my decision-making process. Starting from year 1 until my last year of medicine, i had always thought of what subject to specialize in, but there was no best answer in my mind until after Dr. Sokha Eav, Head of Oncology Department at Cambodian-Russian Friendship Hospital, sincerely talked to me one day about the tremendous lack of human resources in Cambodia in the field of Oncology, specifically Hemato-oncology. In deed, influenced by question (1) above, I was determined to doing my post-graduate in Hemato-oncology. By coincidence, an inter-university project (VLIR) between Belgian and our university arised, and an exam was held to select one senior medical student for a one-month training in Pathology in Belgium. I was quite interested then although most of my friends did not show much interest. I have been told as well that Cambodia also lacks Pathologists, and as I had no idea about what Pathology was and how Pathologists could contribute to improved patients’ management, I was very much eager to explore this subject. At the end of my one-month training in Pathology in Belgium, i got the clue of how important Pathology is. At that time, I had to make a choice of only one specialty, and that was between Hemato-oncology and Pathology. I knew that i equally love both subjects, yet I choose Pathology although my family, especially my uncle who is the Oncologist i mentioned above, very much wanted me to specialize in Oncology. The most difficult question i had to answer to them at that time was ”Why would you like to study Pathology if both subjects are equally important and demanded? Why not choose Oncology from which you will surely make a lot of money upon your return?” My answer to them was ”A lot of students are now interested in becoming an Oncologist. On the contrary, very few or even no students show strong interest in becoming a Pathologist. That’s why I feel the responsibility to study Pathology, and that’s not all; I will make everyone feel its significance so that we can produce more Pathologists for Cambodia.”

You may have felt that this writer is such a stupid social activist. Well, i admit that i really am. I am more concerned about my community than just myself, so my decision is more community-based. Nevertheles, i feel that it won’t sound convincing to you if i discuss this social contribution stuff. Therefore, let me use a very simple business concept to demonstrate why my suggested questions (number 1 and 2) should be considered instead of the previous two (a and b). The concept is ‘differentiation‘. In business, a product or service is differentiated when it is unique. If a company wants to have competitive advantages over and to gain more profit than do its competitors, its newly launched product/service must be differentiated from the existing products/services in the market.

” America has believed that in differentiation, not in uniformity, lies the path of progress. It acted on this belief; it has advanced human happiness, and it has prospered. “

~ a quote by Louis D. Brandeis, Chairperson of American Provisional Executive Committee for General Zionist Affairs ~

The same applies to our decision-making process in the choice of speciality. If you choose to study something in which other doctors or even professors already have advanced knowledge and experience, you won’t make any differences when you finish your study. On the contrary, if you choose to specialize in something which contributes to the welfare improvement of your community and something which very few people specialize in, you will be able to bring about great changes in your whole society. I really can’t see how you can’t earn a good living then as you are so important to your society.

By now, some of you may have doubted why i did not support question (a) “what subject am i best at?” Well, you are right about that. This question should be included in the list, but preferrably not as priority. From my own experience and observation, as long as you have a strong commitment in doing something, you will succeed even if at first you are not best at it. Knowledge can be learned, and experience can be gained. What is more important is our commitment. If at first, we fail, don’t give up! Keep on trying again and again and again and again… until the bright day comes. I knew nothing about Pathology lessons when i decided to choose this speciality. I had to start all from scratch. But guess what! Now, everyone keeps telling me that i’ve improved a lot.Indeed, I feel that i’ve leant a lot, and that’s NOT because i’m any smarter than you or anybody else; it’s all because i’ve always kept trying again and again no matter how many times i failed and got depressed. You may have seen a video I uploaded in the post above and felt the message from the man. Do you want to finish strong? Then never give up when you fail.

I hope by this time, I have, to some degree, convinced some of you how community-based decision, and definitely not selfish decision, can make you live a very happy and honored life.

” Contribution comes first, happiness follows.”
” Taking makes our hands full, but giving makes our heart full.”

Well, i’m not trying to tell you that Pathology is the best speciality. There is no “best specialty” for everyone. In a sense, the best specialty is hopefully the one you like the best and which is the priority in your society; we need good people in all specialties. Besides, there are no “bad specialties”. I am going to tell you what we do in pathology and why it might be a good choice for you.

Pathologists are often referred to as “the Doctor’s Doctor”. Why? When someone has a health problem, he or she goes to see the doctor; and when a doctor has a problem in establishing a diagnosis, he or she goes to the pathologist in search of help. In other words, the pathologist acts as a consultant. The pathologist is an important member of the clinical team; simply put, how the patient will be treated and what the outcome will be depend on the pathologist’s diagnosis. The pathologist does not treat patients directly, but deals with other members of the clinical team. This provides interactions that are intellectually very rewarding and a continuous source of learning.

Pathology is the study of disease; as such it has been described as the “trunk of the tree of medicine.” It draws knowledge from all basic sciences, which in this allegory would represent the roots, and supports and nourishes all specialties of clinical medicine, that are represented by the branches of the tree. This critical position between the basic and the clinical sciences gives pathology a unique versatility.

Pathology is divided into two large areas, Laboratory Medicine and Anatomic Pathology. Laboratory Medicine includes all the laboratories such as Blood Chemistry, Microbiology, Molecular Diagnostics, and so on. Anatomic Pathology deals with tissues; the products of our work are diagnoses. While morphology is an important tool in our specialty and it is thrilling to recognize diseases, the microscope is only a tool and pattern recognition is by no means the “end goal” or “objective” of our practice. Its purpose is to provide information that will result in better understanding of diseases and patient care.

Since the field of pathology is the study of diseases in all organ systems, there are no limits to the field of our practice. We see diseases from every single organ and system, of every conceivable nature: congenital, acquired, neoplastic, benign, malignant, metabolic, infectious, degenerative, etc. and we interact with every single clinical specialist. The variety and opportunities are simply limitless and make for a very interesting and intellectually rewarding practice. The “revolution in biology” that started a few years ago has resulted in an explosive gain in knowledge; it has been achieved in great part through the study of tissues with techniques of molecular biology. Since pathologists work with tissues, they are in a very strategic and privileged position to generate this knowledge and interact with basic scientists and clinical specialists. In this sense, pathology provides a scientific basis for clinical medicine and a clinical purpose for basic sciences. We are only at the beginning of this revolution in medicine. There is much more to come and the future is very promising. Pathology is a good place to be in, if you want to be an active participant.

To learn more about what Pathology is and about training possibilities in Pathology in Cambodia or abroad, contact me via hav_monirath@yahoo.com

The tree of medicine

”A tree with small or weak trunk will not stand strong!”