Archive for the ‘Surgery Centre’ Category

Dr Nous Sarom: master-surgeon…

Dr Nous Sarom was born November 12,1970 and grew up in a small village, Prek Roka , Kandal Steung District , Province of Kandal 30km south of the Capital City of Phnom Penh, He did his primary school and college at his hometown and his high School at capital city of Kandal province. He completed his medical degree at, Universite de la Science Sante,  in Phnom Penh 1995. From 1996 he was appointed as a member of the medical staff and head of the Surgery Department of Kandal Stung District Hospital , the district of his home area.
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Dr Nous  start training (1996-1999 ) in Plastic surgery and Cleft lip/ Cleft palate repair  with Operation Unis,  a Japanese organization  which was the first NGO conducting cleft lip/Palate surgical Missions in Cambodia since 1992 in Dr Nous Kandal Stung Surgical Department .
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From  May 1999- March 2003 Dr,Nous was appointed to the  Medical staff of Rose Charities Rehabilitation Center, Kien Kleang ,Phnom Penh and then promoted to  Chief of Surgery of the Center.  He was interviewed for  THE LANCET.Vol359.March 30, 2002.  (www.thelancet.com).  He also gave presented at the Sunnybrook Hosptial, University of Toronto March 2000.
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Dr Nous carried undertook further  training through a clinical cleft lip/palate surgery fellowship at Queen Marry Hospital , University of Hong Kong, Hong Kong 2000 supported by Professor Nabil Samann.   He then  completed  a further 3 year program in Maxillofacial surgery though a fellowship Fellowship  in Thailand which was organized by IAOMS(International Association of Oral Maxillofacial Surgeon) and PSU( Prince of Songkla University), Hatyai, Thailand at the culmination of which in 2004 he gained a Diploma of  Maxillofacial Surgery Diploma
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After returning home  ,2004, Dr.Nous was appointed to the surgical staff of Chea Chumneas Referral Hosptial, Takmhmao, Kandal Province.  Shortly after this he was further promote to the position of  deputy director of the entire Chea Chumneas Hospital  .
Around the same time, Dr Nous founded his own rehabilitative surgical project in coordination with and partially supported by Rose Charities. Initially under the name of Operation FIRST, the work both in with Rose and also as an independent organization continues to this day.  Operation FIRST forged many international and local links including with Operation SMILE, The Chinese University of Hong Kong,  Operation Rainbow Canada and the University of British Columbia.
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In 2008, Dr Nous undertook an academic fellowship in plastic surgery at UBC, Vancouver supported and instructed  by Operation Rainbow’s Dr Douglas Courtemanche, Dr Cynthia Verchere, Dr David Naysmith, Dr Kimit Rai, Professor Richart Warrant, Dr. Douglas Caberwise and Dr Nicholas Carr.
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Also in 2008 (January) ,2008, Dr.Nous received the award of ‘Credential in Plastic Surgery’ a specialized, and highly valued award of  Operation SMILE.  This was closely followed by a affirmation of worldwide recognition as a cleft surgeon by the Plastic Surgery Education Foundation and The Smile Train Organization.
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Attending the Rose Charities International Conference in Penang in Febrary 2008, Dr Nous was at the occasion presented with the 2007 Charity Rose Award for outstanding contribution and dedication to charity.
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Dr Nous  traveled as a plastic surgery Consultant with joint the international Surgical Mission (several organization) to India’s, Sikim State,2009  and to Laos Parkse 2010. As a representative of Operation Smile Cambodia he was a valued participant  at the Asia-Pacific Cleft Care conference in Perth March 2011 and the Maxillofacial deformity Conference in October,2011 in Melbourne, Australia.
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Since January 2012, he was appointed as Consultant Surgeon to the  staff of Preaket Mealea Hospital, the biggest Military hospital, Phnom Penh, Cambodia . This hospital provides a range of services, both subsidized (mostly free) for the poor and costed services for others.
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Dr Nous is thus, currently  Head of Department of  Maxillofacial, Plastic , Reconstructive and esthetic surgery and a clinical assistant Professor of  Maxillofacial/Plastic surgery . Through him his department maintains and nurtures links with many other organizations both in Cambodia and overseas.  An elective student placement program is run also for medical/surgical students.
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Dr Nous maintains has a considerable international background, benefitting from experience both in the industrialized and developing world.  Having performed, taught and organized a huge number of cleft and general rehabilitative surgeries to thousands of patients in considerably varying conditions worldwide his breadth of  knowledge and practical experience are matched by few.   Dr Nous is thus one of Cambodia’s most valued and honoured surgeons but he uses this wealth of experience as much to help those in need as for his own remuneration.
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Dr Nous  is current Cambodia representative of the Rose International Council.  He is married with 4 children.

Rose of Hope: Rehab, Education and Care for the disabled of Cambodia

Rose Cambodia Rehab Director Jo Thomson (Australia)
examines a disabled patient

Report on Rose Cambodia Rehab Centre in Investor Edge Magazine: Philanthropy Edge Section (click)

A student enjoys her elective at the Sight, Surgery and Rehab Centers

I loved my medical elective at Rose Rehabilitation/Rose eye clinic in Cambodia! I sit in clinics now wondering what I would be doing if I was still out there and reminiscing about this unique experience. 

Cambodia as a country is amazing, it is full of the friendliest people I think I’ve ever met; everybody is keen to help you and make you feel welcome.  This was no different at Rose Rehabilitation centre in Takhmao.  It was a slightly awkward moto journey arriving there from Phnom Penh (capital city) but all the angst quickly disappeared once I saw Joanna, Sophak, Rith and the rest of the team.  They were extremely welcoming, friendly and inclusive; even when there were no medical issues for me to be getting on with – Joanna always invited me to visit the rehab patients in the community to take histories, examine them etc and even teach me.  She (and the rest of the team) answered my questions; always allowing time for me.  It was truly extraordinary to see the healthcare running successfully with limited resources and the variety of patients that Rose Rehabilitation deal with; the immense clinical signs really tested my (limited!) medical knowledge and allowed me to see the aftercare involved in a surgical patient – something I rarely see in hospitals back at home.  This was such a great opportunity to really test my clinical skills too and offer some medical tips back to the team.

I have to stress though that this is not always the case for visiting medical students – it just so happened that my visit coincided with Dr. Sarom’s (the head surgeon) visit to Australia and so I was only able to spend about a week with him.  I had applied for this elective because I am highly interested in surgery and did get to see some cool cleft palate repairs, plastics and grafts but never got a chance to assist unfortunately as I believe Dr. Sarom was training a Khmer doctor at that time. 

It was lucky for me that I have a keen interest in ophthalmology and so I split my time between takhmao (Rose Rehabilitation) and the eye clinic (based in Phnom penh) where I sat in the clinics for the morning and then assisted – that’s right – ASSISTED in ophthalmology surgery in the afternoons!  The eye centre is run by Dr. Vra (who predominantly performs cataract surgery) and his Ukrainian wife – Dr. Natalie (oculoplasty etc) – the rest of the team are lovely however, language is a major problem.  If, by chance, you speak Russian or Khmer – then great!  You will be fine – but if however, you only speak English – it makes life somewhat interesting…. Of course you pick up little things here and there but you can’t really run the clinic or ask the patients much yourself – without a translator.  I was lucky that Dr. Natalie was so keen to teach and wrote everything in English.  She was also very eager for me to practise my surgical skills and although I’m sure I was the local attraction/entertainment at the clinic – her teaching was invaluable.  The very first day there, she made me do an interrupted suture with tiny thread on a blepharoplasty . It soon progressed to me doing complete operations on my own – supervised of course.  If you’re keen or even interested in ophthalmological surgery – this is the place to be, there is nowhere in England that you will get such experience at our level – it is impossible so I am truly grateful for the opportunity I had to complete my elective here.  However, if you are squeamish, then I suggest maybe just attending morning clinic (start at 8am-12pm) as all the patients are under local anaesthetic only for their surgeries!

Bits of advice/ things I wish I’d known before I came:
–    Bring your own scrubs especially for eye clinic and id suggest taking your own crocs too but they all wear flip flops.
–    If you can get sterile hats then bring them too.
–    I’d suggest staying in Phnom Penh – purely as there’s so much more to do there, and it really caters for westerners.  I stayed in Europe Guesthouse on Street 136, which had the perfect location and was run by the loveliest family!
–    Take a book with you to read if you’re spending time in Takhmao as everything runs on “Cambodian Standard Timing” and you do end up waiting around for patients etc.  There is a medical ward there but the doctors speak only Khmer or French.  Dr. Sarom is excellent and speaks good English however. 
–    Getting to Takhmao – if you can arrange for the directions to be written in Khmer and find yourself a nice tuk tuk driver that will do you a deal – take it! I went with a friend of mine (Physio volunteer) from Phnom Penh via tuk tuk there and back and it came to $7 a day but I’m sure it can be done cheaper.
–    At the eye clinic – there is a nice canteen around the back where doctors and other volunteers from the opposite surgical centre eat – lovely dinner ladies and you can eat as much as you want for 2000 riel – that equates to around 25p!
–    Definitely try sugar cane juice when the lady comes around on her moto too.
–    Uniform – it’s so hot (esp. during march-may) that I wore cropped trousers, shorts, and decent tops – there’s no need in dressing too smart as everybody is pretty laid back.
–    Be prepared for things to “go with the flow” – it is not a regimented elective – which I think is good as it really allows you to immerse yourself in Cambodian nature.
–    Ooh if you’re vegetarian – learn the words in Khmer for “no meat, no fish” etc and just re-iterate that when you go to eat. I found it difficult to find vegetarian food – esp. in Takhmao but it’s understandable as it’s not in Cambodian nature to not eat meat!  However, Sophak, Sokney and Joanna all made sure the dinner ladies at Takhmao had some vegetables for me; they really look after you during your elective so just remember to have fun!

Acid violence

Female acid vict
Acid violence defies any bounds of comprehension. It is a violation born and nurtured in hell itself, a pitiless, hideous evil. It takes away both skin and flesh and the very soul of the victim. And it does so with finality that is often absolute.

As a physician, I saw my first acid violence injury around 10 years ago. I had set up Rose charities as an extension of my previous organization, Project Iris. Iris dealt with eye injury and sight restoration but so many injuries extended beyond the eye to the face and torso. Rose went beyond the eye to facial and other injuries. Word had gone around that there were “foreign doctors” helping the injured and had set up a simple operative and treatment clinic on the outskirts of Phnom Penh.

My First Case of Acid Violence.

My first experience with this heinous manifestation of acid violane remains seared in my memory. I came in in the morning and she was there in the waiting area, brought in by a friend. She sat there on the hard wooden bench. I took her hand. She could not cry, she had no tear ducts since the skin fused tightly over where here eyes may or may not lie underneath. She just gazed forward; her skin mottled leather membrane, shrink-wrapped; her face no longer with any elasticity or ability to display any expression. Her name is Vanna.

Vanna had been beautiful, and for many poor, oppressed Cambodian women it is their only possession of value. Before becoming a victim, she had a low paying job in a restaurant. She had a boyfriend. The story goes: One day Vanna refused the advances of a much older man, a government official of some importance. Later that evening two men were waiting for her. They held her down and slowly poured the acid on her beautiful face. And then they continued to hold her while it did its work.

That’s the thing. Simply throwing acid in someone’s face might give the person time to rush to water and prevent much of the damage. But when the victim is held, the acid will continue working. It can be poured onto specific areas; the eyes, the genitals, the breasts and there are cases where large quantities, like a bucket-full, of acid is simply flung at the victim. If the victim can then get to a source of water very quickly she can limit the amount of damage – though it may still be severe, irreversibly damaging her eyes.

It is hard even now, even as a physician who has seen many physical horrors in a lifetime to think back on Vanna’s face and body. It was as though the world had brought out a being so alien, so mutated that no one would ever recognize it.

What We Know About the Problem

Now, some 12 years later I have seen so many victims of acid burn attacks at our Rose Charities Surgery and Sight  Centers. Although statistics are scanty and subject to the inaccuracies of translation  it would seem that around 50% of attacks are the consequence of real or perceived extramarital affairs or other aspects of life leading to seeking of revenge. This is an extreme and tragic consequence of men seeking to control women. But attacks in Cambodia are not restricted to women. Some 15 – 20% of attacks are of men on men, or women (with or without the assistance of a male collaborator).And there are more victims. An additional 15% are secondary victims, usually a child, who have gotten in the way of thrown acid. The rest, not the result of gender-based violence but rather arise from civil disputes, such as over land and other property. Cambodia’s history of conflict and succession of imposed governments has ensured an enormous uncertainty in land ownership, resulting in claims and counter claims.

Historical Influence

Cambodia’s conflicts of the last 50 years have been extreme and brutal. Despite attempts to keep neutral, the country became heavily involved in the Vietnam war, its people first being hit by both sides, before eventually succumbing to one of the most genocidal regimes of human history, that of the Khmer Rouge. In this period, some 2 million persons were slaughtered, tortured, starved, or worked to death. Women were forcibly married to strangers, forced to watch as their children were taken away or their babies bayoneted in front of them.

The injury and illness of conflict and post-conflict can be discussed in three broad categories; primary, secondary, and tertiary. There is ‘primary’ injury that is mostly associated with wars; bullet wounds, blast injuries, etc. Then there is ‘secondary’ victimization, which is the disease or untreated trauma caused by the conflict and the induced breakdown of infrastructure. Third, there is the ‘tertiary’ category, perhaps the most pernicious, the most long-term, and an injury of the mind where the control of others is linked with violence, fear, and terror. While sadly, as we know from global prevalence data,  control and abuse of the vulnerable  is not only restricted to post-conflict scenarios, however, it may well be one reason why it remains rife in Cambodia.

The throwing of acid is particularly linked with the second and third categories above. A very weak and allegedly corrupt legal and law enforcement system means that the control by physical abuse is rarely punished, or prevented. The direct injuries can be inflicted with almost no fear of being apprehended by the legal authorities, and in the event that this does occur, it is easy to buy immunity with an appropriate payment to the right person.

Long-term Consequences and How Rose Charities is Helping

Rose Charities has been dealing with the results of violence against women in Cambodia since 1998. Over this time the range of acid injury has been very wide indeed, from a few superficial injuries covering one or two isolated areas to up to 60% or more of the body covered with deep penetration, even down to bone. The eyes, ears, and nose may be partially or entirely burned away.

Acid burns create a spectrum of disabilities for the survivor ranging far beyond the terrible disfigurement and physical disability. Livelihoods are ruined; there is social stigmatization, and breakup of families, marriages and relationships. Full time care is often needed and in a country such as Cambodia, this care is not provided in any way by the state. If the victims have no family or friends to look after them then they will be utterly outcast. So often the attack takes from the victim the only real asset owned in a quagmire of poverty, her physical beauty, which in many societies is the only way for a woman to advance. So the damage is also both psychological and social.

Dr Nous Sarom of the Cambodia Surgical Center (Operation First & Rose Charities) is now one of Cambodia’s leading rehab surgeons having had years of experience working in the area both on his own and with various generous international organizations and specialists who have come to assist.  Donations and gifts of equipment and transfer of expertise have improved treatment ability but there is still a long way to go.  Rose Charities employs many treatment specialties in its arsenal, from direct eye and corporal surgery through physio and other therapies to give a ‘holistic’ approach to each case.  Where possible specialized education and vocational training may also be provided.  Counseling is always needed, though sadly can be hard to find.

The injuries are often so severe that complete recovery is impossible, even with the most sophisticated methods of treatment. Thus the aim is rather to alleviate as much of the trauma as possible both mentally and physically and then lead on to try to help the victim return to life with quality.

Male acid victim
William Grut, MD, Rose Charities
Contact@RoseCharities.org

(Revision and update of an original article written 2008)

Operation SMILE and Smile Train to merge: Dr Nous Sarom to represent at Op SMILE International Meeting Perth (March 2011)

Dr Nous Sarom, Founder of the Cambodia Surgical Center (Operation FIRST and Rose Cambodia Rehab), is Cambodia’s leading maxillofacial surgeon and a one of the primary consultants in many wonderful Operation SMILE outreach surgical camps.  Smile Train, an equally distinguised parallel organization runs the different policy of supporting currently existing surgical centers to carry out cleft lip / palate operations.  The Operation FIRST Cambodia Surgical Center is one of the foremost Smile Train Centers in Cambodia.  Now, the two organizations (Op SMILE and Smile Train) are joining forces and will in future be known as  Operation Smile Train.  Congratulations to both organizations for this move.

Dr Nous Sarom will be visiting Perth to represent / present at the Operation SMILE international surgical  conference in Perth this month (March 2011) having kindly been invited by the organization. He will then travel on to visit Sydney and meet up with  Rose Charities Australia board members.

Rose Charities Australia supports the Rose Cambodia Rehab Center, the physical therapy arm of the Surgical / Rehab Unit of Operation FIRST at Chea Chumneas Hosptital, Takmau.  The unit is runs under the Ministry of Health of Cambodia, an important aspect in assuring sustainability and proper support of the Cambodian medical system.  It is known by many locals for its kindness and compassion to its patients and staff – an element sadly lacking in at least one other establishment.

Both the Op First Cambodian Surgery Center  and Rose Cambodia Rehab are enormously appreciative to both Operation SMILE and Smile Train for their wonderful and continuing work to help Cambodia and Cambodians in need and support for the Cambodia Surgery Center.  Both magnificent organizations have alleviated an enormous amount of suffering since their inception.

Blog from Jess (Feb 2011)

Cambodia

See www.live-vicariously-though-us.blogspot.com


During a brief study abroad in 2005, I toured a clinic operated by RoseCharities in Phnom Penh and was impressed by the efficiency and dedication of the medical workers there. In fact, this was the clinic that first sparked my interest in becoming a doctor. It was one of the few NGOs my class visited that offered both immediate and long-term relief to people struggling through the effects of poverty: immediate relief through life-saving medical procedures that would have been otherwise impossible for the clinic’s patients, and long-term benefits through community outreach programs and an emphasis on improving the quality of life in Cambodia.

Even in the few short weeks we spent in Cambodia studying aid organizations, it was easy to become discouraged by the waste, and sometimes obvious corruption, that plagued well-intentioned charities, but the Rose Clinic seemed to stretch every dollar it received. As I saw firsthand in 2005, a $20 donation to RoseCharities can restore a person’s sight, and $50 can repair a cleft palate or give a child the ability to walk. For more information on how to donate to RoseCharities, please see http://www.rosecharities.info/donate.htm.

The organization’s efficiency can be traced to its formation, as outlined on the RoseCharities homepage:

“Founded by aid workers who were disillusioned by the waste and bureaucracy often seen in international aid, we started in Cambodia in 1998. The aim was to deliver effective, sustainable programmes directly to those in need, with minimal bureaucracy, and with transparency at every stage….We are run by volunteers, so administration costs are kept to a bare minimum, with 98% of donations going directly to support our work.”

– RoseCharities
http://www.rosecharities.info/

I contacted Rose last October and asked if they’d be willing to take us in for a few weeks as volunteers, and they graciously agreed. Since then, Bill and Jan Johnston have been bending over backwards to find opportunities to put our random interests and talents to work. We started last Wednesday with a short tour of the gynecology ward in the Chey Chumnas General Hospital in Takmao, the hospital where Rose Cambodia is based. That afternoon we helped enter patient files into the computer (data entry is a rare example of a skill that Danielle and I both possess).

Thursday we traveled to the countryside with Sokny, the physical therapist on staff at the Rose office, to work with a woman who had laid in bed for 30 years after a debilitating bout with encephalitis (for more info visit the Rose Rehab page: http://www.rosecambodia.org/?page_id=12). The physical therapists at Rose have been working with her to help her gain the strength to sit up, and in order to get her hands moving Danielle brought a bunch of art supplies. We made simple shapes for her to paint in, and Danielle taught her a few strokes. Danielle and I were so absorbed in watching her work that it took a while to notice the dozen or so kids from the village in a semicircle around her, jealously watching her paint. It was a great visit. As we left, Danielle hung some of her paintings next to her bed with ribbon.

On the way back to the office, we stopped to visit a woman who had been badly burned on her legs by gasoline, and the physical therapists changed a bandage for her. Apparently a skin graft had failed to take, so there was still a gaping wound behind her left knee months after the accident. While we were visiting her, her neighbors brought another potential patient to see the therapists and placed him on the bed next to her. The man had been in a motorcycle accident and could no longer move the left side of his arm. The physical therapists assessed him and made an appointment to see him later at the clinic.

As we were about to leave, the neighbors convinced the therapists to see a woman next door who was having trouble walking. While the physical therapists did their thing, Danielle and I hung back and smiled shyly at some very friendly older women, who seemed to be staring at us. One of them started talking, half at us and half at the women around her. She then started wiping at her nose, as if to inform me that I powdered sugar on the end of mine, so I self-consciously started doing the same but she just laughed. One of the therapists translated, “She wants your nose.” This seemed hysterical at the time, so Danielle and I giggled about it for a while.

After the therapists had finished their work we got back in the tuk tuk, but before we could go there was some kind of commotion. The lady who couldn’t stop looking at my nose jumped into the tuk tuk and handed us each a coconut and a straw. We very gratefully accepted and drove off.


We made one last stop to see a beautiful young girl who was working with the therapists to build the strength in her arms and legs, and then we took a holiday all weekend (2 working days is long enough…)

Today Bill gave us a tour of the Rose Eye Clinic just outside Phnom Penh in the morning, and Danielle and I returned in the afternoon to observe glaucoma surgeries. We watched for 2 and a half hours as nearly a dozen patients underwent the 20-30 minute procedure. It was one of the most amazing things I’ve ever seen.

I may move to Cambodia when I’m a doctor just so I can operate in flip flops

More to come on what we’ve been doing with our play time in this wonderful country.

Posted by Jess at 2/21/2011

Little Tot’s amazing recovery.. with his new mouth !!

Cambodia Surgical Center assited by Canadian Govt. to help victims of Water Festival Disaster Nov 2010

 The Canadian Government is assisting victims of the November 2010 Cambodia Water Festival Disaster by an emergency Canda Fund grant through Rose Charities Cambodia Surgical Center / Operation First Cambodia.  Over 400 persons lost their lives in a stampede over a small footbridge linking an island in the Tonle Sap river just offshore from Phnom Penh, and the mainland.  In addition many persons were injured and need medical, surgical and rehabilitative assistance.   Cambodia Surgical Center which is run by Operation First at Chea Chumneas Hospital houses some of Cambodia’s leading surgical facilities in Camboida as well as a international standard physiotherapy unit.  It is anticipated that several hundred survivors are in current need of assistance and will be helped by Canadian generosity.

Surgery and rehabiliation for little ‘Tot’ with fused jaw..

Little5year old Cambodian ‘Tot’ who has the fused jaw has now had his surgery arranged. Dr Veronica Ventura begin of Community Health Development Cambodia.  He will fly down to Singapore for the operation which will be on the 4th January 2011.   Funds are still needed both fro Tot’ s surgery and rehabilitation, but also for his education and any special needs for return to life.   Rose Rehab Cambodia will be helping with Tots rehabilitation .  Funds are still needed.  Rose Charities is collecting for the Tot fund in Canada and in the USA (in both, tax receipts available). Please say donation is for ‘Tot’

(click image to enlarge)

Dr Veronica Venturas efforts for Tot have been simply amazing. She has worked day and night to ensure the best possible outcome for Tot. There is every chance that this little boy will rehabilitate to a happy, educated life.  Bravo Dr Ventura…!.