A Force for Good: My First Mission Trip to Cambodia

Ever had the desire to do humanitarian work in a third-world country? Dr Sanjeev Shanker, a Senior Resident from the Emergency Medicine Residency programme, fulfilled his yearning to do just that, with the help of the SingHealth Residency Travel Grant*. Dr Sanjeev recounts the challenging, yet rewarding experience he had on his first mission trip to Cambodia.

1. What motivated you to embark on this mission trip?

It started when my Programme Director (PD), Assoc Prof Mark Leong, sent out an email to the Emergency Medicine Residents informing us that he would be travelling to Cambodia to conduct the Advanced Cardiac Life Support (ACLS) course. Prof Leong has been going to Cambodia for years, and he invited the Senior Residents to join him as volunteers to teach and see how the healthcare system works in a different country. Getting involved in humanitarian trips has always been a dream of mine, and I also see it as 'taster' of what my future career could be like, so I signed up for the trip immediately.

2. Tell us about your mission trip.

We volunteered at a public hospital, Calmette Hospital, and worked closely with their Head of Medicine and other healthcare staff from the Accident & Emergency (A&E) Department. The staff were already well-acquainted with my PD as he had made several trips there previously. They were very happy to see us!

I was there with Prof Leong to conduct the ACLS course, which was developed as a structured way to handle cardiac heart problems when treating patients. Having attended several runs of this course previously, I knew that the knowledge provided by the course would be very useful to the healthcare professionals in Cambodia in managing their patients.

The two-and-a-half-day course attracted a diverse group of healthcare professionals—including doctors from the surrounding hospitals, nurses and even medical students. Before attending the ACLS course, the Cambodian healthcare professionals did not follow any guidelines in managing cardiac patients. After the training, they are able to use the standard ACLS structure to provide consistent treatment for their patients.

3. What surprised you most during the trip?

In Singapore, whenever the ACLS course is conducted, Singaporeans will attend it to get their certification, and then move on with their lives. In Cambodia, I was surprised to discover that everyone was so eager and interested to learn—the healthcare professionals had so many questions. It was rather challenging to teach because sometimes the questions asked were more complex than expected.

This was also my first experience working in a hospital with capabilities more limited than what I am used to. The challenges faced by the hospitals in Cambodia were eye-opening for me. I personally saw how the A&E department operates in another country, and witnessed how they managed different scenarios. Comparatively, in Singapore, we have much more established hospitals with advanced technology and more healthcare staff. Hence, such mission trips are useful as reminders for us Residents to keep our versatility no matter which Residency programme we are from.

4. Share with us the challenges that you faced during the mission trip, and how you overcame them.

Teaching the healthcare staff in Cambodia in the short period of time we had was challenging. The baseline knowledge that these doctors have is very different from what we have, and they needed to start learning from scratch without any prior knowledge of the programme. They are a few decades behind what we take for granted as being modern medical practice, and we had to bridge that gap before we could even start teaching the programme. To overcome this, we focused on what was important. For example, we focused on the cardiac part of the ACLS course and assessed their existing practices. We informed them that certain things that they do are now considered obsolete, and we had to get them to discard these practices while updating them on the current practices.

Another challenge I faced was communicating with the locals. Even though they speak English, it is not their main language. Most Cambodians speak Khmer and French. Some even did their medical training in French! So, we had some difficulties in conveying what we were teaching them.

5. What do you miss most about the trip?

I miss the people and their enthusiasm. The people whom I met were very friendly, and very eager to learn about the ACLS protocols and how they can be implemented. When I returned to Singapore and did a round of ACLS with my colleagues, the enthusiasm level was different (laughs).

6. How has the trip inspired you in your personal growth as a doctor?

It was my dream to visit a third-world country. Now, after seeing and experiencing it for myself, I see the challenges they face. I really enjoyed this experience. I learned to rely on my clinical skills rather than on technology. I know this is what I want to do in future, and the next step is to realise the chance to be able to work in such a place again.

In SingHealth, I know that some consultants in the A&E Department have travelled to Afghanistan for three months. Not only is this kind of experience good for our personal development, it is also beneficial for the hospitals. For example, when we do disaster planning for mass causalities, we rely on table-top exercises and drills. When doctors go to third-world countries, these scenarios could be day-to-day affairs, like a bomb exploding on a bus. Doctors must deal with the stress of having a flood of patients coming in all at once. They know the actual difficulties faced on the ground rather than what is 'imagined' as a difficulty. With such experiences, we can tweak and improve our own protocols after we return to Singapore, and this is something that I wish to do.

7. How has the SingHealth Residency Travel Grant opened up new opportunities for you?

The SingHealth Residency Travel Grant has provided me with this invaluable opportunity to do humanitarian work without having to worry about my air tickets, accommodation or meal expenses. I went on this trip as an extension of my day-to-day job, so instead of working in the Singapore General Hospital A&E, I was at Calmette Hospital A&E and teaching in their classrooms.

*The SingHealth Residency Travel Grant for Overseas Education Mission Trip is an additional benefit provided to MOHH/SAF-employed Residents undergoing Residency training in SingHealth. This Grant is set up to encourage and support Residents in their desire to participate in overseas humanitarian activities.