As a member of the Southeastern Board for the American Academy of HIV Medicine, I received a request for volunteers to teach local physicians how to properly treat HIV and AIDS in a developing country. Deep in my heart I immediately knew this was a call from God for me to GO. This would be a three month commitment. I was very fortunate to find a physician to keep my clinic open during my absence.
It was a twenty-eight hour flight to the other side of the world. Jet lag and the twelve hour time difference took some time to get acclimated. Cambodia is located in Southeast Asia bordered by Thailand on the West, Viet Nam on the East, Laos to the North and the Gulf of Thailand to the South. It is the poorest country in the world with an average income of 88 cents per day. Cambodia is populated by the Khmer people numbering approximately 12,500,000. Approximately 95% of the country practice the Theravada Buddhist religion.
I was assigned to two hospitals in the northern province of Bantay Meanchey. The provincial hospital was in Monkol Borei approximately twelve mile from Sisaphon (Sis’-a-pon) where I nestled into my hotel, the Phnom Svay. The hospital in Sisaphon is partially funded by the CDC. I made clinical rounds every morning with the local physicians on their patients teaching them how to perform physical examinations and how best to care for their patients. I found the doctors very reluctant to touch these patients. My primary goal in these morning rounds was to show them how to be compassionate caregivers by hands-on example. Every afternoon was devoted to a two-hour lecture for the entire length of my stay. I found these physicians had a healthy thirst for knowledge. They literally knew nothing about the pathophysiology and the treatment of the HIV virus. They had extensive experience with the common opportunistic infections that accompany the end stage of this dread disease.
HIV / AIDS has decimated this poor country. This disease affects every aspect of its society. Men, women and children alike are dying by the scores daily. When patients are hospitalized in Cambodia, families accompany them to care for them during the hospital stay. Nurses are there only to give medications and family members are expected to feed, clothe and render other care as needed. Children are born with HIV and by the time they are four or five years old they are orphaned. Grandmothers thus become the primary caregivers to these children. Tuberculosis is the primary predator of these children affecting them at any age. By the age of seven or eight years, these orphans’ CD4 counts are under 250.
One day, while wondering through the HIV ward after morning rounds at the Bantay Meancheay Provincial Hospital in Monkol Borei, I found a small child who appeared lost, confused and crying. Little Em Tear, or “Tear” as we came to call him, had accompanied his dying father to the hospital to care for him. Tear had already lost his mother to HIV and had no other family members. He was seven years old…but only looked like he was four… when I found him sick, feverish, coughing and covered with purulent sores on all his extremities. His father had died in the hospital and the workers had carried him away leaving Tear sick and confused. I admitted him to the ward and treated his pneumonia and draining sores.
He responded to therapy rapidly but an HIV test proved he was infected as we had expected. Since he had nowhere to go, I decided to keep him in the hospital for the duration of my stay. Daily I brought him cookies or candy as a way of letting him know he was special to me. He began to call me “his papa”. We became quite attached to each other then went about to find an orphanage that would take in an HIV-infected child. I only found two in the entire country that would take HIV infected children. One, a Pentecostal home, was full and the other was a catholic orphanage operated by the Marynoll catholics in the capitol, Phnom Penh six hours away.
Richard Kauffman, M.D.
