A HOSPITAL IN PHNOM PENH (CAMBODIA), AN EYE SURGERY

Having an eye surgery in a hospital in Cambodia isn’t easy to decide and isn’t something fun.

The lines that follow relate an experience lived in a hospital in Phnom Penh, an ophthalmologic experience, an eye surgery due to a retina detachment. This is my testimony, my experience of a surgical operation (in the left eye suffering of a retinal detachment), in no way a general opinion on a sector of activity. So take it as a personal example, nothing else.

We hear a lot of negative criticisms about the hospital environment and medical care in Cambodia. Apart from a common cold or diarrhea, most foreigners prefer to go for treatment in their country because here it is like: “I don’t trust them” or “they buy their diplomas”, or “they are zeros”. Let us leave these people free of their opinions, of their remarks bordering on defamation and let us have a fair vision of things, as objective as possible.

French version is available on the “ici” link / La version française est disponible ici

SERIAL ACTION

March 16, 2020

I wake up with a blackish spot wandering across my visual field and obscuring everything I am looking at along with thousands of tiny black dots or bubbles. Ouch! What happens to my left eye, the one that was successfully operated on for cataract four years ago at the Adolphe de Rothschild Ophthalmological Foundation hospital in Paris, just before I moved to Cambodia, the one that a 10 / 10 vision (the other having a very weak sight since I was young)?

I call my doctor: “Do you know an ophthalmologist in town?” -“No, but go to the Royal Phnom Penh Hospital, they have a good service”. Ah OK thanks. I go to the hospital website to make an appointment in the appropriate department.

 

March 17

The appointment is made at the Royal Phnom Penh Hospital, near the airport, thus pretty far, with a specialist. As little as I have seen, it is a beautiful hospital, modern, spacious, well equipped. After giving me drops followed by the examination, the doctor’s diagnosis is: vitreous hemorrhage (some injury and blood). Then he adds on the prescription and tells me to see an ophthalmic surgeon because this will require an eye surgery and gives me the name of the doctor and the hospital where he practices. I guess this one just examines eyes and prescribes corrective lenses…

March 18

The next afternoon I go to the Ang Duong Hospital, a fairly large complex made up of several buildings and departments including the Cambodia-Korea Friendship Eye Center where I go. Location is on Norodom Boulevard and 118 Street, 5 minutes and 3,000 Khmer Riel away from my home by Tuk-Tuk.

At the entrance, due to Covi-19, a hostess offers me a mask, takes my temperature with an infrared thermometer, and invites me to use the bottle to put gel on my hands. Almost all of the visitors are Khmer, the signs are written in the local language (with English subtitles), all administrative papers, prescriptions, invoices are printed and completed in Khmer and the amounts in Riel. Only the doctor adds important words in English for the very rare Western or Barang patients. At the reception I ask for Doctor Un (prononce “Oun”) Leng. Bad luck, he is not there and will not be present until the next morning, like every morning except Sunday.

 

 

 

 

 

 

 

 

 

 

March 19

Here I am again at Ang Duong Hospital. A bit old despite the rather recent architecture and poorly adapted. Thus a lot of wasted space, a huge gently sloping access ramp (for wheelchairs) in the center, narrow rooms, offices everywhere, collective examination rooms with rows of devices… In short, this is neither an ultra modern nor a deluxe place but it is well equipped (material made in South Korea I suppose) and clean.

I walk to the room indicated for what will be the first meeting with Doctor Un Leng. Rather young, smart, serene, shirt and tie under a white blouse. Same examination and same diagnosis as his colleague at the Royal Hospital, no eye surgery required yet. Prescription of eye drops and re-appointment two weeks later. Fifteen days during which I wonder what a vitreous hemorrhage is, if it is serious, if it can be treated and how, what result can I expect, etc. But I’m not even going on the Internet to search for any information.

 

April 3

Second appointment and second examination. Modification of the diagnosis: My eye is suffering of a retinal detachment (décollement de la rétine en français). Now this is serious matter. And, above all, that cannot wait, it is necessary to have an eye surgery without delay. “Would you like to go to France for the operation?” -“Uh, Doctor, the planet is currently living with Covid-19 with quarantine and confinement, no more regular flights for over a month. I have no choice and will stay here. I trust you since you are the one who will do the surgery.” Ok here we go for April 8th at 7:30 am. “By then, Mr. Poupard, no alcohol no cigarettes, for three months”. Ouch: no wine or cocktails is just a a lack of pleasure but for the cigarette it’s going to be hard, very hard. “And no physical exercise of any kind.” That, I will be able to manage.

 

April 8

There are a dozen people waiting in the hallway. Before the intervention a session of special eye drops during one hour. Then, sanitized shirt and pants. And let’s go to the 3rd floor, in the operating room. Local anesthesia by a young man who seems to be a specialist. Much apprehension as you see the syringe sticking a few millimeters from the eyeball. Three times in a row! It scares the hell out of it, but it’s not painful. You just have to hang on there and be trustful. When it’s done, I will have the eye surgery, a vitrectomy (getting rid of the vitreous film that is around the retina) using a laser, plus placing silicon oil and a protection.

I am accompanied to one of the four rooms, each with 2 intervention stations and an equipment that seems ultra-modern to me. I will skip the details of the hour and a half of the laser eye surgery. I do not feel anything and am attending a psychedelic, multicolored, rich show. For long minutes appears what looks like a skull that goes through all colors of a rainbow. Not to be taken for a bad omen…

A big bandage is put on my eye and that ends up the procedure. Dr. Un Leng asks me to keep my head tilted forward, to sleep on my stomach, to rest, to move as little as possible. And, guess what,  no “don’t smoke” 🙂

The nurse takes me down to the room which will be my collective bedroom (eight beds) for the night because injections (in the leg’s muscle) must be done in the evening and the next day when getting up. It’s only 2pm, I’m hungry and the afternoon is going to be long, very long. In addition, it is impossible for me to read, to go to my Facebook because my (valid) right eye only gives me a blurry vision of texts. I’m so bored that I walk around the hospital and go outside to… smoke a few cigarettes.

The next morning, the assistants remove the bandages from the operated persons. And for each one of them the surgeon examines the results of the eye surgery. He looks satisfied except this: “Mr. Poupard, I told you yesterday to lie down and not to make any movement or effort. However, an assistant saw you walking through the hallways Luckily she didn’t see me when I smoke! “We’ll see each other in a week and, I repeat: no alcohol or cigarettes for three months”. Ok Doctor, I’ll try. Back home for a series of selfies of the poor eye. Scary isn’t?

April 16

And I tried; I slowed down the number of cigarettes a lot and even managed not to smoke a single one for three days before this new appointment. New examination by Dr. Un Leng. The healing seems to be going well. We change the drops and meet again in two weeks.

April 28

Nothing to say after today’s review. Things are not looking bad and, hopefully, it will be over in two months from now. Before this deadline, the lesions must be cleaned and the micro scars due to the eye  surgery removed. It will be done in about eight weeks. In the meantime, an appointment is made for a new check. And in the meantime, I will still see life in a blur…

May 22

The hospital has modified its equipment to deal with Covid-19: outside, the hostess, dressed up like a deep sea diver, takes your temperature with the infrared thermometer, invites you to put your hands under an automatic dispenser of antiseptic gel, and to pass through an airlock to receive a good blow of disinfectant fogger. With shampoo you could almost wash your hair. But rinsing would not be so easy…

I go upstairs for another exam with my surgeon. Everything is in order, not to say all is well and the second intervention is scheduled for June 27. What I didn’t know is that retinal detachment surgery doesn’t count in days, or even weeks, but months, endless long months. Between the initial operation and the end of the convalescence it can take at least three months and six in some cases. Usually it’s in between.

 

June 27

Second intervention. Nothing to compare to the first one, it’s not going to be an eye surgery. I am given anesthetic drops before following Dr. Un Leng in an unoccupied room where there are 4 or 5 small laser devices, similar to standard analysis instruments but with the famous healing ray. And here we go again for three-quarters of an hour of a very unpleasant and slightly painful session at the end when the very bright laser beam gets more intense and lingers on the spots to be treated.

According to the surgeon, the result is satisfactory and everything is looking good for the final phase set for in a month. Before I leave, a new prescription for more drops and “See you in a month Mr. Poupard and no cigarettes, of course”.

 

July 27

Early in the morning, pre-surgery examination to check that everything is in order, as planned and that the operation can be done the next day. Yes, it’s good, phew! I was so apprehensive about an issue that would have forced a postponement of the final act. This third and last operation will consist in removing the silicone oil protection that was placed around the retina during the first intervention. I can’t wait tomorrow!!!

 

July 28

The longest day for the final ey surgery. Arrival at the hospital at 7a.m. There are many people in the entrance hall, also in the hallway in front of Dr. Un Leng’s office. It seems that there has been a massive attack by a monster bug that particularly affectionates the eyes of the people of Phnom Penh. Like in a (very) bad science fiction movie. Some people have just come over here for an exam and others are, like me, for an operation. What looks like a mess is actually under control: the assistants know exactly what to do, the patient flow is channeled, the papers are in order, the candidates for surgery are called to give them sanitized shirt and pants. The group of five, which I am a part of, is then escorted into the waiting room on the 3rd floor and we are over thirty people. I think that I would be very lucky if I got out of this place before dark.

Not at all, the assistants let one or two people get and it’s my turn to sit in front of the operating room. Dr Oun Leng greets me and casually says two words. A nurse put a few drops (again!) in the eye and, half an hour later, the anesthetist comes to get me for the famous anesthetic injections. Three times this time, even more unpleasant than the first time. Yet I had known this experience and I should have remained calm. No way, the assistant is holding my arm, saying to relax to reassure me. In fact, retrospectively, it’s not the pain or the stings that stressed me out, but the thought of losing your eye…

The nurse walks me to the right operation room on the right chair and sits me in, puts a sheet on my legs, places my arms properly, as for the first intervention. The surgeon is sitting next to the laser machine but, oh surprise, I hear a female voice when she puts the oxygen tube into my nostrils. So it’s not Dr. Un Leng!!! ??? Well I say to myself that if he has delegated it is because he has complete confidence. Correct: she speaks well English and asks me to tell her who I am, to talk about my life in Cambodia, what places I have visited, etc. just to entertain me. This only lasted a short time and with the sterile equipment and the device that keeps the eye wide open in place, it’s going to last one hour.

This time, no psychedelic images or other fireworks, just the laser light coming and going. Halfway through, I hear Dr. Un Leng’s voice speaking quietly to surgeon lady whom he is going to replace to complete the operation. I don’t know why, but I’m happy. The very end of the hour is very unpleasant and almost painful, despite the anesthesia, and I feel he pulls something out in one last movement. Finally, the surgeon turns off the laser, places a large bandage on the left side of my face, gives me some advice for the end of the day and the night, not that of refrain from smoking (for the first time), and gives me an appointment the next morning. He is calm and serene as usual. I can go home.

July 29

Post eye surgery examination. I open the eye once the bandage is removed and the drops (again!) applied. The moment of truth is here, it’s not perfection, but it’s close. I can see fairly well and I am delighted! Still two to three weeks of recovery after the shock of the last surgery, Dr. Un Leng tells me that my sight will be as good as four months ago. Meanwhile, wearing sunglasses is mandatory as soon as I go outside and it is forbidden to wash my face with lots of water or take a dive in a swimming pool for a month. Anyway, I leave the hospital happy. But a little less due to the 2 bottles of drops I have to put in the eye eight times a day, that is to say every hour and a half. What a pain!

August 4

Follow-up examination, one week later. Everything is fine, no aftermath due to surgery, the retina is like new. We will finish the drops previously given to and put two new at the frequency of four times a day. Ten days before my birthday this is good news. I am finally relaxed after four painful months.

CONCLUSION

A retina detachment is not a disease and not physically painful (there many much worse!). It just requires an eye surgery (the vitrectomy) with a rather light local anestesia. But the psychological pain is very strong: seeing everything blurry and cloudy (when you use to have a perfect 10/10), making great efforts to read books or screen, let the eye rest as much as possible, not recognizing people crossed and who take me for an impolite or in a bad mood person, difficulty crossing the streets, seeing all the bright spots at night, the headlights of a motorcycle for example, not as a single point but as a circle of ten or twelve (dangerous!), to think, at the beginning, that the eye may be lost forever. Terrible!

 

THANKS

• My first thank you goes, of course, to Doctor Un Leng, a brilliant Khmer ophthalmic surgeon and whom I was right to trust in the first place. Arkun Chram Kroupet Pnek !!!!
• My second is for the Ang Douong Hospital, a serious establishment well equipped in terms of personnel and equipment.
• My third goes to my Khmer lady Dana Kan who was close to me throughout these endless four months, who was able to free herself for these 11 days and half-days at the hospital (going home alone would have been perilous), was present by my side and administered hundreds of drops in my eye.
• The penultimate thanks are for my three daughters, Eloïse, Lucie & Joséphine and for my brother (in France) who, via the Internet, have regularly asked news about my eye. Same with friends and people bumping into me on Facebook and/or seeing me here and there in Phnom Penh, thank you all!
• And the last thank you goes to my lady’s bosses, Vannaro et Olivier, my very good friends at Soga Bistrot, who, without any hesitation, granted her the necessary changes in her schedule to allow her to accompany me.

Oops! And thank you for reading this story.

Finally, August 28 will be my twelfth and last appointment with Dr. Un Leng. I think and hope that I’ll have nothing more to add on this subject.

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