PEA REANG, Cambodia — Far outside the increasingly modern capital of Phnom Penh, out amid countless waterlogged rice paddies and farms of pink lotus blossoms where villagers eat deep-fried tarantulas as a treat, a survivor lies in a hospital bed tethered to brand new medical equipment.
The genocide she lived through as a teenage girl wiped out a third of Cambodia’s population. The murderous Khmer Rouge executed most of the people with formal education, especially doctors and nurses: 95% of them died or fled the country in the late 1970s.
Now 56, Chun Phaly faces a new threat that challenges the capacity of her province’s health care system. In fact, her sister brought her to the hospital in Pea Reang (pia re-ANG) from a neighboring province, drawn by reports of the new capabilities at this rural hospital, with its eight small, single-story, white stone buildings. One building houses a tuberculosis ward, and it is full.
“I heard Pea Reang had the best hospital,” Phaly says.
The tools her caregivers are using to save her life were unavailable here three months ago.
Phaly recently has grown weaker and weaker. Daily tasks began to leave her short of breath. Then she no longer could walk across a room without feeling dizzy and lightheaded. So her sister packed her up three days ago and brought her to this hospital with a growing reputation as shiny as its new equipment. A new report recently ranked Pea Reang Referral Hospital the nation’s third best.
Here, a medical assistant inserted an IV line in the back of her right hand, placed a white oximeter clip on her right forefinger to measure her oxygen level in her blood. Around her left bicep, a nurse placed a gray cuff attached by a gray cord to a sparkling white electrocardiogram machine that measures her heart’s electrical activity. The monitor revealed her problem. She has Brady cardia, an arrhythmia with a dangerously low heart rate, well below the normal range of 60 to 100 beats per minute. Such a low heart rate is typically a sign of heart damage or disease.
The medical team prescribed a five-day course of medicine. Three days later, as a reporter visited the hospital, the staff puts the oximeter back on her forefinger and returns the cuff to her bicep.
The gold number on the monitor — 64 — shows the medicine is working. She feels better.
Phaly is fortunate. Cambodia doesn’t have paramedics. Emergency rooms and emergency care are rare. So is basic cardiac care and equipment.
She is the beneficiary of a unique new partnership with Latter-day Saint Charities that is rapidly improving basic emergency care and other conditions at this hospital and its satellite health centers in surrounding villages. A surprisingly strong relationship has emerged between the government of a country whose 16.5 million citizens are 98% Buddhist and the Christian charity sponsored by a church with fewer than 15,000 members in all of Cambodia.
Early this century, Cambodian doctors earned $20 a month. Nurses made $10. Health care here lags behind other Southeast Asia nations. One reason is a long-standing, acute shortage of medical workers who face an overwhelming number of patients.
For example, Pea Reang is home to nearly 125,000 people. Its hospital staff consists of 14 doctors, 130 nurses and 24 midwives.
They work without basic equipment. Training also is lacking, more than half of healthcare workers said in a recent survey.
But conditions are changing for the better, and the opportunity for rapid growth is strong. The economy has grown by 7% a year for two decades. The median household income is now $1,500 a year. The government has invested more in health care. Doctors now make $350 a month, nurses $250. The ground was ripe for targeted aid.
Phaly knows she is the beneficiary of a swirl of circumstances lifting the capacity and capabilities of the staff at Pea Reang Hospital.
“Now her heart is acting normally,” said Elder Michael Warner, a retired physician serving as a medical missionary for The Church of Jesus Christ of Latter-day Saints in Cambodia.
The machines attached to Phaly are donations that are part of a new effort by Warner and his wife, Sister Linda Warner, and three other medical missionary couples backed by the donations to Latter-day Saint Charities. The couples live in Phnom Penh, but they are working with national, regional and local governments to upgrade the medical care in rural communities well beyond the capital city.
The oximeter, the electrocardiogram and the monitor the staff is using to help Phaly arrived in August. Other donations have followed. Last week, the missionaries facilitated emergency medical training for 200 police officers.
“Traffic deaths are a terrible problem here, and police are the first responders,” said Elder Bob Armstrong, a retired doctor.
“We feel like we’re on the edge of making a difference,” Warner added.
Lying in her bed as the late morning heat and humidity steadily build, Phaly smiles as she makes a case from personal experience that they have crossed that threshold.
“I have new hope,” she says.
The first donation to this hospital sparked unexpected reactions by hospital staff that went well beyond the excitement of receiving badly needed basic equipment.
First, the staff locked its two new portable defibrillator units with permanent paddles in a locked closet. The medical missionaries were stunned when they returned to evaluate how the equipment was being used. Why was an emergency medical device needed at a moment’s notice locked away out of reach?
Local government officials, anxious to be good partners with the charity, had urged hospital workers to safeguard the new equipment. The medical missionaries discussed the challenge with the staff. The next time they returned, they were astounded and delighted. To resolve the competing issues of security and immediate access, the hospital’s team built a small, secure room behind high glass walls set in concrete.
The defibrillators now are readily available, and the district has its first ER, which doubles as the hospital’s intensive care unit. Phaly lies in one of the ICU beds when her vitals are monitored.
Three emergency care beds for 125,000 people may not seem like a lot, but the construction of the combined ER/ICU sent a strong signal to the medical missionaries. The hospital, its staff and the local government leader overseeing them were deeply invested in improving.
“We weren’t sure at first we would continue with this project,” Linda Warner said. “Then we saw how they took ownership.”
Her husband said the staff hungers for more training. In fact, when the missionaries visited the hospital last week, staff made a new request for help that centered more on training than equipment.
Armstrong said the partners have created a healthy cycle. Donated equipment leads to better diagnoses, which create new questions about providing care to treat diagnosed patients. The medical missionaries feel they are focusing resources in a way that’s building the medical staff in long-term ways.
“The one big difference this project does is provide training so the staffs internalize what can be done with a donation,” Armstrong said. “Then, on their own initiative, they build this glass ER because they realize what is possible for them now.
“They’ve made significant improvements.”
“We’re building an entire location,” added his wife, Bev. “This is not item-specific. It’s need-specific.”
A great unknown
Bob and Bev Armstrong arrived in Cambodia 14 months ago, after he retired as a doctor in Manti, Utah. Their mission was to lift health care in a nation of 16.5 million people. They were alone.
They immediately set out to assess the health care system. They now have visited 60 health centers, the tiny hospital satellites based directly in rural villages.
“We’ve got a good idea of the needs now,” Bob Armstrong said. “We spent almost a year assessing. Now we’re in gear.”
He said the combined ER/ICU is an expression of the needs they found.
The Warners and two additional couples arrived this year to help the Armstrongs build up the initiative, which is a departure for Latter-day Saint Charities.
“This is a different project than those we’ve done in the past,” said Chad Furness, the church’s Asia Area welfare and self-reliance manager. “Usually, we work through non-governmental organizations. We’re not doing that here. We’re working with the government and the hospitals. It’s an effort to get closer to the leaders and people.”
The new method can be more efficient, he said. “What we’ve found is that the NGOs and the government often give us different stories about what the priorities are. They don’t always align. Now we learn the priorities directly from the hospital or health center or the government official overseeing them.”
Then, he added, “We tell them, ‘We will help support and build and train.’”
The Armstrongs, who have four months left in their mission term, are grateful to have three other couples helping them. They say each medical missionary couple sees different needs because of their different medical backgrounds and specialties.
“We’re evaluating and discovering the needs of rural or small facilities and organizing for the donation of needed equipment.
The project is expanding to help the medical facilities with sanitation, from sterilization to cleaner toileting.
‘I wanted to contribute here’
Village doctors here do heroic work, when there is a doctor at all.
While Phaly was being treated at the hospital, a woman named Phirun Manin was giving birth at one of its satellite health centers in Mesa Prachan, a village nearly an hour away by a bone-rattling car ride over dirt roads.
Keo Sarith grew up here. Once he was trained as a nurse, he recognized just how much his village needed a doctor. So he returned to medical school in Phnom Penh. Since 1998, he has labored as the only doctor for about 10,000 people in his and the neighboring villages.
“This is my home, this village,” he says. “I wanted to contribute here.”
These small health centers provide only for basic needs: immunizations, primary care and newborn delivery services.
Dr. Sarith looks tired when the Armstrongs and Warners show up at his center on a recent afternoon when the sunshine here 800 miles north of the equator is at its brightest and warmest. But he smiles broadly as the missionaries and his staff begin to unload a pickup full of equipment. There is a brand new, pink-upholstered obstetric delivery bed, an electric steam autoclave for sterilizing instruments, surgical tools for cleaning and suturing wounds, little blue suction tubes for clearing mucus from the nose and throats of newborns, a pocket-sized fetal monitor and more.
The staff and some government officials stand under an awning in the heat at the front of the center to watch a nine-minute video Warner made about sterilization and the autoclave. The hunger for information again is apparent. The entire group, in spite of standing in the heat, is riveted. Their eyes never leave the screen.
“Cambodia is very grateful for this contribution. We are very honored to be part of your mission,” said His Excellency Meach Sophana. Sophana is a tall, vibrant, athletic-looking four-star general with a shock of black hair. The forward-thinking politician is assigned to oversee this district as a secretary of state in the Ministry of the Interior.
“Dr. Sarith will make sure that when you come back, everything will be intact and in use,” Sophana told the missionaries. “I appreciate this video. They receive this training as doctors, nurses and medical assistants, but this review reminds them of what they learned and to follow the proper procedures.”
Sophana, who studied journalism at New York University and whose two sons graduated from West Point, has been building a relationship with the church and its charity for more than two years.
“These people are really happy to see the church help us improve and gradually upgrade our hygiene, our well-being and our health standards,” he said.
In an interview, Sophana said the Cambodian Dream isn’t much different than the American Dream: People want to live with dignity and ensure that their children have access to good basic health care.
The night before the donations at the hospital and Dr. Sarith’s health center, Sophana met the church’s leader, President Russell M. Nelson, on his first visit to Cambodia.
“Any work the church carries out throughout the country, I join,” Sophana told President Nelson. “I facilitate so the mission is possible and achievable. This is a noble mission we can do together for a humanitarian cause.
He used Asian phrasing to describe to President Nelson his praise for the work of regional and local church leaders and missionaries.
“Your children and son have put a lot of effort into improving the standard of living for some of our villagers, and we are very grateful,” he said.
After the two men met, President Nelson told Sophana and nearly 3,000 other Cambodians during a speech that, “I am very optimistic about the future of Cambodia.”
His traveling companion, Elder D. Todd Christofferson of the Quorum of the Twelve Apostles, spoke with Sophana and other Cambodian dignitaries. He said he’d been to the country once before, about a decade ago, and that he was impressed by what he saw on this visit.
“We have seen significant change for the better,” Elder Christofferson said. “This appears to us to be a country that is progressing rapidly. We’re grateful for that because we want our people and all people to prosper. ... We extend you our deepest gratitude. We pray for your happiness and your success.”
The day Phaly’s heart rate returned to normal, doctors and staff at Pea Reang Hospital held a reception for the medical missionary couples, who brought five IV infusion pumps, two pocket fetal dopplers and four stethoscopes.
“We are so grateful that Latter-day Saint Charities has brought equipment to donate to the hospital,” said Thoeun Pros, a chief medical assistant.
Wearing a white lab coat over a maroon collared shirt and with his head covered by a round, white surgeon’s cap, Pros then provided a slide presentation showing how often the hospital has used each piece of equipment previously donated. The staff has, for example, used the patient monitors 225 times.
“We’re so happy to hear you are using the machines,” Warner told them.
In his presentation, Pros included a request for additional donations. The hospital needed an oxygen concentrator, a new generator and training in echographs and additional training on use of the electrocardiogram machine, he said.
“We’ll look into those and do the very best we can,” Warner said.
Afterward, Warner went around the back of the hospital to evaluate the generator. He returned with photographs.
“It’s abysmal,” he said as he huddled with Furness, the area manager. “It’s sitting in water.”
“The things they asked for are in line and things we can do,” Furness said.
As for the training, some is in the pipeline and requests for more are welcomed. The Armstrongs and Warners already have promised to look into cardiac treatment training.
“In the coming months, we have people from the United States coming to provide training on bleeding after pregnancy and what to do when delivering a child whose shoulder gets stuck or is breach,” Elder Armstrong told them.
The Americans are from ARISE, a Utah-based organization. ARISE signed a contract with the church’s Asia Area to recruit doctors and nurses to travel to Cambodia at their own cost to provide training.
The first visit will be at Pea Reang in January. ARISE co-founder Julie Ann Rhodes previously brought two teams from Weber State, where she is a nursing professor, to conduct trainings in Cambodia.
“Not every country is ready for medical help,” she said. “Some are still learning to feed themselves. Cambodia is ready. It’s doing a good job feeding itself. Cambodians are anxious to start. We find hungry medical staffs who demonstrate that they remembered their training.”
Mutual trust now undergirds the public-private partnership between Sophana, the hospital staff and its satellite health centers and the medical missionary couples, their leaders and the church.
“We have visited all of those centers multiple times,” Bob Armstrong said. “We’re friends now.”
Sophana, the four-star general, was a key figure in the relationship, as were the Armstrongs, said Dr. Hout Kalyan, the district operations director for the nine health clinics.
“When we started, we just spent time getting to know each other,” Kalyan added. “The church came and tried to find out the needs of the hospital. Then the church began providing equipment and training so the hospital can provide better care to people. We hope the church continues to support the hospital with equipment and training.
“It’s much better now because of the equipment and knowledge we’ve received has allowed us to provide better service.”
The hospital staff launched a marketing campaign after they built its glass-enclosed ER/ICU on their own.
“I’m pleased,” said Dr. Kalyan, beaming behind black, horn-rimmed glasses. “I’m very proud.”
The marketing campaign is what brought Sinat Yet here. Yet, 33, gave birth last night to her third child, Mony Rith. She had her last baby at home, but traveled out of her own hospital district to this one so she and Mony would have the best care if complications arose. None did.
Perhaps the same will be true for Phaly, and she will go home on time two days from now.
“I’m happy,” Phaly says, as her sister smiles. “I’m thankful to the church for providing the equipment and tools to help me. And it’s such a relief that the service here is free.”
Sophana said he wanted the church to put up a plaque to commemorate its donations at the hospital and health center.
“I don’t want it to be a freebie,” he said. “I want it to be mutually beneficial. We have to reciprocate what the church has done. I am very pleased and proud to be part of this noble mission, of this humanitarian cause. We are committed to working with the church on it because we want to make a contribution. We will be successful.”