Address correspondence to:
Thomas E. Serena, MD, FACS
The Serena Group
552 Quaker Hill Rd.
Warren, PA 16365
E-mail: serena@healingwounds.com

   In 15 years as a general and vascular surgeon, I have witnessed unspeakable tragedy in the trauma room. Everything from having children die in my arms after suffering abuse from their parents to telling countless patients the dismal truth that they have incurable cancer, to wading through wound clinics across the United States. However, none of these experiences prepared me for Phnom Penh, Cambodia. The surgeon’s machismo that insulates him from the unavoidable suffering of his patients failed me shortly after arrival. Squalor and suffering in the hospital wards of Cambodia’s capital city is piercing. Landfills are populated by orphans. Land mines maim. Torture prisons, which are now museums, and the killing fields serve as reminders of the recent devastation brought on by the Khmer Rouge reign of terror. Yet, despite the sorrow, the Cambodian people remain resilient. Nurses and doctors are inspiring. As for me, the volunteer, I was a wide-eyed medical student anxious to ply the healing art. I left Phnom Penh vowing to return. I cannot thank the Association for the Advancement of Wound Care (AAWC) and Health Volunteers Oversees (HVO) enough for this opportunity.

   Reports from volunteer trips inevitably read like National Geographic travel logs. As a long-time fan of such periodicals, I make no apologies. However, my goal is to introduce you to Cambodia, its remarkable people, war-torn past, and fledgling medical system. I will focus on clinical and educational challenges, the commonly encountered diseases, and the most pressing needs from a wound healing perspective.

   Our team consisted of a physician and a nurse. Joe Meyers, long-time friend, business partner, registered nurse, ex-Marine, and Brooklyn native, handled nursing education and hands-on dressing demonstration. At more than 6 feet tall, he was the largest person in Phnom Penh. The combination of physician and nurse was well suited to paternalistic Cambodian society. After spending 3 hours with a group of nurses from a local Phnom Penh hospital, the head nurse delicately requested that we repeat the lecture for her physicians. “Doctors do not listen to nurses,” she whispered to me. I must have had a guilty look on my face because she quickly added, “Khmer doctors, I mean.” I had to admit that even though I practiced medicine in one of the most progressive countries in the world, I have on occasion failed to listen to suggestions from my nursing staff—and usually regretted it later. We made certain that the medical staff received the same instruction.

   Our only cultural preparation for the trip was watching the movie The Killing Fields, starring Sam Waterson and Dr. Haing Ngor. Although the movie was graphic, the Hollywood version paled in comparison to the real life devastation of Phnom Penh. In the late 1970s, the Khmer Rouge executed all of the nurses, doctors, and anyone else with an education. In fact, wearing glasses alone could result in a trip to Toul Seng, a local high school converted to a torture prison. At lunch one day, the three nurse educators at Sihanhouk Center of Hope Hospital (SCOH) described how their families, most involved in medicine, were executed outside of the city in the killing fields. They had survived by leaving Phnom Penh with the rest of the population to work in the rice fields. One of them, Horn Hong, RN, accompanied Joe and me to the Killing Fields genocide memorial that afternoon. Today, bones of murdered men and decapitated women and children work their way up through the ground from shallow mass graves.