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Imaging in the Khmerâ•Žs Land: Cambodia Country Report

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Imaging in the Khmerâ•Žs Land: Cambodia Country Report COUNTRY REPORT Imaging in the Khmer’s Land: Cambodia Country Report Samantha G. Harrington1*, Joseph Makris1 1 University of Massachusetts Medical School, Worcester, MA, USA *Corresponding author. Current address: 55 Lake Avenue North Worcester, MA 01655; [email protected] OPEN ACCESS economic improvement and a growing healthcare Introduction system improved the life expectancy to 63.78 © 2015 Harrington and Makris. This CAMBODIA is located in Southeast Asia on the years by 2015 (2). The physician density remains open access article is distributed low, at 0.17 physicians per 1,000 people (2). As of under a Creative Commons Attri- Indochina Peninsula and borders Vietnam, Laos, bution 4.0 License (https://creative- Thailand and the Gulf of Thailand (Figure 1). With 2012, there were eight national hospitals and three commons.org/licenses/by/4.0/) a total area of 69,898 square miles and population levels of referral hospitals in the public sector. of 15,458,332, Cambodia’s population density Referral hospitals are categorized by three levels DOI: 10.7191/jgr.2015.1016 has steadily increased since 1980. The country’s of Complementary Package of Activity (CPA): 1) CPA-1 hospitals do not perform surgery; 2) CPA-2 Received: 8/27/2015 annual rate of urbanization is 2.65 %. As of 2014, 20.5% of the population lives in an urban setting. hospitals perform surgeries but with more limited Accepted: 9/18/2015 The estimated population growth rate is 1.63% (1). specialized services; and 3) CPA-3 hospitals The capital of Cambodia is Phnom Penh, which perform surgery with more specialized services. Published: 11/18/2015 is located in the southern part of the country. There are 26 CPA-3 hospitals in Cambodia (3). As of 2011 there were 2,391 doctors, 8,433 nurses and Citation: Harrington SG, Makris J. Other major cities include Battambang and Imaging in the Khmer’s land: Cam- Siem Reap, both of which have populations over 3,748 midwives (3). There are also NGOs that run bodia country report. J Glob Radiol. 150,000. There are officially 24 provinces and hospitals throughout Cambodia, as well as private 2015;1(2):Article 2. one municipality (Phnom Penh). However, many sector health care facilities. consider Phnom Penh to be its own province. Keywords: Cambodia, global ra- As a result, some research puts the number of diology, diagnostic skills, diagnostic The radiology environment equipment, radiology market, global Cambodian provinces at 25. public health The climate is tropical with two seasons: Radiologists in Cambodia monsoon season (May to November) and dry Word count: 4,444 season (December to April). Temperatures range The exact number of radiologists in Cambodia from approximately 70 to 95°F. Cambodia’s is unknown, but informal numbers range from economy largely depends on the garment industry, 20 to 60 radiologists nationwide. Due to the lack tourism, construction, real estate and agriculture. of formal organization within the Cambodian Cambodia gained independence from France radiology community, it is extremely difficult to in 1953 and was first ruled by a constitutional estimate the exact number of radiologists. monarchy under King Norodom Sihanouk. The total number of specialist medical After a five-year struggle starting in 1970, the practitioners in all fields in 2011 was estimated Khmer Rouge captured Phnom Penh in 1975. to be 351 (4); the percentage of radiologists from Pol Pot, the leader of the Khmer Rouge, oversaw the specialist sector is not specified. Cambodian a brutal regime that, through executions and specialists must complete six years of medical forced labor, was responsible for the deaths of at school to receive a Bachelor of Medical Sciences least 1.5 million Cambodians. The Vietnamese (BMedSc), followed by 3-4 years of specialized drove out the Khmer Rouge in 1979. After years training, for a total of 9-10 years of training. After of Vietnamese occupation, the 1991 Paris Peace completion of their training students are awarded Accords established a ceasefire and a democratic a Degree of Specialized Doctor (MD-D.E.S). Much framework for the country. By 1993 elections of the radiology training is structured like an established a new coalition government; yet, apprenticeship. There is no standardized radiology political instability and violence persisted curriculum or licensing exam, nor is there any throughout the 1990s. Cambodia most recently known continuing medical education curriculum held elections in 2013, as a multiparty democracy for radiologists. Since the vast majority of the under a constitutional monarchy. radiology equipment in Cambodia is located in The devastation caused by the Khmer Rouge major cities, where most radiologists are found in has had long-lasting negative effects on Cambodia’s urban areas. political and economic systems, as well as to its infrastructure, and public health. Despite this, Technologists in Cambodia Cambodia has made measurable improvements. University of Health Sciences (UHS) is the ISSN 2372-8418 At the end of Khmer Rouge rule in 1980, life only institution in Cambodia that trains radiology expectancy was 30 years (1). Political stabilization, technologists (4). The total length of training is 1/6 | 10.7191/jgr.2015.1016 November 2015 Journal of Global Radiology JGR Harrington and Makris (2015) Figure 1. Cambodia Map No. 3660 Rev. 4. 104° 105° 106° LAO PEOPLE'S 107° DEMOCRATIC REPUBLIC CAMBODIA THAILAND Samrong Cheom Ksan Siempang an g g S 14 en n 14 ° Sr o ° K BANTEAY Phnom Thbeng Meanchey STUNG RATANAKIRI MEANCHEY TRENG Boung Long Poipet SIEM REAP PREAH VIHEAR g n o Sisophon k Lumphat Angkor Wat e Stung Treng M Siem Reap has C n Battambang e 13° Tonle S 13° Sap Pailin BATTAMBANG KAMPONG THOM MONDOL Moung KRATIE Roessei Kampong KIRI Pursat Thom Chinit Kratie Senmonorom m a T e o P n Kampong le Chhnang PURSAT S a KAMPONG p KAMPONG CHAM 12 Snoul 12 ° CHHNANG Kampong Cham ° ekong M VIET NAM KAMPONG Phnom Prey GULF Krong Penh Veng OF Koh Kong SPEU PREY National capital THAILAND KOH KONG Kampong Ta Khmau VENG Provincial capital Speu KANDAL Banam B Town, village a SVAY s s Major airport a RIENG Sre k International boundary Ambel Chhak Takeo Svay Rieng Provincial boundary Kampong Rroad Saom KAMPOT TAKEO CAMBODIA Railroad Bok Kou Sihanoukville Kampot 0 10 20 30 40 mi The boundaries and names shown and the designations SIHANOUKVILLE used on this map do not imply official endorsement or 0 20 40 60 km 103° 104° 105° acceptance by the United Nations. Map No. 3860 Rev. 4 UNITED NATIONS Department of Peacekeeping Operations January 2004 Cartographic Section United Nations, Department of Peacekeeping Operations, Cartographic Section. January 2004. Retrieved from http://www.un.org/Depts/Cartographic/map/profile/cambodia.pdf. three years and costs $800 US per year. particularly important for medical, surgical and pediatric According to the Cambodian Ministry of Health (MOH), specialists. Ultrasound is also used by radiologists for a variety from 2013-2014 there were 115 students at UHS pursuing a degree of pathologies ranging from abscess localization to ocular in radiology technology. At the start of the academic year the sonography. In June of 2015, China donated 200 ultrasound university matriculated sixty students: six on scholarships and 54 machines. However, ultrasound-guided procedures are still who were self-funded. limited. The degree granted by UHS is called an Associated Degree in Radiological Technology (ADRT). However, many radiology • MRI technologists practice without an official degree. For example, There is only one MRI in the public sector according to the radiology technologists at Angkor Hospital for Children took an World Health Organization (WHO). Traditional diagnostic unspecified 3- or 6-month course before starting work. There is MRI is performed. The number of interventional procedures no known continuing medical education curriculum for radiology is unknown. Other informal reports suggest that there may be technologists in Cambodia. additional MRIs in the country. Diagnostic and interventional skills • Angiography • X-ray Angiography is limited, but is available at Sen Sok International No x-ray limitations. University Hospital in Phnom Penh. A cardiologist conducts these procedures. • Computed tomography No CT limitations. Due to the limited number of CTs, • Fluoroscopy patients must be referred to hospitals that have scanners for Fluoroscopy is available at select hospitals. appropriate treatment. • Other interventions • Ultrasound Surgeons conduct interventional procedures more commonly Ultrasound is widely used by all specialists. FAST scans are than radiologists. 2/6 | 10.7191/jgr.2015.1016 November 2015 Journal of Global Radiology JGR Harrington and Makris (2015) Power supply in the clinical setting, but also as portable screening devices for tuberculosis. For example, under the directly observed treatment, As of 2013, Cambodia consumed 3.553 billion kWh and only short-course (DOTS) strategy, patients with TB are closely and produced 1.77 billion kWh (2). The production of electricity is directly followed. Mobile X-rays are used by the National Centre derived from hydroelectric plants (57.4%), fossil fuels (32.7%) for Tuberculosis and Leprosy (CENAT) as part of a screening and other renewable sources (10%) (2). Approximately 22.47% of program (11). Cambodians have electricity, including 54% of urban households and 14% of rural households (6). The Electricite Du Cambodge, Service a government enterprise that generates and distributes electricity, hopes to provide electrification to all villages by 2020 (6). Servicing radiology equipment is a challenge in Cambodia. The cost of electricity is relatively high in Cambodia. As of Much of the equipment is donated, which in many cases means 2012, the price has ranged between US $0.16 - $0.40 per KWh the warranty has expired. Accessing repair service is a challenge. (7). Compared to other nations, such as the US, where, as of April The MOH published a report in 2011 regarding the acceptance 2015, electricity was $0.10 KWh (8).
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