When I first heard about Sokum’s condition, her husband called it “corollary heart disease”. Obviously he meant “coronary artery”, but why would a 20 year old already have coronary artery disease? It had to be Rheumatic Heart Disease. When I visited last week I wrote “Rheumatic Heart Disease” on a scrap of paper for her husband and told him how to pronounce “Roo-matik”. He would ask the doctors.
Surgery was supposed to happen sometime last week but for some reason it was delayed. She has transferred to the surgical hospital and yesterday I went to visit. A rumbling thunderstorm had rolled into town and the storm drains were pouring out into the roads. The heavenly deluge soaked motorists from above as their tyres drove whitewater at them from below. I was perfectly dry behind the waterproof tarpaulins that my tuk tuk driver had tied down, turning the open air carriage into a car-like cabin, minus ventilation.
Husband came out to meet me with a large umbrella. My tuk tuk parked outside a large open walled building with shining white tiled floors, brilliantly clean whitewashed walls and evenly spaced, equally clean white fans dotted across the unmarked white ceiling. Was this a Cambodian hospital? Entering the main building my astonishment continued. The walls and floors were clean! The staircase was light and spacious. We walked past patient rooms with uniformly black mattresses on the beds. Staff in scrubs were seated at a desk with computers. Only two things distinguished this place from any western hospital – the beds, albeit clean and furnished with mattresses, had no linen; and large oxygen tanks were lined along one wall, indicating that there is no piped oxygen available.
In a five-bed room I met Sokum, her mother, her aunt and a young friend. Family and friends have attended the National Blood Bank en-masse, donating blood so that all blood transfusions Sokum needs during and after surgery are replenished. The blood bank relies on this system of a donation from the patient’s network in exchange for each transfusion. Husband informed me “surgery will be tomorrow at 1pm because they said it is urgent”. A team of doctors including at least one from Korea will be operating today.
When I asked Sokum how she was feeling, husband translated “after the doctors explained about the surgery, now she feels better”. The doctors were happy to answer their questions and had confirmed that her diagnosis is Rheumatic Heart Disease “that she got when she was a child” (RHD results from Rheumatic Fever which occurs primarily in childhood and primarily in impoverished environments where the Streptococcus bacteria is able to thrive). The air was sharp with smiling anxiety from everyone, including her very bright-eyed father who came out to the tuk tuk to meet me as I was leaving. Patients in the beds around her stared and smiled at me and as I left some of them expressed “oor kun chiran” (thank you very much) at me. I wondered at their stories, aware that you don’t end up in a Cambodian hospital without a story of struggle and debt to tell. This shifted my thoughts to an American patient I know of who has been billed $63,000 as the “gap” between his insurance cover and the missing costs of surgery. This is no way to treat our sick and most vulnerable, regardless of which borders they live within.
At 12:20pm today husband called me to talk. Except he didn’t really talk. I did elicit from him that there are a lot of people with them now at the hospital – family and friends have come to lend support. Sokum is scared, her mother is crying and husband obviously escaped to make a phone call in hope of reassurance. All I could say was that it is normal to be scared, normal to cry, normal to feel worried, and that I would not say “don’t worry” because it is okay for them to worry. He said “the doctors say don’t worry”. I said that’s because they are not worried, they know this operation and they know that they can do this, but the family do not know it, so it’s okay to be worried.
He will call me again when she returns from surgery later this afternoon. In honour of Sokum I am posting this blog at 1pm just as I imagine she is being wheeled into the Operating Theatre. As to my earlier blog post, This Thing We Could Do. It seems we did it!
What is Rheumatic Heart Disease?
A short, touching article from Professor Chris Semsarian, an Australian cardiologist who spent a week on a research project in Cambodia:
While rare in affluent countries, RHD is a major public health problem in the developing world in populations living in poverty with low socioeconomic status and limited access to adequate healthcare.
RHD Australia’s Website:
RHD is a chronic, disabling and sometimes fatal disease. It is 100% preventable.