Wednesday November 6, 2019,

Meeting with one of our 3 Cambodian interpreters, who will assist us during our sessions and allow us to make the patient-therapist link.

Their role is very important since they will allow us to provide quality care by having a good understanding of the patient’s problem.

Thursday November 7, 2019,

We had the pleasure of meeting Ms. Théary Sath, head of the NGO Humanitarian Association. It also gave us the opportunity to meet Mr. Loak Chhay, Deputy Secretary of the Senate in Phnom Penh.

We were able to obtain the necessary information for the registration of our NGO in Cambodia.

 Note that Mr. Loak Chhay is a football player and fan and we are fortunate to have, in our team of therapists, an excellent coach! Eric therefore naturally took pleasure in going to attend a football match with Mr. Loak Chhay and he, just as naturally, treated a pain in his hand…

The end of the day was just as exciting since we had the pleasure of meeting Ms. Pioun MEN, general practitioner. She will accompany Sarah BUDD and Mani Burband during the obstructive training which is planned for the February mission.

Course and organization of the mission

The schedule for the 2 weeks:
3 days at the CHREY dispensary
2 days at the PREY TROLACH dispensary
5 days at Moeung Russei Hospital

1) Organization of the team

We are divided into pairs, 3 pairs therefore, and a trainee in the 3rd year of training, who will go from one to another during the entire observation mission. Depending on the difficulty, this trainee will participate in the care while being supervised by a therapist.

Our choice of patient care by 2 therapists has several advantages:
It allows complete and simultaneous care using complementary techniques: acupuncture and Tuina for example. The patient feels “enveloped” and quickly relaxes.
The diagnosis is discussed and argued by each, in order to choose an appropriate treatment protocol.
Volunteers who do not know the field are more reassured, and can be coached by those who have already experienced it

Reception of the patient by a translator:
An information sheet is prepared by our interpreter, detailing information on the patient, the reason for his visit, traumatic events and the general health course.
This sheet is used to prepare for the in-depth interview following treatment.

Pain level assessment: (VAS °)
On a scale graduated from 0 to 10 (0 = 0 pain, 10 = very strong pain), we explain the principle of assessing the level of pain to the patient, which thus gives HIS perception of HIS pain, before and after treatment .
The figures as such speak only in a ratio of more or less. We choose to take this method in order to identify the level of effectiveness of the treatment, assessed by the patient himself.

Diagnosis and treatment protocol:
Once the diagnosis is made, the choice of treatment is made, using acupuncture, therapeutic massage, gua sha and suction cups in an appropriate manner.
The needles are used only once and discarded in an appropriate container, made available.

2) Launch of the mission

Meeting with the director of the DR Peou Sovannarin hospital on Monday morning:
It establishes a timetable which provides for 4 different places to visit and care, including 2 distant dispensaries.
In the end, we decide to limit the number to 3 including the hospital, in order to stay longer in each place.

2.1 The CHREY Dispensary
We stay there for 3 days, from November 11 to 13.
Located 3 km from Moeung Russei, the dispensary is quite large. The staff consists of a mixed team of 5 to 6 nurses.
3 individual treatment rooms are allocated to us in which we use the local treatment tables.
The information having been relayed, a group of patients awaits us upon our arrival.
The staff will follow us throughout the stay, curious and interested.
Very good synergy, and the person in charge of the dispensary regrets that we leave so early.

The main reasons for consultations:

Joint pain, back hips, up to the ankles	26
Head and neck pain	10
Pain in the knees, simple or with one or more joints	6
Pain due to trauma: falls or accidents
Knee pain with tingling of the limbs and / or feet
Pain and heartburn
Multiple pains from head to toe
Back pain with insensitivity and edema of the lower limbs
Pain in one or both wrists
Headache, neck and leg pain
Headache, blurred vision
Ankle sprain
Upper and lower limb pain
Whole body hemi-paralysis
Leg paralysis

Patients often came with multiple complaints that had to be prioritized. One session is not enough to settle everything, we chose to relieve the pain in the first place.
We were able to see several patients several times in order to consolidate the treatment principle implemented during the 1st session.

2.2 PREY TROLACH dispensary
2 days

Farther on, about 35 km away, we go there by minibus chartered by the hospital and an ambulance carrying the equipment (table and bags).
We also have individual rooms in which we settle.
We were surprised when we arrived, with a relatively small number of patients waiting for us.
But in the afternoon and the next day, patients who seem to have tested us, flock.
We will know later that a bad experience with Chinese and Korean acupuncturists who came to their clinic made them suspicious.
We are happy to see that we have been able to regain this confidence.

• Joint pain, back hips, up to the ankles
• Head pain, cervical shoulders
• Pain and heartburn
• Pain due to trauma: falls or accidents
• Back pain going down in the legs
• Pain in one or both legs
• Pain with tingling of the limbs or feet
• Leg pain in the shoulders and neck
• Pain from the knees to the feet
• Calf pain
• Headache, blurred vision
• Shoulder blade shoulder pain
• Knee and shoulder tendonitis

We can see that there too the pains have been installed for a long time. Acupuncture and / or tuina care can relieve and improve well-being, and is felt by patients. But if these treatments are not renewed, the effects cannot last. We were led to give advice in matters of hygiene of life, and dietetics:

Avoid eating too spicy foods: peppers, too sweet, because many people were diabetic;
Avoid drinking too hot or on the contrary favor hot drinks according to the diagnosis
Do simple muscle and joint warm-up exercises
Adopt ergonomic working postures (especially carrying heavy loads)

People were very attentive to these tips.

We were at the end of the rainy season, unlike the previous mission, and the pains were aggravated by the cold and humidity.
By putting our hands on certain joints, they were cold: ankles, knees, lumbar area.
Some patients also had internal heat.

2.3 Maung Russei Hospital
We sit there for the whole week, in a common room where our treatment tables are separated by screens.
This new organization, if it worries us at first, will prove to be very functional and useful for exchanges between therapists during difficult consultations.
The complexity of pathologies increases progressively: stroke, serious traumatic injuries, etc.

The director of the hospital will tell us after the fact that he had not informed anyone of our coming, in order to verify the spontaneity and the confidence of the population who would appear, without there having been any prior information. .
Here again we saw the importance of word of mouth, of testimonies from people who came to receive treatment.
Patients received in previous dispensaries came for a second and then third visit during our stay.

• Back, hip pain to the ankles and / or feet
• Multi-trauma after an accident
• Shoulder and leg pain
• Pain in simple knees or with one or more other joints
• Upper extremity pain: shoulder blades to the fingers
• Multiple joint pain with tingling
• Low back pain
• Neck pain, neck pain, radiating or not in the head
• Headache with or without impact on vision
• War injuries with psychological impacts
• Snake bite, necrosis and retraction of flesh
• nightmares
• Pain and heartburn

3) Highlights

1) A capital of trust that has set up quickly
We saw more and more people flocking, and we had to organize the passages by assigning numbers. We have received the relatives of the patients several times, who have come to receive treatment following the recommendation of one of their own: word of mouth works very quickly.
In the 2nd dispensary (Prey Trolach), few people waited for the 1st day. But from the 2nd, a large crowd which was difficult to manage.
The director of the hospital explained to us that a team of Chinese people had come to practice acupuncture care, but had been badly perceived, and their treatment badly lived: we had therefore a weak confidence capital a priori.

Patients sometimes waited all day to be able to pass, due to several emergencies that we took priority.

Each pair treated an average of 8 patients / day.
In order to allow patients to be seen several times, we must stay at least 5 consecutive days in each clinic.
We saw some patients who did not hesitate to make long journeys the following week at Maung Russei hospital.

2) Behind the appearance, a world of repressed emotions …
At first glance, many symptoms looked alike, joint pain in the knees, back, hip….
But during the interview and observing the faces, expressions, we observed how many other pains were hidden behind those expressed ….
It’s as if, for lack of speaking, and to support them, these deep wounds were expressed by joint and lumbar blockages …

For the first time, we received soldiers, coming for low back pain, headaches.

We were marked by their proud, stiff support, a fixed gaze, straight ahead, which we could not catch during the preliminary interview.

On the first of them, we asked a question:
“Do you get angry easily?” »……
Tears filled his eyes, as if these words had just pierced an armor … We have continued on sleep, laden with nightmares, for years …
Speech is then freed, on the atrocity of the acts that he was probably forced to commit, on the ghosts that have haunted him since then….
A load so heavy for so long, that its back stores and which freezes its movements, even at night.

We saw this patient twice, and his face changed over time.
This meeting allowed us to manage others with this new look, and we saw smiles flourish on their faces.

3) The pathologies treated
The advertised reasons for consultation were for the vast majority of joint pain, most of which had been present for many years.

Motorcycle accidents and falls in the rice fields, leaving painful and untreated after-effects and significant locomotor problems.

The terrain encountered was for many situations of internal humidity and cold, probably due to hard work in rice fields, soaking in water.

We were surprised at the number of patients with diabetes mellitus, liver disease, and hypertension. The high-sugar diet, even if it is balanced, may be the main reason. Many patients were still undergoing treatment for hypertension and diabetes.

Recent or old surgeries left scars and painful adhesions.