During the period of 2006 - April 2011 clinical and surgical activities involved as many as 2744 children under 3 years of age out of a total number of 6860 patients. The distribution of the different conditions and diseases treated is shown in .
Since the construction of the operating room in August 2006, 2164 surgical operations have been performed in our Centre with an average of 500 operations per year (). Over the years, an increasing number of operations have been performed by orthopaedic surgeons and ophthalmologists in the centre, accumulatively amounting to 16% of the overall number. Ear, nose and throat surgery is also a substantial part of the BGPH'S commitment to treating disadvantaged children. In addition there has beener commitment in providing specialized surgery, including urology surgery that accounted for about 2% of the total.
and indicate that 45% of the total interventions were general surgical procedures, compared with 32% in reconstructive surgery. The total interventions were often of moderate complexity, while surgical interventions aimed at improving anatomical and functional improvement were often complex and time-consuming .
Distribution of surgical cases
Increase in number of surgical procedures performed at the Takeo Centre (2011 - Jan.-April).
Reconstructive surgery was for the head and neck (congenital malformations such as cleft lip and palate, burns, release of severe contractures), urological malformations (hypospadias, urinary bladder reflux, and other urinary tract malformations), hand surgery (syndactyly, camptodactyly, burn contractures), and trauma surgery ().
Total plastic surgery operations
Burns remain one of the most important causes of injury in this country. Free flame, gas stoves, oil lamps, and the high number of still remaining land mines are frequent causes of children's burns. Acid attacks on women and young men are very common for reasons of jealousy or revenge.
There is no specialized burns centre in the territory and burns sequelae are often dramatic as a result of inadequate care and the general tendency of the population to develop keloids.
published in 2004 by one of the present authors considered the question of whole person impairment, which rates five classes of skin damage, ranging from 0 to 95% impairment. This scale sets up five classes of increasingly severe skin disorders and disabilities in everyday life due to the scars, which are described here. We also considered the aetiology and the general parameters of the patients' injuries.
In Cambodia some 20,000 burn injuries occur every year, almost two-thirds of them involving children under 10 years of age (accurate epidemiological data on burns are not available in this country).
One hundred and sixteen children with significant burns sequelae have been treated at the Takeo Centre, with scars mainly affecting the limbs and the neck, with involvement also of the axilla, hands, elbow, and knee. We also assisted a large number of young women with serious facial in the face due to the criminal use of acid for sentimental reasons.
The surgeons' wide experience use of the most effective technique in each case, e.g. Z-plasties, skin expansion, skin grafting, and local or distant pedicled cutaneous or myocutaneous flaps. However, owing to Cambodia's lack of technology, simple but most effective techniques were preferably used.
In our practice we laid great stress on post-operative care with physiotherapy, elastic compression, and massages to improve the final results.
Sometimes children with severe burn scar contractures of the limbs, with bone deformities particularly of the radius and hands, needed to be operated on and, in these few cases, alteration of the growing bones was observed. Physiotherapy played a leading role in post-operative care.
Since most burns in rural areas are accidental and occur in the home setting and are therefore preventable, an effective paediatric burn prevention campaign is currently being considered.
Together with surgical activities, the BGPH's commitment to treating pathological cases has been constant, and performed with increasing efficiency and effectiveness year by year.
Finally, as a result of the successful implementation of the Pilot Project for a Mobile Clinic , BGPH is expanding its coverage and area of intervention and has now committed itself to a broader set of complementary health-related activities including:
Distribution of surgical cases: Mobile Clinic Project.
- - Providing maternal health services to vulnerable pregnant women. Recent studies show that up to 80% of Cambodian women have deliveries outdide health care facilities and only 37% of pregnant women deliver with the assistance of a skilled birth attendant. There is also an alarming decrease in the number of midwives in remote areas. All this clearly increases the maternal mortality rate and reduces the chances of survival through early childhood of the children whose mothers do not survive delivery. We expect that in a period of two years almost 240 vulnerable pregnant women will receive psychological counselling and free access to high-quality medical care.
- - Improving the capacity of existing health centres in remote areas through mobile clinics, mobile pharmacies, and community training on hygiene practices. Despite the fact that over 85% of the population live in rural areas, most hospitals and health personnel are concentrated in urban areas, resulting in an unequal distribution of health care for Cambodians.
In one year (2010-2011) over 5,500 children received free clinical and surgical consultation, 350 were admitted to the Centre for medical and surgical assistance, and 60 rural communities had training and seminars in basic health.
702 patients were treated free of charge by the Mobile Clinic Project:
- 201 patients > 5 years old
- 369 patients 5-13 years old
- 132 patients > 14 years old