Cambodia desperately needs life-saving stroke treatment

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Cambodian clinician Dr Keo Piseth Morokot (right) carries out an assessment under the supervision of SSTC speech and language therapist Paula Espinosa. Photo supplied

According to the Centres for Disease Control and Prevention, strokes are the number one cause of death in Cambodia, claiming 153.9 lives per 100,000 people in 2017.

By comparison, road traffic accidents claimed 11.3 lives per 100,000 in the same year.

But despite this, the majority of the Kingdom’s stroke patients are sorely lacking life-saving treatment, greatly diminishing their quality of life.

In 55 per cent of cases, stroke patients develop a debilitating condition called dysphagia, which results in people struggling to swallow certain foods or liquids, while others can’t swallow at all.

But despite the gravity of the condition for those who suffer from it, there are no qualified Cambodian professionals who can fully assess and treat it.

At Speech and Swallow Therapy Cambodia (SSTC), we are attempting to address this shortcoming by providing clinical training and supervision to Cambodian hospital staff.

Without our work, medical staff would be limited in their ways to stop patients succumbing to complications associated with strokes, as Vattey, a Cambodian clinician who has undertaken all of SSTC’s training, explains: “Before the training, I did not know why a patient must know how to eat safely. After the training, I learned that it is truly important because swallowing can help prevent pneumonia.”

Worldwide, there are 15 million strokes per year, resulting in five million deaths, with around 8.25 million stroke patients developing dysphagia.

Without proper treatment, their condition often results in choking, malnutrition, dehydration and even death.

Dysphagia can cause aspiration pneumonia – a respiratory infection caused by food or drink going into the lungs – which can prove fatal.

Dysphagia also impacts on a patient’s emotional and social well-being, rendering a family meal or a trip to the coffee shop unpleasant, dangerous or even impossible.

Imagine no longer being able to enjoy life’s most fundamental pleasures, like eating solid food or sipping a drink without coughing every time.

Internationally, speech and language therapists are trained to treat this problem.

However, there are no officially qualified Cambodians in this profession.

‘It works’

Dr Pov Sothea is one SSTC-trained Cambodian doctor, now able to provide specialist endoscopic evaluations of swallowing.

He explains that lacking appropriately skilled staff in Cambodia, the “management of dysphagia is basic, just using feeding tubes for example”.

This situation means that many Cambodians may die as a result of their dysphagia, or are unnecessarily condemned to a life of having blended food fed to them via a tube through their nose or stomach.

But SSTC, a small local NGO, has been working to improve this situation for six years, bringing internationally qualified and experienced speech and language therapists to the Kingdom to act as educators.

Consequently, as Dr Chhour Channara states, 15 Cambodian healthcare professionals now “know how to evaluate and how to treat [dysphagia] – and it works”.

At SSTC, we also create therapy resources in Khmer, collect data on the needs of patients, procure specialist equipment and provide ongoing supervision for clinicians as they see patients in three Phnom Penh public hospitals – Calmette, Cambodia-China Friendship Preah Kossamak Hospital and Khmer-Soviet Friendship Hospital.

As a result of this work and the impressive dedication of local trainees, clinicians such as Dr Sothea and Vattey can now provide dysphagia assessment and rehabilitation to the Cambodian people.

The programme is expanding, with a new group of Cambodian nurses currently undertaking lectures, examinations and clinical practice.

Yet despite our essential work, and that of a small number of other NGOs working in the field, much more needs to be done.

Stroke is only one of many causes of dysphagia, with traumatic brain injury as a result of road traffic accidents also a common cause.

With the increasing number of cars and motorbikes in the Kingdom, poor road safety standards and often helmetless riders, incidences of dysphagia are growing.

Others causes of dysphagia include throat cancer or progressive diseases such as dementia.

In essence, it is a far reaching problem spanning class, age and gender in Cambodian society.

Estimates suggest that hundreds of thousands of Cambodians need access to dysphagia services, but demand currently far outstrips service providers.

Long-term vision

Part of SSTC’s long-term vision is that no Cambodian with dysphagia suffers without treatment, but to achieve this the Kingdom desperately needs its own speech and language therapists.

To realise this vision, a university level course must be created in Cambodia to train qualified professionals in the field.

Increased public awareness of dysphagia and speech therapy is also required, alongside clinical research and job creation.

A lack of resources is another major issue, with specialised X-ray machines to assess swallowing required, as well as linguistically and culturally appropriate therapy materials.

Furthermore, the value of speech and language therapists to Cambodian society extends beyond just treating dysphagia sufferers, as speech therapists also assess and treat communication impairments – for example speech difficulties after traumatic brain injury, or communication disorders associated with autism.

SSTC’s long-term vision is a future where Cambodia no longer needs to rely on foreign specialists and has its own qualified therapists in health and education settings treating both communication and swallowing difficulties.

SSTC, alongside other organisations such as OIC Cambodia, is working to develop the resources and research, as well as the university and government partnerships, required to bring this vision to fruition.

Reflecting on a patient, Vattey said that after receiving dysphagia treatment “he had changed. Before, he was skinny and had no energy. [After treatment] he could eat properly and gained weight. He looked like a new person”.

This, the basic human right to lead a healthy and productive life, is what all Cambodians with dysphagia deserve.

Annie Johnson is a speech and language therapist working for SSTC and living in Phnom Penh. To find out more about SSTC’s work, or to donate, visit: www.speechtherapycambodia.org.