Journey to the East: U.S. derm leads volunteers in Cambodia

By: Lisette Hilton
Source: Dermatology Times


International report — Robert E. Kalb, M.D., made giving back a family adventure four years ago, when he, his wife and two college-aged children took their first medical mission trip with Health Volunteers Overseas to Phnom Penh, Cambodia.

The experience made such a positive impact on the Buffalo, N.Y., dermatologist and his clan that he has since become the organization’s dermatology director for Cambodia.

After searching volunteer options with the American Academy of Dermatology, Dr. Kalb says, the December 2006 two-week trip to Southeast Asia seemed the right fit.

“I wanted to go, and my kids wanted to go, so it worked out to go over the holiday break, in December and early January. That gave us time to visit Cambodia, because it’s not oppressively hot then, and it’s not monsoon season,” Dr. Kalb says.

“I contacted the Goldstone School of Hope (in Cambodia, www.gshw.org) … and my son corresponded with the principal for my family to volunteer as teachers there,” he says.

Dr. Kalb has since made the journey three times, and plans to return in January 2011. He is director of the Cambodia site for Health Volunteers Overseas Dermatology, which means he is in charge of soliciting dermatologist volunteers for trips.

Other dermatologists direct Health Volunteers Overseas programs in San Jose, Costa Rica; Bangalore, India; and Lima, Peru.

About the mission
The goal of the Cambodian medical mission is to help the local dermatologist (who is the only Cambodian native who has completed a full dermatology residency) to establish a dermatology department and residency program at the local medical school. Volunteers also work at the Preah Kossamak Hospital and/or the Sihanouk Hospital Center of Hope — the only hospital that provides free care in the country.

“You see patients with the local dermatologist and teach the physicians in training, and medical students,” Dr. Kalb says. “You assist in terms of seeing patients with diagnoses and treatment options, but, primarily, it’s an issue of education.”

The hope, according to Dr. Kalb, is that physicians in training and medical students there will take a year or a year and a half of dermatology training so they can return to their provinces and provide adequate dermatologic care.

Unlike many mission trips that require volunteering dermatologists to practice in makeshift hospitals, Heath Volunteers Overseas’ Cambodia opportunity is within the bustling city of Phnom Penh.

“It is a large city with amenities. You’re not in tents in the hinterland. You can stay in a four-star hotel, if you want,” Dr. Kalb says.

The work, however, is grueling. In addition to educating, Dr. Kalb might see 50 patients or more a day.

“You have people who drive 200 or 300 kilometers on the backs of motorcycles to go there. And the hospital can only take probably 10 percent to 15 percent of the people there on any given day, so the patients have to wait,” he says.

While most of the cases he consults on are severe manifestations of what dermatologists see in the United States — such as psoriasis or dermatitis with infections — Dr. Kalb also treats cases that rarely, if ever, present in his New York office, such as pellagra and Hansen’s disease.

Be prepared
Dr. Kalb recommends that dermatologists considering such a trip first talk with the dermatologist on site, as well as Dr. Kalb or other dermatologists who have been to that location in Cambodia. It’s also helpful to ask the local dermatologist what medications he might need at the time, and bring samples, he says.

Traveling with an organization such as Health Volunteers Overseas eases what can be challenging logistical issues. The established medical mission organization contacts the U.S. embassies and handles other paperwork, and offers insight from people at the destination and of those who have already made the trip.

Dermatologists pay their way, buying their flight tickets, hotel accommodations, etc. The trips, however, are considered charitable business deductions.

One of the most challenging aspects of volunteering, according to Dr. Kalb, is leaving one’s practice for what is often two weeks at a time. Dr. Kalb says it’s easier for him than it may be for others, because he has a physician’s assistant to see patients while he is away.

But doctors who are unable to schedule so much time away are still welcomed.

“We normally recommend that dermatologists go to Cambodia for two weeks, but if people can only come for a week, we’re not going to turn them down,” he says.

While U.S. dermatologists can do a lot to improve healthcare in developing countries such as Cambodia, Dr. Kalb says the doctors and their families who embark on these journeys tend to gain even more.

“We experience true poverty and see medical care in an entirely different light,” he says. “In the case with our family volunteering in the school, it was just such an unbelievably worthwhile experience for all of us, and that’s what keeps us coming back.”