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Thursday, July 22, 2010

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, … 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.”

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Cambodian Anxiety Peaks Ahead of Khmer Rouge Verdict

In Cambodia, the trial of a leading Khmer Rouge figure, blamed for the deaths of about 16,000 people, is heading for a conclusion.

The trial of Kang Guek Eav, also known as Duch, has gripped this nation for almost a year and a half. Millions of people are expected to watch on television as the verdict is announced, Monday, by a United Nations-backed court.

Duch ran the S21 torture and extermination center, where thousands of men, women and children were processed before being sent to dig their own graves in the killing fields on the outskirts of the capital.

Initially, Duch pleaded no contest. Throughout the tribunal he has provided an abundance of chilling evidence into the inner workings of Pol Pot and his ultra-Maoists.

They ruled Cambodia between 1975 and 1979 and are being held responsible for the deaths of perhaps two million people, who died of murder, starvation and illness.

But, in a final legal twist, Duch changed his plea to not guilty and asked the judges to release him. He has sacked the head of his international defense team, French Lawyer Francois Roux, and asked for a Chinese lawyer to replace him.

Theary Seng survived the killing fields as a child. She was rescued from the refugee camps and raised in the United States, where she became an author and lawyer. She is the founder of the Center for Justice and Reconciliation.

"There's a lot of confusion at the moment because recently we were told Duch fired his U.N. lawyer at the 11th hour, on the advent of the verdict, which is very perplexing," Seng says. "And, it has raised suspicions again of political interference. It has raised cynicism. It has confirmed the fears of many Cambodians in thinking that Duch is not believable, in the first place - that his confession, his asking for forgiveness - aren't genuine and hopeful the fears won't turn into paranoia."

The Cambodian government has directed all domestic television networks to broadcast the verdict.

At the court, about 300 journalists and hundreds more officials, diplomats, legal observers and Khmer Rouge victims have overwhelmed authorities in seeking seats for the announcement.

Regardless of Duch's last-minute legal maneuvers, Theary Seng, along with many others, believe his admissions to overseeing crimes of torture that included water boarding and medical operations on patients without an anesthetic and the eventual murders of thousands of people will lead to a conviction and life in prison.

His evidence would also prove compelling in cases to follow. Another four surviving Khmer Rouge leaders - Khieu Samphan, Nuon Chea, Ieng Sary and his wife, Ieng Thirith - are to on trial next year.

"It's a catalyst that has broken the silence of the last 30 years of this regime, which has truly taken the lives of one-fourth to one-third of the Cambodian population. Every Cambodian alive right now is directly affected by the crimes of the past," Seng said.

After the Khmer Rouge were ousted by invading Vietnamese troops in early 1979, civil war continued for another two decades. Only then was Cambodian Prime Minister Hun Sen in a position to ask the United Nations to help broker an international tribunal to focus on the atrocities allegedly carried out by Pol Pot and his henchmen.

Further delays followed, amid bickering with the United Nations about the final make-up of the tribunal and funding issues. However, the long awaited trial eventually got underway and is expected to remain a fixture on this country's legal and political landscape for a few years to come.
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New Zealander in Cambodia for Khmer Rouge verdict


PHNOM PENH, Cambodia — The brother of one of a handful of Westerners killed by the Khmer Rouge returned to Cambodia for a landmark verdict in a war crimes tribunal, saying there can never be adequate justice for his family.

It was not clear how Rob Hamill's brother, Kerry, fell into the hands of the brutal communist regime. The 28-year-old's yacht was captured in Cambodian waters in 1978 and he and shipmate Briton John Dewhirst were taken to S-21 prison, tortured and executed.

A third member of the crew, Canadian Stuart Glass, was apparently shot dead when the boat was seized.

When the news reached Hamill's hometown of Hamilton, New Zealand more than one year later, it tore apart what had been a close-knit family. One brother committed suicide months later; Rob Hamill became a teenage drunk. His parents never recovered.

"There'll never be justice for our family," said Hamill, 46, noting his mother died seven years ago and did not get to witness the trial or hear its verdict. "I can't quite reconcile how justice can ever be served with the nature and the way these people's lives were taken."

A U.N.-backed war crimes tribunal will issue its first verdict Monday against a senior member of the Khmer Rouge, the ultra-communist regime blamed for the deaths of 1.7 million Cambodians during their 1975-79 rule.

About a dozen Westerners were among the estimated 16,000 people held at S-21 before being killed.

As commander of S-21, Kaing Guek Eav, better known as Duch, faces a maximum sentence of life in prison if found guilty of war crimes and crimes against humanity.

Those who passed through the gates of his secret prison were deemed the worst enemies of the paranoid Pol Pot regime: spies, saboteurs, traitors — and foreigners. Many were tortured. Interrogators pulled out toenails, drained blood and electrocuted prisoners to extract confessions.

In 1979 after Vietnamese invaders overthrew the Khmer Rouge, Kerry Hamill's so-called confession of espionage was among the meticulous records discovered at S-21.

Last year Rob Hamill spoke at Duch's trial, the only Westerner to do so as a victim, and tried to convey his family's suffering.

He says confronting Duch in court has helped him deal with the grief that has haunted his life, but forgiveness for his brother's killer still eludes him.

"I wanted to forgive Duch so that it would allow me to move on — until I went to S-21 and I got to see what this guy created," he said. "Any compassion I had for him at that time went out the window.

"Since then, time has a funny way of warping things," he said. "I've got an internal battle going on and maybe this sentencing will somehow further that process."

On his first visit, Hamill says he was an emotional wreck. This time he said he feels more in control, more at peace and believes his brother Kerry would approve of the way the family is finally moving on.

"I think he'd be very proud of what we're trying to do as a family to represent him after 30 years of our own family suppressing it and not talking about what happened and the effect it had on us all as a family," he said.

"I think this is a very special time and I'd like to think he's looking down and saying 'Well, it's about bloody time.'"

Rob Hamill, a rower who represented New Zealand at the 1996 Atlanta Olympics, has requested a face-to-face meeting with Duch after the verdict to try to find out more about Kerry's fate. So far he's had no answer.

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Prison Deaths Across Cambodia Increasing: Rights Group

The number of people dying in Cambodia's prisons are increasing, according to a leading human rights group. Adhoc investigators say at least 26 prisoners have died across the country in the first six months of the year.

That number is an increase of 18 above the same period in 2009. The figures are according to a study conducted by Adhoc, which in part looked at prison documents.

The provincial prison in Kampong Cham accounted for the most deaths, which recorded at least six in the month of July, Adhoc reported.

According to a Kampong Cham prison report obtained by VOA Khmer, the prisoners died of Hepatitis B, hypertension and stroke, among other ailments. But Adhoc says the deaths can be blamed on overcrowding in cells.

“I do not believe prisoners died from disease,” Chan Soveth, an investigator for the group, said.

In Kampong Cham prison, up to 23 prisoners are kept in one room, creating conditions so crowded they are forced to sleep on their sides instead of their backs, he said.

Seak Leng Seap, deputy director of Kampong Cham prison, called the report untrue, but he declined to comment further. Officials at the Ministry of Interior's prison department could not be reached for comment.

Adhoc estimates the total number of prisoners in Cambodia at nearly 14,000, an increase of about 400 since last year.
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