Megill, Robin

Cambodia

Health, Economic and Long-term Social Impact of Injuries (HEALS) Study

The Johns Hopkins International Injury Research Unit (JH-IIRU) is currently working to develop an innovative tool and data collection approaches to assess the long-term social, economic, and health consequences of traumatic injuries in a LMIC setting.

The study has the following specific objectives:

1. To develop and implement a tool to examine the long-term health (prevalence, severity and duration of disability), social, and economic impact of traumatic non-fatal injuries;

2. To develop and implement an electronic data collection and monitoring module using the new tool for capturing traumatic injuries and following individuals over time, for use in LMICs.

3. To document pilot data on the long-term burden of traumatic non-fatal injuries in a multi-site study.

Global Health Mentor: Abdulgafoor M. Bachani, PhD, Associate Director, Johns Hopkins International Injury Research Unit

I was assigned to work in Phnom Penh, Cambodia. I worked with Dr. Abdul Bachani on the Long-term Health, Economic, and Social Impacts of Traumatic Injuries Study (HEALS). The HEALS study is being conducted in Malaysia, Kenya, Vietnam, Uganda, and Cambodia. I was the student coordinator in Cambodia, and the only person from Hopkins on-site. I worked at Handicap International, an international NGO in several countries throughout the world, as part of the road safety team.

My initial feelings upon arrival to my location were excitement and also slight uncertainty. It was not completely clear what exactly I would be doing, but I was happy to be traveling, and looking forward to meeting my coworkers. Although I have had prior experience in global health (I spent three months volunteering at a medical clinic in Arusha, Tanzania), the research experience I had shaped my perspectives on global health and I learned many lessons about the field of global health. First, I learned that communication is sometimes difficult yet essential; this applies to both communication between my coworkers who did not speak English as their first language, as well as with the investigator and team back in Baltimore. Second, I learned that there are many barriers that come up, and these differ drastically by country; in my country, poor infrastructure, and unregulated traffic made transportation very difficult, and traveling to the provinces limited our resources and study capability. Lastly, I learned to go with the flow: things will not always be what you expect, and it is essential to be resilient and adaptable and embrace whatever obstacles you are presented with.

Although there were challenges, my experience overall was great. Working and living in a developing country was exciting and transformative, and I learned and experienced new things every day. I had traveled in Southeast Asia previously, so the culture was not a huge shock, and I had worked in very low income country before which also allowed me to make accurate expectations. However, some things pushed me out of my comfort zone and defied my expectations. The most difficult aspect of the experience was staying in good communication with the team at Hopkins. The time zone difference and inability to meet in person made it difficult to have effective communication with the team, and required either waking up early or staying up late in order to have a Skype call, after diligently finding a time when both schedules aligned. Also, I was surprised on how difficult it was to learn the language and communicate with people from Cambodia. I had learned basic conversation pieces from different languages previously, but I have Khmer (the language they speak in Cambodia) very difficult to learn, pronounce, and understand; this was enhanced by the fact that most people tended to pretend they understood me and just nod their heads when they actually did not, leading to misunderstandings. For a future student, I would recommend taking basic language lessons before going to the country, in order to have basic conversations such as ordering food, asking for directions, or having small talk.

The biggest eye-opener was on the healthcare situation in the country, which I was able to experience firsthand. My study involved following up victims of road traffic injuries, and I had the opportunity to attend the recruitment visits in the hospital. The healthcare situation was divided into different hospitals based on price, ranging from low price ($1-5 per day) to high price ($20-40 per day). These prices were directly related to the quality of medical care, amount of medical staff, and number of patients per room.

This was a great experience that expanded my view on global health and culture.

Selfie with the Road Safety Team at Handicap International after a team BBQ:

Interviewing a man who was injured in a road traffic injury to determine how the injury is effecting his health and his economic and social status:

Hospital war where patients pay $2-4 per day. This is the most affordable system, yet lacks adequate santiation and medical staff. Family members do most of the care for their loved ones:

A study participant with a makeshift cast following a road traffic injury:

The Road Safety Team office at Handicap International in Phnom Penh, Cambodia:

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October 2020

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