One sip from the wrong bottle can endanger a child's life from one second to the next. In Cambodia, lye and cleaning agents are usually sold in bottles without secure closures or in powder form. The latter are mixed with water at home before use - and then what? Most of the time, the leftovers end up in a beverage bottle that is no longer used.
In 2022, around 40 children were admitted to Kantha Bopha hospitals with a burnt oesophagus. "Fortunately, this is an injury that we hardly ever see in Europe anymore," says Prof. Christian Braegger, of the University Children's Hospital Zurich. Thanks to educational work and the child-proof locks in bottle caps of dangerous goods.
Christian Braegger has been travelling regularly to Cambodia since 2007 to pass on his knowledge and experience in the field of gastroenterology (stomach and intestinal diseases including endoscopies/gastroscopies). Back then, he brought discarded equipment from the Children's Hospital Zurich to Siem Reap and trained the first two doctors on it. “In the whole country there was no possibility to perform gastroscopies or colonoscopies on children.
”Pungent alkalis burn the children's oesophagus and lead to severe inflammation, which forms scars as it heals. This causes the oesophagus to contract, narrowing the passage. "Sometimes the children can only eat liquid food," explains Christian Braegger. In order to burst the scarring and correct the narrowing, the doctors insert various instruments into the oesophagus via the mouth, including a kind of balloon that can be inflated.
But there are also cases where children are only taken to the hospital weeks or months after the accident. If the oesophagus lets almost nothing through, another method is used: An electrocautery (an electrically heated wire) then helps to cut open the scars. "Here, it is not necessary either to open the chest - we can work, minimally invasively, through the mouth," says Christian Braegger.
The Swiss paediatrician is in constant exchange with the teams in Siem Reap and Phnom Penh, receives reports and discusses special and difficult cases with them. In addition to treating burnt oesophagi, they also examine and treat children who are taken to hospital with bloody vomit or bloody diarrhoea. The specialists can remove polyps, tie off and sclerose varicose veins in the oesophagus, or create IVs for artificial feeding. "These are really very talented local doctors on site," Christian Braegger emphasises. In 2022, they examined and treated more than 530 children endoscopically, a number that is increasing.
