Visiting? On a medical mission! Part 2

Interview with Prof. Ueli Möhrlen

How many times have you come to Cambodia on missions?

This is my fourth time. My first visit was in February 2020, and then there was a break during the COVID-19 pandemic. And now I come here once a year for a week at a time.

Is the goal of all your missions here to advance minimally invasive surgery?

It’s not just about minimally invasive surgical techniques. It’s also about determining indications and planning treatment: How and when do you make the correct diagnosis, and what does that require—medical history, physical examination, further diagnostic tests? How do you then plan the appropriate procedure, and when is the right time to perform it? Of course, the staff want to learn how to perform minimally invasive surgery—that’s their main goal. But for me, it’s also important to teach them careful and medically indicated surgery and to promote interdisciplinary collaboration.

What does a typical mission week here look like?

Basically, it’s about operating alongside the Cambodian team. To show them what they want to see, try to address all their questions and answer them as far as possible. Then to help them develop the mindset of relying on their clinical skills and not operating solely based on radiological findings. And it has become increasingly important to discuss overarching topics. Questions such as: What kind of equipment should be purchased? How should something be expanded or modified?

So far, you’ve only been working in Siem Reap. Why is that?

The foundation is interested in having me go to Phnom Penh as well. Currently, it’s difficult for me to be away from Kispi twice a year. In the long term, however, the goal is to visit the hospitals in Phnom Penh as well.

What is the educational goal of these missions?

The goal is to have the doctors here perform the surgeries, show them the necessary techniques, and then supervise them. It’s wonderful to see that the colleagues here pay very close attention, learn quickly, and adopt the techniques precisely. And that this knowledge then sticks. For example, the colleagues here show me the procedures we observed together during previous missions, and they operate exactly as I taught them. It brings me immense joy to see this sustainability firsthand.

What are the most significant complications during minimally invasive surgeries?

Bleeding or irreparable damage to a structure that cannot be corrected using minimally invasive techniques. It requires readiness and knowledge to switch immediately to open surgery if necessary.

Would you say that all surgeons have the ability to recognize and accurately assess such a situation?

I’m not sure about the youngest team members, but the more experienced ones can handle it. That requires an experienced surgeon who can manage problems. For the younger ones, it’s important to have someone on hand who can react. A professional like Prof. Sokha is precisely the kind of person who can openly resolve these issues.

You seem to have a lot of confidence in the team here.

Absolutely. I believe our collaboration wouldn’t work otherwise. Prof. Sokha also attends to other duties during the mission and then hands over responsibility to me in the operating room. To me, that clearly demonstrates the level of trust we share. The team works very meticulously. They’re all together in the operating room every day, able to observe one another and learn from each other.

What have you taken away from this week-long mission?

I’m thoroughly enjoying my time here. I get to treat patients alongside a highly motivated team and share my knowledge with them. I appreciate the friendly and trusting rapport with the team. I’m not spending my time here performing surgery on particularly difficult cases—patients who just happened to be lucky that I was here—but rather, the focus is clearly on training the local team. That’s what makes a lasting difference.

Do you remember your first encounters with founder Beat Richner?

Kispi has long had close ties to him, as he once worked here. I didn’t know Beat Richner personally. But his practice partner and long-time president of the foundation, Dr. Alfred Löhrer, was my children’s pediatrician. However, my first encounter with Beat Richner was as a child: Back then, there were LPs of his, featuring stories and cello pieces.

Did the project come up as a suggestion when you assumed your new role at Kispi, given your long-standing collaboration?

Not specifically; I had already been involved in development aid before that, in Tajikistan, on a project with the Swiss Agency for Development and Cooperation (SDC). The connection between the children’s hospital and the Beat Richner Foundation, along with the continuous exchange that has been going on for many years, makes the missions here significantly easier, for example, when it comes to absences. There’s also communication outside of the missions. We connect via Zoom calls for specific questions or patient discussions; there are WhatsApp groups, and they also participate virtually in our oncology rounds when needed. So the collaboration extends beyond the missions.

Has any equipment from Zurich found a second life here?

I don’t think so. It was important to Beat Richner that this place not be a “dump” for Western hospital surplus. He didn’t want to practice third-world medicine but first-world medicine. He was criticized for a long time for this approach. People said it was a drop in the bucket. But Beat Richner saw this idea through and succeeded in establishing such modern medical care for children in Cambodia—in a way that is otherwise hard to find here. It’s amazing that such a success story is possible. And now Beat Richner has been gone for almost nine years, and it continues to work.

Warm regards from Siem Reap

Diogo