For those that are unaware, Fiberoptic Endoscopic Evaluation of Swallowing (more easily known as FEES!) is well established as an instrumental tool for both the evaluation and treatment of swallowing difficulty.
It’s an area I have been specialising in for a 21 years now so I was contacted back in 2016 by the non-Governmental organisation (NGO) Speech Therapy Cambodia (STC) who were looking for experts to offer dysphagia and FEES training to Cambodian trainees. STC was founded by an inspirational American SLP Elizabeth Chafcouloff. I have a national role as FEES advisor and know Professor Susan Langmore, the USA expert who invented FEES, who was also supporting this charity and had herself visited several times.
I have previously worked in Asia and have volunteered in other low middle-income countries and I am very passionate about developing
Speech and Language Therapy (SLT) services, both in the UK and especially in resource poor environments. My post in the UK is Consultant SLT in dysphagia and critical care which includes clinical work, teaching and research and I relished the opportunity to use my skills and knowledge to make a difference in Cambodia.
Currently Cambodia has no SLT profession and without the trainees working for STC there is no provision for care of patients with swallowing difficulties in public hospitals. The trainees are doctors, nurse and physiotherapists who are being trained by STC to provide swallowing assessments on the wards in Calmette hospital, Khmer soviet Friendship hospital and Kossamak hospital. Awareness of dysphagia is poor, diagnostic tests such as CT scans are rare, referral pathways are unreliable and multidisciplinary care and equipment are extremely limited. Most patients cannot afford to have tests carried out or have medications or nasogastric tube feeds. As a charity, STC relies on donations and overseas volunteers to fund long-term expatriate SLTs, interpreters and a Cambodian project manager.
I take annual leave from my NHS job at Wythenshawe Hospital to volunteer for STC and first went out to Cambodia in 2017 to provide hands-on FEES supervision in the public hospitals in Phnom Penh. I went out again in 2019 to run a Tracheostomy course which we devised specifically for the STC trainees and this was the first course of its kind in Cambodia. The teaching was challenging as it was carried out through Khmer language interpreters and most of the trainees had very little experience of tracheostomy care or equipment. Alexia Young (SLT from Barking) and Niamh Winters (SLT from Liverpool) accompanied me on this trip.
This year I went out with Alexia Young to provide FEES training and strategy work based in STC’s small office in Phnom Penh. Unfortunately, we were limited from going into the hospitals due to the coronavirus fears but the planning work we were able to do with the trainees was still invaluable
Currently the in-country project leads are Annie Johnson, a UK SLT, and Raul Herreras, Spanish-American SLP and Veasna Leng who is from Cambodia. We worked closely with them on various projects such as dysphagia service development, trainee support via Facebook peer groups, FEES training and developing Cambodian FEES competencies. We are also setting up an international network of volunteer dysphagia/FEES experts that STC can access remotely via social media and skype.
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The impact of these visits is huge. Personally, providing advice and training in a resource poor setting is very challenging but immensely rewarding. Using a problem-solving, flexible approach to tackle enormous barriers to care is very beneficial for my skills and applicable to my work within the NHS. The Cambodian trainees are incredibly motivated and appreciative of our visits and skill sharing and the relationships built between us are inevitable strong. The in-country volunteers and trainees gain support, knowledge and skills from visiting experts which they simply can’t access in Cambodia. And, of course the Cambodian patients receive dysphagia care that they would otherwise never have had which makes a difference in terms of quality of life and mortality.
The NGO is in desperate need of funds to continue the work and to employ Cambodian project managers for marketing and fund-raising which would free up the SLTs to do more hands-on training The ultimate goal is to have a degree programme to train Cambodian SLTs, however in the meantime one of our interpreters on the tracheostomy course last year now starting an SLT degree in Australia as she was so inspired. I intend to keep supporting this NGO both from the UK and by further visits to Cambodia in future.
The donation we received from DP Medical supported the expenses incurred in the visit by Alexia and myself as all our visits are self-funded, and we really are extremely grateful to them for their help. Without this kind of generous corporate support the on-going visits and training would just not be possible so all our thanks go to DP Medical for helping us to make a difference where it’s most needed.