WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTE

Regional Office for the Bureau Regional Pour LeWestern Pacific Pacifique O,ccidenttl

REGIONAL COIv 1ITTEEMEETING

Third Session RC/3/WP/TD/10Saigon:25-30 September 1952

T. E .G H N I C A _L DISCUSSION S

The Education and Training of Medicaland Public Health :Rer.sonnel

EDUCATION AND TRAINING OF MEDICAL AND PUBLIC HEALTH PERSONNEL

KINGDOM -OF CAMBODIA (1)

PART I

SECTION'I

Problems related to the characteristics andQusntit , of. trained personnel and..training resour

A. (a) Aims and tasks of medical and related' education:

1. Medical and surgical care in the :various hospitals,infirmar ies and medical stations in the Territory.

2. Epidemiological supervision and pre*ve'ntive^medicine.

3. Social activities.

4. Inspection of labour.

(b)(b) Types sand characteri stics (medical , nursin and other s aff)

Doctors: Medical doctors with French degree sIndo- Chinese doctors trained at the Hanoi CollegeHealth officers trained at Pnom-Penh College

Note: Certain health . officers who. passed through . the Collegebegan their - studies at the . College of Social MedicalAssistants at Saigon.z, which closed down in 1945... They con-tinued and completed their studies in one or two years atPnom-Penh.

Pharmacists : Pharmacists holding a ,, French diplomaIndo-Chinese pharmacists trained at^ theHanoi College.

Dental surgeons::. Holding a French diploma

(The following information is taken from a document. datedMarch 13th 1951 and prepared for.the. Technical Discussionsthat were held during the Fourth World Health'Assembly).

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Midwives: Holding a French diplomaTrained at the Hanoi Midwifery SchoolHolding certificates of the Pnom-PenhMidwifery School

Women nurses: Holding a French Government diploma

Male and female nursing staff: Holding the diploma of thePnom-Penh Nursing School,for men and women

Health-agents:. Recruited and traine•d.at Pnom-Penh MunicipalHealth Office

Rural midwives `'(Chmop) : These have received the traditionaltraining and are being given ele-mentary and essentially practicalinstruction' eith.er.. at Pnom-PenhMaternity Hospital or at provincial

_maternity . hospitals.

(c) Education and training of these various groups

1. Doctors, pharmacists, midwives and women nurses holdinga French degree or diploma are fully qualified to dischargetheir social..as.well as their technical duties.

2 Health Erf# peers -re-=a-t..present receiving -training whichis still.ina.dequate,,as their college has only recentlybeen'treated to-- iezt=the mmediate needs of -the.. country.

The teaching includes:

Clinical training to enable them to qualify as generalpractitioners able 'to deal with all ordinary diseases andto diagnose and evacuate promptly to the Pnom-Penh centreall patients whom they cannot treat because of insufficientknowledge or lack of the necessary material resources;

training in public health. and epidemiology for theprevention ' of .end.emic and .epidemic . diseases, .and. forinoculations, epidemiological enquiries and populareducation.

The aims of the founders of this College were unpre-tentious. The intention was simply to train here auxiliarystaff for qualified medical men, and a curriculum.of notless than four years' study, was contemplated. Owing tocircumstances this auxiliary personnel was prematurelypromoted to be heads of public health groups and:,to dis-charge duties for which they had not been adequately trained.Transitional measures are.to be adopted in agreement withthe French authorities to find- a remedy for this..situation,which will disappear-as soon as the College is in a positionto train health officers with adequate qualifications.

3. Male and female nursing staff and..:midwives are. trainedin a school opened at Pnom-Penh in_1947. The teaching givenat this school appears to be adequate for their technicaltraining.

1. The only health' agents are those with specialized trainingin the town of.Pnom-Penh.

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5, Rural midwives, who were formed.into.a special body in1949 to deal with the most urgent ca-sses-- are intendedsolely to meet the needs of the rural populations, pendingthe passing out of a sufficient number -of midwives-from, the.school.:

(.d.) Improvements are contemplated

1. In the case of health officers:

in regard to their clinical training. A competitiveexamination is; to be held. for assistants in the hospitalsand dispensaries of Pnom.-Penh. These assistants, who willreceive an additional two years' clinical training,. will beattached later to hospital groups.'

in regard t o social hygiene funct ions, periods oftraining at the Municipal Health Office and with 'the MalariaService will permit of the training of mobile social hygieneagents.

- in addition, the teaching level will gradually beraised so that the School will later become a full-scaleMedical College like that in Hanoi. -Students passing throughthis College will be known as Cambodian . doctors, or Khmers.This , title may also be g iven to health officers who. havealreac)y passed through the school after taking . the' assistants'examination.

- Cambodian doctors and social hygiene agents will besent to France to take more advanced courses.

B.

2.,.., In regard to the auxiliary.. staff the approaching visitof specialized personnel of the World Health. Organization

;.will allow of the completion ' on. modern lines of the trainingof ;auxiliary staff in regard to' social welfare assistance.

Quantitative Aspect of Question A.

(a) Doctors with French degrees 41 (including'17 inor with diplomas granted by private practice)the Hanoi CollegeHealth Officers 21Student Health Officers 68Pharmacists 7 (including 4 in

Dental surgeons

European woman nurseMidwives

male

private practice)3 (including 2 in

private practice)1

17 (including 3 inprivate practice)

39329 ,

8517.

Rural midwives $5

The above figures, especially those for qualified medicalmen and midwives, are insufficient.. A provisional remedymight be supplied` by bringing inn,,Fr.ench doctors in, accordancewith the agreements entered into between the French andCambodian Governments.

Male nursing staffFemale nursing staffStudent: nursing staff,and female.Student midwives

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Co

(b) Educational..resourc .;`

1. Health O 'f icers Cole e

This is installed in primitive provisional pr.em, i.8eswhich are definitely inadequate. Plans are in hand forthe erection of new build ngs i' a-: pac o^zs ..e_,it rhiGh will:meet the needs of the country ,,: that, is to say the creationof a Khmer College of Medecine.

The teaching staff, which is also inadequate, for. themoment ,. may -be supplemented , and everything ''required willbe done by-the French Government at the r'eque st of theCambodian Government.

.2•.. school for male and female nursing staff and formidi e s^ . ...

This is 'running .snoothly but cannot yet meet thequantitative needs of the country, especially for womennurses.and midwives.

^̂j'+ np ^a].,.as ects of the same,. iroblems.

The Kingdom of Cambodia is, a nearly ` homogeneousethnical unit;., -, Accordingly there seems to us tote-homajor problem connected with ethnical minorities.

sEC'ION II

Cambgdia has been ,under' French cultural influence for.near]:ya century, The country has an elite' though thenumbers of the' latter `are small. If -Cambodia is to makequalitative and quantitative progress ,in education andin training health workers, and especially if new, andstimulating ideas are to • spread, the .. country....c.ert.a.'inlyrequires effective assistance.

It should be noticed,'however , that;

1. The instruction and cultural exchanges call' onlytake place. in French. Y:.

2. Direct material assistance might be given by theWorld Health Organization; erection of the College''fitting-=up' of laboratories, supply of teaching equipment,etc.:

As regard.s,.personnel, the forthcoming return ofCambodian social welfare women instructors 'who' have beentrained in France will be of the greatest'value in buildingup the organization for the education of auxiliary personneland the various populations. The shortage, of teaching staffat the Health Officers' College may be deaj.t with 'by'meansof agreements concluded directly between the French andCambodian Governments.

there _is, tferd,fo-re, no cultural; linguistic or national.isolationism, since . all teaching for health workers- is givenin 'French.

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PART II

SECTION I

Medical Education

(a)'

`The minimum ' standard for entrance to the HealthOfficers' College is at present the elementary higherprimary leaving certificate. It is rather below thelevel of the first part of the French.-'.'baccalaureat."

It would obviously be. desirable to raise thisstandard to insist at least ...on the first part of theFrench "baccalaure'at" for admission to the College.

The annexed table. shows the full programme eachyear for the entire medical training given in theCollege. The course is at present one of four yearsonly. End-of-year examinations are held in the Collegein the last'fo,rtnight in each academic year. Failurein these examinations leads either to the student beingexcluded or being given permission to take the sameyear's course again.

The fourth year examination includes theoretical andclinical tests and;the student, if.successful, is granteda diplom- and appointed a health officer on probation.

The teaching staff consists of a Principal of theCollege, whose entire time is devoted to these duties,and professors and lecturers who are doctors and pharma-cists employed in Pnom-Penh.. They are too few in numberand, in addition-,"=' they have exacting hospital dutiesand cannot, as they would like, devote all their timeto the clinical and practical teaching-of.' their: studentsMoreover, it must be admitted that some of-them have notall the requisite qualifications for teaching.

Problems of equipment: The provisional premises)are insufficient and otherwise defective. The"cons-''.truction of a new building is being arranged. for, butfunds are limited. 'The. technical teaching:.equipment!:.is also very inadequate. Orders have been placed toobtain standard'works'',(in'French) for the-school,microscopes, anatomical drawings, wax models, histolo-gical sections, etc. The ECA has just supplied threeimmersion microscopes, and further help is expected.

The entire cost of .teaching and of maintenance ofthe school is borne by-the Cambodian Government. Thestudents are boarded in the school and are furthergiven a small monthly allowance.

(b) Reference to the curricula shows that the weeklytotal for the four years is as follows:

theoretical teaching 36 hourspractical teaching 35 hoursHospital training takes place everymorning from 8 till noon, while thetheoretical` courses are given in theafternoon.

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SECTION IV

At present there is a shortage of qualified medicalstaff, of midwives and, especially, women social welfareworkers in Cambodia. As regards midwives the P.nom-PenhSe-hoof will 'probably supply sufficient numbers- in-a--few,yaps; f:or the chief..pr,ovincial towns..., The, training ofwomen- :social workers ,is. also being considered.

SECTION V

Each' specia-lize'd health service trains its ownauxiliary technio'al personnel; .'!the Health Office trainssanitary agent's,` the' 'Laboratory trains laboratory as-sistants, etc. There are,! hoWever, as yet no specialcourses. for,^the purpose.

..CONCLUSION`

Medical teaching in Cambodia. is being re-organized:..the Health .Officers' College will shortly supply,.Cambodian doctors and social health agents.

The school for male and female nurses and midwivesat Pnom-Penh trains the required auxiliary personnel.

The organization of a social assistance service shouldbe. 'con'sidered.

AS - Cambodia : ,.is a -country of French culture. the WorldHealth Organizatipn:-P,er.sonnel sent to it must be able tospeak French.

Valuable aid could be.,given by the World HealthOrganization in equipping our Medical College and t"hetechnical..-training. of.our„auxiliary personnel (womensoeia^. welfare workers, midwives and male and femalenursing staff ^.. ,

Given at Pnom=Penh, 13.March 1951'

.,UNDER-SECRETARY OF STATE FOR HEALTH,LABOUR'"AND SOCIAL ACTION

(Signed) Dr. Sonn-Mam

Senior Head PhysicianPsychiatric Hospitals

HEALTH OFFICERS' COLLEGE

Weekly allocation of hours of instruction and practicalwork

1st` Year 2nd. Year

Course in medical and' surgieal ' •Course .' in,"medical and surgicalwork every morning from g to `U with " work every • inorhing from 8 to 11 withthe examination of patients and the examination of patients andobservations . . . observations.

Course Practical semiology 1 hr. Course Practical semiology 1 hr.it Practical clinical Practical clinical

medicine l hr. medicine. 1 hr.It Clinical surgery •' I hr. .'± -Clinical surgery ], hr.it Dissection 4 hrs : " Anatomy' 2 hrs.it Anatomy 2 hrs . r'r ...Pathology, internal 2 hrs.It Physiology 1 hr;- " Pathology, external 2 hrs.

Minor surgical treatment 1 hr. Chemistry 1 hr." Semiology 1 hr. Physiology 1 hr.

Histology 1 hr. " Dissection 2 hra.Chemical physiology 1 hr.

Total 14 hra Total 13 hrs.per 'week per week

3rd Year 4th Year

Course in medical and surgical course in medical and surgicalwork every morning from 8 to 11 with work every morning from 8 to 11 withthe examination of patients and ther examination•.' of patients andobservations . observations.

Course Practical semiology 1 hr. Course Practical semiology 1 hr.if Practical' clinical. • " Practical'clinical

medicine 1 hr. ' medicine 1 hr.it Clinical surgery 1 hr. " Clinical. surgery 1 hr.It Obstetrics , puericulttre 2 hrs. " Obstetrics , puericultur'e 2 hrs.it Pathology, external 2 hrs. " Therapeutics 2 hrs.if Pathology, internal 2 hrs . " Pathology , internal 2 hrs.

Topographical anatomy Pathology, external 2 hrs.and operative medicine 1 hr.• " Forensic medicine,

" Bacteriology. and psychiatry and deontology 1 hr.parasitology 1 hr. " Pharmacology 2 hrs.

4t Practical work , " Epidemiology 2 hrs.bacteriology 4 hrs.

' Physiology 1 hr.

Total 16 hrs . Total 16 hrs.per week' per week