Rheum After 5: Dr. Victoria Seligman Helps Create Cambodian Healthcare

Game Changer

Within the next five years, the rheumatology clinic turned a corner. Khun Rithya, MD, a senior physician at the hospital, was sponsored to attend international rheumatology conferences and training programs and then brought that knowledge back to his staff of eight, who handle inpatient, out­patient and emergency department services.

Dr. Rithya, who manages the rheumatology clinic, examines a patient’s X-ray.

Dr. Seligman says the education level of the clinic’s physicians has grown exponentially, as has the clinic’s capacity. Originally, there was just one building. Now there are two. Imaging technology, such as computed tomography scanning, is now available on site.

Although tremendous knowledge gains and improvements have been made, enormous barriers to the delivery of healthcare remain, she says, adding that this population is predisposed to certain rheumatic conditions.

“At least 30–40% of the rheuma­tology patients are young women with severe lupus or connective tissue disease,” Dr. Seligman says. “The costs for prescription drugs are high, and there are always questions about how to balance rheumatic diseases with infections, like TB [tuberculosis] or malaria.”

Since that first visit in 2004, Dr. Seligman has visited Cambodia about 10 times. During her biennial visits, Dr. Seligman still delivers care, but now she acts primarily as a rheumatology consultant. The most difficult challenge is helping children or young adults who are handed a death sentence when in end-stage disease.

“The lack of dialysis access is still heartbreaking and a travesty,” says Dr. Seligman, adding that systemic lupus patients are often young women with severe kidney disease. “We can’t level the playing field even with the newest medications. We have to contend with all of these other elements of healthcare delivery in a country that is so fractured.

A portion of the Angkor Wat Buddhist temple complex in northern Cambodia.

“There’s so much to learn from people who practice in a low-resource setting,” she says, adding that this experience has not been a one-way street. “It was like working in the early days of medicine, when physicians took care of each other and their patients, working together as a family.”

A Transcendent Experience

Looking ahead, Dr. Seligman hopes to involve the next generation of rheumatologists in these types of volunteer programs. “This program has dramatically changed my life for the better,” says Dr. Seligman, explaining that it has helped her learn about pathologies uncommon in the U.S. and build relationships with clinicians from around the world. “The most vulnerable patients are benefiting from knowledge that physicians here take for granted. But just as important, the overall experience transcends medicine.”