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Voices of Japan Heart Vol.3 Clinical Nutrition Medical Doctor Ms. Putheara

Ms.Putheara is a professional and enthusiastic medical doctor. Even though in Cambodia, the certification for clinical nutrition doesn’t yet exist and there is no educational institution that provides a training in clinical nutrition, she went abroad by herself to obtain training and certification and became a clinical nutrition medical doctor. Here’s her story.

Q. Please tell us about your career.

A. When I was young, with desire to help vulnerable people, I decided to study in medical field and graduated from university then became medical doctor. However, my experience as a medical doctor made me grow interests in nutrition, and so I decided to pursue clinical nutrition in order to become medical doctor with confidence to treat patient both medicine and lifestyle especially related to food recommendation. Moreover, to become a medical doctor who could answer related to food and manage nutrition care for patients, because during my internship, there were no opportunity to learn about clinical nutrition which nutritional management has a significant impact on medical treatment,

So, I searched for a place to study clinical nutrition, but in Cambodia, there was none. The National Institute of Public Health in Phnom Penh is the only educational institution where you can learn nutrition, but the curriculum didn’t include clinical nutrition.

Therefore, I began looking for overseas universities. At that time, I had never even traveled abroad by myself, but I was so determined, and did a lot of research on internet. There were many universities to choose from, and I chose Mahidol University in Thailand because I thought it wouldn't be very helpful if the food and culture were too different from my country.


Q. What made you so interested in “medical care and nutrition”?


When I was in medical school, I did a clinical training at a hospital. There were times when patients came to me and asked about food, but I couldn’t answer them. I was shocked with myself. It was a big turning point for me.

Also, I once accompanied a relative to a hospital because she had trouble with eating. It was a large hospital, but when I asked the doctors about diet, there was no clear answer. Although food and nutrition have a significant role during medical treatment, nobody in the medical field seemed to have a proper knowledge of nutrition, and I thought things need to be changed.

Q. How did you come to work at Japan Heart?


After finishing my clinical nutrition training at Thailand, I found Japan Heart while searching for a job at a hospital related to nutrition in Cambodia on Facebook page. In Cambodia, it’s very rare to find a hospital that hires staff related nutrition job or dietitian or clinical nutrition medical doctor, so when I saw Japan Heart recruiting nutrition facilitator, I thought, “this is it!''. With my previous experience working with kids and volunteer many charity events, this is the place fit my background and preferences. Moreover, I could apply my knowledge and skill from Thailand to help people who are vulnerable. I find it very rewarding to work here.


Q. I am impressed by the way you accompany doctors on their rounds and talk to patients and their parents every morning. What do you keep in mind when working at a hospital as a dietitian?


I considered myself as clinical nutrition medical doctor. Dietitian is professional related nutrition care for patients but me as medical doctor and educator, I do more than this. Many patients at this hospital are young children, so the cooperation of their parents or caregivers is essential. I want them to understand that if the nutritional status of their kid is poor, the medical treatment may not be as effective as it should be, and that nutrition is important not only for the treatment but also for the growth of the children.

When I talk to parents and caregivers, I realize that there is different from the theory or book or other experiences that published in other countries. They mentioned some food might affect eating of kids. But more than 2 years’ experiences working here Cambodia context, I observed and did nutrition counselling with older kids and parents of kid. There are many things need to adapt and modify. Some new caregivers think “anything is fine as long as it's edible,'' and they feed their children who are battling cancer with unhygienic or contaminated street food which can be problematic. So, I always provide the small lecture related to nutrition for cancer and how to store and select food with better choice and safety.

I grew up in a similar environment to the patients, so I understand that there are many people who have never had the opportunity to learn about nutrition in the first place, and that sometimes poverty blocks parents from paying attention to their children's nutrition.

I talk to parents and caregivers every day to assist them and make them realize that they are important person who contribute in this long term treatment and could help their children by pay more attention of food their children eating and buying good nutrients food for them. When caregivers follow advice and pay more attention diet of their kids, it makes me happy to see nutritional status kids improve and few kids also grow up and get taller too. I also tried to stay in touch with them, and sometimes I get messages about food and nutrition even after they are discharged from the hospital.

Q. You also work outside of the hospital. How come?


Beside taking care of nutrition support for cancer kids, I also do nutrition counselling for pregnancy women and baby check-up every month. Moreover, I regularly visit local schools and other hospitals to give some lectures. In Cambodia, school health checkups are not common, so we provide nutritional guidance along with simple health checks such as height and weight.

Recently, there has been a movement on a national level to provide nutrition education in schools, and I heard that new textbooks have been created for this. I hope that by educating children, right knowledge will spread to their parents' generation and the people around them. These spreading will help more people and decrease the burden to the health system in Cambodia.


Q. Do you have any other future plans?


In Cambodia, medical care and nutrition are seen as two completely different things. For example, text books about clinical nutrition based on Cambodian food culture are yet to be produced.

I would like to develop the “nutrition support system in hospital in Cambodia” which raise awareness the nutrition care patients can help for saving more money, more lives, better outcome, decreasing length of stay of patients. Especially, decreasing the burden of health system in Cambodia. Therefore, I want to deepen cooperation with other hospitals, and share our experience and know-hows with many other people.

At this hospital, there are cases where unfortunately we cannot save the children’s lives, but we could help their eating better and enjoying eating during their staying with us. I would like to provide our best care for them even they could not stay with us for long time. I am still learning about the nutrition care process for kid’s cancer because currently we do not have the clear guideline to provide them. Even I have joined many workshop or international webinars related to nutrition in Cancer. Its need more researches to apply this field. I have developed new material and make better and better every year. Also, I will share their story to next caregivers to keep motivate, encourage and support each other and my clinical nutrition experiences to medical doctors in hospital too.

I also plan to share topic related to clinical nutrition care in Medical Council of Cambodia in next few years. As I have known now, increasing of nutrition interest, nearly 10 people who are doctors, pharmacists, nurses, midwifes who are working in other hospitals from government non-government and privates related to nutrition care of patients then I would like to make the first “Cambodian Dietetic Association” in near future too when there are enough people and appropriate time.


Clinical Nutrition Medical Doctor Miss. Putheara

Originally from Kampong Speu province is bordered and located to the west of Phnom Penh, Cambodia. Its famous for palm sugar. After graduating from university with a degree in medicine, she pursued her study in clinical nutrition at a university in Thailand and obtained certification in clinical nutrition. She has been working as a clinical nutrition medical doctor at Japan Heart Children's Medical Center since 2021.

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