Where Health Care Is a Luxury

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Where Health Care Is a Luxury

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Power failures are common in rural Cambodia. One that occurred during surgery required improvisation, with several mobile phones providing light.

Where Health Care Is a Luxury

Take a 24-hour flight to Phnom Penh, Cambodia. Board a bus and ride for 10 hours to the rural province of Banteay Meanchey. Help set up medical, surgical, dental, and ophthalmological outpatient clinics. See more than 100 patients a day. A week later, take it all apart and fly home. Repeat in a year.

Though he visits a different village every year, that’s the annual routine that Robert Negrin, MD, has followed for the past 10 years, except for a three-year hiatus due to the COVID-19 pandemic. “It’s wonderful to reconnect with my friends and colleagues each year,” he notes. “We have an incredible camaraderie, and we all missed each other during the pandemic gap.”

Negrin, a professor of blood and marrow transplantation medicine, volunteers in the yearly medical missions sponsored by the Cambodian Health Professionals Association of America (CHPAA). About 100 people participate, of which 30 are physicians. “We work with patients, medical students, and others in an environment where health care is a luxury if and when it is even available,” he says.

Trained as a hematologist, Negrin serves as a general medical physician in the clinic in Cambodia, referring patients to the surgery,  dental, or ophthalmology team members as needed — in a similar fashion to the subspecialty referrals that primary care physicians make at Stanford.

Medical Students Eager for Knowledge

In addition to seeing hundreds of patients on each trip, Negrin and his colleagues enjoy working with the Cambodian medical students who serve as interpreters. “They are all dying for interactions with us,” says Negrin. “They are like sponges: bright, committed, dedicated, and eager to learn about American medicine.”

In fact, some of the medical students Negrin has worked with in the past are now physicians themselves. “They are the ones who will change health care in Cambodia and go on to help take care of their own people,” he says, adding that “an improved healthcare system in Cambodia would make the need for these medical missions unnecessary.”

But right now, the need is enormous, especially in rural areas where thousands of people line up for 10 hours or more every day of the weeklong medical mission to be seen by a physician. “What is remarkable,” Negrin observes, “is that no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Two Patients Remembered

Over the course of his 10 years as a volunteer with CHPAA, Negrin has seen thousands of patients. Although many are memorable, two stand out in his mind.

A 22-year-old woman came to the clinic looking “as white as a ghost,” he recalls. He ordered some blood tests but couldn’t make an accurate diagnosis. He raised money through GoFundMe to send her to Bangkok, Thailand, where hospital staff determined that she had leukemia. Her treatment there resulted in a four-year remission. She and her husband came to the mission site each year, even though it was often a great distance from their home. They adopted a child and became close friends with Negrin. Then, she unfortunately suffered a relapse, and though Negrin tried to get her to China for care, he was not able to do so. Sadly, she passed away.

“This was difficult for me because I had to accept the limitations in the Cambodian healthcare system and that I couldn’t do everything I knew I could have done for her,” he says. “I still think about her and am saddened by the harshness of fate that is so impacted by where you happen to have been born.”

A second memory is of a woman in her late 20s who came to see him but was embarrassed to have him examine her. With the help of a Cambodian female medical student, she allowed him to proceed. He found a lump in her breast. The woman told him that it made her feel like she wasn’t a true woman. Negrin helped collect money from CHPAA volunteers to send her to see a physician who had participated in the CHPAA program as a medical student and was now in practice in Phnom Penh. There, through their generosity, she was able to undergo surgery to remove the tumor. Later, she sent Negrin a photo of her wedding and told him that she felt like a full woman again.

Hundreds of patients from Cambodian rural villages wait for as long as 10 hours every day of the annual weeklong medical mission sponsored by the Cambodian Health Professionals Association of America. Volunteer Robert S. Negrin, MD, professor of blood and marrow transplantation medicine, comments that “no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Take a 24-hour flight to Phnom Penh, Cambodia. Board a bus and ride for 10 hours to the rural province of Banteay Meanchey. Help set up medical, surgical, dental, and ophthalmological outpatient clinics. See more than 100 patients a day. A week later, take it all apart and fly home. Repeat in a year.

Though he visits a different village every year, that’s the annual routine that Robert Negrin, MD, has followed for the past 10 years, except for a three-year hiatus due to the COVID-19 pandemic. “It’s wonderful to reconnect with my friends and colleagues each year,” he notes. “We have an incredible camaraderie, and we all missed each other during the pandemic gap.”

Negrin, a professor of blood and marrow transplantation medicine, volunteers in the yearly medical missions sponsored by the Cambodian Health Professionals Association of America (CHPAA). About 100 people participate, of which 30 are physicians. “We work with patients, medical students, and others in an environment where health care is a luxury if and when it is even available,” he says.

Trained as a hematologist, Negrin serves as a general medical physician in the clinic in Cambodia, referring patients to the surgery,  dental, or ophthalmology team members as needed — in a similar fashion to the subspecialty referrals that primary care physicians make at Stanford.

Medical Students Eager for Knowledge

In addition to seeing hundreds of patients on each trip, Negrin and his colleagues enjoy working with the Cambodian medical students who serve as interpreters. “They are all dying for interactions with us,” says Negrin. “They are like sponges: bright, committed, dedicated, and eager to learn about American medicine.”

In fact, some of the medical students Negrin has worked with in the past are now physicians themselves. “They are the ones who will change health care in Cambodia and go on to help take care of their own people,” he says, adding that “an improved healthcare system in Cambodia would make the need for these medical missions unnecessary.”

But right now, the need is enormous, especially in rural areas where thousands of people line up for 10 hours or more every day of the weeklong medical mission to be seen by a physician. “What is remarkable,” Negrin observes, “is that no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Hundreds of patients from Cambodian rural villages wait for as long as 10 hours every day of the annual weeklong medical mission sponsored by the Cambodian Health Professionals Association of America. Volunteer Robert S. Negrin, MD, professor of blood and marrow transplantation medicine, comments that “no one complains about the wait, or how hot it is, or that they didn’t get to be seen.”

Two Patients Remembered

Over the course of his 10 years as a volunteer with CHPAA, Negrin has seen thousands of patients. Although many are memorable, two stand out in his mind.

A 22-year-old woman came to the clinic looking “as white as a ghost,” he recalls. He ordered some blood tests but couldn’t make an accurate diagnosis. He raised money through GoFundMe to send her to Bangkok, Thailand, where hospital staff determined that she had leukemia. Her treatment there resulted in a four-year remission. She and her husband came to the mission site each year, even though it was often a great distance from their home. They adopted a child and became close friends with Negrin. Then, she unfortunately suffered a relapse, and though Negrin tried to get her to China for care, he was not able to do so. Sadly, she passed away.

“This was difficult for me because I had to accept the limitations in the Cambodian healthcare system and that I couldn’t do everything I knew I could have done for her,” he says. “I still think about her and am saddened by the harshness of fate that is so impacted by where you happen to have been born.”

A second memory is of a woman in her late 20s who came to see him but was embarrassed to have him examine her. With the help of a Cambodian female medical student, she allowed him to proceed. He found a lump in her breast. The woman told him that it made her feel like she wasn’t a true woman. Negrin helped collect money from CHPAA volunteers to send her to see a physician who had participated in the CHPAA program as a medical student and was now in practice in Phnom Penh. There, through their generosity, she was able to undergo surgery to remove the tumor. Later, she sent Negrin a photo of her wedding and told him that she felt like a full woman again.

It’s the human contact with the patients and especially the students, many of whom have become lifelong friends. And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.

We Are So Privileged in the U.S.

Negrin says that the hardest part of each of the trips is coming home. “We are so privileged here in the United States,” he says. “I start to question why are we ordering a CT scan for every little thing? What is the likelihood we will find anything significant? At times, the care we provide is so excessive. It’s made me reevaluate how I function as a clinician in a healthcare system that is rich in resources and the finest in the world.”

Why does Negrin keep going back? “It’s the human contact with the patients and especially the students, many of whom have become lifelong friends,” he says. “And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.” 

Volunteers from the Cambodian Health Professionals Association of America medical mission, with Robert S. Negrin, MD, professor of blood and marrow transplantation medicine (seated on red stool) and Cambodian medical students who serve as interpreters (wearing yellow shirts).

It’s the human contact with the patients and especially the students, many of whom have become lifelong friends. And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.

We Are So Privileged in the U.S.

Negrin says that the hardest part of each of the trips is coming home. “We are so privileged here in the United States,” he says. “I start to question why are we ordering a CT scan for every little thing? What is the likelihood we will find anything significant? At times, the care we provide is so excessive. It’s made me reevaluate how I function as a clinician in a healthcare system that is rich in resources and the finest in the world.”

Why does Negrin keep going back? “It’s the human contact with the patients and especially the students, many of whom have become lifelong friends,” he says. “And the knowledge that I’ve made a small impact on the lives of a few people. I know we are just Band-Aids in the big picture, but lately I’ve stopped asking myself why I do this.” 

Volunteers from the Cambodian Health Professionals Association of America medical mission, with Robert S. Negrin, MD, professor of blood and marrow transplantation medicine (seated on red stool) and Cambodian medical students who serve as interpreters (wearing yellow shirts).

Stanford Is Going South

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Stanford Is Going South

New Cardiovascular Clinic Brings Stanford Care to South Bay Communities

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Bryan Wu, MD, takes care of a patient at the Cardiovascular Medicine clinic in San Jose, California.

Stanford Is Going South

New Cardiovascular Clinic Brings Stanford Care to South Bay Communities

The Department of Medicine’s growth mindset has taken shape in the form of a brand-new Cardiovascular Medicine (CVM) clinic, which opened its doors in spring 2023 at Stanford Health Care in San José, California. The driving force behind the clinic is an interest in expanding not only Stanford’s geographic footprint but also the diversity of its patients.

Expanding to Diversify the Patient Population

According to its champion, Eldrin Lewis, MD, “In California, patients don’t like to travel much for health care, especially routine health care. So, meeting the patient where they live is a rallying cry that I have been seeing during the time that I have been [working at Stanford].” Combined with similar endeavors, the new CVM clinic provides the opportunity for Stanford to expand beyond its traditional role as a “boutique” health care facility that people must travel to in order to receive high-quality tertiary and quaternary care to a system that cares for patients across the spectrum of disease severity and type, right in their own California communities.

Expansion of cardiology services first focused on the East Bay, but when the opportunity arose for a CVM clinic to provide ambulatory care in the South Bay, Lewis and his team jumped on it. Since opening, the clinic facility has had space to see 16 patients at once. 

“This is an opportunity to increase the diversity of the patients that we see in terms of race and ethnicity, with a larger Hispanic and Vietnamese population in the South Bay,” he says. “It allows us to see patients who may not have made the drive up to Palo Alto.” Lewis is Simon H. Stertzer, MD, Professor of Cardiovascular Medicine and chief of the division of cardiovascular medicine in the Department of Medicine.

Growing to Bring Specialty Care to the Doorsteps of New Communities

While several general cardiologists and a few electrophysiologists and interventional cardiologists were already working in the South Bay, the breadth of expertise that Stanford can offer was lacking. 

In addition to standard cardiovascular care, the new CVM clinic provides access to specialists in preventive cardiology as well as experts in heart failure, transplant, and adult congenital heart disease. It currently offers echocardiography and stress echocardiography, and Lewis hopes to eventually add nuclear medicine, cardiac magnetic resonance imaging, and CT angiography. It makes a welcome companion to the Santa Clara location of the Stanford South Asian Translational Heart Initiative (SSATHI) clinic, which is home to cardiologists who specialize in the needs of the South Asian population.

“A lot of patients can [now] stay in San José,” says Lewis. “Those who need more complex procedures or surgeries can come into Palo Alto to Stanford Health Care, then continue to be managed [closer to home]. … I would love to be a resource to the greater South Bay community. … I would also like to see the opportunity for educating the community with health fairs and a variety of other things for people who are not necessarily being seen by one of our providers.”

Renewal Through New Relationships

Lewis has made several forays into the South Bay to talk up the clinic to local cardiologists, regional hospitals, and the community at large, describing what the new clinic has to offer while also emphasizing that the goal is to work in partnership with local physicians to provide excellent patient care. “We want to provide the right care at the right time to the right patient,” he says. “My philosophy is that it should be a bidirectional process.” Patients can remain with their current cardiologists, only venturing to the South Bay clinic when they require specialized care.

An official ribbon cutting ceremony marked the opening of the Department of Medicine’s cardiovascular medicine clinic at Stanford Health Care in San José, California

The Department of Medicine’s growth mindset has taken shape in the form of a brand-new Cardiovascular Medicine (CVM) clinic, which opened its doors in spring 2023 at Stanford Health Care in San José, California. The driving force behind the clinic is an interest in expanding not only Stanford’s geographic footprint but also the diversity of its patients.

Expanding to Diversify the Patient Population

According to its champion, Eldrin Lewis, MD, “In California, patients don’t like to travel much for health care, especially routine health care. So, meeting the patient where they live is a rallying cry that I have been seeing during the time that I have been [working at Stanford].” Combined with similar endeavors, the new CVM clinic provides the opportunity for Stanford to expand beyond its traditional role as a “boutique” health care facility that people must travel to in order to receive high-quality tertiary and quaternary care to a system that cares for patients across the spectrum of disease severity and type, right in their own California communities.

Expansion of cardiology services first focused on the East Bay, but when the opportunity arose for a CVM clinic to provide ambulatory care in the South Bay, Lewis and his team jumped on it. Since opening, the clinic facility has had space to see 16 patients at once. 

“This is an opportunity to increase the diversity of the patients that we see in terms of race and ethnicity, with a larger Hispanic and Vietnamese population in the South Bay,” he says. “It allows us to see patients who may not have made the drive up to Palo Alto.” Lewis is Simon H. Stertzer, MD, Professor of Cardiovascular Medicine and chief of the division of cardiovascular medicine in the Department of Medicine.

Growing to Bring Specialty Care to the Doorsteps of New Communities

While several general cardiologists and a few electrophysiologists and interventional cardiologists were already working in the South Bay, the breadth of expertise that Stanford can offer was lacking. In addition to standard cardiovascular care, the new CVM clinic provides access to specialists in preventive cardiology as well as experts in heart failure, transplant, and adult congenital heart disease. It currently offers echocardiography and stress echocardiography, and Lewis hopes to eventually add nuclear medicine, cardiac magnetic resonance imaging, and CT angiography. It makes a welcome companion to the Santa Clara location of the Stanford South Asian Translational Heart Initiative (SSATHI) clinic, which is home to cardiologists who specialize in the needs of the South Asian population.

“A lot of patients can [now] stay in San José,” says Lewis. “Those who need more complex procedures or surgeries can come into Palo Alto to Stanford Health Care, then continue to be managed [closer to home]. … I would love to be a resource to the greater South Bay community. … I would also like to see the opportunity for educating the community with health fairs and a variety of other things for people who are not necessarily being seen by one of our providers.”

Renewal Through New Relationships

Lewis has made several forays into the South Bay to talk up the clinic to local cardiologists, regional hospitals, and the community at large, describing what the new clinic has to offer while also emphasizing that the goal is to work in partnership with local physicians to provide excellent patient care. “We want to provide the right care at the right time to the right patient,” he says. “My philosophy is that it should be a bidirectional process.” Patients can remain with their current cardiologists, only venturing to the South Bay clinic when they require specialized care.

The new clinic will partner with South Bay primary care physicians who are part of the Stanford Medical Foundation, acting as a local resource for the cardiology care their patients need. “On average, if you have a single general cardiologist paired to five to 10 primary care doctors, you can create ecosystems where you really get to know those primary care doctors,” says Lewis. “That is something I would like to see develop a little bit more.”

This is just one part of a bigger strategy to expand the network. What I would love to see in five years is Stanford reaching out beyond the East and South Bay, where we are now, to go farther east into the Central Valley.

Looking Forward

“This is just one part of a bigger strategy to expand the network,” he continues. “What I would love to see in five years is Stanford reaching out beyond the East and South Bay, where we are now, to go farther east into the Central Valley.” This is an area of California with limited access to specialized care, and patients experiencing acute cardiac events or with conditions that require special expertise to manage may opt not to drive several hours to obtain the care they need. “The majority of Americans live outside of urban areas, and those are the forgotten people, sometimes.”