By Katharine Lowndes, MBBS, FRCPath
In 2018, when I was looking into volunteering opportunities, HVO stood out as – and remains – one of the very few organisations where haematologists can volunteer their expertise. I had previously undertaken some volunteer work through a connection with my hospital in South Sudan, and, on returning to the UK, was keen to continue. Around this time, the British Society for Haematology (BSH) joined the well-established partnership between HVO and the American Society of Hematology (ASH) to support a new project site with Calmette Hospital in Cambodia. I applied to join. Although I had planned to travel in 2020, the trip was cancelled due to COVID-19. I was able to contribute remotely through an online lecture, but the ambition to go in person remained.
In 2023, I was invited to serve as co-director for the project alongside Dr. Ben Watkins. We visited Cambodia together, and I also took on a liaison role between BSH and HVO as the collaboration progressed. Although the project had formally launched in 2019, its development had been significantly hampered by the pandemic. We were only the second team of volunteers to visit the site. During our time there, we identified considerable changes, including a new on-site coordinator, which required us to rebuild relationships and reassess the priorities for the site.
To strengthen engagement with the local team and involve new volunteers, we established a regular on-line education programme. On the first Monday of each month, a volunteer would deliver a lecture, and on the third Monday, our partners at Calmette would present clinical cases for discussion. The cases have often been complex and challenging, but these discussions have been instructive and really helped us to build a partnership with the clinicians in Cambodia based on trust and mutual learning.
There is much discussion at present about professional burnout and the importance of work-life balance. For me, volunteering has provided a renewed perspective on clinical practice. Working within the constraints of limited resources forces you to return to first principles. Without immediate access to expensive tests or newer therapies, you have to rely on clinical judgement, basic scientific knowledge and experience. On returning to my role in the UK, I found myself approaching cases differently, questioning what could be achieved with a more resource-conscious mindset. It also led me to take on new responsibilities, including leading the laboratory service.
At the end of the year, we reviewed the case discussions and noted a recurring theme: outcomes for acute leukaemia were particularly poor. Following conversations with the local team and at their request, we have initiated a project to examine the patient population presenting with acute leukaemia and the decision-making processes around treatment. The aim is to support the development of site-specific protocols, enabling clinicians to identify which patients may benefit from aggressive treatment and which may be better served with palliative care approaches.
With regards to the case discussions there is one case in particular that I think illustrates the value of this collaboration. A patient with recurrent immune thrombocytopenia had been managed with long-term steroids, leading to significant complications such as Cushing’s syndrome. Through multiple discussions, the team felt more confident recommending a splenectomy, a recognised treatment for the condition. Following surgery, the patient’s platelet count improved, she was able to discontinue steroids, and her overall condition improved markedly. It was gratifying to see that, through collective discussion, we were able to support a change in management that had a tangible benefit for the patient.
Volunteering has offered considerable professional and personal rewards. It has provided the opportunity to work alongside colleagues in Cambodia, in a completely different setting, from whom I have learned a great deal. Certain conditions, such as abnormal haemoglobins, are more common there, and the local clinicians have significant expertise in areas less frequently encountered in the UK.
At times, clinical work in the UK can feel somewhat remote from its impact. Volunteering has reminded me of the value of direct clinical engagement and professional collaboration. For anyone considering volunteering, I would strongly encourage it. HVO offers excellent support, and the network of volunteers ensures that even in challenging situations, assistance is always available. It is demanding work, but highly rewarding.
I am very grateful to HVO for providing the opportunity to contribute to this project. It has been one of the most positive and formative experiences in my career, and one I would readily recommend to others.
