Special Feature. Three Days in Cambodia: What a Volunteer Saw Before He Had the Words

In an outdoor, temporary mobile clinic in rural Cambodia, on his second day at the clinic, Thomas was recapping the 30th used syringe of the afternoon. He had been shown how once, that morning. The caps did not always stay on. Sometimes he came to a syringe and found the needle exposed. He would recap it, remove the assembly, set it aside. He knew this was where something could go badly wrong. He was careful, and nothing happened. It was only later, back at school during his sophomore year, that he grasped how dangerous those three days in clinic had been.

We interviewed Thomas, a pseudonym, about his volunteer experience with a medical relief organization in the summer of 2025, between his freshman and sophomore years at Vanderbilt University. As a premed student, he wanted a first taste of global health work. He joined a team of medical professionals and students deploying mobile clinics into communities that go years without care. He expected to shadow, learning how medical care is given outside of US medicine. However, during the 3 days he spent at the mobile clinics, he took vital signs, assisted with extractions, and reprocessed instruments, none of which were assigned in advance and none of which he was trained for.

This experience was not caused by a negligent organization. Thomas was simply a well-intentioned volunteer doing whatever was asked of him under severe constraints. His short time in the field provided a stark education in resource disparity. What it exposed was not a shortage of equipment. It was the absence of anything that would have told him what the equipment was for.

On day one, the Cambodian government shifted the schedule to an informal tour of a rural hospital. The tour offered no discussion of infection control, Thomas’s upcoming role, or his readiness. It was the only day built for orientation, and it was the last chance anyone had to ask what he could actually do. The clinics opened the next morning.

One Blood Pressure Cuff, No Mask

A couple of hours into his first day in the clinic, he was completing triage vital signs. He was shown the blood pressure cuff, given verbal instructions, a single demonstration, and left to begin. He used the same blood pressure cuff on every patient in the queue. He was told it only needed to be cleaned if the patient had a rash. Then clean it with soap and water. He did not know that disinfection between every patient is the standard of care.

The day’s work carried a risk he was not aware of. At one point, Thomas overheard clinicians casually mentioning that a patient in line had tuberculosis, after which he saw one team member put on a mask. He never learned if the report was accurate, who the patient was, or if any isolation or screening took place. No one mentioned that he may need to wear a mask, to put one on the patient, or that there might be a potential TB exposure.The transmission risk of tuberculosis was not mentioned, nor was any respiratory workup performed.

Recapping Used Lidocaine Needles

As the day progressed, Thomas volunteered to help where he was needed. This took him from performing vital signs to assisting the periodontist with tooth extractions.

The provider gave an overview of the procedure and what was needed of Thomas to assist. He was told to wear gloves when touching the patient, to never touch the lidocaine cartridge with his hands, never reach across the sterile field, keep used instruments away from clean ones, place the gauze afterward, and wash his hands.

Every instruction is correct. Note what is absent. But look closer at what was missing: an actual foundation for infection prevention.

He was never taught to don a mask. He was never taught the 5 moments of hand hygiene. He was never taught when to don gloves; he watched others and copied. He washed before gloving because it made sense to him to, not because others were doing it.

The extractions ran on reusable aspirating syringes: a disposable needle, a lidocaine cartridge, and a metal barrel that goes back into service. Recapping is the correct move here. There is a technique for it, and there is a place the needle goes afterward. Thomas was shown the motion once and left with it. Nobody told him the technique had a name, or that the way he was doing it was the way you get stuck.

There was no sharps container. He was working outside. The needle had nowhere to go that an infection preventionist (IP) would recognize. Instead, recapped needles went onto the instrument tray, and the tray went to the reprocessing area. Thomas had no part in what happened after that. He does not know what became of the needles.

He was never told what would happen if he got stuck. He was never told of the risk. It was treated as a non-issue.

Three Buckets and a Timer

The staff moved to a different clinic location each day, the second and third in more rural and resource-limited locations. Thomas was moved from assisting to reprocessing reusable aspirating syringes. These sites lacked sinks and used a 3-bucket chemical system to decontaminate, clean, and disinfect. Thomas was provided with a brief tutorial, which included instructions to scrub until the visible bioburden was gone, move to sequential timed baths, and then air-dry on paper padding. He was given a timer, a pair of gloves, asked once to repeat the sequence, and followed it conscientiously.

What that achieved was disinfection, not sterilization. The site did not have access to electricity or reliable running water. No autoclave was in use for the instruments he processed, and Thomas did not recognize the word when we asked. Initially, the disinfection buckets were filled with bottled drinking water. When that supply ran low mid-clinic, the team resorted to using water from an outdoor hose. He was unsure whether it went into the chemical baths, the rinse, or both.

While this practice concerned Thomas, he was not aware of the associated risks of handling instruments with bioburden with exam gloves and without a mask or eye protection. Nor the risk of waterborne pathogens from unknown water.

Unmasking the Chain of Infection

Back at school, Thomas began building clinical context. He has since observed surgery, in which the sterile field is defined and monitored, and in which every instrument arrives sterilized and packaged. Twice in our conversation, he learned something midsentence. He called the 3-bucket process sterilization, was corrected, and understood at once what that meant for every instrument he had handled. He learned that the use of personal protective equipment was determined by standard and transmission-based precautions.

Strip out the geography and the equipment list, and what is left is the chain of infection, the same six links we work every day.

Thomas came home unharmed, and that is the only thing about those three days that went right without anyone designing it. He was at risk of infection each day her worked and did not know it. Recapping by hand across two afternoons. No container. No plan if a cap fails. That is a portal of entry, and bloodborne pathogens are what come through it. Taking vitals down a queue reported to hold a patient with tuberculosis, unmasked, never told who or whether. A highly infectious pathogen transmitted through the air. Reprocessing instruments in buckets topped off with water from a garden hose: That is a reservoir introduced at the step meant to remove it.

He Was Not an Outlier

Each year, volunteer organizations mobilize thousands of participants into low-resource clinics where infection-prevention infrastructure may be minimal or absent. What happens to them there has been measured once. Researchers surveyed 223 clinicians and trainees who had worked in lower-resourced countries and asked whether they had been pushed past their training. Half had been asked. Of those, 61% did it. The rate climbed as training fell: 51% among licensed physicians, 81% among residents and fellows, 100% among medical students. Among respondents whose trip carried no clinical focus at all, one in four were still asked to perform clinical tasks they had never been trained for.2 The survey did not reach people like Thomas, who arrived with no clinical training to exceed. It did note that pre-health students seek these opportunities out.2 What happened to Thomas is predictable, and it is preventable. It’s the inevitable result of a fragile system that, out of sheer necessity, overly depends on volunteer labor.

His experience is valuable to IPs because of the latent risks it reveals, rather than a specific negative outcome. Hazards such as untrained needle handling, using disinfected instead of sterile instruments, shared equipment, and unmonitored tuberculosis exposure all point to the same systemic gap. CDC’s ambulatory-care guidelines address these issues, including Thomas: The guidance defines health care personnel as all persons, paid and unpaid, and names volunteers among them.1 The standard already covers him. Yet, he didn’t know how to read it.

What Infection Prevention Is Worth

Asked what he would tell a premed student considering the same trip, he questioned the premise of the trip he took. Untrained undergraduates, he suggested, might contribute more by building outreach systems or training modules than by occupying space on the ground. For the professionals reading this, his account is a mirror: what the absence of those systems looks like from within, seen by someone who lived it before he knew the vocabulary.

Mobile missions face real constraints. There is pressure to keep moving. Treating patients was the priority, and the organization treated them however it could. There were training failures, and training failures are correctable. What was missing was basic infection prevention education before he flew, or twenty minutes of it on the orientation day the team spent touring a hospital; with that, he would have had enough to protect himself, enough to protect the patients, and enough to ask an informed question.

That last one is worth sitting with. The value of infection prevention lies in providing a framework for applying best practices in the field, establishing a universal baseline of care that protects patients and providers alike. We do that work in world-class academic systems and in small, rural critical-access hospitals. The guidance does not change between them. Only the room does.

References

1. Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. Version 2.3. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. Updated September 30, 2025. Accessed July 17, 2026. https://www.cdc.gov/infection-control/media/pdfs/Outpatient-Guide-508.pdf

2. Doobay-Persaud A, Evert J, DeCamp M, et al. Extent, nature and consequences of performing outside scope of training in global health. Global Health. 2019;15(1):60. doi:10.1186/s12992-019-0506-6