Sitting in the airport

Well, Jon made it safely here for the medical mission on the boat. Brandon did not. Apparently his flight out of Dallas was canceled and he wasn't able to make it in time to connect. Not really sure what happened there, but we missed him this week. There wasn't any internet available on the boat so the blogging had to be postponed. Now I'm sitting in the Phnom Penh airport waiting for the EVA airlines ticket counter to open and have loads of time on my hands. Jon's already headed off for his very round-about trip home. I figure I'll post some back-blogs about the week on the boat for the few of you still reading at the end of the month. It has been a wonderful month. They've almost convinced me to just leave it all and move over here for a while. Almost, but not quite. Good friends, satisfying work, beautiful people, a quiet, lazy river, tens of thousands of bugs after dark forcing you to retire early and make the most of the daylight. Every heartbeat is precious here. I am very reluctant to come home. If only I didn't have so much left to learn! But still, I'm not relishing the thought of arriving back in Omaha at 11:00 tonight (Sunday) after 30+ hours of flying, turning on my pager and getting up for work on Monday morning. Thinking back on the week will be good for my attitude.

Last Day of Research!

Wednesday we went to Prey Ta Chey, the last village for our nutrition research. It was a pretty slow day, but a good way to end the study. We saw about 40 kids, giving us a grand total of 519 kids weighed and measured over the past three weeks. Depending on who has what jobs to do on the boat, we may try to measure kids next week in some new provinces upriver, but I'm not sure. Anyway, I think we have our answers and a plan for the future. Not sure if I can get a publishable paper out of the data, kinda doubt it, but I'll deal with it when I get home. Right now, I'm celebrating.

Kyle, an Irish medical student here for a month, arrived today. He and I and Rick, the boat's dentist, spent the day Thursday trying to track down cassettes, film, lead aprons, and chemicals for the ship's x-ray machine. There's a radiology tech coming next month to train one of the guys on the boat to take x-rays, but it won't do much good without the supplies. All of the medical supply shops in the country are within two blocks of each other, and, like most things in Cambodia, unlike medical supply stores anywhere else in the world. It was definitely an adventure.

Poorest of the Poor

I am training as an urban underserved doctor, and Tuesday I got some urban underserved experience. Troy and Tabitha had visited a displaced persons camp in Phnom Penh and wanted to take me back there to see the conditions, meet the medical student who showed them the area, and see what I thought about expanding our efforts to help the people in this camp. This was poverty.

We started out by meeting up with Isaac (pictured with a coconut). Isaac is Khmer, but he left the country when he was two and traveled to a Thai refugee camp with his mother. He immigrated to the States when he was six and grew up in California with adoptive parents after his mother died. He is a Christian and attended a Bible college with the idea that he'd come back to Cambodia and run an orphanage. Three years ago, he moved back. He now teaches English for six hours a day, runs a tuk-tuk around town, has a restaurant, has two adopted children less than 15 months old that he cares for alone, and decided to go to medical school. All of his spare time he spends running mobile clinics out of his tuk-tuk. This is an absolutely amazing guy. Interesting to talk to, too.

Medical school here is vastly different from anywhere else in the world. It's taught in Khmer in night school and on the weekends. Anatomy lab has one cadaver that was originally dissected in 1989. It's used by 200 medical students a year, all the students from both medical schools in town. Isaac says the lectures are worthless. If you don't study on your own, it's possible to go through school and become licensed without actually knowing anything. Students begin their training in the OR and treating patients, and only after many years of study will they learn anything about pharmacology, physiology, or neuroanatomy. Isaac, in his second year, has already done cleft palate repairs with minimal supervision, something I've never even seen, but he couldn't identify ear wax on physical exam (literally). The bottom line: If you get sick in Cambodia, be very careful which doctor you go to. Some of the things I've seen...

But enough of that aside. We headed out to the outskirts of Phnom Penh. There's a settlement there know as the "New Well Town". Predicatably, it's located next door to the "Old Well Town." Our first stop was a visit to the town chief. He originally just ran Old Well, but then New Well was dropped in his lap and now he has a mess on his hands.

New Well is a settlement of people who were kicked off of government land and relocated to the outskirts of the city. There was a huge settlement of squatters on government land along the riverbank, most of whom had been there for upwards of 20 years. The gov decided to sell the land to developers last year, so they moved everyone off. The wealthiest of the squatters, who owned stores or businesses, were moved to a nice settlement with doctors and shops and running water and electricity. The middle classes who owned houses or property (as much as they could being squatters) were moved to a slightly more rundown area, but still livable. The poor, who rented their houses from the middle classes, were moved to New Well.

New Well. There is one well. There is no running water. There is minimal electricity. There is one pharmacy. There are two latrines, surrounded by standing water. There are 1,554 families in 2-3 hectares of land (about 6-7 acres). For now, every family has a plot four by six meters, but new families are being moved in every day. This is real poverty.

Supposedly, the land belongs to the people who live there, but who knows how long it'll be until the government changes its mind. And how are that many families supposed to divide up that morsel of land? They run out of water already. The well runs dry in the dry season and they have to pump water in from central Phnom Penh. There is no food, and no place to grow food. Feces-contaminated standing water is everywhere. Dengue, malaria, TB, typhoid are rampant. I have never seen so many scrawny naked kids in my life.

So, we weighed and measured the kids for our study. Isaac and I saw patients and handed out a few medicines. We smiled at them, and touched them, and came home absolutely exhausted. I wanted to cry.

Resting

Saturday was spent shopping. So many pretty things to buy! I also learned how to push-start a van by putting it in third gear and popping the clutch. Felt like a scene out of Little Miss Sunshine going down the streets of Phnom Penh. Since Troy and I were the only ones who could drive stick, I got to sit in the front and push all the pedals while he and the others got out and pushed the van. Fun!

On Sunday I got to see some old friends. Bill and Owana Kidd and David Darrah arrived safely to spend some time on the boat. Bill has come to set up the lab on the boat and they will be here for a month. Dr. Darrah will be here for two weeks seeing patients with Dr. Watt, the ship's Khmer physician. It was so good to see them all again and I'm looking forward to spending time with them on the boat.

Monday was a quiet day for me. Troy and Tabitha took everyone to the boat, so I stayed home and worked on my data. I also took the first nap I've had since I arrived. Nice. Our next-door neighbors are doing construction on their house, and the hammering starts about 6:00 every morning, so it's no use trying to sleep in. They take an afternoon break though, especially if it's raining, so the nap was undisturbed bliss.

Tuesday it's back to work for a few days, until we leave for the week on the boat.

Jesus Loves the Little Children

Back to the Villages

Friday it was back to work. We headed back out to Kampong Chhnang, a province about 2.5 hours away from Phnom Penh where we're feeding three villages once a week. We spent the day surveying kids in two different villages before heading back to town. The truck must know when we're far away from home, because once again it broke down in Kampong Chhnang, but on the roadside after panic breaking to avoid a car randomly stopped in the dead middle of the road. The cows stared, the rice waved, and passing motorists honked helpfully at us as they flew by mere inches from our stopped vehicle. Thankfully, Savan and Bora weren't far behind in the Nutrition Truck. They pulled over and the guys conferred over the engine while Tabitha and I investigated the local flora and fauna. There's a type of ground-cover here colloquially known as "Shy Grass". If you touch it, or the rain hits it or a bug lands on it, the plant closes up its leaves and looks rather unappealing. It's fascinating. The rice is really growing as well and is a beautiful vibrant lime-green right now. Eventually we got back on the road and headed home. Tabitha and I spent the evening trying to relax while suffering through traditional Thai massages. I've never been so poked, prodded, and generally abused in a massage. It was either the best massage of my life, or the worst. I haven't quite decided.

For Sherry: The big fruit hanging off the tree is a Jackfruit. It has deep yellow fruit, is highly sticky, and smells and tastes like Juicy Fruit chewing gum. Durian, the much despised baby-vomit-reminiscent fruit, is often called Jackfruit, but you should never-ever confuse the two. You'll either miss out on something truly wonderful, or receive a nasty surprise.

Wandering in Phnom Penh

So, I headed out on Thursday on a quest to find ginseng tea by special request. I'd been told about a great grocery store here with a wide selection of teas and had even driven past it once. Seemed easy enough to find, or so I thought. I started off walking very purposefully, passing numerous tuk-tuk drivers, moto taxi drivers, cyclo drivers, and loitering Cambodian men, confident that I knew where I was going and would get there eventually. Well, I must have passed it at some point, because I never found it. The longer I didn't find the store, the more aware I became of the numerous people watching me walk purposefully down the road, and the more I realized that they were leaving me alone because I looked like I knew exactly where I was going. At this point I had no idea where I was going but thought it best to continue acting like I did. This prevented me from turning back the way I came, and the only thing I knew of in the direction I was headed was the Central Market, several kilometers away. Ignoring the noon-time heat and the dripping sweat trail marking my passage, I valiantly carried on to the market. I never found the tea, but I did find the stall in the market selling fried tarantulas, spiders, cockroaches, grasshoppers, termites and scarabs for a tasty afternoon snack. I wanted to take a picture but found the buckets of fried bugs a little too disturbing to linger over. Maybe I'll go back sometime. No longer appearing lost, I was able to hire a tuk-tuk for the ride back home across town.

The lesson here is that if you look like you know what you're doing, people assume you do and leave you alone, even if you're red in the face and look like you've sprung a leak. Thanks to my vast on-call experience, I've honed my skills to near perfection. I was able to bluff all of the Cambodians. You'll never again trust the on-call doctor!

That evening, Teo and I headed out in the twilight rain shower to the Olympic Stadium. Best we can tell, it has nothing to do with the Olympics but is merely the only stadium of any size in Cambodia. Turns out, every evening the locals gather for Jazzercise on the top of the stadium. Attendance was down because of the rain, but there were still several hundred people milling about. Many of them had paid the 500 riel (12.5 cents) to join the various dancing groups. One group of mostly middle-aged women was doing step-aerobics/line dancing. The teens and 20-somethings were in a boy-band-wanna-be-very-enthusiastically-flailing-about group. The slightly less enthusiastic were Jazzercising. The kids were having Karate lessons. And the recently-engaged were honing their traditional Cambodian Apsara dancing skills for their upcoming weddings. One guy was sitting with a scale. For a small fee he'd let you check your post-exercise weight. We had a lot of fun watching the festivities until the rain picked up and we headed back home, darting through the crazy rain-parka covered moto drivers.

I love being here!