Saturday, June 16, 2007
Sitting in the airport
Thursday, June 7, 2007
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
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.
Friday, June 1, 2007
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
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!
Wednesday, May 30, 2007
More Villages and Even More Kids
Tuesday and Wednesday we were back on the road to the villages. We went to Toe Tung Tngai and Thom Nup Thom and surveyed over 120 kids. We were a little frustrated at first in TNT because none of the kids' mothers showed up, and none of the children have any idea when they were born. Often mothers don't even know when their kids were born and the whole village will confer and decide upon a birthdate. It's a laborious process at times. Thankfully, Kimsom eventually laid down the law at TNT. He just closed the gate and told the kids they couldn't come in for the feeding program until they brought a parent. We wound up seeing over 80 kids and had to turn some of them away at the end of the day.
I also saw some sick kids come through the line. I carry a small pharmacy with me every day and can take care of most fevers and skin infections, though I had to restock recently. Since it's rainy season and the mosquitoes are breeding, many children are coming down with dengue fever and malaria. I'm doing my best to sort the two out, but it's hard without a lab to confirm the disease. I do try to keep the fevers down and teach the moms to make a homemade rehydration solution using salt, sugar, water, and bananas. Piscey, my translator, has become expert at instructing them in the signs of dehydration and adequate rehydration. And I always tell them to go to the hospital if the child gets worse instead of better. I haven't seen any really sick ones yet. I just pray that it's not too little, too late.
We also checked in on the baby in the last picture. He had a cleft lip repair back in March with Operation Smile, a group of volunteer plastic surgeons that travels the globe fixing baby mouths. He is scheduled for a cleft palate repair in November. Right now his palate is open to his nose, so he can't swallow anything. He's eating by chewing on the nipple of a bottle and squirting formula into his mouth where it runs down his throat. He's gaining weight appropriately but going through tons of bottles every day. Formula just doesn't fill up a two-year-old. Mom is supplementing with rice water, the starchy water left over from cooking rice, but that doesn't help much. The church in Phnom Penh has been buying his formula with their collection money, so I'm going to give them an update on Sunday and see if they'll be willing to provide him the formula he'll need until his operation in November. I'm sure they'll come through for him.
Picture Captions:
Kids at Toe Tung Tngai lined up for lunch. They always let the little ones go first.
The Cambodian equivalent of the Little Red Wagon. Pile on for a quick ride home from big brother. Yes, there are six kids on that moto.
Savan and Bora, having survived the crash with the cow, still take the truck out five days a week. Savan is unusually tall for a Cambodian, almost as tall as my husband. Bora is more typical. They're so good with the kids and are usually equally kind to farm animals.
The baby with the cleft palate. Sorry it's not a great picture. I had to grab it quick before he started gnawing on his watermelon rind again.
Boat at First Sight
Sunday and Monday we took a trip to Kampong Cham province, where the boat is currently stationed. It’s about 3 hours from Phnom Penh, which afforded a good chance to see the countryside. This is a gorgeous land filled with beautiful people and funny billboards. (It's not a ghost... It's Casper the Friendly Condom!) Arriving at the boat, we had to navigate between cows, chickens, pigs and their laughing farmers in order to reach the riverbank.
The Nutrition Program will be expanding into Kampong Cham soon, so we spent Sunday and Monday surveying kids in two villages in that province. We got to go back across the bamboo bridge, which was just barely wide enough for our 12-passenger van to scrape through. Then, we got to try to squeeze past motorcycles with five passengers in the middle of the bridge. The moto driver was actually hanging onto our side mirror with one hand, his 2-year-old daughter with the other and hugging his moto between his legs at a dangerous angle, trying not to fall into the river with his family. More fun than boats!
After surveying about 50 kids, we headed back to the boat and arrived there just before the afternoon rains hit. We get a good storm almost every day now, which really cools things off in the afternoon. Makes for a muggy morning but pleasant afternoon. The next day we visited another village where we saw another 50 kids before hitting the road back to Phnom Penh. Exhausting trip, but it'll be good to get a nutrition truck set up for those kids.
Party with Penguins
Saturday, Teo invited the girls from church and her English class over for a party. She’s leaving at the end of June to return to Romania and wanted to spend a little more time with the girls. She was also hoping that they’d get to know each other better. Teo and I got up early and went to Troy and Tabitha’s to bake a cake and brownies. There was a wedding going on outside their house. For those of you who have never heard lovely Cambodian music non-stop for hours on end, you can’t imagine what you’re missing. It’s as much a treat as fish paste! Seven girls showed up and giggled their way through Happy Feet. Not sure if the cake was as much of a success, but they seemed to have fun.
Saturday, May 26, 2007
Another day, another car problem.
The pickup is notoriously unreliable. Yesterday, on our way through Kampong Chhnang city, Troy slammed on the brakes to avoid a bicyclist that darted in front of him. The engine stalled and refused to restart. After many unsuccessful attempts at restarting it, Savan and Bora arrived in the Nutrition truck to rescue us. Together, they were able to push start the truck and pop the clutch and we were on our way again. Later that day, Savan tried unsuccessfully to brake the Nutrition truck when a calf darted out in front of him. The guys are okay, but the cow is hamburger, and the front of the truck has a young cow indentation. Poor Savan feels so guilty, but there was nothing he could have done.
We did eventually make it to the countryside. Kampong Chhnang province is two and a half hours from Phnom Penh. We are currently feeding three villages there once a week, and Savan wants us to expand into a fourth. Troy and Tabitha are hoping to get another truck with more drivers to be able to go out there more often. We visited one of the current feeding villages and the new village where there are over 100 young children. We got measurements on some of them and will be going back next Friday to finish the job. Another long day, but mercifully it rained some which refreshed us all.
Picture captions:
We tried talking to the engine, but it didn't respond to either English or Khmer. Finally we had to resort to brute force. (Troy and Tabitha Snowbarger, pictured, are here for a year to supervise the nutrition program.)
Troy helped out with the weighing and measuring of the kids -- backbreaking work since both he and I were too tall to stand up underneath the house. The kids love him, though.
The fish are gutted, but still raw. They're left to dry in the sun and then eaten like beef jerky. At least that's my understanding. The gas station had these for sell as a yummy treat. I'm told it's a delicacy, but the smell alone puts them low on the scale of deliciosity.
Like moving in slow motion.
It must be the heat that just zaps your strength here. I like to think that I paid LOTS of money to spend a month in a very expensive sauna. I think they say you're not supposed to stay in those things for more than fifteen minutes, but if a little bit is a good, more is better. Right?
It was so hot in Krosaing Pa'aim that none of us could think on Thursday. All four of us sat and stared blankly at each other as our brains tried to subtract five from ten, or add fifty to sixty. I kept telling everyone that they needed to drink more water, but then my slo-mo brain would forget about the water before my hand reached the bottle. It didn't help that we worked through lunch without a break, or that the road out to the village was so incredibly bumpy that we all had massive headaches from our brains sloshing around our skulls on the two hour drive out. Thankfully, it's the rainy season now. Everything cools off around three in the afternoon when the rainstorm comes. It's a welcome wetness.
On the plus side, we saw lots of cute little kids. Many of them still had their cards from last time, which will help when it comes time to analyze the data. I also saw lots of cute little kids with skin infections. Thankfully, I had brought Bill's emergency pharmacy with me, so I had some antibiotics to hand out. Piscey, my abundantly patient translator, did catch that I was handing out antibiotics in little baggies that had antidiarrheal instructions on them. He tried to clarify matters, but I'm not sure it worked. There were more ill kids in this village than I'd seen so far, but it is one of the poorest villages we feed. One kid had fallen out of a tree a month ago and broken his arm at the elbow. Now he's unable to flex his arm more than ten degrees. The local folk healer pulled it straight, put it in a splint, and made a poultice for him when it happened, but he hasn't seen any other medical person. There's a children's hospital in Phnom Penh that will treat him for free, but mom couldn't bring him on Thursday. She'll make arrangements for her other kids and then we'll bring him into town to the hospital next week. After waiting a month, another four days should be okay. I also saw a kid who likely has cerebral palsy. He's almost one and floppier than a newborn. He was born at home, the sixth child of this mom, and hasn't ever seen a doctor or had an immunization. It was hard to tell the mom that he'll never be a normal child. You could see how much she worries about him. It'll be very hard for her to take care of him in the village, but there's not much we can do for him except try to educate her. If anyone knows a good physical therapist, send them over!
Picture captions:
Friends don't let friends have lice! The little girls would pull out the lice and hand them to the girl in the middle. She'd mercilessly squish the lice while her friends looked for more. It builds teamwork and a spirit of cooperation.
Cute babies. The little one's hair just cracks me up. Her mom was making sure she got her fair share of the bread and milk from the nutrition truck.
To market, to market, to sell a fat pig. These poor pigs were so upset at watching the world rush by upside down. There'll be a prize for whoever can guess how many pigs are in the pig truck. They're squeallier than jellybeans in a jar.
Worst Advertising Campagin Ever...
Wednesday, May 23, 2007
How to identify an American...
Yesterday we went to Prey Toe Toeng, a village I had never been to before. They have around sixty children involved in the nutrition program. Savan and Bora drive the truck to the village twice a week. They do some English lessons, Bible classes, and health education. Each child gets a piece of bread and a glass of milk. The milk is made from a Nestle nutritional supplement, sugar, salt, and distilled water. Troy and Tabitha have been working with Savan and Bora to develop the curriculum, but the guys took the initiative to start educating the kids. Troy and Tabitha are also working with the village leaders to develop drip irrigation vegetable gardens. If the fields work for the village leaders, perhaps others in the village will try them as well. So far they’re struggling, but the rainy season begins this month, so maybe things will start growing. As it is, the kids in the village live off of rice and bread, with occasional fruit if they can find it. Meat and vegetables are almost unheard of. Please pray for rain this year so people can afford to eat more than rice.
Today, Troy was suffering from one of those wonderful Cambodian ailments. Neither Tabitha nor I were brave enough to drive ourselves out to the village (I’ll make a video of the road chaos here and you’ll understand), so after dosing Troy with Tylenol and Cipro, I had a day off. Teo (my roommate from Romania who’s teaching English in the PIP school here for the year) and I headed to the market to buy gifts for home. I had forgotten how unbelievably stifling it is under all of those tarps at one in the afternoon, but we had a lot of fun. After a year here, Teo is a much more aggressive bargainer than I am. I was impressed! One girl asked where we were from. “America.” “But how? You are not fat!” I took it as a compliment. Much as I’ve enjoyed the day off, here’s hoping that the Cipro kicks in for Troy tonight so we can head back out to the village again tomorrow.
Monday, May 21, 2007
Church and First Trip to the Village
Yesterday being Sunday we had church at the house. Many of the Christian English students want to practice their fledgling English skills outside of class. The Khmai church in town has grown significantly over the past two years. It is a fully Cambodian church now, and most of the Americans have decided to let the congregation continue to be Khmai and to hold services elsewhere for English-speakers. On Sunday and Wednesday nights, a group gathers at the Partners in Progress house where services are held in English and Khmer. Though we do sing many English songs with Khmer translations, every week they practice new Khmai songs, too. One of the Christians is a local surgeon who has taken on the role of song leader and tries to teach everyone the new songs. Turns out, Khmer is not a particularly musical language, at least not to western ears! But, they do sing with enthusiasm. I have some delightful video of the teaching session, but can’t post it right now. Ask to see it when I get back.
Today we had our first trip out to the village to revisit the nutrition program. We started at TNT (Tum Nup Thom), which we’ve seen change dramatically over the past five years. They were talking about starting an orphanage and had just adopted their first orphan when I was here last. Now the orphanage is finished and houses about 20 kids. The orphanage is run by KimSom and Sokal and is supported by the church in TNT. A privately run, community based orphanage is unheard of in Cambodia. Under the direction of the Khmer Rouge, society was disassembled. Families were fractured. Trust was destroyed. Orphans abounded. Everyone was struggling to survive and to care for himself, and then maybe his family. No one had the time, resources, or emotional strength to care for a non-relative. After the Khmer Rouge and the Vietnamese left, no one knew he was supposed to care for anyone except himself. A whole generation has grown up without knowing how to be part of a community. The Christians in TNT recognized the need for an orphanage for their community several years ago. PIP helped them start it up, but it is really the dedication of the church there that has turned the dream into food, clothing, and shelter for these 20 kids.
Saturday, May 19, 2007
Finally here
Today being Saturday, we have the day off. We went to the International School's annual garage sale, which felt like a carnival, complete with Slip-N-Slide, streamers, cotton candy, hot dogs, and black pepper popcorn (more of a Cambodian delicacy I think). Tomorrow we'll have church and another day to rest, then Monday we'll go to the village for the first time.
Phnom Penh hasn't changed much. The traffic is actually a little less crazy now. They put up traffic lights! Otherwise, the market is still close and hot, the air is still filled with the smell of Durian (a beloved Asian fruit that smells like a cross between baby vomit and rotting garbage), construction still begins at 5:30 a.m. outside our window, and it's a thoroughly lovely place to be. I'm afraid the month will go by all too fast.
I'll try to post as often as possible, but no guarantees when that'll be. I'll also put up pictures as soon as I can figure out how to compress them so they'll upload quickly. Check in frequently, and I'll stay in touch! Feel free to respond and I'll do my best to answer questions. Take care all, and God bless.