Cambodia travel log
The following was written originally as postings on my Facebook page. In most cases, the postings occurred the same day as the date, so the memories were pretty fresh.
Friday, January 18, 2013: Eating all the way there.
We started our journey to Cambodia on Friday afternoon. Once we started traveling, I think we made up for lost sleep by eating. Here’s a summary of the trip to Phnom Penh marked out mostly by the meals we ate.
- Dinner at Wolfgang Puck’s – rosemary chicken and mashed potatoes.
- Plane to LA was uneventful but for sitting next to Mike, who was in the center seat. Mike is a 6′-6″ 340 lb body builder who recently competed in the World’s Strongest Man competition on ESPN. He’s a very nice guy with a wife who wants to move from her six-year position as a staff nurse in the NICU at Children’s to a charge position or maybe onto the transport team. He told me about his competitions; he was on his way to a gripping contest in LA. He had also recently been to China and Spain. Very nice guy but takes up a bit of space in the seat!
- Had an apple on the plane
- Ate orange chicken at Panda Express in LAX
- 13 hour flight to Taipei. I sat next to Sharon in the middle class seats. We were both fairly comfortable and able to sleep some. I had ‘Western’ dinner of steak, potatoes, veggies and salad. Also had a Ballantine’s. later I had to have ‘Eastern’ breakfast as they were out of ‘Western’. The ‘fish floss’ didn’t improve the taste of the rice pudding.
- I had a marinated pork chop in the Taipei airport, along with the world’s worst coffee and a Taiwan beer (tastes like Coors)
- On the plane to Phnom Penh, I had chicken & rice. It wasn’t bad, although I worry about eating fresh fruit. Everybody says it’s a bad idea to eat any fresh produce in the third world. Hopefully EVA air and its base in Taiwan isn’t really third world.
Sunday, January 20, 2013 – Which way is up?
After 30 hours of travel and six meals, we finally arrived at the Hotel Phnom Penh. It is a majestic building with a beautiful drive that curves up to a spacious lobby. A huge curved marble staircase dominates the room, leading up to the ground level of the central plaza where the swimming pool is. My room overlooks the pool from the second floor. The room is spacious and dark, and smells of the rich teak furniture and paneling. The bed was as hard as a board, but a housekeeper showed up at my door with a foam pad that has made it comfortable to sleep on.
We went to an allegedly French restaurant tonight, although the only thing French I saw was the onion soup and the name: Les Maissons. I had a nice beef fillet for $9 American (the local economy accepts dollars as readily as Riels, the local tender). Overall, the group of 14 of us ate and had wine for $175 including tip!
I am exhausted even after having napped this afternoon, and I must arise early to make our 7:15 AM departure. Off to bed!
Monday, January 21 – A Barbarian with a Wrench in his Pocket
Today we went to the surgery center. My first impression of the building was that it has a LOT of air conditioners! We came in the back way among a throng of people waiting to be seen in the various clinics that occupy the first floor. Our surgery area is on the second floor with two operating rooms and a pre/post anesthesia care area that can house maybe six beds. The third floor has more clinic space so the doctors can see patients there and begin the difficult process of scheduling those patients they can do the most good for. They did see one patient who had a large palpable mass in her abdomen: a case of uterine cancer that was far beyond treatment. They had to tell her that she probably only had six months to live. But for that story, there were 15 other patients seen that could benefit from the services of our team. They began establishing the schedule while the nurses began getting the OR ready.
Our issue with supplies was not one of shortage, but of where to put them and figuring out what we have. Nancy began the difficult task of going through the overcrowded shelves and trying to find the items that are of no value to the center. Sharon helped Nancy and Patty both. Patty began organizing the instruments and working with the staff on getting ready for tomorrow’s cases.
I stood ready to help in any way I could. It turned out the way I could help most was to put my technical skills to work. There were many pieces of medical equipment that weren’t working. I had brought a few small tools along, mostly thinking of what I might need for SCUBA diving at the end of the trip. Nevertheless, my Leatherman all-purpose tool and my SCUBA combo tool came in very handy today.
The anesthesia monitor wouldn’t stay on for more than a few minutes. I found that the battery had swollen up like the one in our Mac had done a few months ago. By removing the battery, I was able to get the monitor to stay on by being plugged into the electric current only. We ordered a replacement battery on Amazon and the next team will bring it out.
There was an issue with the main vacuum pump for the OR’s that kept leaking and forcing the pump to run 24/7. This is a heavy duty piece of equipment that costs a lot in electricity to run. I was able to readjust the pipes and get the leaks to stop. Yes, it’s almost impossible to believe, but I fixed plumbing for once when the nearest Ace Hardware was over 7,000 miles away. Amazing!
That started a dizzying parade of devices that all had one problem or another. I was able to fix some and unable to help with others. But overall I think I made a difference in keeping some of the gear operational for the center. There is an amazing collection of 10-20 year-old stuff on the shelves. Some are set up to run on 120 volts, others on 240. There are voltage converters and plug adapters everywhere. You have to look at every device and check it before connecting. I have no idea how some of the stuff works, but used my best guesses to try to get things working again. Does anybody know how an oxygen concentrator works? Guess that’s one for Wikipedia tonight.
The worst of the day for me was that I began to succumb to a cold. My nose is dripping and my brain is getting foggy. I thanked the team for the invitation to go out to yet another nice restaurant this evening and took a meal at the hotel restaurant instead. Then I went to bed. At this point I can barely breathe through my nose and it’s dripping like a leaky faucet. That’s some plumbing I can’t do anything about, so I guess I’ll go to bed again. 🙁
Wednesday, January 23 – Slow News Day
Today is day two of my confinement to my hotel room. I’ve come down for meals three times a day, but otherwise been in my room in bed resting as much as possible. My cold has progressed from massive amounts of sinus congestion to being clearer, but now I have a slightly elevated temperature (99.9 for all the clinicians reading), sore throat, and a cough that seems to hurt my ribs when it comes. Regretfully I need to spend another day recovering before I’m ready to work with the team again.
I have met with the team at breakfast and before they go out to dinner. They told me that yesterday they did two cases that were fairly successful. The first was planned to be a laparscopic procedure (using a tube with a camera), but for various reasons, Kevin decided he had to open the patient up to complete the procedure. Nevertheless, the procedures were successful and two patients lives were changed for the better yesterday (Although I’ll bet they’re wondering if that’s true this morning – day after surgery pain sucks!).
As I said, I spent a quiet day yesterday hanging out in bed. I watched a couple of movies and only came down to the lobby for lunch and dinner. Lunch consisted of the buffet. The food was good and the most entertaining part of it was my waitress. She spotted my cane and decided I was simply not allowed to carry dishes. She was on me like a remora every time I got up, and chattered at me in K’mai (the native Cambodian tongue) as I passed around the room. Apparently her idea of buffet was to load up at the first item you stop at and then head back to the table. My habit is more to tour all the possibilities and then make up my mind what I want. So she almost loaded my plate with a number of dishes and then politely stopped and followed me as I wandered on. She was quite pleasant and I thought the interaction was really fun. I’m not sure what she really thought of me.
I observed a multi-national group of educators sitting at a table near me. My guess is that they represented all the Southeast Asian nations as well as Japan. The interesting thing about these groups is that they all speak English as a common language (albeit not too well). This group was apparently talking about opportunities to educate the people of Southeast Asia better in the use of English. They seemed to cover a variety of topics around education, even delving into the history of education over the last 600 years. I couldn’t hear much clearly and didn’t want to appear too nosey, so I lost a lot of the detail. But still I find it fascinating that when a Laotian wants to speak to a Cambodian, they speak English.
I stepped outside the hotel for a few minutes and took a couple of shots of the building. It is a very nice example of local architecture. The building is largely made up of poured concrete. I have seen other buildings under construction here and they use tree limbs (not bamboo) to support the floors and beams as they pour the concrete. As a result, the rooms are very quiet with several inches of concrete between each. There is a lovely little garden out front with some fountains and some very impressive concrete lions guarding the front door.
I had a little opportunity to watch the daily operations of the hotel. It is much like any large high-end hotel: there is a pecking order for the employees and they tend to keep to their places. One of the things I find different though, is that they seem to occasionally drop the formality and have a good laugh with one another. This can happen across several levels of the hierarchy. It’s nice to see this kind of egalitarianism sneaking in even in the formal environment of the hotel.
I’m currently in the lobby of the hotel where the internet connection works best. It sort-of works in the room, but can take a long time to even send an email. Facebook can take forever, so I’m posting down here. But I’m also feeling the effects of the Benadryl I took (thanks to Dr Todd for being prepared!), so I’m off to bed again in hopes that I feel better in the morning.
While I’m slowly recovering from this virus, I couldn’t pass up the opportunity to see the Choeung Ek Genocidal Center today. This is a memorial to the millions of people who died between 1975 and 1979 in Cambodia under the rule of Pol Pot and the Khmer Rouge.
Thursday, January 24 – The Killing Fields
Pol Pot was a communist activist and teacher who took power in 1975 during the time when the United States was pulling out of Southeast Asia. While he started out as a teacher, he believed that the way to true communism was to remove all corrupt city influences including education and to make all the people farmers of the land. In a single well-executed maneuver, nearly all the people in the cities were moved into the country within 48 hours. He then systematically worked to take all educated professionals out of the population and kill them.
To that end, over 300 of these ‘killing fields’ were employed. Trucks would bring people in and soldiers would kill them within 24 hours of arrival. No bullets were used for this killing; farm implements and blunt trauma were employed as they were less expensive. DDT was widely available in the area, so it was used to finish killing people that didn’t die from the initial blows, as well as to keep the stench of rotting flesh down.
The memorial is an eerie place. So many deaths occurred there! I was overwhelmed by the sheer scale of what happened. As you walk around the grounds, you can see bits of cloth peeking out of the ground. This is the remains of clothing that the victims wore which are slowly finding their way to the surface with each rainy season. Bits of bone also emerge and you can see several collections of them among the displays.
The Cambodian government built a memorial “stupa” to house the remains of those who were exhumed from the mass graves during the first 1980 excavation and forensic analysis. The stupa includes Hindu and Buddhist symbols of peace and the grisly reminders of the time can be seen through the large glass windows on each side.
It’s estimated that 25% of the population of Cambodia were killed during Pol Pot’s four year reign. This has resulted in a population that is much younger than most other parts of the world. Nearly half of the population of Cambodia is under 25 years of age. We took along Narry, a 23 year-old administrative assistant from the clinic. She told us that her grandfather was lost to the regime, although she hadn’t been born yet. She also told us that presently there is no formal education on this event in history in the Cambodian schools. In fact, most Cambodians are uncomfortable talking about that time even though nearly everyone lost some member of their family to the mass executions. While I don’t suppose anyone wants to re-live such horrific events, it seems to me that an understanding of what happened should be established with the public.
Building this memorial was a good first step. I am humbled by the massive scale of this murder plot and I, for one, will never forget.
Here are some photos I took while touring around Cambodia:
Friday, January 25 – Welcome to Cambodialand
OK, for starters I have to admit that I haven’t touched my goal of working with patients yet. I’m finally starting to feel human – I’ve had no fevers for 24 hours and my cough no longer feels like I’m shaking splinters loose from my ribs. But we had to reschedule the OR cases for today because our flight to Siem Reap (syem-ree-ap’) was moved up to 1 PM. So about the most critical patient I’ve seen this week was an oxygen concentrator that needed a new circuit breaker. And, of course, I kept seeing myself in my hotel bathroom mirror. Anyway, we have a full week ahead of us so I’m confident I’ll get to that pesky clinical stuff soon.
Today a small group of us flew to Siem Reap so that we can tour the temples of Angkor Wat tomorrow. I’ll write more on that after I’ve seen the place, but it’s reported to be the largest religious shrine ever built by man. For those of you who know fine cinema, it’s the location that Lara Croft, Tomb Raider was shot – you know, the place with all the Buddhas that come to life and chase Angelina Jolie around the temple in those skimpy shorts. Anyway, more of that later.
Today was mostly about getting to the region in the northwestern portion of Cambodia. We flew Cambodia Airways, a relatively new airline funded by Viet Nam Airlines and the Cambodian government. We took off in a French-Italian ATR 72-500; a 78 seat twin turboprop aircraft that makes a lot of noise but seems to get the passengers in the air. Other than an interesting approach to the airport that appeared to drive north of Siem Reap by about 20 miles, then circle to the west of the town and finally zeroed in on the landing field, the flight was uneventful. Most of the flight was over Tonle Sap, a massive fresh water lake that stretches almost all the distance between Phnom Penh and Siem Reap. I read in the in-flight magazine that the Tonle Sap is the largest fresh water fishing source in the world. Nice to know the Cambodians have a few world records to their names.
The flight attendants politely handed out tiny box snacks that consisted of a four ounce plastic glass of water and a muffin. It was a good thing the water came with it, because the muffins were awfully dry. By the time they got the boxes handed out, we were descending and they were back with their little cart demanding them back.
Once we landed, we were greeted by our tour guide, Ratana. He is a charming man who speaks better English than most Cambodians and had a compelling tale of his life as a child and being separated from his family by the Khmer Rouge in the 1990’s (yes, more than a decade after they were removed from power in Phnom Penh). Apparently, the Khmer Rouge continued operations in northwestern Cambodia right up until Pol Pot’s death in 1998 and continued their crazy version of communism that requires everybody to be a farmer. Ratana said he was separated from his family through military activities and was sent to Siem Reap to live in the Buddhist monastery and later in the nunnery. Overall he spent 12 years of his life with the Buddhists and had a lot of positive things to say about what they did for him in the time he was separated from his family.
He has now rejoined with the surviving members of his family, including his mother and a couple of his brothers. But he also lost several siblings to the military activities of the Khmer Rouge. This country has had a really hard time of it.
Once we finished our introductions on the bus, we arrived at our ‘upgraded’ hotel. This one is a ‘supreme’ rating. OK, so it’s a little seedy and run down. It turns out there were a lot of tourists in town for the weekend and I guess the tour operator forgot to make reservations early or something. Whatever the case, the room is mostly clean, but every time I put the card in the little thingie that turns on the electricity in the room, different things turn on and off. I still haven’t found a switch for the bathroom lights, but they do come on sometimes when I pull the card out and put it back in. I inspected for bedbugs and haven’t found any evidence of them, so I guess I’ll sleep OK tonight.
We then piled back onto the bus and went to a place called Artisans Angkor. It’s a place that makes all those cool little trinkets you see from Southeast Asia: tile paintings, silk weaving, silkscreen art, carved elephants and buddhas from soapstone and teak. The nice thing about this operation is that they recruit both talented artisans and handicapped folks to work in the shop. I had a nice conversation with a young deaf woman – I brushed off my college ASL and found that ‘work’ and ‘beautiful’ and ‘thank you’ are the same signs in Cambodian and American.
There were many nice things made there and I felt obligated to pick up a couple of things (I guess somebody’s getting a present!).
We then moved on to the Buddhist compound where Ratana was raised. It was fascinating, with many ornate buildings and ‘stupas’ (see yesterday’s posting). The only problem was, it was about an hour after sunset and the place was almost completely unlit. So, after stumbling around in the dark for a half hour or so, we got back on the bus and went to the culmination of the evening: dinner and a show at the Kullen II restaurant. The Roman numeral should have given us a hint. It was a combination of Casa Bonita and a Hawaiian luau. There was a crowd of about 1500 to 2000 people all swirling around a variety of asian steam-tray dishes. I tried a few things but really didn’t find satisfaction with anything but the steamed rice and chicken skewers. I think I’d rather have the enchiladas at Casa Bonita in retrospect. Once we had our fabulous dinners, we sat on the front table to watch the floor show. This consisted of some very stylized musical and dance performances of what we were told were traditional Cambodian forms. They looked a bit like images I’ve seen of Hindu forms as well, and there is apparently a strong Hindu influence in this primarily Buddhist nation (the Buddhist monks all pray in Sanskrit, for example). The dancers were talented and bent their bodies in interesting ways I couldn’t imagine doing, but the overall feel of the show was that it was “one more round for the tourists”. One girl in the back row looked like she was positively annoyed that she had to dance tonight. The music was cacophonous and anything but harmonious. We were ready to go well before the show was over.
Hopefully we will see more interesting sights tomorrow; the temples are supposed to be truly awe-inspiring. From the reading I’ve done about them so far, they are a remarkable accomplishment for people living in the 1400’s. Until then, I think it’s time to toddle off to bed and hope there aren’t any surprises during the night. Wish me luck!
Saturday, January 26 – Angkor Park
Wow, what a day! We got up in the morning to the news that we had a new and much better hotel. Unfortunately, it took a while to make the final arrangements, so we didn’t leave for the park until nearly 10. Once we got there, I got quite an eyeful!
The ‘park’ area is actually 81 hectares (about 200 acres) of temples built between about 500 AD and 1500 AD. This area to the north of Tonle Sap (the giant fresh water lake) was a center of Cambodian leadership until sometime around 1500 (I’m still sketchy on this date) when the center of power moved to the south end of the lake in what is modern day Phnom Penh. During the time of power in Siem Reap, many religious monuments were built. Cambodia has vacillated between Hinduism and Buddhism (Cambodia is 95% Buddhist today). As a result, there are many competing structures and evidence of how folks who came along later changed previous work to suit their own beliefs (some might call it vandalism, others call it updating).
If this gets confusing, check out the map I included in the pictures – this is kind of complicated navigation.
The first area we visited was Angkor Wat. The word ‘Angkor’ has multiple meanings in Khmai, the language of the Khmer people. It can mean a single structure or a group of structures on up to a whole city. In the case of Angkor Wat, it refers to a group of towers, or stupas, that were built to celebrate Hinduism. It is a very symmetrical design which includes nine towers, some of which have fallen over the years. There were fascinating bas relief depictions of the Hindu gods and demons and the stories of Hinduism inscribed around the entire structure.
The ruins are, as you would imagine, tumbled down in many spots and the footing is uneven. More than once I was quite grateful for my cane, which saved me the ignominy of a fall in public. There were a couple of other folks beside me in our group that weren’t into climbing the higher structures, so we hoofed it around the towers and met the rest of the group on the other side.
We then moved on the great city of Angkor Thom. This is an area about 1000 meters by 1000 meters surrounded by a wide moat and a tall wall that is mostly still intact. We didn’t have the stamina to make it all the way from one end to another, so our mini-bus dropped us at the northern edge of the central structures and we walked around to the eastern or ‘front’ side. There we found an interesting little market with lots of vendors wanting to sell us cold drinks, silk garments and interesting other trinkets. We stopped for a few minutes there and then walked over to a restaurant nearby and had lunch.
After lunch, we tackled the last of the monuments we looked at today: Ta Prohm. This is a Buddhist monument that was built about 50 years after Angkor Wat. It has been less excavated and restored than the other two structures we visited. This is also the actual area within the park that Lara Croft Tomb Raider was shot. We looked around a bit, but never did spot Angelina Jolie or Daniel Craig.
One of the interesting things our guide Rattana pointed out was a vertical grouping of carved illustrations of animals. There in the middle of all the elephants, birds and other critters was – a dinosaur! His opinion was that the people of Cambodia had probably unearthed one in the excavation of the city. But maybe Jules Verne had it right?! 🙂
At the end of the day, we were all very tired but our travel agent Linda had scored us a treat for our recovery: the Angkor Village Hotel & Spa. This is truly the most beautiful five star hotel I’ve ever seen – even beyond the Broadmoor. My room was restful and just perfect. I didn’t want to leave!
Sunday, January 27 – Last Day in Siem Reap
The remaining four of us in the tour group arose late and met for a casual breakfast in the hotel. The rest of the group left early for the airport; they either had to catch planes home to Denver or wanted to get ahead on setting up for surgery this week.
Harvey, Judy, Sharon and I carried on with Rattana and first visited a little streetside market where we saw some amazing things people eat that I wouldn’t think about. Eggs with developed birds inside, fried crickets, and parts of chickens nobody should think about! Overall it was about as good as a gross-out session with middle schoolers, but was educational nevertheless.
After the market, we carried on to a silk farm operated by the Artisans Angkor group. It was fascinating seeing how silk is made. Worms are fed on leaves, they form cocoons, they are harvested before they mature into full moths. One interesting point to me is that they also harvest the moths, fry them and eat them. Not anything I would consider, but supposedly they are ‘just like peanuts’.
This farm also had a spinning and weaving operation, so we were able to see the warping process as they took many threads and laid them out for weaving long scarves and swaths of fabric. All the processes in this place were very hand-made, but I am told that silk operations of larger scale have a lot more automation in place.
Once we finished the tour, we again had an opportunity to buy some of the crafts that were created there. More presents!
After the tour, we carried on to a lovely little restaurant in town where we spent a leisurely two hours eating and talking about Cambodian politics with Rattana. It was interesting swapping stories of how the US history had unfolded after leaving Viet Nam and sorting out that we really missed the bad problems in Southeast Asia. We wasted fifteen years in Viet Nam and because of that had no chance to go into Cambodia and prevent the genocide of millions of people there. It turned out that the
Viet Namese army was who liberated Cambodia in 1979. But that liberation only extended to Phnom Penh and the Khmer Rouge continued to be the ‘official’ government of Cambodia for another 10 years. They even had a seat in the United Nations! I feel so sad about how this country has suffered because of badly timed politics!
Finally, we returned to our tour van and travelled to the airport, where we boarded the plane for Phnom Penh and returned to the Phnom Penh Hotel. The good news of the day was that my bags were still in the hotel and my stuff was all intact. We had a bite of dinner in the hotel restaurant and all went to bed in anticipation of a big day of surgery in the morning.
Monday, January 28 – Finally, I get to go to the OR!
It only took a week to get here. We arrived in the clinic at about 7:30 and started the day with a devotion led by Nancy, one of the nurses on the trip. Mealday interpreted for the Cambodian participants and the lesson was about loving your enemy and doing more for others than you expected in return. Matthew 5 was quoted with the discussion.
We then changed into our scrubs and got ready for surgery. Both cases for the day were abdominal laparotomies (meaning abdominal incisions to remove something). I acted as the third circulating nurse in the OR and helped out here and there. I got a little opportunity to do some teaching with one of the Cambodian medical students. Overall, I felt like I was actually doing something of the clinical work I had set out to do initially.
But once the case gets going, it gets pretty dull for the circulating nurse. The first and second one aren’t very busy. The third one is really just in the way. I did a little research for the anesthesiologist, Jim. But then I went back out to the recovery / ward area and found more broken medical equipment to work on. It may not be sexy or very clinical, but the Cambodian nurses working in the clinic have been vocally very grateful for my efforts. They have been stumped by these broken devices and I know that my little efforts in getting things working again will make a difference for a long time after I’m gone from here. I will take great satisfaction from this.
I got back from the clinic only to find that my laundry was not picked up today, so I am down to one t-shirt and one pair of socks. I rinsed them out and will hope that we get our laundry tomorrow. I elected to stay home from the group dinner tonight in favor of writing this journal. I had a nice dinner in the hotel restaurant, so don’t worry that I went hungry!
Wednesday, January 30 – Just another day in the OR
I’ve had three days of working in the OR now, and we finished our last case today. There was a bit of shortage on patients this trip: somehow the word didn’t get out to referring clinics and they didn’t see that many patients that needed surgical service. This may be an issue I can help with next time: finding patients and marketing referrals from outside clinics. Anyway, the last case was a doozy.
We’ve seen lots of patients in the last week that had benign tumors on the uterus. The biggest one so far was a 9 pounder. But today was the most amazing thing any of us have ever seen. Our 39-year-old 43 kg patient had no less than an 8.5 kg (18.7 pounds!) ‘teratoma’, or benign solid tumor in her abdomen. That’s nearly 20% of her body weight! This will be one satisfied customer when her incision heals!
It was great to work in the OR with a wonderful crew of both American and Cambodian nurses and doctors. We had guest doctors in that were locals, as well as an American missionary doctor who was brushing up on her technique.
I also got a bit of time outside the OR. The surgery center is small, so we house patients in a single area with little separation. There is room for six beds and that serves pre-op, PACU (Post Anesthesia Care Unit), ICU and routine post-op recoveries. The Cambodian nurses provided most of the care while we did some training with them on assessment and delivery of care. Sharon did a neat training session on CPR. Patty went over OR procedures. Nancy worked on assessment and interventions. I spent some time with Sopheak (so-pay’-ak), the head nurse working on documentation procedures and some strategies for continuous quality improvement projects.
I was also asked to continue in my role as bio-med technician. While I’m still not exactly qualified, Dr Soary (swa-ree’) asked me to come and check out a Chinese anesthesia machine he had set up. We got in a car and travelled across town to a very nice hospital. There I reviewed the English manual (thank goodness!) and checked whether all the hoses looked like they had been put in the right places. All appeared in good order to me, so we turned it on and it looked as if it would do the job of ventilating the patient and evaporating anesthetic into the circuit, so I told him I thought he’d done a great job. Hope I’m right…
I also fixed a few more devices here and there, and helped out as I could around the clinic. Tomorrow we will do some organizing of supplies and try to make the center ready for the next group that comes in three weeks (Cardiology). For my part, I have committed to Sopheak that I will help him revamp their ICU and post-op flow sheets and get those forms looking good for future work.
Tonight, we took a little ride on a party boat with the whole staff (except for those nurses that were caring for patients!) and had pizza and beers to celebrate the week. It was a lovely ride with a nice breeze to temper the afternoon sun. I got some great shots of folks living and working on the Mekong river – quite a different image than I carried from Apocalypse Now, I’ll tell you!
I’ll probably write a little wrap up of my experience in the clinic tomorrow night and discuss my plans for riding the bus to Sihanoukville on Friday and then taking the ferry to Koh Rong Island on Saturday. SCUBA diving awaits!
Here are some photos of the operating room, personnel and general working conditions:
Friday, February 1 – Team Pelvis has left the building!
We’ve had a great run. In all, about 10 patients received operations and only one turned out less than successful. Dr Davis thinks we should have had more cases. Upon discussion, we all felt that what’s needed is some basic marketing of the clinic. That may be how I can help the effort in the future: going ahead of time and recruiting patients from around the city and region. We’ll have ongoing discussions about whether I can afford the time and money and whether I can tolerate that much time away from home.
I rescued many pieces of medical equipment but also lost of few of my ‘patients’ to trauma and general aging without adequate maintenance. If I return, I will have a much better idea of what I need to bring and how I can be of even better service to the equipment. It might be worthwhile to take a little class on biomedical technology if one is available somewhere – suggestions are welcome.
I had a few opportunities to teach nurses about assessment and interventions, but not as much as I imagined. I’m OK with that – the things I did really contributed to the mission and there were lots of great educational opportunities for the other nurses on the trip. I guess the thing to remember about volunteering in the third world (second world?) is to be flexible and to be prepared to use any skill you might possess, because you never know what’s going to be needed when you get there. I’m just glad I could help and feel this good about being here.
I have to say I am developing a love affair with Cambodia. This strange little nation has been in the shadow of Thailand and Vietnam for centuries and it really has been buffeted around by crazy politics and an absence of practical leadership. I can’t fix those things, but I know when I come here, I can help in a small way and make this a better place for some people. Speaking of those people, they are incredible. Everybody has a story to tell about relatives lost in ‘the war’ with Pol Pot. Yet they smile at the slightest prompting and are always ready to enjoy a good joke. Their resilience is truly amazing, and they are just a joy to talk with. This is a magical place in many ways and, despite the bad smells here and there, it is a beautiful country with lots of opportunity to make life better. I hope I can come back here!
I’m off to Sihanoukville, reported to be a true party town with lots of resorts on the beach. Tomorrow I’ll be on a ferry for Koh Rong Island and will enjoy three dives each on Saturday and Sunday. I’ll post the pictures I get as internet connections become available. Until then, dear readers, onward and upward! -e
Friday, February 1 – Have Mercy – Been Ridin’ on the Bus All Day
The ride to Sihanoukville was a comedy of errors in every way. It started by asking the porters at the Phnom Penh Hotel to arrange a cab to the bus station. They looked at my bus ticket and at first said the roads were closed for King Sihanouk’s funeral. Then another came along and said they were re-opened. It turned out they were both right. A cab was arranged, and we rode down to where the bus station usually picks up riders. Unfortunately, the road was indeed blocked to get there. The cabbie dropped me off about three blocks away and I dragged my overweight dive kit down to the bus station. There I met another earnest young man with an ID from the bus company (Phnom Penh Soraya, for those who are thinking about making the trip). He said that I had to go to another bus station to catch the bus.
A tuk-tuk was arranged. These are a unique mode of transportation in Asia. A small (120cc) motorcycle is rigged with a fifth-wheel type of trailer hitch on the back seat and a two-wheel trailer with two bench seats is attached. This results in a fuel-efficient vehicle that will tow up to six people. My tuk-tuk driver dutifully took me to the other bus station and dropped me and my baggage off. Ticket in hand, I proceeded to ask at all the busses where I would board for Sihanoukville. I finally found one small bus that the driver said was the right bus. I pressed him to be sure, and he responded: “Yes! Change bus!” This sounded promising so I boarded the very crowded bus and piled my dive kit up next to the driver. We then proceeded to drive right back to the first station that I had started at! Apparently, there was special dispensation for the bus, so it got right to the station and we got off. I then stood on the ticket line to ask which bus, and finally got the answer I was looking for: Bus Number 50. I found the bus and got the driver to load my large bag into the luggage bin below. I boarded and found my two assigned seats (I had bought two on the advice of a friend who had travelled here before). The bus proceeded to load up with many riders. On several occasions, the driver and some bus company employees asked if I had both seats – I confirmed and showed my tickets. We finally got underway at 1:45, about 45 minutes after the planned departure time.
We then drove southwest towards Sihanoukville. The road was very rough while still in the city, but once we got to open highway, there were fewer potholes, and the going was a bit quicker. I’d guess we were going about 40 mph on average. We passed many slower vehicles, accented by the driver honking his horn every time he pulled up behind a motorcycle or ‘lorrie’. The countryside was mostly flat as we left the city, but about two hours into the trip some low mountains began to rise up. We stopped for refreshments at a small roadside shop. The bathroom was as you’d expect in a rural area: rudimentary. I did my business without touching anything, bought some potato chips from the vendor, and got back on board. The rest of the trip was fairly uneventful, other than the occasional stop to pick up or drop off passengers. I have no idea how this was communicated, but they seemed to have the process down. Along the way, the driver turned on the television at the front of the bus and began to play Cambodian Karaoke / Music Videos at full volume. These were entertaining for a few minutes, but I finally retreated to my own headphones and listened to music from home for most of the trip. It was kind of interesting listening to bus songs like Simon & Garfunkel’s ‘America’ and several John Prine songs about bus rides but doing it in Southeast Asia.
I finally arrived in Sihanoukville around 6:00 PM. There I engaged another tuk-tuk driver to take me to my assigned hotel: The Family Bungalows on Serendipity Road. Sihanoukville is an interesting place – reported to be a party town this was absolutely true. Imagine Daytona Beach during spring break but with a young international crowd speaking every language you can imagine. My hotel had a lobby with many PC’s connected to the Internet. I was shown up the dozen steps to my room (the porter kindly took my bag after I had struggled halfway up) and was given the key to the padlock on the sliding doors. These doors turned out to be welded square steel tubing that offered security by locking either on the inside or outside. The room was sparse to be sure. It had two beds a table and a refrigerator. I had to plug in the fridge to get it started. There were no chairs, so I dragged the table up next to the bed and sat there to type this note.
I went to dinner at a pizza place a few doors down from the hotel. The pizza was OK, and the beer was cold, so I’d call it a successful dinner. When I went back to my room, there was a loud party going on in the courtyard outside my room. I retreated inside, pulled the curtains and watched a movie on HBO with Cambodian subtitles. I finally turned in for the night and awoke the next morning for the next phase of my journey.
Saturday, February 2 – Do You Know the Way to Koh Rong Island?
I had received a text message from Sarah, one of the dive masters at Cambodian Diving Group, asking me to meet her at the Koh Rong Diving Office. Unfortunately, there are about a dozen signs along Serendipity Road that claim to be the Koh Rong Diving office. So I called her and she coached me up the hill to the right one. There I was given a breakfast of watermelon, croissant and coffee and we waited for the bus to take us to the ferry. When it came, the bus filled almost instantly, so Sarah arranged for a tuk-tuk to take me to the docks instead. We picked up three other travelers along the way. Two were from Johannesburg and one was born and raised in Morrison Colorado. Go figure. We talked about diving and traffic and all the interesting things to be seen in Cambodia. Eventually we reached the dock and got on board the ferry for Koh Rong.
The ferry turned out to be a small dive boat, about 40 feet in length. There were about 30 people on board, including a crew of three. We made the crossing in about two hours. There was virtually no wind, so the bay was very smooth. Sarah told me it can be very choppy, so I felt blessed that we had such smooth sailing.
We arrived in Koh Rong at about 10:30 and there I met Simon, the owner of Cambodian Diving group. I made my payment and then they took me by small boat to my hotel, the Monkey Island Resort. To call this place a resort is a bit of an exaggeration. All the construction is wooden posts and beams with thatched roofs. My ‘room’ is a small grass shack with grass walls and roof. There is just room to cram three beds, each with a mosquito net. In the back there is a bathroom with a sink, a shower (same space, no curtain or separation) and a toilet. The toilet is a ‘manual flush’, meaning there is a big trash can full of water next to the toilet and a pan to pour water into the toilet until your business has washed out. Heaven only knows where the effluent is going. The young man who carried my bag up to the cabin told me that electricity was only available between 5 PM and Midnight. There is one outlet, along with two fluorescent bulbs (one in the main room and one in the bathroom. This is rustic living with a vengeance!
I quickly unpacked my bags and grabbed my dive gear. We were to start for the dive site at 11, so I hurried down to the main bar of the hotel to catch up with Simon. A couple of people sitting in the bar told me Simon had gone into town to fetch the boat because the pilot didn’t understand he was supposed to wait. So, I waited about a half hour there. They finally came back to pick me up and we went back to the dock in town. There we loaded lots of dive gear on board this small boat (about 25 feet – one of those Asian designs that’s a lot like a canoe with an outboard motor that has a long drive pole with a prop that drops down behind the boat). We then sat and waited some more. Apparently, the fellow who fills the air tanks had been under the weather the night before and they had to fill all the tanks while we waited. A couple that had planned to dive decided to cancel because they were packing for departure and wouldn’t have time to get organized with the late departure.
The final boat’s complement consisted of two guests: a lady from Switzerland named Daniella who had been diving for 30 years and yours truly. There were three dive masters: Simon, Sarah and a young man named Adam. They were all British. There was the pilot, possibly 15 years old with almost no English. And finally, there was an elderly British lady who was hitching a ride to the smaller island of Koh Rong Soary. We set out for the smaller island and took about 20 minutes to get there. We dropped off our passenger and then went on to the first dive site.
Dive #1: The Corral. Simon describes this site as ‘muck diving’. We dove to a maximum of 20 feet for just over an hour. The bottom is mostly sand. With the clear weather, visibility was very good for the area: apparently it can be very bad with any amount of wind on the water. We saw lots of interesting creatures, including several varieties of sea cucumber I had not seen before. The prize was supposed to be sea horses, but we did not have any luck in finding them. They reportedly cling to a certain variety of sea urchin and are usually encrusted with sand and muck so can be very hard to spot. All in all it was fun to get back in the water and we saw some interesting creatures.
We took our interval on land at a small inn on Koh Rong Soary. Our British lady was nowhere to be found, but we had a bowl of noodles and passed the hour with an interesting drunk man named Said, who told us he was a surfer.
The second dive was on a proper coral reef. This site was called “Last Tree”, named for the navigation point the dive masters use to identify the location. There is a small outcropping of rock with a tree that hangs over the water and even I could spot it. We dove to a maximum depth of 44 feet and saw a nice variety of fishes and coral. Again, one of the more interesting and unique sites was a few coral heads that were covered with small white sea cucumbers.
Scuba Diving in Koh Rong Island:
Sunday, February 3, 2013 – Which way did they go?
Today’s diving was from a larger boat; in fact it was the same boat on which I had made the crossing from Sihanoukville to Koh Rong. It had been converted from a freight and ferry boat to a proper dive boat with a full complement of about 30 divers and a half-dozen or so dive masters from various different diving companies on the island. Our group from Cambodian Diving Group was 8 divers with two dive masters and Adam, our dive master in training. Unfortunately, Perom, one of the dive masters, had an open wound on his toe and couldn’t dive. That left 8 of us with a single certified dive master. This becomes interesting because deadbeats like me like to hang behind the group and shoot photos all the time. We had to surface multiple times to find the rest of the group but did finish both dives as a single group.
The first dive was in a location called “Oregon Bay”, a coral reef that stretches the full length of 7k beach, a 7-kilometer-wide beach that stretches out on the southern end of the island (Koh Rong is about 77 square miles, or about the size of Hong Kong). This was a beautiful reef with lots of interesting fish and creatures. The only problem was the visibility and logistical issues of keeping the group together. You could only see about 15 feet, so if divers got much ahead of you, they were gone from vision entirely.
My dive buddy for today’s dive was a lovely young lady from Holland named Manon. She was on her first dive after certifying yet carried herself like an experienced diver. In fact, she did a great job of spotting a lot of interesting photo opportunities. She hung with me and tolerated the other newbie divers all crowded around Nate the dive master and kicking us in the face with aplomb.
We were under for just under an hour but had to surface three times to find the rest of the group. As we were in only about 20 feet of water, surfacing was not really an issue – you only worry about decompression sickness if you’re coming up from 40 feet or more. We finally finished the dive as a group and got back onboard the boat for a lunch of noodles and watermelon. Then we carried on to the next dive site.
The next dive was in a location called Furbo – another section of the reef on 7k Beach that extends a bit beyond the beach. Again, the visibility was terrible, so we had a few issues of losing the group and catching up again. In spite of this, we saw some neat creatures including some cool nudibranchs or flatworms with bright colors and interesting textures. We also saw about the biggest puffer fish I have ever seen – at least two feet long! We swam among coral heads and found a few other fish and creatures and spent about an hour on this dive as well. That’s the neat thing about shallow dives – you never run out of air! I surfaced from both dives today with well over 1000 pounds of air in my 3000-pound tank (I have been known to surface with less than 300 pounds at times in deeper waters – just ask Suzi).
Manon was again a terrific dive buddy, finding lots of good subjects and dealing with the crowded circumstances. I think she’ll be a great diver as she gets a few more in her log.
After the dive, we all got back on board the boat and headed back to the dock on Koh Rong. At that point, I started talking with Adam and we wound up going to one of the local watering holes for a beer. We kept talking and then joined up with a few more of the dive masters for a few more beers. We traded diving stories and had a great time talking – they were from lots of places like England, Ireland, France, Bosnia and Italy. Simon, the owner of Cambodian Diving Group, then joined us and later invited me to join them for dinner. This was probably the best meal I’ve had in Cambodia. The dive companies all pitch in together to support a kitchen that serves three meals a day to the dive masters – about 20 in all. Lunch is of course served on the boats, but breakfast and dinner are in the kitchen on the dock. There was a fabulous selection of chicken curry, creamed chicken, rice, mashed potatoes, four kinds of salad and overall, it was a great way to end the day. I felt honored that they let me into their group, and we had great conversations over the meal.
I finally bid them farewell and headed back to the Monkey Island resort. It was quite dark by that time – about 8:30 PM. But I managed to fumble my way the 1/4 mile down the beach and find the hotel bar without falling down. I’m now sitting in the hotel bar where the internet seems to be working, and I’m writing this last day’s journal.
Tomorrow I will take the ferry back to the mainland and then make my way to the Sihanoukville bus station for the five-hour trip to Phnom Penh. There I will check in for one more night in the Phnom Penh Hotel and enjoy the first hot shower I’ve had since Thursday! On Tuesday morning, I’ll check out of the hotel and head for the airport and the 28 hours of flying and laying over on three flights to get home. I am so looking forward to getting home to my Suzi and getting normal again! Until then, dear readers, I’ll post as I get internet access and time to write. So long for now!