Humanity

I found myself alone for dinner, my interpreter staying with some friends in a neighboring town. With the sky turning dark, I heeded the advice I received many times to not be out in Poipet after dark. As walked down the road to find the nights food stall, the sky opened up with a fire hose of water. It was as if God himself was trying to drown every living being on earth. The dark streets were lit by the constant crashing of lightning on nearby buildings. I ducked into a corrugated metal roof to take refuge from the elements only to have a wide eyed Cambodian grandmother looking at me, gesturing to one of her plastic chairs to sit for dinner. After scanning the establishment I wanted desperately to go to anther restaurant, but I weighed the risks and benefits of food poisoning against electrocution and decided that there was a reason I brought antibiotics and nausea medication. I stayed for dinner. I pointed to "fried beef with rice" on the menu and an Angkor beer and she disappeared.

One hour later I ask the woman if the meal would be ready soon. I didn't see any cows out back, so the meat procurement couldn't possibly be the hold up. It is my fault for not speaking Khmer... but there was no change at establishing what was happening in the kitchen, and if my dinner was part of it.

From behind me a man in camouflage asked if he could help. Thankful to hear English, I explained to the man what had happened. He discussed it with Grandma, and filled in the details that I was already sure of... she didn't understand that pointing at the menu meant I would like to order it.

With my order on the way, the man took pity on me, seeing me wait for so long and insisted I join him at his table. I was at first hesitant, being in Poipet and having recently returned from Siem Reap where everything is cheap, but NOTHING is for free and everything comes at a price. He stated that I must be starving, and to share his dinner with him until mine came out.

He was a soldier in the Cambodian army, married with a 9 year old boy and  5 year old girl. Because the army doesn't pay well, he spends his free time trying to earn extra money in Poipet with his brother.

3 women come up to our table from the street, their attention on the soldier and not me - almost as though I didn't exist. A short conversation occurs in Khmer and he pulls out his wallet. He gives them each a small bill and they leave.

Without explanation he simply states, "even though I don't have much... I have more than them."

My dinner eventually comes out, but by this time we are both full but don't dare waste the food.

Dinner turned out be excellent, but even more satisfying was sharing a friendly conversation with a complete stranger on the other side of the world. He could have asked me for money, robbed me, or simply ignored me.

With the rain still coming down like a waterfall from the sky, he gave me a ride back home in his jeep to the hotel.

Check mark... put one down for humanity.

Poipet & Siem Reap

 The emergency department doesn't see that many people, yet. This is largely due to the fact that this is a new hospital and many people in the community are not used to using it. It is also about a 5K walk down a dirt road from city center to reach it - thus not everyone can make the journey easily


The Khmer doctors I have found bright, resourceful, and generally practice good medicine. Because government funding if limited, most.. if not all doctors at government hospitals hold private clinics which diver most of the clinical time. As a result, only the on call "duty" doctor is available in the hospital after noon. This doctor is generally a non-residency trained medical school graduate covering the whole hospital. In this picture, I was invited to radiology rounds to discuss chest X-rays. No shortage of TB patients, about 20% on the board.


By chance, a group of medical students from Singapore were volunteering with children at a local church. Their goal is to bring down a group of surgeons from Singapore to do a mission-style surgical trip for 2 to 3 weeks. This is the third year their group has been doing this. 





Today was my last day working with Visal, my nurse translator. He has been a tremendous help, and has a true passion for improving the healthcare in his country.

 To get a little fresh air and air conditioning, of often make the walk over the border crossing into the Thai casino zone for iced coffee. This company "Palais Coffee" seems very similar to another Seattle based coffee company I know all to well.

 The only food within walking distance from the hospital is this restaurant literally across the beaten path. They have one option for breakfast and lunch. It might as well be this way, as I wouldn't know what to order off the menu anyway. I personally found the cow intestine soup and tongue fry a little on the adventurous side.

 We hired a taxi and made the 2.5 hour drive to Siem Reap. It is as if we drove into another country all together. I imagine this is what it is like to drive through the dessert and suddenly wake up in Las Vegas. After taking a nice swim, I bought my trinkets at the famous night market and then headed to "pub street"... the unmistakable district with good restaurants for tourists.

Our hotel, the Frangipani, is like a colonial guest house from India. What a stark contrast from Poipet. As I arrived, an assistant literally took my bags off my back, handed me a cool, mint infused towel for my face, and handed me a fresh glass of mango juice. I definitely will be coming back to this place. The best part is that in Cambodia, this place is still 1/4 the cost of a Motel 6 in the bad part of LA.





Tomorrow I wake up at 5AM to make the sunrise over the Siem Reap temple. I talked a few of the URC staff into having dinner with me tomorrow.

Poipet Referral Hospital

Poipet is an interesting town with an odd relationship with the Thai. Technically Poipet is withing the Cambodian border (although many Thai history books apparently teach their children that it should belong to Thailand) yet it is illegal for Cambodians to gamble. Casinos are illegal in Thailand, but they are allowed to gamble in Cambodia. So... between these rules, the only place either can gamble is in Poipet! Historically this made for an unsavory crowd, but this has been an area of development for both Cambodia and Thailand. In fact, rumor has it that Thailand will be investing in a light rail from Bangkok.

Today we rode by motorcycle (the only way to the hospital from the city) to Poipet Referral Hospital. It was built in 2011, and opened just a few months ago. The floors and walls are still squeaky clean. Like many new hospitals that were built to adapt to a growing population, they have more beds than staffing for them, and thus several empty beds. A total of 13 physicians staff this hospital, providing basic minor surgery, a handful of elective general surgery cases, obstetrics, pediatrics and internal medicine. Doctors here take overnight call once every third day and are responsible for the emergency department.

The emergency department is a small 4 bed room with a locked cabinet with a sampling of resuscitation medications and equipment. Sick or potentially unstable patients are sent here and kept until "stable" to be admitted to the floor or discharged home. When they looked up the literal translation of how they were using the space, they found the English term "ICU" and put the wrong sign above the ED doors. The actual "emergency ward" sign in on the floor in the nursing break room... that was intended to be a procedure room. Overall the day was productive as I met a very eager and nice junior doctor... Dr. Tam. We rounded on the inpatient ward, and I was very impressed with his physical exam and clinical diagnosis skills. When one doesn't have access to many labs and imaging, every little additional piece of information counts. We spent about 10 hours discussing various emergency medicine topics.


With the blistering heat winding down to a simmer, we walked around the casino district of Poipet. I was fascinated to see this mini replica of Vegas. I was very impressed. The majority of construction capitol was placed in these casinos, and like their inspiration back home in the US, I'm sure it made quite a bit of money.



Growing up in Seattle, I immediately noticed a familiar sign from across the casino floor -Starbucks? When I got closer I broke out into laughter when I discovered Palais Coffee! A little much like our Northwest mermaid?

The actual Thai-Cambodia border crossing is marked with this gigantic hindu sculpture in similar design to the large temple, Siem Reap.













Siem is the Cambodian spelling for Siam, a synonym for Thailand. The Thai... or historically the Siamese had once occupied much of Cambodia. Siem Reap literally translates "Flat defeat of Siam." It is ironic then that this archway is a portal for the Siamese back into Cambodia to gamble. In fact, we had to change our money into Thai Bath... even though we were still in Cambodia!









Our hard days work was well rewarded with a cold Angkor beer. It turns out that my translator and nurse is somewhat of a pool shark. Funny how quickly "I've never played this funny game" turns into "I won a third time?" It was nice to have a quick escape back to familiar life... even if only for an hour. Back spicy noodle soup for breakfast in the morning.

Drive to Poipet

The flight on EVA air couldn't be better... good food, friendly staff. I arrived in the capitol city of Phnom Penh around 11AM, just in time to make it to the Anise hotel, put down my things, and head to the city with co-resident Usha. Fortunately, she allowed me to tag along for her afternoon agenda.


It was a sobering, yet appropriate start to my experience by visiting S-21, the Khmer Rouge interrogation and torture prison during their reign. We followed this by going to a local "killing field," a scar on the face of Cambodia that serves as a constant reminder of the atrocities that took place here. Human bones and teeth still work their way to the surface of the earth, guests quietly and respectfully trying to not step on them.


The following day we took a 9 hour bus ride to the border city of Poipet - a small town famous for 2 things, the border with Thailand and casinos (illegal in Thailand). Often referred to as the "armpit of Cambodia" in tourist books, this city seems to be full of life. Tomorrow I will check out the hospital and meet the other doctors there.

My nurse and translator, Visal, is a native Cambodian with better than average training form the Angkor children's hospital in Siem Reap. He tolerated my 9 hours of questions on the bus trip and gave me an excellent introduction to Cambodian culture (including beef intestine soup).

More later...