Sihanoukville

Hey Y'all,

This will be a text post since the camera is at home. Sarah is over there applying for jobs, so I am posting. I finally can sit down at a computer without having to do research. I was given three research projects to do while I am here. Basically all three consist of collecting outcome data on all patients with a specific diagnosis or operation and making a presentation to show how CSC is doing. One also consists of turning the 150 or so pictures of a specific operation into a description of the procedure in a power point.

We are at Sihanoukville for the second time now. It's the main beach city in Cambodia. Last time we played in the water, sat on the beach, got a massage, and pretty much just got sunburnt. It was really fun and relaxing. We stayed right on the beach in a nice place for only $15. This time we are in the same place and even in the same room. It's nice to have such a great view and A/C. Today we kayaked up the coast to a lagoon with mangrove trees. It was a fun paddle. The kayak was like a surfboard with sides. It wasn't very fast. Tomorrow we are going scuba diving out by two islands. We have three friends here with us this time from England and the US.

Work at CSC is going well. I scrubbed in to assist with my 41st operation of this trip on Friday. I have seen a lot of cool things here. I've helped with brain surgery, spine surgery, plastic surgery, and many orthopaedic cases. I understand surgery much better after having been here, as well as its role in developing nations. We have a week left. I'm very fortunate to have ended up here. And my research was presented at the Orthopaedic Society of Cambodia last week, so I have some research to put on my CV for this summer after all. One other project I am working on will be presented in Sept.

My Khmer is coming back. I don't speak as well as I did at my prime in my mission, but I know a lot more about medical Khmer. I can honestly say that I am fluent again in most situations. People are usually amazed that I've only studied for two years, and I'm usually amazed that I still remember after three years of being home.

Well, we are doing quite well. Hopefully some pictures will appear on the next post.

-Ben

surgery, pysiotherapy, Battambang

Random Buddah in Battambang.

I made a split for this women who was stabbed in her arm.

Lengthening a triceps tendon. Ben is in the back and an American Spine surgeon on the right.

I gave up and getting Ben to post on our Blog. Ben has gotten to help with many surgeries while here and has enjoyed that. Some of the surgeries include: Amputating a woman's 6th toe; implanting internal fixatures on a woman's jaw that was cut by a knife; debreading an old woman's mostly rotten arm; clef lip and palate repair; scoliosis; tumor removal; and many others. The one in the first pictures is a surgery to lengthen a boy's tricepts tendon. I am able to walk in and observe surgeries when I can't find anything else to do.

Yesterday was particularly gruisome to see a skin graft surgery on a young boy's arm pit. After a burn, his arm was fused to his chest. The surgern cut out the scare and replaced it with a skin graft. The surgeons scraped little bits of skin from the health portion of the boy's arm and then ran them through a perferator device. Then tried to piece the scraps of fishnetting (skin) together and onto the large open wound. The head surgeon came in and betted $100 that the graft would not take so they had to start over and scrape skin from the leg to get larger pieces. The medical students, including Ben are able to do a bit of suturing, lots of holding wounds open, suction, pullion staples out, etc, and observing. My favorite is the watching the American Dr do consulataions and morning rounds and because it's in English and he takes a little more time to teach about evaluating and diagnosing.

I have been triying to do a bit in the physiotherapy department. The biggest frustration is communication. Documentation here barely exists and often I cannot find anything on patients. Doctors are certainly not in a habit of talking to therapists. I cannot talk to patients and often they don't even know what's going on. The one pysiotherapist here has pretty poor Enlgih pronouciation and sometimes I think he gets tried of trying to talk with me and just ignors me. I have started volunteering across the street for a couple weeks at a rehabilitation center that treats the non-surgery conditions such as cerebral palsy, torticollis, musculoskeletal, club feet, and amputations. They give a lot of orthotics and prosthetics and wheelchairs. There are a little more organized over there.

I am not sure what to do for the children with cerbral palsy. Any many cases the parents don't either. I worked with a young girl yesterday. Several months ago, her mother dropped her off at a NGO anonymously. The Khmer NGO worker was very nice. He did not know how old the girl was but guessed 3-4 years of age. The girl could not track objects with her eys, she could not stand up, and had zero attention span. The NGO mans' moto driver recognized the little girl and said that he knew the father. The father his wife that if she went and got their daughter from the NGO, then he would divorce her.

Last weekend we went to Battambang: A city 5 hours north where Ben used to serve. We visited some members of our church, and went a little out of town to see an ancient temple, and then climbed a mountain to see a more modern one. Also, we saw a cave where bats fly out at night. The bats flew out of the cave fore at least an hour because there were so many of them!!! Unforturnately I don't have 8 hours to wait for another couple pictures to download so these will have to suffice.

food and bikes in Phnom Penh

Locals commonly wear masks while riding on the dusty and exhausty roads; as did we. We ride our bikes mostly. But sometimes take bicycle carriage things or a moto which is the back of a motor cycle. We are not currently traveling, but still spend a fair amount of time in transport which a fun/amusing/different part of being here. Traffic laws and lanes don't mean much. The semi-trucks, and motos, and tuk tuks and biclycles all cram together and fend for themselves.
Killing fields during Khmer Rough. See human bones and clothing. Signs says that they hung a large speaker here to drown out the moans of victims.
Sarah riding across the bridge after work. Sorry about scratching my face at the wrong moment. This picture is to show my mom that we are wearing helmets.
This is the hospital.

One highlight since last post was eating ...peculiar foods I will call it. We went to a nice-ish restaurant with two other medical students and Cambodian surgeon and all ordered a dish to share. Another student ordered goat with ants. It should have been called ants with goats "parts." The ants were small so I ate a couple bites before even knowing they were ants (All I knew was that he ordered goat). I thought the white parts were okay until I realized they were larva. The goat I thought at first was tounge. Another student said it was tender. We all wondered what it was so I took a piece to examine that looked exactly like a neuroanatomy specimine: pons, medulla, etc. The waiter claimed it came from the "belly." I ate it before I knew what it was and then I had a 1.5 cm insect with wings between my chopsticks and called it quits. I regret that I did not have a picture. The other suprise that evening was the incredible amount of alcohol that the Cambodia surgeon consumed the sum total we did not stay to witness.

Next peculiar food incident was when we stopped at a restaurant way out of town. I feel a little disrespectful writing this, but I will continue. There was nothing else nearby so we asked what they had. They had two things so we orded one of each. We got duck soup and duck ..pieces with paste and plants. From as best as I could tell they only thing not in the soup was the feathers and the contents of the stomache and intestines. We even identified the skin. Otherwise they take the whole duck and cut it into one inch cubes. That was difficult for me to eat much of with splinters of bone and even a solid rock that I think is called the gizzerd in there. Otherwise we have found good things to eat. I like the noddles and vegetable/meat stir fry.

Another thing of note is that we purchased bicycles. We can ride them to work now which saves us money though is an extremely hot endeavor. Many people want to know what we will be doing with them afterward so I hope we may not have a hard time selling them. On Saturday we went on a 18km bike ride to the killing fields where we saw many human skulls and saw the mass graves of thousands. Sad. It was a long and extremely hot ride. We managed to find a cheap ride home in a common mode of transport that is like a motorcycle carriage.

We stayed in town this weekend and went to two different branches for church today which we enjoyed.

I will leave reporting on out hospital experience to Ben.

s

Ben and I made it safe to Phnom Penh. Our first night we spent in Bangkok. After staying up for 36 hours we couldn't sleep much so we got up and wondered around town and the Royal palace. It is required to have an elbow length shirt and pants, so I am wearing a rediculous outfit, but when we got there we didn't want to spent the 20 dollars to get in so we walked around the outside. That afternoon we flew to Phnom Penh.

Today is out third day at the Children's Surgical Center (CSC). We are up early because last night we decided to take a nap before dinner and woke up at midnight. At that point we decided just to keep sleeping.

At CSC, Ben is making lots of Khmer friends and the staff is impressed with him. I'm learning some Khmer words aswell which the children find amusing. I wouldn't say that we are any bit of help just yet but we are learning and amusing ourselves well enough. Ben has been in the operating room holding incisions open and doing a few sutures. I am able to walk into any surguries whenever I want as well.

Yesterday I went to what I guess you would call the burn unit. It is seveal km away from CSC. It is sad to see the violent crimes. These people are victims of acid burns. Most of the patients were gone to a court case yesterday so I only met a couple. We have also seen a couple women who have been savagely abuse by their husbands (i.e. stabbed and UE cut off).

The first picture just uploaded, so I will stick with only one picture for now.

More later.