A DOCTOR'S STORY
Looking to incorporate some “off the beaten path physical activity” into our three week adventure through Laos, Vietnam and Cambodia my husband and I enjoyed a guided kayak excursion of Tonle Sap. We kayaked through the colorful maze of stilted homes in the community of Kompong Khleang. We watched and waved at boats full of children who floated by us on their way to school. We marveled at the ingenuity of the Bahn Mi salesman who outfitted his boat with the same unique fixtures as to the moto cum food truck. We mused at the boats tied up to the stilted variety store with five foot high ceilings selling gasoline in used “coca” (cola) bottles with the sweet treats next to balls of twine and baskets of mangoes. The further we paddled the more the bright colors and the spectacle of this unique way of life fell into the background allowing us to focus on the people and their homes. We saw one-room homes that were assembled with found materials, hardly weather proof. It was difficult to imagine how these structures might hold up in the heavy rain sand winds that occur here seasonally. We saw women cooking over wood fired stoves inside their homes. Fishermen chopped their catch and washed-up with brown lake water. Children bathed and played in the water. It became very obvious to us that there is no running water and no sewage containment. To the people who live here, the lake is everything. It is a source for drinking water, food, washing and all the other important matters of life. There are few places in the world where people live in such impoverished conditions. It was unforgettable. My husband Dan snapped a picture of “The Lake Clinic” boat next to a stilted house.
A year later, as we prepared dinner at home in Canada, our computer screensaver rotates pictures of our travels. The photo of the TLC clinic popped up and Dan wondered out loud “do you think they need any help”? And so it began.
The TLC clinic, I was told has a role for western trained physicians who can provide bedside teaching and clinical updates for Cambodian trained TLC physicians. Cambodia’s medical community is developing, like the rest of the country. However the courses and conferences that western physicians rely on to refresh their training are not yet a reality for Cambodia. Jon Morgan, founder and director of the The Lake Clinic welcomed my offer to come and work with the TLC doctors for 1 month.
After a brief orientation to Siem Reap and The Lake Clinic’s modest headquarters I set off on my first outing. The journey started at 6AM when the group worked together to stock the weathered mini-van with boxes of equipment and supplies. Everyone piles in for the three plus hour drive/boat ride to the river clinic, one of five locations served by TLC. I am curious and excited to go even further into the river than our kayak excursion years before. I appreciate the beauty of the landscape while at the same seeing homes that become ever more meager the further we travel from the port. As we approach the TLC clinic I see a barge with a simple structure of 4 walls and a roof approximately 20 X30 feet. My western eyes see something akin to a large gardening shed. I know the Khmer villagers see it differently. This structure will function as the waiting room, clinic, kitchen, dining hall and sleeping quarters for the next 3 days. The team members get to work by sweeping up the remnants left behind by the critter-inhabitants who invade when there is less activity. All the boxes are unpacked, the kitchen and bathroom are made serviceable while the patients start to arrive.
Soon, twenty or so patients congregate in the waiting area sheltered from the sun by a tarp. Each patient is registered. Individual medical charts are retrieved from storage. A record is made of the patient’s height, weight and blood pressure. The group is offered an informal talk about public health topics such as basic hygiene and nutrition while they wait for their turn to visit with the doctor or midwife. Then one by one, accompanied by a locally trained doctor, I meet the patients. Many of the problems are similar to the illnesses I treat in my own clinic in rural Ontario, Canada. Problems like ear infections and sore throats. But then there is more…. severe malnutrition, severe dental carries, and new presentations of advanced diseases. There are traumas and lacerations from accidents with knives or boat propellers. There is Type 2 Diabetes and hypertension in people much younger and thinner than the western world, a consequence of malnutrition in their younger years. With each new encounter I am amazed at the care and attention that is provided by TLC staff. For instance, there is gentle teaching of lifestyle factors that can be adjusted to help their conditions. Is it possible to reduce the salt that is used in cooking one patient is asked? The answer is that sometimes it is possible, but salt is a much-needed preservative for fish so that it can stored for later consumption. Is it possible to eat more vegetables? Maybe, the next patient says, the only source of vegetable here is what grows naturally in the lake. Medications are provided free of charge. Patients are invited to follow up on the plan of care in the weeks to come when the clinic staff return to this location. Women are encouraged to engage in birth spacing and are offered the education and support to achieve this. Birth control pills or IUDs are offered free of charge. Trained midwives offer antenatal counseling and care. The patients are offered the same kind of care I give my own patients at home. Because of TLC it is absolutely free of charge, without judgment, without expectation, all with a good measure of respect. The day wraps up with a wonderful khmer meal served on the same tables that served as desks minutes before. The team members sit together and talk over the events of the day. They share updates and stories about their life at home. They are connecting with their work-family. Then its time to set up the cots and mosquito nets and settle in for the night, before it gets too dark and insects flood toward the solar powered lights.
Once day breaks the clamor of boats and patients arriving coincides (thankfully) with the smell of coffee and the line up for the single bathroom. There is time for a quick breakfast before this room is turned into a clinic once again. This morning I am asked to accompany the TLC doctor on a house call. House calls, I wonder, aren’t they a thing of the past? This morning a very tiny one-year old child, suffering of severe malnutrition receives a follow up visit. His elderly grand parents are the primary caregivers while mom and dad are away at work in a neighboring country. He is provided with calorie dense food supplements as he is not yet gaining enough weight to be healthy. The grand parents are counseled about proper hygiene and care of their little charge. Later, another house call for a woman who is unable to walk because of a spinal cord problem. She has several chronic diseases but her life is being made better by the treatment she is receiving from TLC. This family is so grateful for the care we receive a freshly caught snake as a gift. I am impressed by the sensitivity that is given to the patient’s circumstances, and the flexibility that is inherent in this organization’s culture. Each patient’s needs are met in the best possible way.
I am in for yet another surprise when I join the Lake Team on the second week with TLC. I am invited to join the doctor and dentist for a school visit. I was so pleased to see a classroom full of students eager for our visit. Each student has a medical chart. From this I can see that TLC visits every 6 months. It’s an opportunity to measure height and weight, as these are indications of nutritional status. Those students who are not keeping pace are given nutritional supports and close follow up care. An eye test is completed, and the children who received their free glasses are reassessed. Each child has a dental and medical check up. There is time at the end to teach the enthusiastic group about dental care in a fun, lighthearted way. Every child receives free deworming pills and tooth brushes. The kids crowd around me the foreign doctor for some laughs as we take group selfies making funny faces.
As Sovann, Nurse, and clinical leader of TLC says, “when you work at TLC you bring your heart to work with you”.
I am truly amazed at how much TLC staff are able to accomplish with the limited compliment of resources. Much of what is accomplished is driven by a desire to offer the best possible care, with the most loving, respectful, flexible approach possible. This is a small but very mighty organization. I am so happy to have been a small part of it all for one short month. I leave with a heart full of inspiration and gratitude for the experience.