Dr. Eash - Day 132 - 148

Day 132 - 10th July 2019


This week’s clinic was fairly well paced, however as it is now dengue fever season, I kept vigilant, always on the look out for the tell-tale signs and symptoms of the dreaded fever. A 4-year-old boy arrived with a high fever of 39 degrees Celsius and looked slightly more unwell than the usual cold appearance. Vital signs were normal and the history didn’t point towards dengue. I performed the tourniquet test on the child to help me with my exclusion or inclusion of dengue. The test consists of wrapping a sphygmomanometer (blood pressure machine) cuff around the patient’s arm making sure to cover the inside crease of their elbow (antecubital fossa). Then the blood pressure is taken and a half way blood pressure is calculated. The sphygmomanometer is left with a pressure inflated to a point midway between the systolic and diastolic blood pressure for five minutes. Then the cuff is deflated and the clinical will look at the arm and look for small red spots called petechiae. A positive test consists of having 20 or more petechiae per one inch squared of skin. Petechiae occur due to bleeding under the skin and occur secondary to a low platelet count (platelets help with clotting; therefore, low amounts mean more bleeding). And a low platelet count is an indicator (one of many) of dengue. The tourniquet test is used in settings where blood taking and monitoring is not an option. The child was thankfully negative for this test. Dr Sombun (who has dealt and continues to deal with many dengue cases inpatient) reassuringly also didn’t think this child had dengue.  We safety-netted the mother and symptomatically treated the child for a common viral fever.


Day 139 - 17th July 2019


I am currently sat in a restaurant in Luang Prabang, Laos. It is my third day here. Loas was a last minute decision to come to and somewhat booked on an impulse. I hadn’t undertaken travel research and therefore didn’t know what to expect. It was also a surprise to learn that they required a visa and a photo of myself. This was something I learnt at Siem Reap Airport half an hour before departing!

I knew I had made the right decision to travel here as I peered out the aeroplane window as the captain stated we were approaching to land. The tea-brown Mekong river looked like it was slithering through the dense jungles of this nation. There were mountains everywhere, unlike Siem Reap and the landscape was dark green, again unlike Siem Reap.

Luang Prabang is a small village like town encompassed by crimson jungles and mountains with the Mekong river cutting through it. Wikipedia states that Luang Prebang consists of 58 adjacent villages, of which 33 comprise the UNESCO Town Of Luang Prabang World Heritage Site. Simply put it, this place is beautiful. As a city, it reminded me of Chaing Mai with the little streets interspersed with Wats and a blend of the south of France with its attention to detail, cleanliness and many tourists.

I was pleasantly interrupted by my food here...Grilled buffalo on skewers, sour chicken soup and rice. Delicious.


Day 140 - 18th July 2019


Today I went on a minibus to visit the Kuang Si waterfalls. As a place it sure did deliver. I saw a good handful of waterfalls and swimming areas scattered about. The water here is turquoise due to the calcium carbonate it contains. There are also paths that lead one up to the top of the waterfall through the jungle. In the stupidly humid and hot climate and without a bottle of water at hand… I began the climb. It was a steep climb, but once I was at the top it was fascinating to be in the midst of a jungle.

Walking through the jungle reminded me of when I used to walk through woodlands situated on the outskirts of Leicester some three years ago. I would bring a book with me and go exploring and would eventually find a nice spot to read. I did not do any reading here though, I would have drenched the book with my sweat.

When I experience new places and especially places that I want to remember, I usually spend 1-5mins being mindful. I find a quite corner and take in every visual detail, smell, taste and sensation on my skin. In that very moment I get immersed in it all. It reminds me why I travelled so far to be there. Afterwards when reminiscing about these moments, I find it easier to take myself to that place and time again.


Day 145 - 23rd July 2019


I am currently on the river clinic, under my mosquito net and sweating. I have 9 days before my departure and over the last few weeks have come to realise the adaptability of humankind and the power within to prepare for changes. I have had a mental shift. Whereas previously I did not know how I would feel going back. I am now looking forward to it. And in fact I cannot wait. I have made lists of things to do and am prepared to work. I’m most looking forward to cooking (other than seeing loved ones). I will miss this place, but I also miss home.


Day 147 - 25th July 2019


And like that, it is my last morning of clinic work with TLC. I slept outside and in fact very well. It had rained in the evening and it continued to lightly sprinkle throughout the night. I was unaffected by the falling water thanks to my roof and the strategic placing of my bed to avoid leaks. The continuous cool breeze always joined the rained - meaning there were less mosquitos and less heat. Both things being very welcomed at night.

150m away in a nearby village by the river a family were having a funeral for a loved one. A 24 to 72 hour event the staff on-board said. Yesterday morning monks were chanting Sanskrit through loudspeakers from 4am. Songs and praises were broadcasted during the day. Last night we watched fireworks as the body was taken to be cremated. This morning Buddhist chimes and bells have been playing since 5am. This music has been the theme song to my travels in Indochina. I have heard those chimes in audio-guides of museums in Siem Reap and Bangkok, and in the Wats of Luang Prabang.

It is nice to see the deceased being celebrated by music and fireworks. I do not doubt that their family mourned and continue to do so. But not all is bleak, here they believe a life of suffering will mean a life of less suffering in the next one (if one accumulates good karma). But I like to think they also celebrate the persons life, the near infinite rarity to have life and the certainty for it to end.

And like that, it is my last morning of clinic work with TLC. And even though I am sad to leave, I am very happy to have experienced what I have experienced. I am grateful for the feeling of loss.


Day 146 - 26th July 2019


After our usual general staff meeting (my final one) I was given presents by the staff. Gifts included traditional kramars (scarves), T-shirts and souvenirs. I was taken aback, it was a surprise and it warmed my heart.

TLC had also organised a going away party for me at a BBQ restaurant with prepaid food and beer. That evening, we all sat and ate together and I went around saying my goodbyes. These people have been my family, social support and friends for the last 5 months. Every goodbye hurt. After this, a good handful of us went to sing karaoke. Hayden, Jon and I sang English Christmas carols and the Cambodians sang their catchy Khmer pop songs. Finally, I ended the night having beers with Hayden.

My cheeks hurt from smiling so much and I felt so genuinely happy it felt like my brain had been marinating in dopamine.