Dr. Eash - Days 14 - 19

Day 14 – 14th March 2019

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It was refreshing sleeping in an room with air-conditioning and without the eardrum-tearing screaming of longboat engines. But in a way I also missed the communal feeling of people sleeping around me. I met with Jon and Madie (the new fundraiser) in the morning and we headed of to the TLC office for the usual weekly roundup.

The other members of the medical team that were on the lake had already arrived. We had a group discussion about the couple the we had seen on the 12th. I explained that the lady was unwell and at high risk of developing sepsis. Jon listened and felt that we should see the couple again next week. I agreed.

We also discussed root causes and human factors around poverty and ill health on the lake. Jon highlighted that the number one biggest risk factor for mortality and morbidity was ignorance around basic medical knowledge and that this increased poverty, which in turn worsened ignorance. Both ignorance and poverty fed into each other like two gluttonous evil snakes.

On the Tole Sap, most people were illiterate, grew up bathing and drinking the lake water. They also used the lake as their toilet. Most lived day to day, just trying to survive. Jon had many a time spoken to the villagers about the impact of large family sizes worsening poverty. He explained that he had also tried a wide range of different water filtration pumps, many ended up not being used or sold for food. The problem here lay deeper than the lake itself. Through constant education and little changes, TLC believed things would change. I agreed.

Day 15 – 15th March 2019

It rained today.

Day 18 – 18th March 2019

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I am madly in love with a fruit. A plum sized fruit with an inedible thin green skin and a golden delicious interior. It melted in my mouth releasing flavors similar to peaches, pears and honey. Sweet but not overbearingly. I was hooked. New areas of my brain where lit up like the streets of Tokyo. My pupils expanded as my tastes buds were bathed this new heavenly flavor. Succulent too, it soothed my parched esophagus. Like a man hooked on drugs, I frantically asked everyone what it was called – they said it was lamut in Khmer. A quick google search revealed it was the fruit of the Sapodilla. I wanted to take stuff my pockets with Sapodilla seeds. I wanted to take home a full orchard of this divine berry so I wouldn’t experience a day without it. After telling my mother on the phone, she told me it was my grandmother’s favourite fruit too. I didn’t blame her.

Day 19 – 19th March 2019

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Today I was on the lake again, with a full day of clinics. I saw patients with acne, children with fevers and a patient with extraordinarily high BMs. She had a puffy round face with dry skin covering her arms, legs and neck. Slightly Cushingoid, I asked to see her again the next day for bloods. The clinic doesn’t have complicated tests like 48hr dexamethasone suppression test, so my diagnosis would have to rely on other bipods e.g. hypokalemia. Her facial appearance was probably due to her long term untreated Type 2 Diabetes. Cushing’s disease is a rare disorder – but I would have liked to make that assumption certain.. We started her on metformin. I gave her antifungals for her skin, and asked her to return if she did not experience any improvement. If her skin did not improve she was most likely suffering with eczema.

With my free time, I enjoy people watching on the lake. I realised that no one choses poverty. You’re born into it. For most it’s hard to leave the system. Poorer places are disadvantageously located. Children here aren’t going to the best schools in Cambodia. At home they are lead by role models who are disadvantaged themselves (unable to read/write). They are born into poverty and to them that is all they know. They know no different or how much better/easier their life would be if they moved. You are somewhat strongly anchored to the location and way of life you’re born into. It takes great courage and luck to leave the system. And I believe its up to the privileged to help so everyone lives with equal opportunities.