Dr. Eash - Days 32 - 38

Day 32 - 1st April 2019

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I’m on the lake this week and the teams have switched up a little. Dr Rida was with us today as well as Dr Phirom, Sary (midwife), Channy (chef), Soben (administrator), Soda (Outreach nurse) and Sonita (Outreach nurse).  We travelled to a village I hadn’t yet visited call Pechakrei and instead of the one usual long boat, we took two smaller ones to get to our destination. Cramped on this boat with the constant roar of the engine traumatizing our ear drums, I learnt a funny fact…I had found out that human beings are quite capable of sleeping anywhere when the right amount of fatigue sets in.

I saw the village chief's wife today for a check up on her hypertension. If anything her blood pressure was on the low side, so I reduced her usual antihypertensive regime. I asked her if there was anything else I could help her with, and she said yes and showed me her left hand. She said that she was unable to fully grip that hand due to pain in the fingers, she also complained of left knee pain. On further examination of the hand I could see that her thenar eminence had wasted away (fleshy muscle on the base of the thumb on the palmer surface). Outstretched, her middle finger was unable to fully extend and was bent at the proximal interphalangeal joint. That finger was also swollen and skin tight. She was unable to fully grip that hand due to pain. Her right hand was better but I elicited pain in both hand by palpating the joints of her fingers. Her left knee was also painful and slightly more swollen than the right. Rest of her examination was normal. The lady was suffering from poly/oligoarthritis and her presentation and symptoms pointed towards rheumatoid arthritis. To make sure of my diagnosis I asked for her to come on Wednesday for blood tests and to discuss getting an x-ray.

Day 33 - 2nd April 2019

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The Tonlé Sap is massive and it will only get bigger throughout the year. Wikipedia states that 'in the course of a year the lake varies from an area around 2,500 km2(965 sq mi), a volume of 1 km3 (0.24 cu mi) and a length of 160 km (99 mi) at the end of the dry season in late-April to an area of up to 16,000 km2(6,178 sq mi), a volume of 80 km3 (19 cu mi) and a length of 250 km (160 mi)'. That's a lot of water fluctuation!

Dry season on the the largest freshwater lake in Southeast Asia can also be quite stressful. On our way to the clinic we came across a few difficulties. As we were skimming across the water, I could hear that the boat’s engine becoming increasingly louder. The noise rose steadily and the engine was obviously struggling. Our boat wasn’t moving anywhere. We were stuck. The water was so low that the hull rested on the bottom of the lake. The driver got out and manually pushed the boat as Dr Phirom stood at the front with an oar trying to help. We managed to wiggle out and after 20min of further struggling we were clear. I knew this war wasn’t over. We would face similar difficulties on our way back.

I was right. But this time the whole team of six including myself had to get out and push the boat forward as another boat pulled us out from muddy floor to slightly deeper waters. The floor of the Tonlé Sap is not something I want to experience with my bare feet again. It felt like I was stepping on wet tissue paper and cold flesh. This feeling was accompanied with the known fact that people used the lake as their toilet, and waste dump. However, we all had a great fun time. As a team we had managed to get the boat out of trouble. The girls also managed to pick a lot lily flowers for food later on. Soon we were flowing through the sunset-waters heading home. I was sweaty, dirty and wet but carried a huge smile on my face

 

Day 34 - 3rd April 2019

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Baby X was born during a stormy night. 6 months earlier his mother tiredly woke up at 4am with the sensation to pass urine. Through the darkness and rain she found the toilet. Unbeknown to her, the sensation to pass urine was actually the beginning of labour. Thunder roared above and her floating home rocked from side to side. A few minutes later flashes of lighting illuminated her world revealing her new-born crying on the floor only a few inches away from the lake itself. She picked her child up in horror and saw a bruise across the left side of his head.

I saw 6month old Baby X for a check up. Unlike most other children of his age he wasn’t fixing his gaze on me or any object in particular. His right hand was held clenched as his mother held him.  I asked his mother to place him on the bed. He had a tendency to look to the right with his right arm and leg straightened. He wasn’t turning his head to sounds. Not rolling. Not babbling. Unable to hold his head up straight. His face was also abnormal – he had a large fontanel and grunted when he wanted milk. Baby X had cerebral palsy and had a developmental age of less than 1 month.

Cerebral palsy whilst living on the lake is not promising. Those with the condition need multidisciplinary support as well as regular check ups. Baby X would most likely need a wheelchair when older and this seemed unfeasible and unrealistic in an environment which revolved around water. Dr Rida explained that there were NGOs providing support for those with CP but these were based near Siem Reap. The mother did not want to send her baby there. I felt saddened by the fact that if Baby X were to live on the lake that his days would be outnumbered. He would most likely be unable to walk, talk and look after himself. He would end up living all his life indoors with fixed contractures on a straw mat until disease ended his suffering.

 

Day 38 - 7th April

Madie and I decided to climb Kulen Mountain. Regarded as one of the most sacred mountains to Cambodians and boasting a swimmable waterfall – there were lots to look forward to. Our journey actually began a week before whilst thinking of things to do. A quick google search revealed Tripadvisor and other blog sites stated that walking up this mountain was doable and fairly easy. WRONG.

6am our journey began on a larger tuktuk driven by Pappa, a sweet man probably in in his 60s that spoke not one word of English, and a friend of Madie’s. The journey to the mountain entrance had taken approximately 2hours passing small villages and grassland as the crimson sun slowly climbed the sky.

On arrival we paid for our tickets and began walking. As soon as we began we were confronted by two men asking us if we wanted a lift up. We politely declined. Blogs online stated that the climb would take an hour and a half to two hours long. We could do this. The day was hot as usual but bearable in the shade. We ate our mango and joyfully climbed. The path was just a dirt road, but we were grateful we weren’t in the thick of the jungle. The windy journey up had soldiers/park rangers scattered at checkpoints every 15min or so. Every time we passed them they would point at their motorbikes and asked us if we wanted a lift. We politely declined. An old lady stood by and we waved hi, she replied with ‘very far’.

During the first hour of our journey we were fairly comfortable. Many minibuses and cars passed us with waving children in the back. We stopped only shortly for water breaks. The incline was steady but not challenging. However as time passed we became more and more impatient. Every road lead to other roads and it felt like the journey would never end. Did we make a mistake by walking? Possibly, but our pride kept us going.

Two and a half hours later, we had made it. Our legs felt like jelly, our tops drenched in sweat and bags dirty. We saw the fresh faced groups of people who had driven up in air-conditioned vehicles and loathed them. Next step, the waterfall. After a walk down some questionable stairs, change of clothes and a beer, we were in the water underneath a magnificent waterfall. The water was perfectly cold and to make sure we weren’t getting too comfortable, little fish nibbled at our feet randomly. But we stayed there with the biggest smiles. It felt like this was our award. It was so worth it. I tried to take it all in, I couldn’t get this in England.

We left the water to grab some food and see some other tourist spots. Waking was difficult now due to aches and pains. Food was delicious and the black jelly drink was much welcomed. After food we walked around to see ‘The Thousand Lingas’ a historical site where a thousand statues of Lord Shiva (the Hindu Deity) had been carved into a river bed. Madie bought a lovely wooden cane with a carved elephant as the handle. As we reached the exit, it dawned on us…we couldn’t walk it back, we were too tired and in too much pain.

I asked around for rides now, but no one was willing to help. I don’t blame them, we probably looked like we stunk (we did). I was willing to try my luck and stuck my thumb out to hitchhike. Amazingly someone stopped and was willing to do it for free. He had a black pickup truck with two kids and an elderly gentleman in the back and they welcomed us aboard.  WE HAD STRUCK GOLD. The journey down now took only 30minutes with fresh air blowing in our faces and a view of the canopies above.

Once we had reached the entrance at the bottom again we jumped off. The driver didn’t except my 5 dollars so I gave it to the little boy. We thanked them all for their kindness. Waiting for us there with two bubble teas stood Pappa. What a wonderful day.

Bliss

Bliss