Sunday, July 31, 2011

Week Off--Phnom Penh

The crew had the past week off--vacation for them, and for me, it was supposed to be an easier week in which I caught up with my research data, read, and relaxed. It was a relaxing week, but little research got done, and it was not quite as quiet as I expected. I did a lot of cleaning--dishes, laundry, even some of the kitchen (after I spilled oil all over everything). I realized that even cleaning could take on a sort of meditative element (no, this doesn't mean I will clean more, it just means that cleaning intentionally makes it almost meditation, though I did take frequent breaks!). After the day Marie Claire and I spent cleaning though, Bill came down and told us he would take us to dinner in town (Phnom Penh)--we went to a beautiful hotel with a delicious buffet, and even got a bit of Filipino music before we left!

I had the chance to experience a bit of the Phnom Penh market scene this week. On Monday, the PIP manager in Cambodia, Somnang, dropped me off at the market with 40,000 riel or $10US and an order to buy some fruit and vegetables so we could eat in our week without the cook. I moved between vendors with magenta dragon fruit, pink and black rambutans, plum-colored mangosteens, some healthy and some wilting heads of lettuce, plump carrots, and a myriad of other things. How much? I would ask, pointing at the desired item. Each vendor would reply with the price in Khmer, but we understood each other no problem. I got 1kg of lettuce for 2500 riel, or about $0.50, a kilo of dragon fruit for about 3000 riel ($0.75), and other prices that would shock a Westerner--prices as good as our Khmer cook gets, which made me proud of my shopping skills. Even my tuk-tuk (moto with a cart attached) back to the ship was only 5000 riel, which was a lot for the trip, but not for a foreigner. This morning, I had a different kind of market experience--I went with the cook to buy fruit and vegetables for the week (we will be moving for two days, so there will be no ability to get to a market). The market truly is a sensory overload--a cacophony of sights, sounds, smells. Again, the vivid colors of the fruits and vegetables stood out. Rain poured from the sky, courtesy of a storm over the South China Sea, in between tarps for the vendors, into buckets, keeping merchandise remarkably dry, but legs and ankles mud-streaked. There were fruits and vegetables, brooms, meat. Some sold pig ears, intestine, frogs. Some crabs were still crawling out of the bucket, some of the fish still flopping--nothing like fresh! I tried to take it all in, all the produce, the way in which the cook talked the vendor down on the price of bananas, which vendor had the best-looking tomatoes, all the while making space for other customers and dodging the motos trying to get through. It was exhilarating, and really, a lot of fun.

Other than stay on the ship and do a bit of research and a lot of cleaning, I also got a walking tour of Phnom Penh, courtesy of Lieng, the night guard (we left at 6am), Sanh, the cook, and Jack, the electrician. We walked by the Independence Monument commemorating Cambodia's independence from France in 1953, a year before other Indochinese nations like Laos and Vietnam became independent. We crossed the bridge to Diamond Island where during the Water Festival last year, 300+ died in a massive but unnecessary panic (I won a mug on the island throwing darts at balloons, following Sanh's sage advice to just not think about it). We fed pigeons in front of the Royal Palace and I learned that Cambodia was once Hindu, and an old woman created the city's temple on a hill. It was great exercise, great learning, great company.

In the morning, the ship will move up 140km to the entrance to the Tonle Sap Lake, where it will spend the next six months. On Tuesday, I leave the ship and on Wednesday, I leave the country. It will break my heart to leave--I have once again fallen in love with the Khmer people and the kingdom of Cambodia, and I have made many wonderful friends among the crew. It is truly a blessing to have been able to be here for seven weeks. Thanks to all for your prayers and love, and I will catch you all stateside!

Saturday, July 23, 2011

Last Week of Clinic

Time in Cambodia has an incredible way of both lingering and passing too quickly. Already, I am six weeks into my time; already, I have to think about returning to the US and to medical school. Already, my time with the clinic has come to close. Because Aug 1, the ship travels two days to move to the Tonle Sap Lake near Siem Reap/Angkor Wat, which is far from Phnom Penh and most of the crew's families, they get this coming week off--all but a few are home at this point. It will be both a blessing and a curse--a blessing because it is a quiet week, where I will be able to relax and work on putting some of my research together, and a curse because I love the clinic, I love working with the Khmer patients and witnessing their kindness and the kindness of the crew. It is as it is though, and I know this will benefit all, and I am happy for the crew, for their time with their families.

Clinic on the ship works half like a well-oiled machine and half like organized chaos. 20 patients come in at 8am, up the gangplank and up the stairs. Children, mothers, fathers, men and women in their 80s, all traipse up the steep ship stairs for triage--blood pressures and temperatures. They come down in clusters of five for the doctor, of four for the dentist. When I am not interviewing or doing something else, I am standing downstairs, making sure everyone sits where they're supposed to, people see the doctor in something that resembles number order, and that everyone is ok while they wait. Or mostly, I try to speak Khmer and smile, or play with the children or sit with the old women, while they try to speak to me in Khmer or tell me my nose is beautiful. We delight each other, and it is beautiful.

The Khmer doctor will see 80 patients a day, every day, and the dentist will see 35. Everyone is grateful and excited--very few appear pushy, too eager to see the doctor, though a few are disappointed when they do not receive a slip to get the glasses the ship gives out to those the doctor says would benefit. I understand now when people tell me about their eyes. I nod and say (in English because I do not know the Khmer), yes, tell the doctor.

The beautiful thing about clinic is that I have the opportunity to interact with nearly every person who comes on the ship. Whether I check their number as they come in, tell them to go up the stairs, help them down the slippery gangplank after rain, or tell them the doctor is ready, I see nearly every face at least once. Everyone has a smile. The last village we were in was poor despite its proximity to Phnom Penh, some of the patients and children came in dirty and probably hungry, and yet everyone looked kindly at me, many put their hands together in the Khmer greeting of respect and thanked me as they left. There is such a sense of mutual love every day--it is energizing and utterly amazing.

Now the ship is in Phnom Penh. Acrobatics from Piseth, who I am convinced is Superman because he can literally do almost anything and Kha, who is just amazing in his quiet work ethic and huge heart, helped us tie the ship down next to a boat in dry dock. We have to walk down three gangplanks and two boats as well as cross a bit of the river on a raft made of a metal grate and four empty barrels to get off the ship. At night, we can see the multicolored lights of the ferris wheel across the street and the tour boats. It's a different world here than in the villages for sure, though still quiet in its own way.

Be blessed and well!

Saturday, July 16, 2011

Many Words for Perfection

There are many words for perfection, but few can come close to describing the elements of the last evening in Cambodia. We worked yesterday (Saturday) so the crew can have a full week off starting the 24th, before it moves up to the Tenle Sap lake, which is about four hours from Phnom Penh, where many of them live. The day was peppered with little children (two of whom peed on the floor in a span of five minutes--babies in Cambodia don't often wear diapers, because parents cannot afford them), some of whom were precocious, all of whom were absolutely adorable. There was an impossibly fat little baby that laughed without teeth, a little girl who could speak a few phrases of English, another little girl with pigtails and missing front teeth, and a boy who put three or four stickers on his face. Children are a delight--and you don't need language to communicate. All you need are smiles and hands and a playful spirit. There are few things that can lift a moment of frustration like a child, or like one of the old women in Cambodia who continue to smile and tell me my French Canadian nose is beautiful.

Once the crew left for the night (most went into Phnom Penh for the night--the ship is very close), I watched the rainclouds move (which has become a favorite pasttime...Cambodian rainy season pre-storm winds carry such energy!) over Phnom Penh to the other side of the river and helped the cook make chocolate-filled sweet rolls, when suddenly I noticed--a rainbow! I love rainbows--there is something so breathtakingly spectacular about them. They often appeared in Trinidad in the rainy season, sometimes full, vibrant arcs, sometimes two. I get so excited at the simple beauty, but usually cannot say a word, lest people think I am insane, but because the crew members here are my friends, they watched as I tried to get them all to notice (and fortunately, one of them was equally as excited and another just watched with amusement as I got even more excited when a second rainbow became visible) and took a few pictures. Later, I finally got the sunset I had been waiting for all week (there had been a beautiful one Monday night, but I did not have time to get my camera in between English classes), played Monopoly cards with the other Americans on the boat (at the moment, there are five of us, with two more returning from Ankor Wat tomorrow), and came out to the moon making me catch my breath. In a few days, it will be full and by the time I was outside today, it had already risen to a decent height, but it lit the bank up and made the river sparkle and gleam. Even though the Mekong is brown from silt and often filled with litter, most of the disappears when it becomes shades of almost-black at night, and it completely fades from memory when shining with the moon.

Today will be quiet--filled with the interview transcripts on which I am behind (again), reading on the deck, and perhaps a walk through the village. Tonight, we have our worship service. I love worship here--it is so simple, in the ship's dining room, and the lessons must be translated, so they too are simple, but often eloquent. My favorite is singing though--singing in English is difficult for the Khmer, and none of us Americans know how to sing in Khmer, but something about the mix of off-key melodies feel very much like prayer, and the enthusiasm with which they are sung most certainly must be. A few weeks ago, we sang "Yes, Jesus Loves me,"which makes me smile anyway because I remember learning it in kindergarten, and I remember the captain singing softly for most of the chorus until he got to the "loves me,"which he belted out. Even the memory of it makes me smile. I especially love when we sing in English and Khmer together.

It is a complete privilege to be able to be in Cambodia for seven weeks in my last real summer vacation ever. The people here are so kind and generous, always willing to share a smile or call out "hello!" They are all so gracious to me as a foreigner, and my Khmer has improved by leaps and bounds (which still doesn't say much, given that I know very, very little Khmer)--I can communicate just a little, and I have a few excellent Khmer teachers (and a very, very disorganized piece of paper nearly entirely covered with phonetic pronunciations of Khmer vocabulary). Thank you for the love and prayers, and I wish you all blessings.

Sunday, July 10, 2011

Wanderings

Cambodian villages are a delight to walk around in. The roads are dirt, even in this most recent village, where it is easily wide enough for two cars (cars are rare; I've only seen them close to Phnom Penh, and close to Vietnam). Pavement doesn't happen except in main roads and Phnom Penh. Many people ride by on motos with surgical masks for the dust. Motos are the most popular form of transportation. Apparently there is a law now limiting the number riding to two, though I've still seen three or four people in the villages themselves, particularly if a few of them are children (and I've ridden one with four of us total), though not the six that Bill (the NGO founder and ship manager) had once seen. The wealthier villages have more motor bikes, whereas the poorer ones have more bicycles. Often rusty, the bicycles astoundingly still manage to get people from point A to point B, often with stacks of fruit from the market, maybe rice, maybe Khmer cakes to sell. Children will ride bikes three sizes too large for them, maybe seven years old on a bike designed for an adult, and will carry younger siblings on the handlebars or standing just in front or just behind them. It always works, and what truly amazes me is the lack of fear.

The village we are in right now, maybe 20km and across the river from Phnom Penh, is one of the wealthier ones I've seen. Wealth is determined by things like the size of the house, whether a car is present, if the floors are tiled. Homes here seem pretty large, and they receive electricity for the most part, likely from Phnom Penh. Large here is not large by US standards--large here is maybe three or four rooms, elevated by steps and poles from the road. Still too, the larger houses are intermixed with those where bamboo makes up the walls and thatch (which must be changed every few months) makes up the roof. Like everywhere though, children come outside and play and delight in yelling hello to the foreigner as she passes. (In one village, a boy of about 3 with a mullet called to me and Marie-Claire, hello, barang! (barang meaning foreigner, particularly French).) One yesterday, playing soccer with his friends, shouted hello, and as Bunthoeun (the clinic assistant) and I passed, asked why you no play? I do so love the children!

Last week in the clinic, we had a nurse practitioner from the US as well as the Khmer doctor, so we saw close to 140 patients each day (plus the ship now has a Khmer dentist, and he saw about 30). It is always amazing to be able to hand out more numbers at the end of the day when we have time to see more, but also amazing to see how many more people come out when we take more patients. Last week Thursday, the line exceeded 200 and snaked down the road, and then curved towards the river. I caught my breath--so many people. No matter what, no matter where. People tell me sometimes they forgo the medical care they need because of their living standard--they simply don't have enough money. It breaks my heart that people must make a choice to receive care or eat. I am grateful to play even a small role in the work the ship does--though many are not seriously ill at the moment, because simply being present and giving medicine is healing in a sense.

And the medical student in me must express my gratitude to the nurse practitioner, Clay, who was here last week and to the Khmer doctor, Dr. Tha, for teaching me! I saw an incredible jugular venous pulse (something we've heard in three or four physical diagnosis lectures) and an inguinal hernia in a 9-year-old, listened to lungs with bronchitis, and learned what we give for epilepsy. Really, I love the experience. I love the people I work with every day, the ship's crew, who all love to learn and talk with me and teach me about themselves and their country and who can always make me smile. I love the patients who come on, particularly those who want to trade noses or marry me to their sons, the babies with their chubby cheeks, and those who smile, whether with one tooth or 32. God bless Cambodia, and God bless you all as well. Continue to be well!

Saturday, July 2, 2011

Life on the Ship of Life

I really had missed the easy rhythms of life on the ship, the way the days in Cambodia both seem to stretch on endlessly and pass too quickly.

Knowing the poverty in Cambodia (and having learned much more about it last night from my friend Lieng, the night guard on the ship), it is an incredible privilege to be able to live on the ship, to have three meals a day (and the cook is vegetarian, so he always makes me vegetarian food! It's fantastic!), air conditioning, a bed (actually, I have two beds, but the upper bunk has become much like my apartment's kitchen table--covered in papers and things and completely unable to be used for it's intended purpose). It's a privilege to even be able to be here--both the patients who come on the ship and the crew who have already begun to feel again like brothers and uncles are beautiful beyond words. There is a simplicity among the people of Cambodia, their genuine smiles, the way a conversation or simply letting someone take my hand and marvel at my smooth, white skin can mean so much both to them and to me.

Days on the ship are much the same, and yet always different. We have breakfast at 7, and then by 7:30, many of the crew go out with the doctor to hand out numbers to the people who are lined up. Many come the night before, maybe at 3am, maybe at midnight even so they can be sure to get a number for the morning. Always, there are more people than there are numbers, though Dr. Tha, the full-time Khmer doctor on the ship, can see about 83 patients a day. Patients pass on and off the ship all day. Many seem to have nothing immediately wrong with them, but being able to see a physician for a chronic problem or simply to see a physician at all is a gift for them. One woman told me through Bunthoeun, the clinic assistant and often my informal translator, that she always wants to stay on the ship as long as possible. There is so much love on the ship. I watch it every day in the faces of the crew members and the way they interact with the patients. I love watching the ship's Captain or the pharmacist, Bun Roth, interact with the people. You can see the kindness in their eyes and their utter love for each person. All of the crew members are quick to pause a minute and joke with the patients. Even the cook, Sanh, who spends most of his time in the kitchen and rarely interacts with the patients, cares deeply for each of them. On Friday, we had a walk-in patient (who we rarely take, since Dr. Tha's days are always so full) who had liver cancer and in the absence of anyone who spoke proficient enough English to effectively translate for me, I asked Sanh to help. He ended up not needing to, but when he watched with concern and when he came back from the market, he asked after the patient. I think I may have said it last time I was here as well, but the Ship of Life crew are some of the best people I know--they have beautiful spirits, all of them.

My interactions outside of my interviews are relatively limited, given that though I am learning Khmer (I have an excellent teacher--I teach him English, he teaches me Khmer, and it works well for us both, and during the day, he will quiz me on the Khmer words and ask me the English ones), I still speak precious little and probably understand even less. Many patients tell me how beautiful my skin is, and Cambodia is the only place I have ever been where everyone tells me how beautiful my nose is--and often want to trade! (I am tempted to say yes....) They often ask me how old I am (among the only questions I understand in Khmer, and I can respond myself since I know the numbers in Khmer through 999), and inevitably will then ask me if I am married and ask why not? I am old for the villagers--many of them are married at 18 or younger and I am always a little astounded to hear from women in my interviews who are younger than me and have had three children, maybe a miscarriage. Between that and listening to Lieng last night, I know Cambodia is a completely different world than I am used to, but I do love it--the people here make the country a special, special place. Like with many of my patients last year in Trinidad, I wish everyone could see what I see when I look at Cambodia.

The last village we were in was filled with friendly children who loved my camera. My friend and translator for the week, Minea, and I, went out and played with them the last few mornings. Minea led the games and I joined the kids, with one little girl attached to each hand. Minea had taught them songs and we all sang "God is so Good" in English and Khmer--I cannot even begin to express how beautiful it was to witness that singing. I made friends with a 16-year-old who spoke decent English and spent half her time at the clinic with her blushing face hidden behind her clinic paper, giggling as she asked me questions and I responded. My favorite of the children was a little five-year-old with rotting front teeth and a daredevil streak (she climbed trees like a monkey), who sat on my lap while I interviewed her mother and always broke into a shy smile when she saw me. Minea had taught all the children my name, so yesterday as I moved about the ship, the children would all yell "Hello, Nicki!" (or some variation that sounded enough like Nicki)--from the riverbank, from trees, from the river near where the ferry docked. The village also had a lot of beautiful old women--the Khmer word for grandmother is vieille, or at least it sounds like that, which is the French word for old. I am delighted by them and they by me. I so love their smiles, always broad and bright, with one tooth, no teeth, blackened teeth, or full clear teeth. Some need help to move into the ship and up the stairs, while others move with an unexpected spryness for their age. Spunky, I will tell Bunthoeun as they come aboard.

Otherwise, the week was beautiful. It would storm every day sometime between 2 and 5 (though mercifully not yesterday as we moved the ship). The sky would darken, winds would come and cool the otherwise sticky air, and eventually, it would pour. Sometimes for a few minutes, sometimes for a few hours. There was such energy in the air! We are now at a new village, taking a breath for the day before beginning another week of clinic. It's a beautiful spot across from a pagoda, with some large trees and lights across the river that make the water iridescent at night.

I hope you all are well and wish you blessings in the coming week!