28Oct Church, Pizza and Final Post

Ah, still getting up early, but we don’t have to dress in scrubs for clinic.  Forgot to mention yesterday.  As we finished with our last clinic and in the bus going back to the hotel, Thomas, our “crowd control” man, (Actually a successful businessman in Singapore), came down the isle passing out “communion”.  These were our post clinic, post tropical environment de-worming pills!  It will kill 19 different worms and flukes.  We will wait to take ours after our 2 weeks in Borneo!

Last night was our “banquet”, celebrating our 5 days of clinic, even more food then usual, then an opportunity for everyone to publically reflect on the week.  7-10pm.  A great time.  All were moved by the friendliness of the Cambodian people, both the poor who we served, but also our interpreters and helpers.  Several were medical students, others, businessmen, one sold diamonds in her family’s business.  Some of  the Cambodia support team work for the different churches, many, though, took time away from their studies or businesses to help us.

A great church service.  Video projector of praise music, the keyboard reminded us of karaoke!  Victor, or leader gave a great sermon, reminding both old and new Christians, that the God’s “arrangement” with  Old Testament Jews was a covenant not a contract (one way), and for New Testament Christians, grace not works, again one way.  Few people, anywhere, really understand this.

After lunch, we said goodbye to everyone, they were heading back to Phnom Penh in the bus (6 hour bus ride), we cruised the isles in the downtown market place and ended up at the Lemongrass Spa for massages.  (May’-soj).  Tourism note:  always check the internet for massage parlors before you show up.  Not all are legitimate, some downright dangerous.  This one had a great rating, hey, it was also $10 for the hour.  Can’t beat that.  Finally, a break from Asian fare, we went down the street for pizza, although Asian style, it was the first cheese (!) we have had in a week. Nice.

So, what do we take away from our week in Cambodia?  People really are the same everywhere in the world.  What separates us from each other, income, language, health, religion, resources, opportunity are all man-made.  Bridging that gap benefits all; misunderstandings diminish, barriers diminish, peace arrives.

26Oct 2012 5th clinic day–Siem Reap

Fifth and final day.  Clinic was in the Siem Reap New Life Church.  Smaller group, shorter hours.  A baptism in the afternoon.  Gloria and I are still struggling with the amount of decay and infections.  Especially with the children.  Decay is rampant, chronic and really an epidemic.   I sat down with the physicians in the evening and shared my concerns.  They wouldn’t ignore other epidemic diseases, I encouraged them not to ignore dental disease as well.

No more pictures of Gloria and I bent over patients pulling teeth!  A few pictures of our team though.

These are the All Stars!  Gloria and I with Ligar, our triage nurse, Lisa, our sterile tech, and Nara, our assistant and translator.  They were the best!

This photo is of Ligar and Keng, our treasurer and travel coordinator.  (Check the office website for the same picture we took three years ago)

Baptism in the afternoon

Breakfast Khmer Style

26Oct 2011 4th clinic day—Bantey Meanchey.

Our clinic today was at the Bantey Meanchey Orphanage, staffed by New Life Church, but built and supported by a group of Korean business men.  Very nice orphanage, with around 20 children.  Another 400+ for medical exams.  Gloria and I saw around 30+ patients.  Again,  many needed multiple extractions, my “personal best” was 13 on one patient!  We quit an hour early, so we could eat with the pharmacy and medical teams and actually travel in the bus with the group, rather then in the equipment/supply van later in the day.  During lunch we got to watch “bath time” out the window

Several female Buddhist monks came in today for extractions.  Nice ladies, quiet.  And very appreciative.

Maybe a note about our routine.  First, with 400+ triaged, you have to guess that more than 30 people need or want to see the dentist.  The dental triage is Ligar, and Indonesian Chinese gal.  She is the flight attendant for Singapore Air.  She finds out who needs extractions and who wants fillings or cleanings.  We have had to really limit our treatment to extractions on this trip.  We don’t have the equipment to do fillings, or the time to do cleanings.  She then lets us know as she hits 15, 20,25 people in the queue, so we know when to cut it off.

Because most people need multiple extractions and there only two of us taking teeth out, 30+ keeps us very, very busy for the whole day; 6-7 hours.  When they come into the room, they are greeted by our translator and Gloria or I determine what their needs are.  Our translator the first 2 days was Singh; we discovered that he is a businessman in Phnom Penh and an unemployed veterinarian!  In the past he lived in Cuba for 5 years to get his veterinary degree, but found the need for veterinarians was limited in Cambodia!

The other three days we have had Nara.  He is in medical school, sharp, as well; they both have a good command of English.  When we determine where and how many teeth to remove, either Gloria or I dig in and get the job done.  Oh, our 5 member of the team is Lisa, she is in command of our sterilization.  Very busy.  After we are finished with the patient, they get a toothbrush.

25Oct 3rd clinic day—Battambang Orphanage

 

Another busy, busy day.  A little shorter though, 6 hours, not 7 and we stopped 15 minutes for lunch.  Tough,tough teeth though.  Lots of them, lots of infections, broken, bombed out, rock solid teeth.  Sorry, getting too graphic here.    One case:  5 year old comes in with almost all of his teeth decayed.  Not unusual, but the upper front teeth, although they were baby teeth had infection tracks.  No tough decision here, they have to come out; 5 of them.  Oh, and on the lower left, two more baby teeth, infected.  So a total of seven teeth needed to be  extracted.  And, he isn’t too happy to see us.  See the pictures below

                    

Before and after pictures. This is our setup for multiple anterior extractions.  Lay them down and hold ‘em.  Two more holders for the other side, and an RN, Timmi, from Australia, who knows how to hold a child’s head so it doesn’t move and we are ready to go.  Notice, we already gave him his tooth brush!   We go quickly, it is over before he knows it.  He actually was a really good, cooperative patient.  Someday he will thank me!

Food note:  Half the fun (challenge?) is the food in Asia.  Interesting here in Cambodia, as we travel from province, to province, the food varies widely.  Not only the food, but also how it is served and how we eat it.  Below is the typical breakfast in Battambang.  Rice porridge with a variety of ingredients.  You have to be a little selective when you dish out your portion.  We don’t find the chicken feet as tasty as others.  Still eating carefully, you have to negotiate the chicken claws that have cooked off the feet!  Also, frequently bread, and then eggs.  Even the eggs have ingredients you have to be careful of.  In Asian, it is perfectly acceptable to spit out or remove un-chewable/swallowable food.  Everyone has a pile of “parts” next to their plate.  Are you vegetarians squirming yet?

Finally, our hosts stopped on the side of the road to get some sugar cane drink.  They didn’t even ask if we wanted some since it is ice and sugar cane juice, and they and we know we don’t eat the local ice.  The interesting sight was the gal who was vending the drink.  She was dressed like a winter day in Montana!  Coat, gloves, wool hat.  Yes, the weather remained unchanged since we got here.  Temperature and humidity in the high 80’s lower 90’s.  And, she is smiling!

24Oct 2nd clinic day–Pursat New Life Church

Into a routine now.  Early rising, around 5am, putting all the chargers away for the lights, computers, kindles, etc. and take everything down to the bus.  Bus ride from hotel to breakfast and/or church or orphanage.  Another longer than expected bus ride to our new destination; arrival at 8:30.  Waiting for us were 400 people!  Gloria and I started pulling teeth, and didn’t stop till 4pm.  No lunch, a couple of 2 minute banana breaks.  On our feet for 7 hours.

 

Lisa, our Cambodian “sterile tech”, she has done a great job for us!

We saw 32 patients by triage count.  Probably pulled between 75 an a 80 teeth.  One of the hardest days of mission-style dentistry I can remember.  Am I getting too old for this?  What was unique today, was many of the teeth were abscessed.  Typically, we pull lots of broken roots and decayed teeth, but rarely an infection is present.  Not the case today.  From 8 to 80 year olds; old root tips when the teeth broke off, maybe years ago, but now with exudate and fistulas.  Many were sent to the pharmacy for antibiotics after we finished with them

Not a lot of pictures today, just too busy to take them.    And, not a lot to say, too exhausted to write much more.  Interesting note: as we travelled to our next destination, Battambang, we stopped on the roadside to buy some bee larvae!  Driver wanted some, I had to try it.  Looks like a honey comb, with some bees in it, they shake the bees off then pop it into a plastic bag.  What does bee larvae taste like, you ask?  Well, like cocoanut!  Hmm.

23Oct 2012 First clinic day

Early start today. Breakfast at 6:30, then a cross-city bus ride to New Life Church’s Phnom Penh orphanage.  31 children live here. A very nice facility, several buildings; kids are well taken care of.  As we arrived, there must have been a hundred people waiting for us!  A shade awning was set up with chairs for everyone.  All were triaged, and they cued up in several lines.  One for exams by the physicians,  the women had a separate room, and lines for pharmacy, or dental.

          

Our Welcome banner as we arrived.                                                                    Our typical field set-up before we start our day.

We were in a small room next to the physicians.   Also, we were joined by a local dentist, Dr. Serey.  A young guy, has been practicing for 8 years, his wife became a dentist 4 years ago.  He can only help us today, his wife is pregnant, and he has dental continuing education to attend later in the week. He gave me his business card. He works 6 days a week, from 8-7.  Our cue was reasonable, so we got to work.  Mostly adults, for some reason we did not evaluate all the kids.  We don’t ask questions; just see each patient for their chief complaint.

           

This is Gloria working with Dr. Serey; a busy time.                This is Charlie starting down the path of extracting 13 teeth on this fella.

Interesting cases:  Other than the routine extractions of one or two teeth, (usually root tips).  This one gal came in with a “gum infection” .  She was 14, I thought she may have a retained baby tooth causing the lesion.  Dr. Serey, numbed her up and started to currette (clean out) the tissue, when she really started to bleed.  He called me over, we got the bleeding controlled, but as I was evaluating the lesion, it sloughed off.  A piece of tissue about 2cm by 1cm!  This exposed the bone and the roots of the teeth.  I wish I could send it to a pathology lab, but all we could do was clean it up the best we could, put in a couple of sutures and hope for the best.

Another patient came in wanting one tooth extracted, then four more.  As I extracted teeth, he pointed to other teeth in his mouth, I pulled 5 more, then finally 3 more. After I finished pulling those 13 teeth, he wanted another one, but since we had to shut down the clinic, it will have to wait another day.  I would say that he was a satisfied patient though.  Finally, another patient fainted!  Dr. Serey and Gloria were extracting two of her teeth.  She had high blood pressure so she was bleeding more than ideal.  Finally to control the bleeding, Dr. Serey put in a couple of sutures.  That got the bleeding under control, but then she fainted.  So, I took her down on the floor, raised her feet, confirmed we had a good pulse and called one of the physicians.  Her blood pressure was lower!  We believe she was just worn out by all the work.  She was taken to another room, monitored and was dismissed about 30 minutes later.

Awe, just a typical day.

22Oct 2012 Phnom Penh

Airport arrival and pickup were uneventful except for the huge number of people waiting for arriving travellers.  As is customary, there is usually a group of family or drivers, with signs.  This time; quite a gauntlet to go through.  We shortly discovered that a famous politician was arriving on another plane, with many people there to welcome him.  No Secret Service, or police, just a lot of well wishers to take his photograph and applaud as he went by.

                      

We are settled into Le President Hotel by midafternoon.  Since we are 14 hours ahead of California time, jet lag sets in.  We are off through the streets of the city to stay awake and explore.  We walk a couple of miles to the domed market famous in many pictures of Phnom Penh.  There, you can buy anything imaginable.  Inside the dome they specialize in cheap jewelry and clothing, surrounding the dome are the food stands and the little stalls that keep the locals supplied with everything they need to survive.  We did ask where the local supermarket was and found it a couple of blocks away.  Indeed, it was a 5 story mega-mall!

Not like the Glendale Galleria, but lots of things to look at and buy.  Again, for the locals.  Our intent was to buy some ice cream (very hot and humid here in Cambodia) and score some bottled water (25 cents for 500ml).  Back to the room at 3:30, (1:30AM California time), couldn’t fight it any longer, we slept till 7:30!  We were awakened by a phone call.  Our leadership had arrived and we were invited to dinner.

 

      

         Phnom Penh's iconic Central Market or Psar Thmei. This is the center of “old” Phnom Penh.

 

  

This is the requisite picture of the meat market.   These are all dried meats, other stalls specialize in fresh meat, or live meat!

22Oct 2012—In the air

As all of these adventures start; long flights. Our departure from SFO was at 1AM, Sunday, 21Oct.  14 hours, 4 movies and 4 hours of sleep later, we arrived in Hong Kong.  I would only recommend the animated films; Brave and Madagascar III.   A short layover in Hong Kong, then the final flight to Phnom Penh.  The final leg is where I am writing this today. 

  

Hong Kong International Airport is the gateway to Asia; one of the biggest airports in the world

         

Breakfast on board our DragonAir flight to Phnom Penh.  An Asian flair, but with western utensils. Starting tonight, no more knives, spoons and forks, chop sticks for the duration.

Preparation for this trip went smoothly.  Gloria and I have done this enough that we have a mini dental office boxed in our basement. Since this trip will be extractions only, the instruments and supplies can be carried in two suitcases.

The case on the right contains all our instruments and supplies that we will be bringing back with us.  The suitcase on the left carries the disposables.  Anything not used, including the suitcase, stays in Cambodia.

All the missioners are flying in today, tomorrow we start work in the local orphanage.  Physicians will be doing exams, the pharmacy team will be passing out meds and Gloria and I , with a Cambodian dentist will be extracting teeth and doing cleanings.