Indelible Roots

Dr. Jim greets me in the morning in his undies and pot belly. He’s actually quite nice about it, asking me how well I slept and motioning me to eat breakfast with him. The gal from the night before then tells him his yellow lab, Goldie, didn’t come when she got its food out. I tell him he’s probably in with Jesse, but get no reply. He then goes on to ask me if I saw the dog get out when he let me in last night. So I had to reiterate to him that he’s probably with Jesse who’s still passed out. Maybe his hearing is going too.

We decide then to load all my bags up and Sukhai will then take me to find a guest house or apartment later from the clinic. As I’m loading things up his wife comes down and nicely says hi. She’s carrying a toddler with her and introduces herself. Tanya speaks very good English and, well, is a bit younger than our dear doctor.

My first look at Phnom Penh in the light of day reveals a dirty, but vibrant city. There are people everywhere, there’s garbage everywhere, many of the houses are decrepit, many still are half gutted for some reason. Motorcycles are everywhere and surprisingly, I would say 10% of the drivers are wearing helmets.

The traffic circle was also quite interesting. Instead of stopping and giving right of way when you enter, the people on the inside slow down to get out. Of course, the bigger you are the less you have to be concerned with any of this.

We get to Kien Kleang Rehabilitation Centre which houses CSC and several other NGOs around 8:30. Dr. Jim introduces me to a few people and importantly to “Art.” Sam Ath last name Eng is the physiotherapist at CSC. He speaks very good English and has been a wealth of information and my personal translator. At 29 he is married with an 18 month old and a new baby on the way. I met everyone else through him throughout the day.

I ran into a volunteer speech therapist or SLP student who gave me some information on apartments. I also ran into Penny at this time who questioned me as to why I ended up at Dr. Jim’s house for the night. Jeesh! I tell her that Sukhai told me he was taking me there and I assumed that was where I was supposed to stay. Otherwise I would have had him take me to the guest house she mentioned, though that probably would not have ended well as you’ll see later. She tells me that Sukhai was supposed to tell me we were just going for dinner.

Anyways, we have rounds and I watch and ask questions of Sam Ath throughout. He also shows me around. There is the scrub room where you exchange your shoes for flip flops that are sanitized daily and worn throughout the inside of the clinic to include surgery. There are 3 surgery tables, and adjoining post-op room with 2 beds, and two or three bay rooms with patients. Several of these patients had external fixators on their lower extremities. There are a couple of hand surgery patients who have lost parts of digits and several infants with cleft lip and palate repairs.

We then go to the physiotherapy room which is all of eight feet wide by thirty feet long with one short table and a few chairs. Throughout that morning we see one patient there, a young girl of about seven who is crying as Sam Ath cranks on her knee. She has a thick scar on top of the knee stretching about twelve inches. Sam Ath tells me he can only get her to about forty-five degrees and that Dr. Jim has told him to continue pushing it. He tries some passive stretching by dangling two dumbbells wrapped in ACE wrap and hanging it over her ankle in a sitting position. She tolerates this for about thirty seconds and is actively fighting it.

I try out my luck and check her range. It is pretty stiff at the end and even gentle PROM is producing pain. It also feels crunchy. Her patella is difficult to palpate and doesn’t seem to move freely side to side. The knee is slightly swollen. Even scar massage produces pain at the knee. I try to distract her with “Finding Nemo” on my mp3 player, but she wouldn’t have any of it. I then try some static progressive stretching with a knee brace I brought. I can get it to about thirty degrees with just a little bit of pain, but at four minutes she crying again. I discuss games and the need to distract pediatric patients with Sam Ath and he doesn’t seem to buy it. I’m thinking I need to stop at the local toy store and get a bunch of toys until I go through the two cabinets. There are several toys there from previous volunteers apparently.

At lunch Sam Ath walks me over to the kitchen which is actually a separate two room building. It’s free to the patients and 2000 riel (50 cents) for the staff. Well, let’s just say there’s a difference in cultures, but they just put the bones and inedible stuff on the table next to their plates. And paper towels are somewhat of an endangered if not extinct item here. They use colored toilet paper instead. I did get to talk with Son, the IT guy and Lila, the accountant and manager. They are all pretty young folks and rib me a bit about my Khmer skills. But for the most part, they are pretty supportive of actually trying to help me speak it. They all speak English well. I also meet the native doctors and the head nurse and we speak briefly in Khmer. Again they are all very nice and supportive.

After lunch we go back to the therapy room and Sam Ath tells me it’s Khmer culture to relax and even sleep during the middle of the day. I take this opportunity to pull out my books and file them with the other texts on the shelf. He’s pretty interested in my “Rehabilitation of the Upper Extremities” texts. Finally we get off our butts and “get to work.” A thin, frail man comes in for an evaluation. He had been sidelined by TB for six months and his shoulders had frozen up. I observe Sam Ath take measurements and he asks me how to take IR/ER and I show him. He then MMTs the gentleman and gives him some exercises and sends him to Veterans International next door who has exercise equipment. VI also does a lot of prosthetics and orthotics and has several physiotherapists. We make it a point to go over there for an introduction on another day. I ask Sam Ath about using pulleys for the shoulder and he says he’s never tried that.

A fourteen year old girl with a non-union tibia comes in as the frozen shoulder patient politely thanks us and leaves. Her left leg is in externally fixated. Apparently they are progressively compressing the bones together and she will do this on her own daily. However, her left foot is now a good two inches shorter than the right. She is wearing an AFO (reused of course) and the extra padding on the bottom was coming off. Also, the strap at the top has long been ripped off and she is using an Ace wrap there. I pull out my Velcro and slap it and some strapping material to replace the Ace Wrap. I then re-tape the extra padding and then rummage through the cabinets where I find a cast bootie. I put this on her and she reports it feels better as it actually raised her left leg to a more even height with the right. Plus now she won’t wear out the tape on the bottom of the AFO.

Next comes in a shy young girl with a severely injured right hand. The fourth and fifth fingers are adhered down from the DIP to the palm. The long finger is badly swollen and doesn’t bend well. Her index finger is pinned into extension and is newly healed along the volar surface. There is thick dead skin at the volar MPs of finger two and three and more on the long finger along the sides. Her thumb moves freely, but is slightly swollen and I have her try to oppose to the pinky, which she is unable to reach. I tell Sam Ath that I want to debride the dead tissue and we discuss splinting. He wants to splint into extension and I tell him I want flexion as it’s more functional. We agree to debride tomorrow and go from there.

I’m then off with Sukhai to find a place to lay my head without fear of getting yelled at. Sam Ath discusses which way to go to get to the Okay Guesthouse. It lasted an extraordinarily long time. We get to the guesthouse in short order, but they are fully booked. I flip through my Lonely Planet book and find the next guesthouse to check out. Sukhai has an extraordinary hard time finding it, going to the wrong street until I point it out to him for the fifth time.

This guesthouse is run by a nice man and woman and rates are $5 per day. We walk up the stairs and he show me the room and points out the amenities, this fan and that fan and the bathroom. The room has about a fifteen or twenty foot ceiling and there are open blocks at the top of the wall for circulation. There are now windows and it’s pretty warm in there. It looked too much like a prison cell to me, so we go on.

The next place is only half a kilometer away, but again, Sukhai has trouble finding it. I have to tell him which street it’s on a few times. I’m glad we’re in the Toyota Land Cruiser as we’re bigger than most traffic on the roads. That’s good because Sukhai is making U-turns in the middle of intersections in heavy traffic and does this several times.

We finally make it to Dara Reang Sey Hotel with it’s café/diner on the bottom floor. It’s neat and clean from the outset. There is a Caucasian male eating there which makes me feel better for some reason. The gal asks me if I want air conditioning and I tell her no. We walk up some very nice, but tall stone steps. On the third floor we go out to this veranda and into the $10 room. He then takes me to the fourth floor to the $8 room. The $8 room is directly on top of the $10 room, but you have to pass the laundry on the rails to get to it. It offers a better view of the city, but was definitely not more appealing, so I sign up for the $10 room.

Just like the city, this is a room in contrast. It’s one of the nicest rooms I’ve stayed in with stone floors and nice furnishings. The lack of a separate shower is a change though. But there’s also the lizard droppings on the walls of the bathroom with one right next to the free toothbrushes. And the staff isn’t as friendly as everyone else I’ve come into contact with.

So here I am without internet which is the biggest bummer since I can’t call people on Skype, but at least I have cable television with English speaking channels. I listened to “The Empire Strikes Back” and am now listening to CNN as I write this. Tonight I’ll sleep to the sound of constant beep beeps of traffic outside on the streets below. Tomorrow will be even more interesting as I will have to hire a motorcycle ride to get to work.

This entry was posted on Wednesday, October 24th, 2007 at 6:19 pm and is filed under Travel. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.