Moto Burns

So I've heard all about moto burns since I arrived in Cambodia. Too many people pile on to a moto and then when they hop off someone gets a wee bit too close to the engine thingy bit. They say moto burns are a right of passage and oh so painful.

Six weeks into to my time in Phnom Penh I was still injury free, no falls, no trips (despite some intoxication). But this all changed. Yes my friends, little did I know my moto burn was only round the corner. I'll keep the story short and sweet, so here's a photo!

But don't worry about me, I got the burn in the most respectable way, which was entirely down to my complete inadvertence: not driving a moto, not on the back of a moto, but walking past a moto. Well at least now I'll watch where I walk!

Abcess treatment... Cambodian style!

This week the medical team ran out of money... BAD TIMES. Well not entirely out of money I suppose, there was a cheeky $10 spare in case of a medical emergency... We managed to get a wee cash stretch as one of Korsang's participants in the hospital had been diagnosed with TB, he also had two dysfunctional lungs. His condition has been causing him to retain water in both his lungs, resulting in a "big belly" as my medical supervisor, JB, liked to call it. So the emergency money went towards the daily draining of the water.

Being short of money has not been easy, we've not been able to get patients prescriptions, blood tests or take poorly patients to the hospital for medical care. This became a problem on Tuesday, as a 40 something year old man hobbled into the clinic. His foot was easily double the size of the other foot, and as we peered round to exam it we caught sight of a huge abscess. The old man had fallen down a week previously and had neglected his wound. Unable to take him to the hospital the rest of the medical team dealt with the situation quite routinely. As the man hopped onto the bed, JB prepred the equipment: gauze and betadine. As he squezzed the abcess I could hear the man silently screaming into the pillow. No anesthetic, no doctor, but he didn't seem worried and neither did JB, ten minutes after squeezing we slapped on a bandage and the old man stood up already saying how much better he felt. Job done! We gave him some antiB's and he was on his way. It really makes you think that at this clinic the treatment they provide is as effective if not more than the one given at the hospital. We've seem the same guy every day this week, where we've continued to drain his abscess, we even used lidocaine yesterday! The people giving the treamtent might not be doctors but they all easily know way more than what I thought and I hope that before I leave in Decemebr I'll be draining my very own abscesses ;-)

Flying Solo

So I've been really rubbish at updating this blog, I'm coming up to the end of my first month in Cambodia and so far have managed weekly updates, so I'm going to try and increase the frequency of posts for the keen readers ;-)

This weekend has probably been the most excessive since arriving in Cambodia... It was Chris's, one of the other volunteer's last weekend, so we decided to go out with a bang! We agreed that happy hour at Corner 33 was on the cards. As we arrived to the bar and ordered our first round, the heavens opened up and rain began chucking it down. The rain so far hadn't been too bad and only really ever lasted an hour or so, however this night it was different... As the rain began to pour down we figured all we could do was make the most of the cheap drinks. The water level on the street was gradually rising and the pavement was slowly disappearing, motos were getting stuck, people were bathing in the water and there was also flocks of monks traversing the water. We saw all of this happen in the company of many cocktails, so things weren't all bad! We stuck it out in the bar until the rain stopped and the water on the streets only reached our ankles, before heading back to the volunteer house... After then that things started to go down hill, we decided to pick up a couple of bottles of liqueur from a nearby Cambodian off licence and continue with the drinking back home. Needless to say we didn't remain classy for long after that!

Apart from copious drinking I've been pretty busy at work this week, I sorted out a whole new list of equipment and medicine for the Clinic at Korsang, and we rinsed the medical supplies budget and went shopping. We spent 300USD on loads of medicine and first aid stuffs, probably the most exciting $300 I've spent so far! Before our massive shop the clinic only had a very limited range of medicine so we bought everything from Gaviscon to scabies cream!

I also finally realised how rubbish some of the doctors/healthcare system here is too. On Wednesday one of the guys from the centre, Curly, fell of his moto and fractured both of his collar bones. We took him to the hospital, where they did all the routine stuff: consult, x-ray, diagnosis, treatment... Not to sure about the treatment though: Curly came out of the consultation room prescription in hand and a bandage (a small compression bandage, to be precise!) linking just one of his wrists to his neck. Now, I'm not a doctor but I was definitely thinking that if you break both collar bones you want a slightly better treatment. The best thing about the treatment was that they tried to charge us $20 for the bandage they had done (we chucked the bill away on our way out of the hospital)...
So after that pretty much pointless trip to the hospital we brought Curly back to the clinic where we cleaned up his wounds and make shifted two slightly more acceptable slings.

As I explained before Korsang have outreach programs, where a team drive around the main drug use areas in Phnom Penh and provide first aid treatment as well as information about Korsang, hygiene and safe needle use. Friday was the first time I went on outreach by myself, I was really excited about the prospect and the responsibility. As we arrived to the site there were four drug users who were high, one of whom I recognised - he was a deportee who I had met a few times at the drop in centre and who was currently on methadone treatment. All four users had minor injuries, cuts to their feet, heads and faces, and a few also complained of headaches. As I opened my kit and started to treat the paralytic users it finally dawned on me what I was doing, these people were unable to talk and had syringes sticking out of their pockets. Being out of the clinic and also unable to understand or talk to the drug users was really difficult. Eventually a few of them began to regain consciousness and crowded around me and began to look through my first aid kit, searching for something more. The whole experience was pretty intense, it's one thing dealing with the people who come to the drop in centre but being by myself on the streets surrounded by drug users was something else. Even though I was a bit shook up by the encounter I'm definitely going to do more outreach, it's very good exposure and is quite different to anything I have ever done before.

There was one point where I began to question whether what I was doing was serving a purpose... It was disheartning seeing all these people on the streets high, after having had conversations with them, after having seen them play with the children at the drop in centre and having seen them receive the methodone treatment...

I guess that's why they call it an addiction.

Bicycling, Happy Hours and Khmer

Phnom Penh, 3 weeks on. So I finally feel like I'm starting to know my way around, I know some of the tuk tuk drivers, how to give directions in Khmer and the cleaner even told me I was the same colour as Khmer people too!

I've started to settle into Korsang too, even though it's only been a week. It's basically like being a first aider full time! Although I have to admit the language barrier is quite challenging, on the plus side I'm getting quite good at using my hands to describe things. The main things that I've treated are moto burns and other small cuts, nothing too exciting yet! Although they have loads of cool equipment in the medical post like bibs, blood sugar level testers and one of those really sophisticated syphgys which give you about 5 different readings. So as you can probably imagine it is very exciting. The items listed above are only to name a few, if you're lucky I might even reveal further fun items in my next posts, so stay tuned! I've also been put down on the on-call list, so I'm eagirly awaiting the night I will be rung up...

Last week I went to visit the methadone clinic, located at the Russian Hospital. Everyday, Korsang take 25 of thier drug users there to receive mathadone. The clinic seemed to be very well run: there were at least 2 doctors, 3 nurses and a pharmacist. It seemed like administration was very well controlled: each participant was required to have an interview in order to assess the dosage of methadone, whether it should be increased or decreased, whether the patient was using less heroine, ect, ect. If the dosage given was changed from the previous day each drug user was asked to stay in the clinic for a further 2 hours in order to monitor their state. The whole process ran very smoothly and the doctors and nurses were all very friendly, and didn't not seem to be passing judgment on the drug users (unlike in other parts of the hospital). Oh, and I forgot to mention that the whole treatment is entirely funded by the WHO and FHA, which just goes to show that Cambodian healthcare treatment isn't all bad!

So apart from that I also soaked up some of Phnom Penh nightlife this weekend. Cambodians have many traditions: 3 day weddings, the krama (scarf) and of course happy hour. Happy hour in Phnom Penh takes place in pretty much every bar, every night (and even all day for some). So Friday night after work, a few of us decided to head down to Riverside (where all the touristy bars are) to see just how happy Happy Hour was.... Well I can definitely say that I wasn't dissatisfied by the drinks on offer: $1.50 for a cocktail (and they were all delicious too!). Now if that's not a reason to come to Cambodia I don't know what is! After having made the most of the cocktails, we figured we'd keep up the happy theme so headed to a place called "Happy Pizza". The food at Happy Pizza was nice, although we could have done without the neverending propositions of the tuk tuk drivers, stationed nearby...

I'm just going to include a brief note on tuk tuk drivers. Now these are the most persistent people I have ever met in my entire life and on Friday night this came to an all time high. The drivers are just waiting outside restaurants for tourists to finish eating and once one person gets up to leave it's literally a race between drivers to see who can get the client first. In retrospect it's quite funny how persistent they actually are, they're almost like "Hey, don't mind me, I'm just going to sit at your table whilst you eat. And then when you're finished you get my tuk tuk, OK?". And also note, if the tuk tuk driver quotes you a price to go somewhere make sure you never pay more than half the amount he told you.

Luckily I don't have to deal with tuk tuks on a daily basis as I'm cycling to work. Remember how crazy I said all the drivers were in Cambodia... Yeah, enough said! Bearing that in mind I'm still alive and have not had an accident, not even close! Although I do feel like I'm tempting fate everyday... It literally is mental on the roads though, but most people don't drive too fast and stop to let you pass. So far so good! As the adrenaline from the cycling isn't quite enough for me, I've also asked to try out driving one of the medical vans at work, I've been given a provisional yes, so will post that experience up next time!

I've also started having Khmer lessons, I've got lessons twice a week so hopefully I'll get ace really soon! Although I think my pronunciation's not up to scratch quite yet as people definitely can't understand me and ask me to speak in English. It's not got me down yet though!

Korsang - Serving Cambodian Drug Users With Dignity, Respect and Compassion

So after a fair few days of wondering whether I would actually be working at Korsang, I finally managed to visit the center, whoop! Anyone wanting more info on this NGO can visit the following link :-) http://www.korsangkhmer.org/index.html

After some informal introductions and casual chitchat, I was shown around the center by the Director, Tango, he explained to me Korsang's vision and some of their current ongoing projects: including an alliance with the new Methadone clinic at the hospital and a nursery construction, which was being funded by UNICEF. Korsang seemed to have come quite a long way since they started up 6 years ago when there were only just 5 members of staff. The NGO was housed in an open space building and had recently expanded to the building next door which had become the shelter for woman drug users. There were makeshift beds lined up in both buildings where the occupants of the center lay, I was later told that there were around 80 people currently staying at the NGO. As the locals arrived they were patted down in order to ensure that they had no weapons or drugs.

I was also shown the medical room, I was told that they had neither doctor nor nurse, both these healthcare professionals had recently left and they were in the process of hiring new staff. The medical room was filled with first aid equipment and drugs (shame no one could use them), it seemed quite well equipped (I think I had low expectations based on everything else I had seen in Cambodia), so was pleasantly surprised! I met the medical team leader JB, and he told me how he had spent his previous night on call: a guy who got his leg caught in a moto wheel the night before. He also told me about some other injuries he'd seen: dismemberment, gangrene, child delivery. All this information was highly exciting and hoped I would be able to see something as remotely exciting as what he had told me about!

The next morning I showed up for my first day, which consisted of running jobs in the local hospital as well as some outreach to local drug users. At 8.30am I hopped in the tuktuk with 7 other volunteers and I went on my first outreach. We didn't need to go far to find the first drug users, just of the main road people were gathered around cooking up heroine and crystal meth, there were dirty syringes around and the users didn't look they had seen a bed in a long time. It was pretty intense seeing people shooting up that early in the morning, and I felt pretty helpless as I couldn't speak or understand Khmer. The other workers chatted to the users and handed them out small packs containing soap, shampoo, a toothbrush and a condom, as well as offering them a safe place to stay at Korsang if they so wished. A few users had injuries and one man was taken back to the medical post as he could no longer move his leg after injecting heroin into it 4 days before. I was glad that he agreed to go back to the center as I have noticed people here tend to put off getting medical help until it becomes a substantial problem. Outreach was like nothing I had ever witnessed before, the passers by seemed so nonchalant about the drug users, who were located just by where they lived and small children were also walking by unaware.

In the afternoon, I accompanied the medical team to the hospital, where they were checking up on various patients who had become ill whilst in Korsang: one person with pneumonia, one with TB and another who had water in his lungs. Although before we could go and see any off them there seemed to be a considerable amount of bills to sort out. The phrase "no money, no honey" clearly applied in hospitals in Phnom Penh, as even if someone is on their deathbed the doctors refuse to give treatment if payment has not been received... We also took the man with the stiff knee to the hospital who was prescribed some meds.

Other than the drug use and grim money issues it's pretty relaxed here, and the staff and residents are all very nice (like most Khmer people really). I saw the man with the bad knee today when I was working and he seemed so much better, and was very grateful to the whole medical team. It's difficult working here as there are no HCPs so people must often go to the hospital, which drug users particularly are very reluctant to do, but those who do go seem OK once they've received treatment (apart from the ones are required to stay in the hospital and try to escape...). The medical team are great too and you can tell that everyone who works here really cares about the NGO: most of the staff were drug users before and there are many deportees from the US who work there (which is good for me because it means people who speak English!).

I'm going to visit the Methadone clinic tomorrow and I am also on call over the weekend with JB, so hopefully should be interesting :-)

From Phnom Penh, Alex Malet, Over & Out!