Home at 23.24h, that must be a record! A fun filled OR day with dr Hahn en dr Lemsokong with gastric perforations, appendectomy, ureteroscopy and stone removal, and more appendectomies... Hear and see all about it in Kate's up and coming videoblog!
Up at 6.45 tomorrow so...
Goodnight,
L.
Wednesday, March 30, 2011
Tuesday, March 29, 2011
The right place
Today was another regular day at Siem Reab Referral Hospital. Staff meeting, ward rounds (the new patients and the ones that we operated on yesterday), and off to the OR. Katie had to work until an amazing 13.45h before she was let free to have lunch. I had been hanging around since 12.30 waiting for her. This might sound a bit harsh for me so I must add that this "waiting" consisted of having a cappuccino and a cinnamon roll in a nearby coffee place. But half an hour later we were ready again for the emergency surgery. And soon enough it found us!
First Katie was dispatched to Room A with dr Rithy for an appendectomy. And I waited for the intramedullary-nail-material to finish it's sterilization proces after this morning's use. But my waiting (in horizontal position in one of the hospital beds in the hall) was rudely and bruskly interrupted when I was hauled in Room B for some heavy lifting and pulling. The patient was a 40 year old with a dislocated hip since a month who decided to come to the hospital after all. He was layed on the floor (that makes it easier for the doctors and also because during the manipulating it avoids the patient falling from the OR table to the floor below) and sedated. My job at first was to hold down the patient while two other doctors were pulling his leg (no pun intended), hoping for the bones to snap back in place. But after a couple of minutes we were all panting and sweating. Then we switched and I pulled the leg as hard as I could; lifting the patient off the floor despite the efforts of the three people trying to keep him on the ground. But no success yet. It was only shortly after that we heard the comforting sound of the joint realigning. I walked off again, but to no avail; although they were six in the room, I was asked to help lift the patient from the floor to his bed. Well, that the drawback of being 30cm taller than most around here...
Then Dr. Rada took me to the ER department to see a trauma patient and after that a strangulated inguinal hernia. It was as hard as a rock and it took a lot of valium, patience, massaging the hernia and perseverance to usher it back into the abdomen.
And thus the femur fracture we were waiting for, started late in the afternoon. Maybe it was out of the kindness of his heart or maybe it was his tiredness or his constant coughing and sniffing but he let me do most of the hard work (drilling, clamping, realigning, more drilling...). On the subject of his "grippe" as he calls it; I think there are chances it might be TB but since yesterday he mentioned Anthrax, I tend to look away when he coughs... Just to be on the safe side. Anyway after a lot of heavy manual labour, it was pitch dark when I crawled out of the OR. The sight of the three little boys (see pictures earlier) dancing to some pop music renewed my energy and I played with them for a minute. Lifting them over my head, chasing them round the courtyard, ... I'm sure they'll sleep well tonight. I also do remember thinking that their dancing reminded me of Huntington's Chorea which is completely stupid since it's the medical equivalent of seeing a Zebra and thinking "what a coincidence they must be named after the stripey road crossings!"
Anyway it was with a feeling of a good day's work that I cycled to the hotel and along the way I caught myself humming the radiohead song "everything in it's right place"...
Goodnight
L.
First Katie was dispatched to Room A with dr Rithy for an appendectomy. And I waited for the intramedullary-nail-material to finish it's sterilization proces after this morning's use. But my waiting (in horizontal position in one of the hospital beds in the hall) was rudely and bruskly interrupted when I was hauled in Room B for some heavy lifting and pulling. The patient was a 40 year old with a dislocated hip since a month who decided to come to the hospital after all. He was layed on the floor (that makes it easier for the doctors and also because during the manipulating it avoids the patient falling from the OR table to the floor below) and sedated. My job at first was to hold down the patient while two other doctors were pulling his leg (no pun intended), hoping for the bones to snap back in place. But after a couple of minutes we were all panting and sweating. Then we switched and I pulled the leg as hard as I could; lifting the patient off the floor despite the efforts of the three people trying to keep him on the ground. But no success yet. It was only shortly after that we heard the comforting sound of the joint realigning. I walked off again, but to no avail; although they were six in the room, I was asked to help lift the patient from the floor to his bed. Well, that the drawback of being 30cm taller than most around here...
Then Dr. Rada took me to the ER department to see a trauma patient and after that a strangulated inguinal hernia. It was as hard as a rock and it took a lot of valium, patience, massaging the hernia and perseverance to usher it back into the abdomen.
And thus the femur fracture we were waiting for, started late in the afternoon. Maybe it was out of the kindness of his heart or maybe it was his tiredness or his constant coughing and sniffing but he let me do most of the hard work (drilling, clamping, realigning, more drilling...). On the subject of his "grippe" as he calls it; I think there are chances it might be TB but since yesterday he mentioned Anthrax, I tend to look away when he coughs... Just to be on the safe side. Anyway after a lot of heavy manual labour, it was pitch dark when I crawled out of the OR. The sight of the three little boys (see pictures earlier) dancing to some pop music renewed my energy and I played with them for a minute. Lifting them over my head, chasing them round the courtyard, ... I'm sure they'll sleep well tonight. I also do remember thinking that their dancing reminded me of Huntington's Chorea which is completely stupid since it's the medical equivalent of seeing a Zebra and thinking "what a coincidence they must be named after the stripey road crossings!"
Anyway it was with a feeling of a good day's work that I cycled to the hotel and along the way I caught myself humming the radiohead song "everything in it's right place"...
Goodnight
L.
Sunday, March 27, 2011
The Ocean of Milk
Hurray, the weekend is here! Long lazy sleep-ins, bleary eyed study sessions, coffees, strolling through the town... But that would have to wait! Saturday morning at 5.45 I jump out of bed and start annoying Katie till she does the same. Lights on, music on, gathering all the stuff for the days trip: camelbak, knife, map, guidebook, hammock, petzl, toiletpaper, sunscreen, hat, etc. Our shiny new rented MTB are just itching to grind some gears. Or is it just me?
I wait until Katie finishes showering (it seems like forever), we hop on the bikes, and start speeding towards the temples. It's too late for the sunset but it's a cloudy day so no big loss. A very slight drizzle combined with the cloud cover creates the perfect 25°C ambient for cycling. We have a short break in front of Angkor Wat for a spot of prima colazione. And prima it was!
Today's objective is the remote mountain-hill temple of Phnom Bok. It's about 25km away. And as I test out my MTB on the side of the side of the road, Katie nearly get's hit by the buses who race and overtake on the narrow roads. We're glad to leave the busy tourist roads and continue through the dried rice fields of Eastern Baray. These fields were once a gargantuan pool dug out in the Angkorian age. The dimensions are hard to grasp (7km on 1.5km). We are cheered and waved all along the way by smiling Khmer kids "hello! hello! hello!". It's great fun.
With the sun in the zenith we ride up the foot of Phnom Bok, but we soon have to leave the bikes behind. With exactly 600 steps going straight up it's not entirely biking material. Our escorting policeman named Euin keeps up the morale by calling out when we climbed another 200 steps "bpee mroy!", "booun mroy!" and finally "pram mooy mroy". Heavily perspiring and constantly drinking from our water bottle we reach the top! The view is spectacular, but the ruins of the temple is even more so. Two frangipani trees grow out of the entrance buildings and cover the fallen stone blocks with their white flowers. It's a magical place. Since we're the only ones there, it's perfectly peaceful... We thourougly enjoy the views, the ruins, the fruit trees and then start to make our way back down. This was relatively harder than we had anticipated. With trembling knees we sit down to an fresh coca cola before racing down the hill on our suspension bicycles over the rough gravel track (what a great feeling).
We retrace our steps to the temple of Barey Samré for lunch. This extremely well preserved complex is definitely Katies favourite temple. After visiting we find a nice spot behind the 4m walls to hang our cherished hangmats. We're the happening of the day for the local children. The suspend their fruit-picking activities to watch us and our strange hammock tying and hammock sleeping techniques, hardly suppressing their laughter...
On the way back I try to get to most out of the bikes and we do some fun trails, we attempt to cross a rice field, I even find a patch of mud to cross and don't leave a single termite hill "unjumped"... I'm sad to to hand in the bikes in the evening! What fun that was...
Today sleeping until 7.00 AM seems almost like extravagance... ;-)
Enjoy the photos. I didn't take as many as usual because my camera was safely tucked away in my rucksack, and thus rather unwieldy!
L.
I wait until Katie finishes showering (it seems like forever), we hop on the bikes, and start speeding towards the temples. It's too late for the sunset but it's a cloudy day so no big loss. A very slight drizzle combined with the cloud cover creates the perfect 25°C ambient for cycling. We have a short break in front of Angkor Wat for a spot of prima colazione. And prima it was!
Today's objective is the remote mountain-hill temple of Phnom Bok. It's about 25km away. And as I test out my MTB on the side of the side of the road, Katie nearly get's hit by the buses who race and overtake on the narrow roads. We're glad to leave the busy tourist roads and continue through the dried rice fields of Eastern Baray. These fields were once a gargantuan pool dug out in the Angkorian age. The dimensions are hard to grasp (7km on 1.5km). We are cheered and waved all along the way by smiling Khmer kids "hello! hello! hello!". It's great fun.
With the sun in the zenith we ride up the foot of Phnom Bok, but we soon have to leave the bikes behind. With exactly 600 steps going straight up it's not entirely biking material. Our escorting policeman named Euin keeps up the morale by calling out when we climbed another 200 steps "bpee mroy!", "booun mroy!" and finally "pram mooy mroy". Heavily perspiring and constantly drinking from our water bottle we reach the top! The view is spectacular, but the ruins of the temple is even more so. Two frangipani trees grow out of the entrance buildings and cover the fallen stone blocks with their white flowers. It's a magical place. Since we're the only ones there, it's perfectly peaceful... We thourougly enjoy the views, the ruins, the fruit trees and then start to make our way back down. This was relatively harder than we had anticipated. With trembling knees we sit down to an fresh coca cola before racing down the hill on our suspension bicycles over the rough gravel track (what a great feeling).
We retrace our steps to the temple of Barey Samré for lunch. This extremely well preserved complex is definitely Katies favourite temple. After visiting we find a nice spot behind the 4m walls to hang our cherished hangmats. We're the happening of the day for the local children. The suspend their fruit-picking activities to watch us and our strange hammock tying and hammock sleeping techniques, hardly suppressing their laughter...
On the way back I try to get to most out of the bikes and we do some fun trails, we attempt to cross a rice field, I even find a patch of mud to cross and don't leave a single termite hill "unjumped"... I'm sad to to hand in the bikes in the evening! What fun that was...
Today sleeping until 7.00 AM seems almost like extravagance... ;-)
Enjoy the photos. I didn't take as many as usual because my camera was safely tucked away in my rucksack, and thus rather unwieldy!
L.
 |
| First stop by the sunrise spot |
 |
| 600 steps |
 |
| Phnom Bok |
 |
| Phnom Bok |
 |
| Flower close-up |
 |
| Our little siesta disturbers |
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| Off-roading by the sunrise lake |
Friday, March 25, 2011
When you have two...
Under a rosy-fingered sky I went for a jog in the twilight. Since our hotel is on the far northern side of the town, I soon left the busy streets and I was running in the midst of the greenery. On my left the red glow of the setting sun shone through the trees. But soon I had to curb my enthusiasm and slow the pace. Although almost dark, the air was still very humid and it felt like running wearing a wet wetsuit. Nonetheless I was very pleased with the little escapade!
Fridays always start with an extensive ward round. I need about 10 minutes for every patient (in the meantime dr Rada and Cheavuthy manage to do 10 patients). Today was somehow more confronting than before. My first patient was an 18-year old who had been in a road accident. The charts said he was severely comatose, but when I went to see him he opened his eyes, spoke and could move his left arm. But he was still very somnolent. Since he was in such a bad shape neurologically over the past few days, everybody had agreed to wait for the (expensive) investigations like x-rays etc. No point in diagnosing a fracture if he's brain-dead is somewhat the line of thought. So no x-rays to orientate me I soon spotted that this young man, who didn't complain of any pain anywhere, could not move his arm. Under a single "sterile" cotton swab a bulging muscle mass was visible. I took hold of his arm and immediately felt the crepitations of the broken bone fragments inside: open fracture of the humerus. Closer inspection of the legs revealed that his right thighbone was in an odd unnatural angle and when I exorotated his left leg the movement somehow didn't make it all the way to the hip. So fractures of both femurs. No feeling in the toes: peripheral or central neurological fall out. Without MRI it's mostly guessing ( and waiting ).
The second patient had lost all four fingers in a machete "accident". Two of them had been reimplanted but he screamed when the bandages were taken off. It looked extremely painful.
A few patients further down the track I saw the young girl who had lost her scalp. She was already feeling better, no fever; so everything looking good for the skingrafts! But the nurse asked me if she could change the dressings on her legs ( where the grafts were taken ). I agreed that it was time, but soon this 16 year old girl was howling with pain. I myself had put the fatty bandages (that are supposed to be non-stick). It was horrible to have to stand there and watch it. After that I went to see a patient whose file only said "accident de travail". The back of his foot was one big pus-filled hole with only one tendon remaining crossing the gap like a bridge. The violent smelled nearly flattened me. Infected wound: antibiotics and debridement.
The last patient was a young man who had a severe trauma to his right arm a week ago, and due to massive swelling of the muscles he developed a compartment syndrome (that's when the nerves and vessels get crushed because of the pressure of the swelling). So the doctors performs a fasciotomy (to give the muscle room to expand). But since then he had not recovered neurologically. Nonetheless he is always in high spirits, always smiling, always with his girlfriend by his side. Today he asked about the recovery of motor skills in his arm. I admitted that it wasn't looking very good, but that nerves grow very slowly and it might still improve over the months. I asked about his job and he said he was a truckdriver. I said in the future his girlfriend might have to shift the gears for him. They both laughed very hard. Mentally they are for sure unbeatable. What a tough people.
Dr Lemsokong took Katie and the (new) New Zealand student (Angela) on a little trip since they had no OR today. They bought 'kuy', a very special kind of fruit, only to be found in cambodia. This resulted in us being pointed at and amazed cambodians whispering "kuy" anywhere we went with it. Dr lemsokong has overloaded us with his aphorisms over the last week. One that will certainly stick in our memory is:
"In cambodia we have a saying; you can only have one wife! If you have two: hide one! If you have three: hide two!". He's alot of fun to be around!
Rie, a OR nurse, saw us with the Kuy and promptly gave us a bag of fresh sweet mango's to compensate for the sour Kuy. She was also convinced that if there wasn't anybody scheduled for operation in the afternoon this must mean that everybody in Siem Reab was healthy!
Dr Rithy invited us to the cambodian new year party at the hospital on april 11th. By that time we should accually be back in Phnom Penh, but maybe we can just linger here for a few days longer....
Some pictures below (watch out; some medical ones might be shocking!)
Fridays always start with an extensive ward round. I need about 10 minutes for every patient (in the meantime dr Rada and Cheavuthy manage to do 10 patients). Today was somehow more confronting than before. My first patient was an 18-year old who had been in a road accident. The charts said he was severely comatose, but when I went to see him he opened his eyes, spoke and could move his left arm. But he was still very somnolent. Since he was in such a bad shape neurologically over the past few days, everybody had agreed to wait for the (expensive) investigations like x-rays etc. No point in diagnosing a fracture if he's brain-dead is somewhat the line of thought. So no x-rays to orientate me I soon spotted that this young man, who didn't complain of any pain anywhere, could not move his arm. Under a single "sterile" cotton swab a bulging muscle mass was visible. I took hold of his arm and immediately felt the crepitations of the broken bone fragments inside: open fracture of the humerus. Closer inspection of the legs revealed that his right thighbone was in an odd unnatural angle and when I exorotated his left leg the movement somehow didn't make it all the way to the hip. So fractures of both femurs. No feeling in the toes: peripheral or central neurological fall out. Without MRI it's mostly guessing ( and waiting ).
The second patient had lost all four fingers in a machete "accident". Two of them had been reimplanted but he screamed when the bandages were taken off. It looked extremely painful.
A few patients further down the track I saw the young girl who had lost her scalp. She was already feeling better, no fever; so everything looking good for the skingrafts! But the nurse asked me if she could change the dressings on her legs ( where the grafts were taken ). I agreed that it was time, but soon this 16 year old girl was howling with pain. I myself had put the fatty bandages (that are supposed to be non-stick). It was horrible to have to stand there and watch it. After that I went to see a patient whose file only said "accident de travail". The back of his foot was one big pus-filled hole with only one tendon remaining crossing the gap like a bridge. The violent smelled nearly flattened me. Infected wound: antibiotics and debridement.
The last patient was a young man who had a severe trauma to his right arm a week ago, and due to massive swelling of the muscles he developed a compartment syndrome (that's when the nerves and vessels get crushed because of the pressure of the swelling). So the doctors performs a fasciotomy (to give the muscle room to expand). But since then he had not recovered neurologically. Nonetheless he is always in high spirits, always smiling, always with his girlfriend by his side. Today he asked about the recovery of motor skills in his arm. I admitted that it wasn't looking very good, but that nerves grow very slowly and it might still improve over the months. I asked about his job and he said he was a truckdriver. I said in the future his girlfriend might have to shift the gears for him. They both laughed very hard. Mentally they are for sure unbeatable. What a tough people.
Dr Lemsokong took Katie and the (new) New Zealand student (Angela) on a little trip since they had no OR today. They bought 'kuy', a very special kind of fruit, only to be found in cambodia. This resulted in us being pointed at and amazed cambodians whispering "kuy" anywhere we went with it. Dr lemsokong has overloaded us with his aphorisms over the last week. One that will certainly stick in our memory is:
"In cambodia we have a saying; you can only have one wife! If you have two: hide one! If you have three: hide two!". He's alot of fun to be around!
Rie, a OR nurse, saw us with the Kuy and promptly gave us a bag of fresh sweet mango's to compensate for the sour Kuy. She was also convinced that if there wasn't anybody scheduled for operation in the afternoon this must mean that everybody in Siem Reab was healthy!
Dr Rithy invited us to the cambodian new year party at the hospital on april 11th. By that time we should accually be back in Phnom Penh, but maybe we can just linger here for a few days longer....
Some pictures below (watch out; some medical ones might be shocking!)
 |
| Right to left: Dr Rithy, Dr Sap, Dr Lemsokong, Dr Vaon |
 |
| Hurrying home under the stormy skies. |
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| Watching a banana-pancake-artiste perform, and then eating his masterpieces. |
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| Our three little guardians of the OR-entrance. |
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| Front to back: Dr Cheavuthy, Dr Rithy, Dr Huy and Dr Penh in pensive mode. |
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| Machete accident. |
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| The girl with the scalp accident. |
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| Accident de travail. |
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| Lunchbreak entertainment. |
Monday, March 21, 2011
Dragon Soup
Up at 6.30 I was packing in my bacon and eggs in a matter of seconds. Ready for rounds! Dr Rada and Vuthy were giving the president and founder of the "sign nail" orthopedic-stuff company a grand tour of the department so that left 50 beds to visit for dr Chea and me. One of the first patients was a young woman who had suffered an injury to the pelvic ring. So I ask to see the radiographs and unmistakenly both pubic rami were broken on the right. I rejoice because only yesterday I had been reading all about these kinds of fractures in my german orthopaedics book (gift from Dr Gotterbarm from Schlierbachen). I check the color of the urine to discover that is it clearly red. I holler to get dr Chea and ask him about organizing an external fixator for the pelvis but he responds that they don't have the right material. Than I ask if it is possible to perform a retrograde urethrography to discover any ruptures but again : no apparatus. Slightly downed by this I decide we'll just have to wait and see...
During the rounds I notice that my shirt is glued to my chest ... it was not particularly hot but extremely humid. At 11h I was happy to leave the department but there were two more tasks for me. First I had intruded upon dr Chea while he was inspecting a big mass on a patients forearm and I'd asked if he planned to remove it in the department or in the OR. "In here of course", and he added "do you want to do it?". I accepted, in the vain hope that he would assist me and check that I wasn't doing anything stupid. But I pull on my gloves and I see him through the first floor window walking towards the OR ... I was by myself. Luckily I had Sokchea, a fluent english speaker/physiotherapist/nurse to assist me. The patient in question was lying in the corridor on a straw mat. So it was going to be a kneeling affair. We pretend to create a sterile environment, I inject the skin with local anestheticum and I make the incision. I look around to see that a crowd has gathered to watch the spectacle and to encourage me on the way! It's harder than I think and with just the scalpel, a clamp and tweezers it's tricky. "Just don't cut anything you're not supposed to", I keep repeating to myself. The lump is about 8cm by 4 and very mobile. But as I am careful to remove it entirely, I am making things hard for myself. The patient starts complaining of pain when I attack what I believe is the vascular pedicle. This means that it isn't... So it must be a tendon or a nerve (let it not be a nerve I mutter under my breath). I peel off another layer to reveal the actual mass itself; smooth and round I dissect it out with my finger and after washing it all with some isobetadine I close the skin (with alot of difficulty: round needles don't cut and with no needle holder but just a clamp it's damn tricky). I extensively test the patients motor and sensitiveness but there seems to be no problem.. just a tendon then... phwew. A little girl who was watching the whole show from nearby remarks that the mass looks very much like "a pig's testicle". I'm sure she's right.
After that I'm rushed to a man with a warm, hard, painful swelling under his right shoulderblade. Probably an abces so I jab a needle in and... bull's eye; bright green pus in the syringe; scheduled for OR asap for extensive drainage.
Mango juice and fried noodles for lunch. Then I hang my hammock at the OR gates and I listen to some music. But before I know it it's quarter to three and I'd slept for an hour. Dr Rada sees me waking up and gives me a sharp laugh... it must of looked pretty funny seeing me climbing out of there still half asleep.
Katie assists on a caesarian and just when I've started changing my scrubs for civilian clothes, i hear "mooy deetut!" One more! An amputation; grangreen of the foot. And sure enough as I walk in ; the nasty (blue)cheesy odour hits me in the face. Dr lemsokong jokes that after amputating it they will carry the leg to the nearby soup restaurant called "Soup Dragon"..." and then I'll invite you!" I know it's very misplaced but since the patient can't understand it I don't refrain from laughing; in a morbid way it's a very funny joke!
After manually sawing the femur (just like in the movies about 16th century naval battles) I drop the leg in a bucket, we close the muscle around the bone, close the skin and it's time to go home. Immediately I notice that it's much cooler; but then thunder strikes and I am rained wet to my underwear when I get to the hotel. Once inside I watch the thunderstorm pick up pace and buckets come pouring out of the sky. Even as I am writing, 1 hour later, the lightning is still illuminating the roofs...
And now... I am hungry again,
L.
During the rounds I notice that my shirt is glued to my chest ... it was not particularly hot but extremely humid. At 11h I was happy to leave the department but there were two more tasks for me. First I had intruded upon dr Chea while he was inspecting a big mass on a patients forearm and I'd asked if he planned to remove it in the department or in the OR. "In here of course", and he added "do you want to do it?". I accepted, in the vain hope that he would assist me and check that I wasn't doing anything stupid. But I pull on my gloves and I see him through the first floor window walking towards the OR ... I was by myself. Luckily I had Sokchea, a fluent english speaker/physiotherapist/nurse to assist me. The patient in question was lying in the corridor on a straw mat. So it was going to be a kneeling affair. We pretend to create a sterile environment, I inject the skin with local anestheticum and I make the incision. I look around to see that a crowd has gathered to watch the spectacle and to encourage me on the way! It's harder than I think and with just the scalpel, a clamp and tweezers it's tricky. "Just don't cut anything you're not supposed to", I keep repeating to myself. The lump is about 8cm by 4 and very mobile. But as I am careful to remove it entirely, I am making things hard for myself. The patient starts complaining of pain when I attack what I believe is the vascular pedicle. This means that it isn't... So it must be a tendon or a nerve (let it not be a nerve I mutter under my breath). I peel off another layer to reveal the actual mass itself; smooth and round I dissect it out with my finger and after washing it all with some isobetadine I close the skin (with alot of difficulty: round needles don't cut and with no needle holder but just a clamp it's damn tricky). I extensively test the patients motor and sensitiveness but there seems to be no problem.. just a tendon then... phwew. A little girl who was watching the whole show from nearby remarks that the mass looks very much like "a pig's testicle". I'm sure she's right.
After that I'm rushed to a man with a warm, hard, painful swelling under his right shoulderblade. Probably an abces so I jab a needle in and... bull's eye; bright green pus in the syringe; scheduled for OR asap for extensive drainage.
Mango juice and fried noodles for lunch. Then I hang my hammock at the OR gates and I listen to some music. But before I know it it's quarter to three and I'd slept for an hour. Dr Rada sees me waking up and gives me a sharp laugh... it must of looked pretty funny seeing me climbing out of there still half asleep.
Katie assists on a caesarian and just when I've started changing my scrubs for civilian clothes, i hear "mooy deetut!" One more! An amputation; grangreen of the foot. And sure enough as I walk in ; the nasty (blue)cheesy odour hits me in the face. Dr lemsokong jokes that after amputating it they will carry the leg to the nearby soup restaurant called "Soup Dragon"..." and then I'll invite you!" I know it's very misplaced but since the patient can't understand it I don't refrain from laughing; in a morbid way it's a very funny joke!
After manually sawing the femur (just like in the movies about 16th century naval battles) I drop the leg in a bucket, we close the muscle around the bone, close the skin and it's time to go home. Immediately I notice that it's much cooler; but then thunder strikes and I am rained wet to my underwear when I get to the hotel. Once inside I watch the thunderstorm pick up pace and buckets come pouring out of the sky. Even as I am writing, 1 hour later, the lightning is still illuminating the roofs...
And now... I am hungry again,
L.
Saturday, March 19, 2011
General Malaise and UN interventions...
Another week flown! After the rather dramatic start, things got back to "normal" for the rest of the week. The usual routine of morning staff meeting, ward rounds, OR - lunch - emergency OR - feierabend... And on one of those long lunchbreaks/siestas Dr Rada happened upon us while I was reading and Katie lay napping in one of the beds at the entrance of the changing rooms. "Oh, Malaise Général?" he remarked, but no, nobody had fainted; all the sleeping was intentional. But since then I like to refer to Kate as my "General". She purchased a very comfy hangmat of her own the day before yesterday. And we are getting quite handy tying them up in the coolest places. They are the best way of relaxing during the sweltering midday hours.
As far as my enteric inevitabilities are concerned, I thought I had won without the help of antibiotics (or as Dr Lemsokong calls them " the UN forces " (within the Thai-Cambodian army/bacteria metaphor). But I was mistaken, and finally I succombed and started my cipro treatment, which worked a treat! I was as good as cured the next day...
Mr Samath, one of the OR nurses, likes to have a chat with us once in a while and when we were discussing which temples he likes visiting best he named a few remote mountain top temples. I asked if he ever went to Prehear Vihear (that's the one near Thailand, were the fighting was only last month). He denied ever visiting it, but also denied that it was due to the fighting. "I am not afraid of fighting. When I was 11 I was fighting in that area myself. With the Khmer Rouge." I asked if he had ever killed anybody. "I don't know, I was shooting in all directions, maybe...." I showed him the cover of "the killing fields" and he'd seen the movie; "Dith Pran is the best" he says, and " I don't understand why so many Cambodians killed so many Cambodians". Now dear readers you should know that Samath is one the kindest people around. Constantly smiling and ever helpful. This is a country with many hidden faces.
Friday afternoon came with a nice surprise. Dr Chea Vuthy announced that there were two acute appendicitis'. Jokingly I say "One for me and one for you?". But five minutes later he comes in the OR room and says "you are the first operateur, ok?" "Sure!" But I was lucky to have him on the other side of the table to check and help. Lucky too that Katie was besides me to help (she's seen many more of these since she is in the visceral surgery department). Next time I'll do it all by myself! In return I let Katie close, so she too got her kicks!
Today we headed for the temples at 7.30 and climbed the hill of Pnohm Bakheng, saw the south and victory gates of Angkor Thom and Bayon itself too. After the hottest hours (in our hangmats by the deserted victory gate) we pushed further still, towards Ta Prohm, one of the few temples still overgrown and not completely renovated. It was magic. Enjoying the sunset on the waters of Angkor Wat we rode back home... Early bed tonight because tomorrow we are invited to a wedding, cambodian style; very curious to see what that is all about!
Mr Samath, one of the OR nurses, likes to have a chat with us once in a while and when we were discussing which temples he likes visiting best he named a few remote mountain top temples. I asked if he ever went to Prehear Vihear (that's the one near Thailand, were the fighting was only last month). He denied ever visiting it, but also denied that it was due to the fighting. "I am not afraid of fighting. When I was 11 I was fighting in that area myself. With the Khmer Rouge." I asked if he had ever killed anybody. "I don't know, I was shooting in all directions, maybe...." I showed him the cover of "the killing fields" and he'd seen the movie; "Dith Pran is the best" he says, and " I don't understand why so many Cambodians killed so many Cambodians". Now dear readers you should know that Samath is one the kindest people around. Constantly smiling and ever helpful. This is a country with many hidden faces.
Friday afternoon came with a nice surprise. Dr Chea Vuthy announced that there were two acute appendicitis'. Jokingly I say "One for me and one for you?". But five minutes later he comes in the OR room and says "you are the first operateur, ok?" "Sure!" But I was lucky to have him on the other side of the table to check and help. Lucky too that Katie was besides me to help (she's seen many more of these since she is in the visceral surgery department). Next time I'll do it all by myself! In return I let Katie close, so she too got her kicks!
Today we headed for the temples at 7.30 and climbed the hill of Pnohm Bakheng, saw the south and victory gates of Angkor Thom and Bayon itself too. After the hottest hours (in our hangmats by the deserted victory gate) we pushed further still, towards Ta Prohm, one of the few temples still overgrown and not completely renovated. It was magic. Enjoying the sunset on the waters of Angkor Wat we rode back home... Early bed tonight because tomorrow we are invited to a wedding, cambodian style; very curious to see what that is all about!
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| View from my hammock. |
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| Other end! |
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| Break of day at Angkor Wat |
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| The stairs at Pnohm Bakeng. What do you mean; no escalator? |
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| Bakeng: top! |
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| Victory Gate; off the beaten track (just like we like it!) |
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| Purr-fect |
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| North Face of Victory Gate |
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| Ta Prohm |
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| Ta Prohm outer perimeter |
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| Sunset on the waters around Angkor Wat |
Monday, March 14, 2011
Why I hate mondays...
Today was one to remember. First ward rounds of course, then surgery. But after half an hour I asked to be excused since I was still feeling terribly feeble; and there was no one I trusted to break my fall if I went down... So lunchbreak and back in the OR with Dr Rithy for an emergency laparotomy on a 18 year old girl with abdominal pains, fever, distention and all the signs of a complicated appendicitis. As first assistant i was scared of feeling queasy and the putrid smell of pus could have done it but we were amazed at the seriousness of the case; emptying yet another abdomen of liters of pus and blood... Dr Rithy meanwhile was constantly on the phone with the ENT surgeons who had a difficult case. And thus he left us to close the abdominal wall and went to look at this case of dyspneae and inspirational stridor. The only thing we heard were the gasping sounds of stridor of someone in the corridor as we were closing the skin of the young girl in the most hurried fashion imaginable ... since she was already completely awake and reaching for her stomach. The anaesthetist was too busy in the other room to come and sedate our patient for another 15 minutes for us to finish our sutures. But while Katie was escorting the patient to the recovery, I walked into the other OR out of curiosity to find the extraordinary sight of a seizing patient on the operation table. I get Katie and before we know it we are performing CPR and pumping away; with no EKG monitoring but our fingers to feel a pulse on a seizing patient. Meanwhile the anaesthesist is asking us what medication he should give and in what dose... Completely of our guards and not understanding why suddenly we were in charge just because we walked in when there was a problem we hesitated at first. Grasping that if we didn't act quickly nobody would we order Diazepam first whilst resuscitating and then with the seizures stopped and the definite absent pulse we quickly order 1mg of adrenaline IV and atropine after that... after a minute and many more seizures we finally get a pulse. With immense help of Marvin, a 76 year old retired american anaesthesic nurse, we have the patient ventilated and somewhat stable; but still seizing. The surgeon who was performing a tracheotomy on her declares that he hasn't got a clue what to do in this kind of situation, because he's just the surgeon. But his reassuring words are that he had spoken to the husband of the patient and if she were to die "it was ok!" and he laughed! With many conflicting stories and no official documents nobody is really sure about what happened and/or why. For a moment it looks as it they were about to roll the patient to the post op and order the family to keep ventilating her manually .. indefinitely. But a mechanical ventilator is provided and the patient is left to the surveillance of the family... Nothing more can be done. Nobody amongst the doctors or nurses seems in the least shocked or even disturbed. They go about their business in their jolly and smiling fashion as if nothing had happened...
We, as you can imagine, are less adapted.
Goodnight,
L.
We, as you can imagine, are less adapted.
Goodnight,
L.
Sunday, March 13, 2011
Angkor What?
Despite Lolo's overactive bowels, we finally visited Angkor Wat this evening!
(Angkor Wat is de grootste tempel van het gigantische tempelcomplex dat hier vlakbij Siem Reap ligt, dé must-see van Cambodja. Gebouwd in de 12de eeuw, oorspronkelijk voor de hindu-god Vishnu, daarna samen met de bevolking naar het boeddhisme geconverteerd.)I'll let the photos do the talking!
Gisterenmiddag: een koortsige Laurent doet een dutje in de hal tussen het OK en de ontwaakruimte. (Dit is ook de plaats waar ik mijn middagdutjes hou.) Hierna trok hij huiswaarts om wat uit te zieken, terwijl ik Dr. Lemsokung assisteerde bij de orchidectomie en een appendectomie.
(Dr. Lemsokung had duidelijk gezien dat Laurent er niet zo goed aan toe was. Zijn advies was dan ook eenduidig: "Go home! Take medicine!" Daarna bespraken we dat het toch ook niet de beste avond was voor een Cambodjaans feestje: "Your friend... sick. No dancing tonight.")
Our first glimpse at Angkor Wat...!
The masses are evacuating, all in search for a perfect sunset picture - which has the sun setting behind Angkor Wat, thus is taken from a higher point close by. Just our luck, this way we have the temples practically to ourselves.
Sfeerbeelden... en een videootje!
Goodnight, Belgium!
-- Katie
Saturday, March 12, 2011
Light entertainment and Oysters
Dear readers, I have been keeping you waiting for news from South East Asia! Fortunately we were not hit by the tsunami (as some of our more tensed readers might have been supposing). But it was a very busy time none the less... Strange and hilarious things are happening all the time and I can't keep track of all of them; so here are some of the highlights of yesterday and today.
Friday started with a very long visit of all (and I mean all) patients on the ward, both ground and 1ste level. With no assistants it was just dr Rada and me. After the wardround (using hands, drawings, nurses and my very elaborate Khmer vocabulary...), I headed for the OR, tired as a horse from the long week. There I found the two other traumatologists replacing a fractured hip with a prothesis. There were already aided by an instrumenting nurse and I saw the perfect opportunity to eclipse myself towards my cushy hammock. But my plan was foiled by a very generous dr Vuthy who insisted on my helping (in this kind of surgery the fourth player is generally just holding the leg in various positions). No problem I though, just an hour of work and it's breaktime; sleep; food, coffee, ... it was all just a few inches away. But as the operation progressed we had the switch from one prothesis to another and back to first whilst interchanging the heads to find the best fit. One part of the prothesis fell on the ground in this proces and twice I managed to catch another slippery bastard trying to get away. Two hours later and with some pulling and pushing the hip snaps into place and it's closing time. Dr Vuthy leaves this to the assistant and I help him... until the lights suddenly go out. Seconds and then minutes go by leaving us in the most complete dark. I have the genius idea of getting my torch (in my packback). Thrilled with this proof of intelligence I hurry back and shine the brightest Petzl light they could imagine... until after two sutures it fades to a mellow cellphone light barely illuminating anything (damn you cheap belgian supermarket batteries!!). The works proceeds and the final wrapping and bandaging is left to me and the nurses. The final straw came when apparently they ran out of sticky tape just that morning so we had to improvise on how we would go about fixing our construction of sterile swaps. For the "drain" which in belgium is an expensive looking proper drain with a vacuum mechanism bottle, we use a bit of silicon tubing with holes cut in and a surgical glove and for tying it to the tube I use a longitudinal plastic wrapper which had contained the urinary catheter. Under the appreciative eyes of the cambodian staff I start to grasp the Khmer way of improvising.
After that we have a quick lunch and head for the photo-shop to get passport pictures taken for the prolonging of our visas and the tickets to angkor wat. Snap snap and finished... but the processing of the pictures takes several minutes and the printing seems to be a terrible task to perform. Our midday break vanished in smoke. We hurry back to the OR where Katie perform a lumbar puncture (rachy) and I assisted her and dr Rithy in an emergency appendectomy. She can just about to the whole operation! Thank you dr Rithy!
A bite in our favourite local restaurant proves an agreeable experience and we manage to order food and drink! Quite a challenge if nobody speaks anything but Khmer... Early bed for us... but ! As we're getting to the hotel we see our fantastic dr Rithy at the table of the hotel restaurant (owned by him and his wife). He is there in the company of dr Lem so Kong (terrific guy as well), and their wifes. Apparently they were having a company sponsored dinner (in a post-communistic community!) and dr Lem so Kong inquires if we possess a cambodian cellphone number. He urges us to buy one soon because how else will he contact us on a weekend day when.. he's on duty! No temples for us yet....
And so slavishly we get a sim card and head for the hospital at 10.00 AM were we are informed that an appendix is just springing... to meet us. So OR scrubs it is and not feeling too well today (quite some enteric infection since yesterday) I'm not looking forward to it! But then comes a well humored dr Lem So Kong and when we are ready to start operating he introduces three white-clad cambodians girls to stand with their backs to the wall and observe. Midwifes in training he explains! S'ray Saat... The three beautiful girls he translates. The atmosphere is well set for the day. I'm the first assistant today and los geht's. Dr Lem so Kong explains that the pus-like fluid in the abdomen is the result of good and bad soldiers fighting over the appendix. He adds that the good soldiers 'cambodian soldiers' are fighting the bad ' thai ' soldiers. I don't dare to laugh but as he does; we do too! He explains that sometimes a metaphore is the best way to explain something. Searching for an example he turns to Katie and says "when you want to say I love you" and you can't, you say "I am a bee... and you are the flower". General hilarity guaranteed. Then disaster strikes and an instrument falls to the ground; no biggy but superstition states that this will surely mean alot of work to come today! I'm allowed to finish closing for him and he stands by to observe the job being done. He instructs us to insert a urinary catheter but then changes his mind and asks us to assist one of the midwifes (who has never done it). She get's ready to do it under our guidance and halfway through dr Lem So Kong bursts out laughing and says "she has never held a penis in her hands before". We can barely keep it together as the mood is really up today. Afterwards I feel really cold and tired and quite feverish . Dr Lem so Kong had a resembling experience after eating some "delicious oysters" and as he puts it "they made me love the toilet". Howls of laughter... So we retire to a quiet location to have a rest, drink and ... some blogtime!
This afternoon has already an orchiectomy scheduled (that means amputation of the testicle) ... so we're not free as yet! And rumors of beer and dancing we're already in the air ( to celebrate the happy duty day)... so ... very curious about that as well...
Bye bye for now!
L
PS: katie has promised to blog and post pictures in the very near future... ;-)
Friday started with a very long visit of all (and I mean all) patients on the ward, both ground and 1ste level. With no assistants it was just dr Rada and me. After the wardround (using hands, drawings, nurses and my very elaborate Khmer vocabulary...), I headed for the OR, tired as a horse from the long week. There I found the two other traumatologists replacing a fractured hip with a prothesis. There were already aided by an instrumenting nurse and I saw the perfect opportunity to eclipse myself towards my cushy hammock. But my plan was foiled by a very generous dr Vuthy who insisted on my helping (in this kind of surgery the fourth player is generally just holding the leg in various positions). No problem I though, just an hour of work and it's breaktime; sleep; food, coffee, ... it was all just a few inches away. But as the operation progressed we had the switch from one prothesis to another and back to first whilst interchanging the heads to find the best fit. One part of the prothesis fell on the ground in this proces and twice I managed to catch another slippery bastard trying to get away. Two hours later and with some pulling and pushing the hip snaps into place and it's closing time. Dr Vuthy leaves this to the assistant and I help him... until the lights suddenly go out. Seconds and then minutes go by leaving us in the most complete dark. I have the genius idea of getting my torch (in my packback). Thrilled with this proof of intelligence I hurry back and shine the brightest Petzl light they could imagine... until after two sutures it fades to a mellow cellphone light barely illuminating anything (damn you cheap belgian supermarket batteries!!). The works proceeds and the final wrapping and bandaging is left to me and the nurses. The final straw came when apparently they ran out of sticky tape just that morning so we had to improvise on how we would go about fixing our construction of sterile swaps. For the "drain" which in belgium is an expensive looking proper drain with a vacuum mechanism bottle, we use a bit of silicon tubing with holes cut in and a surgical glove and for tying it to the tube I use a longitudinal plastic wrapper which had contained the urinary catheter. Under the appreciative eyes of the cambodian staff I start to grasp the Khmer way of improvising.
After that we have a quick lunch and head for the photo-shop to get passport pictures taken for the prolonging of our visas and the tickets to angkor wat. Snap snap and finished... but the processing of the pictures takes several minutes and the printing seems to be a terrible task to perform. Our midday break vanished in smoke. We hurry back to the OR where Katie perform a lumbar puncture (rachy) and I assisted her and dr Rithy in an emergency appendectomy. She can just about to the whole operation! Thank you dr Rithy!
A bite in our favourite local restaurant proves an agreeable experience and we manage to order food and drink! Quite a challenge if nobody speaks anything but Khmer... Early bed for us... but ! As we're getting to the hotel we see our fantastic dr Rithy at the table of the hotel restaurant (owned by him and his wife). He is there in the company of dr Lem so Kong (terrific guy as well), and their wifes. Apparently they were having a company sponsored dinner (in a post-communistic community!) and dr Lem so Kong inquires if we possess a cambodian cellphone number. He urges us to buy one soon because how else will he contact us on a weekend day when.. he's on duty! No temples for us yet....
This afternoon has already an orchiectomy scheduled (that means amputation of the testicle) ... so we're not free as yet! And rumors of beer and dancing we're already in the air ( to celebrate the happy duty day)... so ... very curious about that as well...
Bye bye for now!
L
PS: katie has promised to blog and post pictures in the very near future... ;-)
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| Nurses on my ward |
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| One of the corridors of the ward, surplus patients are put in the hall until one of the beds is freed up |
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| Our trusty companions the OR nurses Mr Diamond (Pich) on the left and Mr Clean (?) on the right |
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| Friday afternoon staff meeting with the speaker Dr Rada and with regular intervals Dr Rithy (subject shoulder dislocation) |
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| Katie doing a spinal lumbar puncture. The patient has had traditional hot ventouse treatment. Unsuccessful apparently. |
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| Cute kid! |
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| Pre-Appendectomy with Katie on the right and the S'ray Saat on the left. |
Tuesday, March 8, 2011
Le Moustique est sterile...
Monday 7th; after ward rounds on monday morning I headed to the OR for the day's surgery but there wasn't an anesthesist in sight. Dr Rada explained that the hospital director had announced that all salaries would be paid in full at 9.00 AM. Since by now it was already 10.00AM there was clearly a delay in payment. Dr Dara also told us that a waiting period of 2-3 months for the monthly salary was standard... he's a very patient man. At 11.00 AM we decided to postpone the operation until the afternoon; so we wheeled the patient back whence he came and retreated to have an early lunch. On the way we crossed an indoor market aerea and I decided to ask once more for a Hammock (all cambodians own one and sleep in it at least 3-4h during the day!). But I could only find cheap tourist stuff and had refrained from buying anything until today. The shopkeeper told me to wait and after a while jumped from behind the corner with a magnificent army style hammock complete with mosquito net. Nice but maybe a little extravagant for my noon nap. She also showed me some simple but sturdy nyloncanvas hammocks which were very much to my liking. After some harsh bargaining we walked away with it for 7$ when she wanted 12$... so reasonably happy about it (while she obviously wasn't!). I'll soon posted some action pictures of me and my hammock...
The afternoon kicked off with an acute appendicitis and the femur and tibial fracture afterwards. Katie was assisting dr Vuthy on the appendix (and I was watching, waiting for the traumasurgery to start), when suddenly a mosquito landed in the middle of the operating field. Quickly chased away by dr Vuthy he added "c'est pas grave, le moustique est stérile!" and smiled. We all laughed very hard!
Tuesday 8th; international womens day! Celebrated as a national holiday in Cambodia we were only due in the OR at 09.00AM. It is a remarkable fresh day (about 20°C) covered with clouds as wait in front of the surgery doors until suddenly; out comes dr Rithy to tell us that there is an abdominal abces waiting to be drained but no staff to be found (because of the holiday). The session is recessed until the afternoon. Back in the OR the drainage is nearly at an end but my supervisor dr Rada is happy to have an assistant for the EUG he's about to start. An EUG is a pregnancy which isn't located in the uterine cavity and can cause serious problems (like bleeding). Strangely enough the patient seems quite fine. Most of them do as a matter of fact. She complains about pain but shows no sign of discomfort. I was already convinced that this was bad diagnostics and a terrible candidate for surgery... but as soon as we open the abdominal wall a gush of old blood comes to the surface. Katie stands in as instrumenting nurse for the occasion and off we go emptying the belly. Big chunks of coagulated blood are dug out manually and the suction device is working full time. The source of the problem is located and dr Rada performs a salphingectomy. Then we continue cleaning the bowels of the bloody mess. Dr Rada and I do one side each and he urges me to put my hand inside the abdomen until I can put my fingers between the liver and the diaphragm (to avoid quantities of blood remaining there when the patient is in a supine position). As I see my hand disappearing inside I have the feeling that my whole arm is inside the patient (luckily for her it wasn't). But an interesting exercise one the less! We pour large quantities of saline solution in the belly to wash and once we aspirated it again, we can start closing. Dr Rada does the fascia and the muscle wall. I finish the subcutaneous fat and the skin with very delicate (and time-consuming) stitches. Katie approves of the work!
The afternoon kicked off with an acute appendicitis and the femur and tibial fracture afterwards. Katie was assisting dr Vuthy on the appendix (and I was watching, waiting for the traumasurgery to start), when suddenly a mosquito landed in the middle of the operating field. Quickly chased away by dr Vuthy he added "c'est pas grave, le moustique est stérile!" and smiled. We all laughed very hard!
Hearty Breakfast before the day's Work
Traumatology Ward on the right, open air "kitchen" in the distance
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| The ever-smiling Dr Rithy |
Katie!
Yours Truly
Sunday, March 6, 2011
Jack Fruit
Well, it's nearly time for bed here but there's just enough time left for a bedtime story. It all started on saturday when having enjoyed our eggs and bacon at the breakfast table we climbed on our trustworthy iron steeds and headed East. Our saddles were hard and the temperature was already nudging the 30°C. Crossing the town bridge we took the NH6 in the direction of Phnom Penh/Kampong Thom heading for the Temples of the Roluos group and the temple of Bangkor specifically. So off we trodded through the busy Siem Reap roads lined with shops, markets and restaurants while pedestrians, cyclists, motos, tuktuks, cars and trucks whizzed past us both left and right. Eventually we got out of the centre and the more tranquil countryside. Tranquil but hot, and with speeding busses not really more relaxing. After about an hour and a half I had no idea how far along we were since our little lonely planet map didn't offer that many landmarks.
But then out of the trembling hot air came a little painted "Bangkor 2 Km" sign that almost made us dance with happiness! Full throttle ahead until we discovered our very first pieces of sandstone and behind it ... our very first cambodian temple. Set in the midst of greenery in the midday sun it was a sight to behold. Full of enthusiasm we headed for the entrance but a guard stopped us and asked us for our tickets. We gently responded that we did not posses any such document and kindly wished to purchase some from him. But unfortunately the purchasing of tickets is only possible at Angkor Wat... So the temples would have to await our closer inspection if we wanted to avoid a 100$ fine. But none the less enthusiastic we cycled ahead to the little town of Roluos to get a drink and find the most beautiful temple of the group: bangkor. This even more impressive towering edifice was magnificent to see... from far away. No entrance without ticket we were told in a friendly but unavoidable way. So we retreated to the town (about 4km further away through small dusty country roads). Enjoying the views and the people on the way.
Cambodians in general don't expect foreigners to speak any Khmer at all and even the minimum of words in their language usually provoke admiration... and hilarity! They often look at you with a grimace of suspicion until they hear a friendly "sour s'day" and then their faces break open into the most heartwarming smile you could possibly imagine. Visiting the local market I feel that the chain of my bike is loosened but when a group of boys come to bring me the chain I realize we might have a small problem. Being about 20km from home with a broken bike. Luckily I spot a little garage type workshop where a young man is mending a moped. I ask if he can fix my chain and after some looking and discussing he simply says; "wait". In the meanwhile we make ourselves comfortable in the 30°C hot shadow and I start conversing in my very best broken Khmer with his wife. Their little son is there too, his hands black from playing with some dirty engine parts. They are a very tender bunch. Soon we are laughing and talking (Khmenglish) and being offered fruit. Jack fruit more precisely. We had encountered this bizarre fruit in Zanzibar before. The outside is rough and green and the inside is yellow and wirey with large pits in it. It rather tastes like pine-apple but more meaty and less juicy. Delicious. When the bike is ready we are quite sad to leave this lovely family. And when I ask him how much we owe he simply says "up to you". Unkowning what to offer we hesitate between 10 and 5$, we don't want to offend anyone and I suggest to give him 5$. They all burst out laughing; 1000 reels is all they want (20 times less). What a lovely people.
We head back for Siem Reap, passing by Bangkor again, and after two stops we make it to the hotel. We end the day in the city centre with a cambodian bbq (beef, chicken, squid, snake and crocodile meat). A welcome reward!
Sunday is spent reading and studying (it must be done sometime!). And just resting in general; preparing for the week to come...
Bangkor Temple with it's impressive artificial pond surround it (view from the North)
But then out of the trembling hot air came a little painted "Bangkor 2 Km" sign that almost made us dance with happiness! Full throttle ahead until we discovered our very first pieces of sandstone and behind it ... our very first cambodian temple. Set in the midst of greenery in the midday sun it was a sight to behold. Full of enthusiasm we headed for the entrance but a guard stopped us and asked us for our tickets. We gently responded that we did not posses any such document and kindly wished to purchase some from him. But unfortunately the purchasing of tickets is only possible at Angkor Wat... So the temples would have to await our closer inspection if we wanted to avoid a 100$ fine. But none the less enthusiastic we cycled ahead to the little town of Roluos to get a drink and find the most beautiful temple of the group: bangkor. This even more impressive towering edifice was magnificent to see... from far away. No entrance without ticket we were told in a friendly but unavoidable way. So we retreated to the town (about 4km further away through small dusty country roads). Enjoying the views and the people on the way.
Cambodians in general don't expect foreigners to speak any Khmer at all and even the minimum of words in their language usually provoke admiration... and hilarity! They often look at you with a grimace of suspicion until they hear a friendly "sour s'day" and then their faces break open into the most heartwarming smile you could possibly imagine. Visiting the local market I feel that the chain of my bike is loosened but when a group of boys come to bring me the chain I realize we might have a small problem. Being about 20km from home with a broken bike. Luckily I spot a little garage type workshop where a young man is mending a moped. I ask if he can fix my chain and after some looking and discussing he simply says; "wait". In the meanwhile we make ourselves comfortable in the 30°C hot shadow and I start conversing in my very best broken Khmer with his wife. Their little son is there too, his hands black from playing with some dirty engine parts. They are a very tender bunch. Soon we are laughing and talking (Khmenglish) and being offered fruit. Jack fruit more precisely. We had encountered this bizarre fruit in Zanzibar before. The outside is rough and green and the inside is yellow and wirey with large pits in it. It rather tastes like pine-apple but more meaty and less juicy. Delicious. When the bike is ready we are quite sad to leave this lovely family. And when I ask him how much we owe he simply says "up to you". Unkowning what to offer we hesitate between 10 and 5$, we don't want to offend anyone and I suggest to give him 5$. They all burst out laughing; 1000 reels is all they want (20 times less). What a lovely people.
We head back for Siem Reap, passing by Bangkor again, and after two stops we make it to the hotel. We end the day in the city centre with a cambodian bbq (beef, chicken, squid, snake and crocodile meat). A welcome reward!
Sunday is spent reading and studying (it must be done sometime!). And just resting in general; preparing for the week to come...
Roadside restaurant km 12
Bangkor again, view from the East
Our saviours!
No comment needed
Jack Fruit
Roadside view, almost home
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