Santé Mental (Sentimental)

Our first week at the Siem Reap provincial hospital has come to an end. The work is rough and enjoyable at the same time. Luckily we have plenty of opportunities for reward in the city centre (iced coffees, great food etc). Because after some of the things we've seen and done, we often need some quiet time to make sense of everything (and to get away from the heat).

The day usually starts at 8.00 AM in the staff meeting room. All the doctors are there and discuss the previous' day exploits. Furthermore whenever a problem arises it is discussed in this place. Then we both head to our seperate departments. I start doing the ward rounds with dr Radad. The little building has about 50 beds. Although not every patient has a bed to lie in. There is no glass in the windows and a constant draught keeps the rooms cool and the smell tolerable. Since the day before yesterday I have been handed charts like dr Rada, and they expect me to interrogate patients by myself! (I guess it's my own fault for trying to learn some khmer words!). My medical vocabulary is extremely limited and apart from the 'do you have pain', 'where is the pain' and 'is it better than yesterday' which I learned from dr Rada, it's mostly gestures and clinical examination. Patients are treated very differently here. For as much as I can gather the doctor still enjoys a god-like status and patients are happy even if he only stops by for 10 sec to check the medication. Then we go to the Operating Room or BO (bloc operatoire). At noon we take a break and have lunch in town. Then we sit outside the BO to read in the heat until the emergency operations or the afternoon schedules gets going. In the mornings we usually join in the operations of our departments but the afternoons are a variety of ENT, visceral, urology, gynaecology etc...
After all that we cycle home between the crazy scooter and tuktuk traffic to our superb hotel. And if we can manage at al to get down the stairs again .. we have a swim!

It is not my intention to scare or nauseate anyone but here are some examples of what kind of things happen at the hospital. Yesterday I was hurried to and operating room together with an abdominal surgeon because of a "péritonite". Before I truly grasped what was happening I was holding the man's swollen intestines looking for the problem inside his belly. Appendix looked fine, gallbladder ok, but then somewhere between the intestines we stumbled upon alot of green blubber. looking closer it had the appearance of an abces. Looking closer there were multipel holes in the intestinal wall... I asked the surgeon what he thought of it and he said "typhoid", I very much doubted that but what do I know. So we start emptying the gut through one of the holes. A gallon of bright green fluid and rice comes flowing out. Until suddenly we feel something hard. A tumor? No, it moves... we enlarge the hole and with a clamp the surgeon pulls out a piece of bone like a bunny out of a hat. It was extremely sharp and hat perforated the gut several times. Close and out.

The other patient I want to mention is a little girl of about 16 who got her long black hair caught in a stone grinder in a diamond factory. She survived but was completely scalped. I had seen here lying down at first. But yesterday she was sitting in bed. Crying a little bit. The doctor removed a few loose cotton swabs to reveal a large part of her skull exposed. We were looking at the girl's skullbone. The doctor explained they would perform a skin transplant as soon as there was enough scar tissue. The girl asked about her hair. But  ofcourse she will never have hair on her head again. And I think she'll be lucky to be alive next month. But the nurse suggested something which made the doctor laugh. I asked for a translation and it seemed the nurse had suggested they use skin from the pubic region so she would have hair again. They laughed very hard. I was very shocked. Things are very different here...

Well, it's weekend now and we'll try to get a sneak peek at some temples. So off we go!

 Old Market Siem Reap

 Breakfast at the hotel

 Crossroad at 8PM

L.