I'm writing from Sihanoukville, Cambodia, the location of the final battle of the Vietnam War (the Mayguez Incident) in 1975. I've had a busy last week, volunteering for day missions that supplement my night shift work (this translates into 24+ hour shifts with a few hours in between to sleep), so please factor in my fatigue when reading this post. (And thank you, Cpt. Faye Pyles, for obtaining computer access for me after several unsuccessful hours of attempts to get on-line this morning).
The week began with the cultural issue of trying to figure out how to persuade pre-surgery patients from eating the large pots of rice we keep on the wards. A sympathy reaction of such extremes was evoked in the other patients that they began sneaking food to those awaiting surgery; explaining aspiration risks means nothing to hungry people who are uncertain whether and when a next meal will arrive.
Another cultural issue is the concept of time for people who do not wear watches. When the lights go out (i.e., the sun goes down), the patients immediately fall asleep and become a little frightened if we have to rouse them for medications during the night. I will say I never saw a group more prompt in rising once the lights come on in the morning. Issues of time also arose when patients had to wait for scheduled medications or for the doctors to make their rounds.
I continued to pass out gifts and at one point had every patient on the ward wearing a Vroman's bookstore sticker that said, "proud member of the human race." I donated the bookmarks to the library, however, because the interpreter explained my patients don't own books. The most unique gift, by far, was courtesy of the US military. A menstuating woman asked for a bit of cloth and when I gave her a sanitary napkin she was the talk of the ward. Every female patient that night, from the teenager to the woman in her late 80s, began to menstruate and I was happy to pass out souvenirs to all.
Every patient is deloused and undergoes a TB test prior to boarding but our patients on land suffer from both of these maladies. Healthcare access is rare (the Khmer Rouge executed most of the nurses, dentists, and doctors in this country). A patient my daughter's age boarded the ship with her young husband for treatment regarding pain she had experienced a considerable amount of time. The team discovered the young woman was filled with Cancer and the doctor's last written sentence was "beyond the capacity of this ship." The young woman explained there had been no available local doctors from whom she could seek diagnostic tests.
My days ashore were equally interesting. I commuted via transport owned by the USA, Cambodia, and Japan (the latter present in the area for a joint exercise). I noticed more cars in Cambodia and, to my surprise, traffic lights (evidently merely ornamentation as not a single vehicle slowed - let alone stopped - for a red light). Like Thailand, small golden altars (they look like elaborate bird houses on poles) appear outside every building. Cows, monkeys, and dogs (many sick - there is no such thing as a rabies shot here) roam the streets and, in one section of town, workers fix crab nets that line the sides of the streets. Many people are barefoot, the more affluent shod in what look like flip-flops.
I saw 3 types of homes: tin shanties in town, wooden houses on stilts in the more rural areas, and the colonial French architecture common to Vietnam. I talked myself into the last of the three and entered a foyer used as a living room, then 3 bedrooms in a row with futons (no closets or armoires), and a small kitchen in the back (no electricity or running water) with what looked like a gas-fueled 2-burner camping stove. The bathroom had a bucket and rainwater for showering. Three generations of 6 people lived there.
During the week I joined different teams to teach, visit schools, orphanages, and churches (Cambodia has not outlawed missionaries as has Vietnam). Students wear the national school uniform of white shirt and navy blue skirt or pants with flip-flops. We gave every student at every school and orphanage a beautiful pack filled with school supplies donated by the LDS (Mormon) church. At the first school about 100 children stood in long lines of girls or boys and greeted us in Khmer and then in English. They sang for us and then we played games with the children, finger-painting, blowing bubbles, soccer, and comforting some of the younger ones.
One orphanage I visited this week is run by a missionary from St. Louis. His wife said their children arrive either because poverty has forced their parents to abandon them, their parents died of TB (very common here), or their parents died of AIDs (also common here). The youngest child, nearly 2-years old, was found last year in the local market with a "for sale" sign around her neck.
We toured the grounds of the school and watched their "cafeteria ladies" cook lunch (mounds of whole fresh fish) outside, over large open fires. The orphanage kept pigs and alligators for food and each child had a small garden plot to grow vegetables.
When it was time to go the childrern were clinging to us and many asked to be hugged.
I had the privilege of teaching (I use this word loosely since my materials were in Khmer, a language unknown to me, and my students didn't know English) where our medical teams were working. We traveled first by boat and then by van into a rural area devoid of running water and electricity. Hundreds of people were waiting for us in weather well over 100 degrees, without water, without restrooms, and in the monsoon season when there are - and were - sudden heavy downpours. Frantic to be seen by a health care professional, I saw many of them lose their shoes after being directed to enter the area. They were so desperate for medical care they literally ran out of their shoes and didn't dare take the time to stop to retrieve them for fear of losing an opportunity to receive care. When it came time for me to leave I counted the shoes left behind.
My small group of 4 tried to enter by foot but so many hundreds of people starting crushing in on us that the Cambodian military escorted us in by a different route. Approximately 550 people were seen the morning I was there and an equal amount were seen that afternoon. People waited in long lines and were triaged (prioritized) in one room, each person receiving a colored paper bracelet denoting their next destination (for example, a blue paper bracelet might indicate the patient was to be seen by the dental team).
Nurses, dentists, and doctors all put in many long hours treating people who had rarely, sometimes never, seen a health care professional. Pharmacists dispensed medications (all free) and the Japanese managed to unload a huge hospital vehicle from their warship that was a cross between a tank and an recreational vehicle (RV), with large sliders on the sides to extend its width, and a portable generator.
There was no air conditioning and no shade and everyone worked many hours in extreme heat interspersed with heavy downpours. There were many children, a few pregnant women, Buddhist monks and nuns, and a woman with unequal pupils who was carried in by 2 men. She died en route to the hospital and I heard from the physician (one of my room-mates) who accompanied the patient that the hospital looked like an open-air school with a lot of rooms but no medical equipment.
I enjoyed a few hours of liberty in Cambodia and experienced a foot massage provided by fish eating the dead skin. It was excruciatingly ticklish but my feet emerged smooth and shiny. The cost for this was $3 USA and it included a regular foot massage before the fish foot massage and my choice of beer or soda. The tuk-tuk (cyclo, or rickshaw) I rode cost $5 USA for 5-10 hours of riding around town. Before the fish foot massage I visited a Buddhist monastery and pagoda that had on its grounds a fountain circled by statues of little boys peeing into it.
Adjacent to the pagoda and monastery was a cemetery reminiscent of the spirit houses of Eklutna (near where we lived in Anchorage, Alaska) and the cemetery near our home in New Orleans, Louisiana, with above-ground spirit houses. Atop each grave was an elaborate mini-pagoda with the elegant and ubiquitous tile I saw all over Vietnam's sidewalks and in the buildings of Cambodia.
Everywhere I went my Project HOPE shirt was spotted and I was thanked either in Khmer ("aw-koon") or in English "thank you for what you do for my country" and every time they would make the "Y" (hands clasped before their faces) and smile. This has been a profoundly humbling experience.
I spent a busy week working, teaching, and visiting schools and orphanages. I was invited to be part of the team to represent Project HOPE at the closing ceremony this evening on the Japanese military carrier. After the ceremony I'll return to our ship and assume charge nurse (supervisor) night duties in my ward until 7 a.m. tomorrow morning. There is not much time left before I meet David in Singapore and I can't wait to be with him again. All of us work long hours, realizing this is the time to serve - sleep can wait.
