Out on the Lake

I have known Jon Morgan since 2001, seeing him each year on my volunteer trips to the Angkor Hospital for Children. I had heard a lot about the TLC project and was anxious to see how the project delivered health care to the remote floating villages on the Tonle Sap. I was the pediatrician on the December 16-18, 2008 trip.

I had met with the staff and Drs. Mette and Stein several times for briefings before the trip and went over the medical supplies that would be available on the boat. It was with great excitement that I met Jon at 6AM at the Blue Pumpkin for coffee and last minute instructions. The crew assembled at the TLC office, loaded the supplies to the van and drove about 1.5 hrs to get to the boat dock.

The boat was actually larger than I had imagined from photographs and had a spacious cabin below deck, complete with cooking area, a sand filter for clean water, berths and toilet/shower. Solar panels for electricity were on the upper deck.

Any anxiety I had about the trip, fell away as I got to know the medical crew on the boat, learned more about what types of patients we would see and realized how supportive the crew would be to me. This was also the first trip for Dr. Somboun, a Cambodian physician who would see the adults while I saw the children. Savann, a nurse I remembered from AHC would be my nurse, translator and I would rely on him to tell me how various medical problems were handled on the TLC.

We made a brief stop at Moat Klas to check in with the village chief, then continued on to Peck Chikrey for our afternoon clinic. This was a restful, lovely 4 hour trip on the glorious Tonle Sap Lake, which included lunch enroute cooked by our ship’s mate, Aly.

We saw about 30 patients that afternoon, most of them children. Some were there for their first ever visit to a doctor. Many had respiratory problems and various forms of mild gastrointestinal disease. Several patients stand out in my memory.

I saw a 3 month old with significant pneumonia. He had mild respiratory distress, and difficulty breathing. We were able to ease his breathing somewhat, start him on antibiotics and he will return for follow-up at the next clinic.

An 8 year old boy had a very large abscess on his buttock. This obviously needed to be drained. Savann and Dr. Somboun and I took him to a separate area, away from all the waiting patients, the dogs and general village activity of cleaning fish and mending nets that was also going on in our clinic space. We explained the procedure to him and I was pleased to see that everything I asked for, Savann quickly pulled out of his “surgical” kit. I did the incision and drainage, inserted a drain (a finger of a sterile glove) in the wound and dressed it. The child was given antibiotics and would be seen the next week.

There was a 3 year old boy with an extensive 2nd and 3rd degree burn on his torso from boiling water that had happened 3 weeks ago. This was the first time he was being seen. I debrided the area as best I could. But felt it would have healed better and with less scarring if he had been seen sooner.

After Clinic, we had a 1 hour ride back to Moat Klas, enjoying the sunset on the lake. Following a great dinner of rice, chicken, vegetables, fish soup, a little socializing with crew and village chief, it was time for lights out about 8PM. I slept pretty well in my berth, with my mosquito net, bug spray and the help of a sleeping pill. It had been a great day. I felt we had made a real difference to some of the patients we saw, did some important screening exams and were a part of bringing a modicum of health care to people who have had no access to care.

I was up at 6AM, swam in the lake, did yoga with Savann on the upper deck, ate breakfast and then we started clinic about 8AM. This was a busy day with over 90 patients seen. They included another 2 month old with pneumonia, several children with draining ears, one who had had a seizure and another burn patient.

The clinic was on the village chief’s float, which was a large space and functioned as the village center. This was a major social event for the village. People came to be seen by us and also just to see what was going on. Food sellers constantly pulled their boats up and sold noodles, rice and candy to the villagers. Fish sorting, net repair and other parts of village life went on a few feet from where I was seeing patients.

We watched the sunset as we took a boat ride around the village, saw fish traps, how people lived in their tiny floating bamboo shacks and returned to our boat for a dinner of fish, rice, vegetables and soup. I went to sleep around 8PM as the Karaoke across the lake was closing down.

The next day, I watched children going to school by boat. Some paddling, some in motor boats of various sizes. After breakfast, we had another clinic and by the time we left, we had seen a total of about 140 patients.

I thoroughly enjoyed my time on the TLC-1. The Program offers a much needed service to the people living on the Tonle Sap, by providing health care and health education. I look forward to another trip when I return to Cambodia next year.

Robert Nassau, MD
7 February, 2009