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Second trip 29 September, 2009

The weather was very different and although the first day started well, albeit with deeply overcast skies, the weather changed dramatically in the evening after the first Moat Klas clinic and supper.
We went to bed early as usual around 7.45 pm but I was woken around 11pm by water around my feet and legs and discovered the bunk and sheet were soaked . It had started to rain heavily with a high wind and this, we discovered afterwards, was the tail end of the tropical cyclone Ketsana that had just battered the Philippines. The hatch above the bunk open had been propped open with an insecticide aerosol to achieve some much needed ventilation and when the rain had started the water had come in to the cabin fuelled by the increasing wind! A quick dry out, the removal of the sheet and replacement with a damp but adequate towel solved the problem (although a persistent ?dampness? remained) but the weather worsened rapidly and we woke to torrential rain and very high winds at 5 am. There was no visibility at all and the TLC-1 was moving around a lot, banging against a pontoon away from the chief?s house to which we had been moved during the night.

The forecast was for continuing severe storms and rain over the next two days so the only option was for us to stay moored at Moat Klas and ride it out and wait. Luckily I had two books, which I had not expected to read, and this laptop. We also used the time for some clinical discussions about the management of hypertension CCF Diabetes and stroke secondary prevention ( there is a woman with a hemiplegia at Moat Klas and a very high blood pressure around 170/120).

The chief said that 7-8 people died during the night in the storm and apparently ended up in the water when their house broke up. They have not yet been found and may not appear again for several months, if at all. Some of the houses are fragile and unstable and would be expected to come apart in winds of this magnitude. A further 20 people suffered injuries overnight including fractures which have not been treated and they could not get across here to be seen due to the wind. Another house was completely turned over in the wind. No one was injured in that case but they lost all their possessions and their home. The village chief advised everyone to stay home and for some to move their houses, if they could, to more sheltered locations.
During the clinic the day before I saw a one month old baby who was failing to thrive and sick. His birth weight had been 3 kg, he had had a fit at about 10 days of age, although getting a clear history was not easy. It made me realise the limitations of an outreach clinic but also the benefit because we were able to tell his mother to take him to hospital - previously the parents would have done nothing except wait and he would probably have died. He still may but his mother was willing to take him to hospital in Siem Reap although unfortunately not that afternoon as it was too late to get there through the waterways. These are the logistics of remote health care which we do not need to consider when working in the West.
The following day we woke to light rain and a reducing wind and we were able to do a further morning clinic at Moat Kla for about three hours. We saw no injuries in fact and it mainly consisted of children.

We set off again after lunch and had a fairly uneventful trip back to Kampong Klang but we saw some wonderful birds including Pelicans.
On the way back in the Land cruiser we began to see some of the effects of the storm. A small village had been 70% destroyed by the wind with broken houses and even a concrete wall. They were already beginning to try to repair this. As we approached Siem Reap we began to see evidence of significant flooding. The Siem Reap river had burst its banks for the first time in nearly twenty years and the roads were littered with broken down cars and tuk-tuks. In the picture below the river is to the left behind the trees and the road ahead is completely covered in water.
We drove through this, boat-like, in the Land cruiser scattering water in all directions to the TLC headquarters where we unloaded prior to bicycling back to our apartment via the Angkor Market. We managed to avoid the water until we arrived at Raffles Grand Hotel where the water began. We crossed the river on the bridge and proceeded to Wat Bo road where we hit the water which continued to our apartment (fortunately on the first floor) with a depth varying between 6 inches and a couple of feet. So we got pretty wet but it was a unique experience and gave us a whole new take on Siem Reap.

Dr. Michael Shepherd
September 2009