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December 2009

Dr. Robert Nassau and a young patient.

As I planned my return volunteer trip to Cambodia, I was looking forward to making another opportunity to spend time on the TLC Boat. In December, 2009, I went out on the boat twice, once for three days and once for four days. Here are some of the thoughts and impressions that stand out most in my mind:

Jon Morgan has put together a great crew who work well as a team. Several of them, Savann, the nurse/translator, Dr. Sambun, and Aly--the pilot and chef--were on the trip I took in December, 2008 and have gone out on the boat almost weekly for over a year.

We were joined this year by Ya (right above), a midwife/pharmacist, and several village health volunteers from the floating villages who help with cooking and registering patients.

It's not easy to live, eat and sleep in such close quarters with 6-7 people week after week. However, the staff was always in good humor, joking, laughing, sometimes I?m sure at my expense, and clearly enjoyed working together. The meals were always exotic and delicious. Villagers gave us fresh and dried fish, Aly brought plenty of fruit and vegetables, and of course, there is no shortage of rice!

Villages are scattered along the lake, sometimes on rivers that flow into the lake. During some of the trip, we are on the huge open lake where there is often a very distant view of one shore and no sight of land in any other direction. The views are spectacular. At times we motored through very flat water, under a leaden sky making it hard to see where the sky meets the water in the far distance. The trip to some of the smaller villages involves following meandering narrow channels, choked with water hyacinths and half submerged trees.
Navigation can be tricky and Aly and Savann do it together using a GPS. Sunset, sunrise, and the myriad of nighttime stars, planets and satellites are a real visual treat.
TLC brings medical care to people who have no access to any medical care because of their isolation on the lake. The expense involved in getting to shore and from there to a medical facility is more than most of them can even contemplate. As a result, there are many children and adults with previously undiagnosed conditions.
TLC is able to provide screening exams for villagers, treatment for many acute illnesses, and medication and follow up for chronic problems such as hypertension. Midwife services and prenatal exams are also provided. Many patients have minor problems but for some the medical care provided by TLC is essential and long overdue.

On my two trips this year, I diagnosed significant problems in a number of new patients that will require further consultation and surgery. I saw two infants with congenital deformities of the penis who will need surgery, and two young women with congenital orthopedic problems that should have been addressed many years ago. They were a 15 year old who hopped around on one leg because she was unable to fully extend her other knee and put that foot on the ground and a 21 year old who had a non-functioning hand from birth because the four fingers were fused together to form a cup. Sadly, although they can both have corrective surgery now, it is difficult to know how much their function will improve. We also discovered a 5 year old girl with congenital heart disease who will require a workup and surgery.

After returning to Siem Reap, Savann and Jon made plans for the evaluation and treatment of these patients by the staff at Angkor Hospital for Children. TLC will bring them to shore for their appointments and has funds to provide them with a place to stay and money for food. When I asked Savann how will he get in touch with them again, he said: "No problem. I have their cell phone numbers!"
One man had a huge laceration on his hand from trying to start his balky outboard engine. The laceration had to be well cleaned and sutured using all my surgical skills! Savann had all the necessary supplies in his surgical kit. There was also a 2 year old who was rushed into one of our clinics. He had just swallowed some gasoline but seemed ok, probably had not aspirated and his lungs were clear. We told the family we would call them back in 4 hours for a progress report and make arrangements to pick him up if he was having breathing problems. When Savann called, he was doing fine.

Lastly, on our return we brought back a man with a severely gangrenous toe that required amputation in order to save the rest of his foot. TLC made all the necessary arrangements for him.

My few trips on the TLC have shown me how important this project is for the people on the Tonle Sap Lake. It is bringing basic and essential care to those who have had no access to care in the past. Importantly, TLC has a plan to provide consultations and sophisticated surgical and medical care for these people when indicated. There are funds that have been donated specifically for this purpose. I look forward to more trips on the boat and will to continue to support this program financially.

Dr. Robert "Bob" Nassau, MD
Putney, VT
December '09