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The Tonle Sap is big, really big!

It’s not only the largest lake in SE Asia, but home to some of Cambodia’s poorest and most isolated families. They live by fishing, and their livelihoods and floating homes move several times each year, according to the water. By the end of the monsoons the lake will cover 8 times the area that it covers in the dry season – vast bodies of water become vegetable gardens, navigable boat routes become tiny streams, and access becomes increasingly difficult.

All of this makes life and work a challenge for the health care teams who work on The Lake Clinic boat, a floating health care service for thousands of families for whom there are few other services available – no electricity, no clean water supply, no sewerage, no public transport, and no food supplies other than those harvested from the lake. Floating school rooms, and sometimes even floating health clinics, are present in many villages, but rarely do teachers or health care staff from the land stay to work in these inhospitable locations.

The Lake Clinic boat, TLC 1, with its teams of Khmer doctors, nurses, midwives and support staff, visits each village on its route every 4 – 6 weeks. People paddle in small wooden boats, motor in fishing boats, or get lifts with friends and neighbors to gather at the clinic reception. Children are often malnourished, old people have untreated chronic illnesses, fishermen may have injuries, and pregnant women come for ante natal care. People needing more intensive treatment are advised to go to hospital in the towns, women are encouraged to go to hospital for delivery of their babies, but often they don’t have the resources to make these trips. Babies born in the floating villages suffer one of the highest neonatal mortality rates in the world.

I worked as a volunteer nurse and midwife on TLC 1 during the wet season, when we had access to many villages. This entailed a 5 – 7 hour trip across the lake from a port near Siem Reap, carrying all supplies and equipment needed – easy in fine weather, but treacherous in heavy rain and strong winds. Over 100 patients are seen on many days, and float home with medications, or bandages, maybe new glasses, and always with reassurance. This service is provided without charge, and the caring connection between patients and staff is a joy to see.

The service could be improved. Days of travel time to and from these isolated villages means that only 2 clinics are held each week – a faster boat would mean less time commuting and more time seeing patients. Access to many villages is difficult or impossible in the dry season due to low water levels – a large boat with a shallow draught would accommodate staff and adequate supplies year round. In an emergency such as acute illness, accident or equipment failure, a rapid response boat for support would be very much appreciated.*
Lorel Adams; midwife and author (L)
However, the TLC 1 visits continue, and families living on the lake are healthier and happier because of this support.

*TLC Note: Not just one, but funding for two new boats has been secured and will be constructed this year.