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"I alone cannot change the world, but I can cast a stone across the waters to create many ripples." -Mother Teresa

By John Vaughns | June 07, 2013

As we embark on the last day of clinic, I think back to how frustrated I was the first day with limited resources and having to communicate through an interpreter. Even with mental preparation of expectations, I could not break what I have grown accustomed too in an American teaching hospital. With unrealistic idea that I could provide the standard care that we receive in our developed, wealthy country, I quickly had to learn solutions with the resources that we had. Most of my frustration surrounded the lack of followup, whether if it was an appointment or an email, in this age of telemedicine. Without the followup, I have no idea if my patients were compliant or even understood my assessment and plan.

 

During this trip, I did have the opportunity to see two of my patients in a followup setting, giving me the ability to see the fruits of our labor. The first patient was the older male with a 12cm by 8cm mass on his neck that was causing him to have trouble breathing and swallowing. He followed my instructions, went to Sonja Kill, and received evaluation. It might not have changed the outcome of his prognosis, but if there was a chance at improving the quality of his life, our care and the presence of Sonja Kill Memorial Hospital gave him the best chance at a higher standard of care.

 

My other patient was a older lady, who presented in Hypertensive Emergency, with a blood pressure of 220/110 and right-sided numbness with weakness.  I spent the majority of our time convincing a poor farmer with little resources to get her son to immediately drive her over to Sonja Kill Memorial Hospital nearly an hour away for yet another chance at the healthcare afforded to us. I told her to come back in the morning to make sure that she actually went to the hospital and took the medications we gave her. She came back the following morning  and followed my instructions to the very last detail. Sonja Kill gave her amlodipine, a medication not at our disposal, and aspirin prophylaxis. She also received blood work and a follow up appointment in a week. It might have not been as quickly as we would have done it in America, but it was done and she will have managed care to prevent any future organ damage secondary to hypertension, whether it be her heart, kidneys, or brain.

 

They both were so trusting and appreciative for what we able to do for them. These patients were a reaffirmation that our work was not in vain nor was it lost in translation. The work we did truly improved the quality and the quantity of life here in the Kampot Province, and the impact will be felt for many years to come. With over 1600 patients seen, examined, and reassured, referred, or treated, I am grateful to have this opportunity to serve and want to thank everyone who made it possible from the initial donors to Mercer On Mission to the faculty, who donated time or money, to interpreters, locals, and hospitals giving us a foundation to stand. The people here are of great potential held back by a minority of misguided souls hellbent on power and control. The greatness, the will and the strength of the people in Cambodia cannot be constrained or controlled. I hope to come back one day to see more progress by the people and for the people of Cambodia.

 


FINDING HOPE IN THE LEAST LIKELY OF PLACES

By Kelly Davison, MS III | June 07, 2013

We started at a new location that is called the blue church.  The morning brought several patients that had a higher level of illness than many of the patients we as a group had seem in the past several weeks.  One of the first patients that I treated had advanced amyotrophic lateral sclerosis, also known as Lou Garrick disease.  She lost the use of her legs over a year ago and now had begun to loose the use arms.  Additionally, she was starting to have difficulty breathing which is why she came to seek our help.  Her breathing had significantly worsened over the last few weeks.  I knew this was an ominous sign and that her muscles of respiration were now greatly affected.  There is no cure for ALS and here in Cambodia there is even less I can do to ease her discomfort.  I know this patient has only a few months left to live at best.  She not only does not know about the extent of her condition she has no idea how short her time actually is.  Apparently, in Cambodia when a patient has a terminal condition, it is common practice to NOT tell the patient.  The premise is that since nothing can be done to help them and the news will only cause added suffering, it is best for the patient that they not know.  Additionally, if a doctor informs a patient about an early death and that patient dies then the doctor is seen to have caused the death.  It is kind of like a self-fulfilling prophecy.  All I could do in this situation was to refer her to the local hospital and write out an assessment for whom ever treated her there.  I hope they will be able to ease her suffering.  

 

Another patient I treated was a 26 year old women whom had sustained a fractured leg at the age of 4.  The leg was never properly set and thus as the bone ends grew back together they did so misaligned. Due to her favoring the injured leg from the age of 4, but still using it, her good leg ended up growing abnormally.  Over the next 20 years her body adapted to her old injury to the point where now both of her legs are abnormal.  Currently at age 26 she is having bilateral hip pain from walking.  Again, there is little I can do for this patient outside of some pain medication and a referral to the local hospital.

 

In continuance of this theme, the next patient I saw had breast cancer.  She had a 3 cm mass in her left breast that was firmly attached to her pectoral muscle and several swollen lymph nodes in her axilla.  She first noticed the mass about a year ago.  She was not having any pain and again all I could do is refer he to the local hospital and hope she could get treatment there.  Unfortunately, her cancer is already at least a  stage 2 and I got the feeling she would not be following up with the referral I was trying to encourage her to get. 

 

One last example was an 83 year old lady with an abdominal aortic aneurysm that was about 10 cm in diameter.  She has had this AAA for several years and while she had a little discomfort form the pulsating mass she was otherwise doing well for her age.

 

These patients are all well outside our ability to treat and provide care for.  Also, they are the poorest individuals from the poorest country in South East Asia.  Lack of monies coupled with lack of adequate health care in the region sets up the scenario where they will never receive any care other than what this mission provides on a yearly basis..  That is probably the hardest part about this job.  I have always said, the worse feeling to have is one of wanting to help another individual and not being able to do so.  I have felt this way before and today, this feeling for me still holds true.

 

These are just a few of the difficult patients I saw at this one particular clinic.  It is easy to get discouraged at times, but fortunately, my next patient would would give me the encouragement I needed to finish out my time in Cambodia.  Unknown to me at the time, he would do more for me than I could ever do for him.

 

The particular patient I am speaking of experienced a stroke 5 years ago that had left him and paralyzed basically from the neck down.   He was no longer able to speak and it was a miracle that he was still able to breath on his own.  What surprised me even more is that over the last 5 years his family had been able to keep him alive.  They feed and cared for him daily and had even washed and dressed him in clean clothes for his visit to the clinic.  They transported him on a scooter sandwiched in between the driver and another person on the back.  The passenger on the back held him tightly and they were able to transport him down the road.  In America, this man would most likely have been placed in a nursing facility and died of pneumonia by now, but here in Cambodia he was kept at home and his entire family helped to care for him.  While many commented on how pitiful he looked and how discouraged the patient made them feel, I came away with sense of encouragement.  The love, support and amount of care to keep this man alive for 5 years is enormous.  The level of commitment that these people show to each other is amazing and this man's survival for 5 years is a testament to their devotion to family and community.  While I could do little for the man outside of helping with his blood pressure control and anticoagulation, for me he did much more.  After meeting with him and his family and hearing their story, I felt a renewed sense of hope, passion and energy.  I was ready for whatever the day would bring my way and I was sure to wear a smile for the remainder of my time here.

 


When it rains, it pours

By Kristen | June 06, 2013

Today, began with the usual hustle and bustle of clinic, but I was especially excited because I was finally able to rotate to the pharmacy. I enjoyed working in the pharmacy this morning. Working in the pharmacy gives me  a chance to work independently, because it's just you, the patient, and the interpreter. I also like the pharmacy, because i get to do a lot of patient teaching on the effects of malnutrition and dehydration, give tips to prevent constipation, and how discuss how to properly take the medicine they were prescribed.

 

I began my afternoon helping to see patients in the clinic. Of course as the saying goes, "when it rains, it pours". The rain came down harder and harder, and little did I know that my emotions regarding the next patient would go down with it. Our next patient was a 50 year old woman who came with several family members glued to her side. As we began talking with her, we could see the concern all over her family members faces. Their loved one was not herself and they brought her hoping for some guidance. I sat there almost in a trance watching as the signs pointed more and more towards a possible life threatening disease. I began to  get so overwhelmed with sadness for her and her family. Someone very close to me that is currently having medical issues came to mind, and the next thing i had to step away as tear drops were falling like the rain. No matter back home or here in Cambodia, seeing anyone's loved one in pain is extremely difficult. I really empathized with their concern and wished there was more I could do. As I pray for this woman and her family tonight, I thank God for the peace he gave me to get through the rest of this clinic day. While it was a tough day, i'm so thankful to be here experiencing something so unique and real. I am so greafful to have these experiences to take back to the states with me as I continue on the journey to RN BSN.

 


My Heart Grew 3 Sizes

By Lindsey | June 06, 2013

Today was a tough day in clinic. I broke... just a little bit... ok just a lot-a-bit.... ok I cried like a baby. Luckily, I had some wonderful people to pick me back up. I don't know why this was my moment. I don't know why this one patient hit me so hard. As I looked up from taking a blood pressure I saw a moped, aka the Cambodian minivan, rolling into the clinic packed full with a family of four. Not an unusual site over the last three weeks, but sandwiched between two people was a man who couldn't hold on for himself, he couldn't move his own body. He was scooped off the moped by a son, head bobbing every which way, set in a chair for vital signs to be taken and rushed into the clinic to see if there was anything we could do. As it turns out this man had a stroke 5 years ago and his family has be taking care of him ever since. He was clean. He was fed. He was in the best condition for the situation which is amazing in and of itself. It is the perfect example of the unconditional love of family shown by members of the Cambodian culture.

 

As I reflect upon this moment and my own reaction, I think I just hit the boiling point of emotion that was already simmering over the duration of this trip. Not everyone we see is in such a condition but there are some that we know are in desperate need of care they may not be able to afford or able to get because the nearest hospital is too far or may not offer the services they need. They come to us asking for answers or maybe even that we will tell them something better than they have told before. We can't always do that. It touched on my fear, before coming here, that we wouldn't be able to help everyone, calm their worries, make them better and be the healers they want us to be. There are even moments we can't tell them everything we are thinking because it would do more harm then good. We can just refer them to the nearest hospital that can work with their resources to confirm our diagnosis. I see the worry in the eyes and it breaks my heart. We have done so much good here but we always wish we could do more. It is the nature of the beast. I am so thankful for this experience and these people for trusting us. These three weeks have been eye opening, soul brightening and life motivating. "Well, in Whoville they say - that the Grinch's small heart grew three sizes that day." - The Grinch (Well let's hope that's not completely true because it could call for a referral to nearest healthcare facility for an enlarged heart, but you get my point :) ) 

 

Good night friends,

Lindsey

 


Here and There

By STM | June 05, 2013

Today we initiated clinic at our final location near Chouk. The church is located on an island surrounded by rice paddies, and it is the size of a three car garage. Clinics have been hit or miss in terms of how packed they are when we arrive around 8, but this one was slammed. The first morning at a new clinic is always slightly chaotic as we bring in all our supplies and figure out how we are going to set up for the day, but the diminutive nature of the blue church and the fervor of the crowd made this morning particularly challenging. Never the less, we started our day strong and ended up cranking out over two hundred patients in the sevenish hour stretch work day. We finished our obligations for the day by convening in the cabana at our hotel and discussing the fact that the people we saw were some of the poorest in the world, and that the majority of the world exists in similar poverty. Living in the United States, we certainly have poor and impoverished people, but here there is little to no middle class, and everyone seems to exist in either opulence or in a tiny shack. As our trip draws to a close, I know that we will all return to our respective lives and career paths not only more aware of the world that surrounds us, but much more prepared to face a multitude of new situations that arose during our trip and clinics. Whether it is remembering to appreciate and practice cultural competence, or how important it is to keep a smile on your face no matter how many patients you have already seen during the day, each and every one of us has gained much from this experience. I will be sad to leave this place, but I greatly appreciate everything that the country and its people has given us.

 


“I'm blue da ba dee da ba di”

By ML | June 05, 2013

Day one at the blue church was where, ironically, the blue man showed up again for a follow up. The blue man is exactly what he sounds like, a man with a blue tent to him. I am not sure if he has mentioned in previous blogs, but basically we think his chronic rifampin use has resulted in a rare side effect of blue skin. For me, the experience at this "blue" church made me feel blue for a couple of reasons. The first being the fact that we had to send Dr. Scheetz back to the states in the middle of the day. She has been a great help to us all, as well an incredible and patient mentor. Another reason for me being blue was a particular patient that I had today. When she sat down to be seen, she immediately began crying. She is 49 years old with a massive necrotic lesion where her left breast used to be located. Unfortunately, we had to inform her about the reality of her diagnosis. Her chest wall had multiple fistulas that had been draining for about 4 years with enlarged lymph nodes that indicated metastasis. After some counseling we referred her to a local hospital to hopefully get the palliative treatment that she needs. After escorting this tearful lady to the pharmacy for her measly vitamins, we all had to take a minute to gather our emotions. It is just as awful and painful to give bad news to a patient in Cambodia as it is in the U.S. Nothing can describe the pain I saw in her eyes as we told her that not even western medicine could cure her cancer. After a calming lap around the church and a whole bottle of water for my dry mouth, I was ready to step up and see my next patient.

 

To be optimistic, we saw over 200 patients today and there were multiple success stories of individuals who truly were helped.

 

The second half of my day involved working outside under a tent. At first I thought this would be more difficult than working inside, but I was quickly proven wrong as we were greeted by a glorious rain. This perfect drizzle brought a welcome breeze and dropped the temperature by about 15 degrees, Fahrenheit that is. The change was a welcome one that helped the day at the clinic fly by give everyone that extra push to get through the long day.

 


History Gets a Heartbeat

By Lindsey | June 04, 2013

Most nights after clinics we have a "family" meeting. Tonight Dr. Bina shared with us an article on the prevalence of Cambodians suffering from PTSD, a repercussion brought on by the excruciating era of genicide inflicted by Pol Pot and the Khmer Rouge. This issue not only affects individuals who are forced to deal with symptoms of this disorder but it feeds into the families through increased domestic violence and creating an upcoming generation that will carry on these learned aggressive behaviors. How can be break this cycle? What change can our group make? All we can really do is give them our time, consideration and compassion. Each day we see patient after patient complaining of shortness of breathe, headache, blurry vision, neck stiffness and muscle aches, the exact physical manifestations found in Cambodians with PTSD. It makes us wonder, how many people have we treated for these physical issues whose problem at the root is psychological. We learned about this history in the first days of this trip but until this moment, for me, it was surreal, the past. It's over, right? Nope, not for them. We forget how powerful the mind is. If our mind is sick, our whole body can suffer. In clinic they sit in front of us hoping for any amount of help and sometimes we forget to look past just the physical. Tonight's meeting made the history of the country real. These people have not and will not forget. They are still feeling the pain caused by the actions of others.  

 


Last day at Korean church

By JW | June 04, 2013

Today was the out final of three days holding clinic at the Christian Korean church here in Kampot.  While yesterday was a slow day for most as we were still dragging from the total relaxation of the weekend in Kep, everybody was on their A game today.  Clinic was set up quickly, and we started seeing patients.  One of the more interesting aspects of the day was when all of the children from the local orphanage came to get check ups.  Most of them were healthy and just received well checks, but a few had some common problems such as sinusitis and head aches that we were able to address.  These children and teenagers were some of the most polite kids with whom I have ever interacted.  They were thankful and showed all of our team members respect, and I could not help but have the utmost respect for them.  I did not not ask any of them about their living situations at the orphanage or how it was that they ended up there, but from the smiles on their faces, I could tell they were appreciative of what they had, no matter their station.  I have visited orphanages back in the US and have compared the lives of those children to that of my own and my peers.  When I then think of how the "regular class" Cambodians live in a third world country and then try to think of these kids maybe being even worse off, it is both humbling and saddening.  I hope the future generations of Cambodians do not forget about their less fortunate as they are trying to build their country so that everyone can have an equal opportunity to strive for personal improvement.