Monday, February 14, 2011

Primary Care at The Lake Clinic, Tonle Sap Lake, Cambodia

Floating Villages

Hasan Merali, MD
Moat Khlar Village, Tonle Sap Lake, Cambodia
I am sitting out on the front of our boat, TLC I, as we enter a small channel with reeds on either side. After a seven hour journey on Tonle Sap Lake with just the horizon in every direction, it's nice to see some signs of life. As we go further down the channel I spot some small huts in the distance. This is the floating village of Moat Khlar. As we draw nearer to the huts, I see that none of them are connected. Each small hut floats alone separated by at least 3 meters from the next structure. Some homes are bigger, and sturdier, while others only seem to have enough room for one person and are slowly sinking. My eyes are drawn to the children sitting at the edge of their homes, feet dangling in the water, smiling and waving at us.

The team was at this village last week for a clinic and they wanted to follow up with an elderly woman with a severe burn on her hand. We pull up to a larger home, the chief's home, and wait as he sends word to the woman that we have arrived. About 15 minutes later she comes with her daughter. Dr. Sambun, TLC's primary physician, examines the wound. It appears to have healed well since last week, despite the fact that the woman spread pig fat on her wound against his advice. Her hand is cleaned and a dressing is applied. We are thanked by her, and the chief of the village and then set off. About 2 hours later we arrive in Pichakarei. The sun is just beginning to set so we anchor the boat, eat dinner, try some fishing with no luck, and rest.

The next day we are up with the sun setting up our clinic in one of the floating schools. There are 5 desks in an open room. The first desk is for registration, three physician desks and a desk that is the dispensary. Luckily the two other physicians I am working with, Dr. Sambun from Cambodia, and Dr. James from the UK are both family medicine doctors. This is perfect for the pediatric resident who has not done any adult medicine for nearly 2 years! That day we worked from morning to night with only a short break for lunch. I saw countless children, making recommendations, giving advice and prescribing medicine all with the assistance of my translator, Sri Mom. As a first year resident, it was certainly nice to have Dr. James and Dr. Sambun sitting just a few feet away so I could ask them questions and get their opinions on the many cases I was unsure about. I also found the 'Oxford Handbook of Tropical Medicine'' and 'Where There Is No Doctor' to be invaluable resources that Dr. James and I were constantly passing back and forth.
Overall, I was struck by the amount of malnutrition and dental problems these children have. I want to spend more time learning about their diet to see if we can possibly make some recommendations that will make a difference to them.

In the evening we quickly place a sheet and a mosquito net over the bucket seats in the boat to sleep on. It is only 8 pm, but with complete darkness, quiet, some jet lag, it is easy to fall asleep. When I wake up the next morning we are already on our way home since it is such a long journey back to Siem Reap. I wish we were able to see more patients, but I understand the limitations of the boat with so much travel in such an isolated region. Next week we have a longer, 4 day journey planned, and I can't wait to be back.

The Lake Clinic:
Short Documentary:

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