Friday, March 4, 2011


Hasan Merali, MD
On the way to Poveuy, Tonle Sap Lake, Cambodia

I went to visit Say-la last weekend but she had already been discharged. She had her echo done and it turns out she has aortic stenosis. The physician who saw her recommended a follow-up echo in one year. All of her care while in the hospital was provided at no cost by the Angkor Hospital for Children transportation back to her village was provided by The Lake Clinic.

Our regular boat is now in Phnom Penh where the water levels are higher so this week we had the pleasure of taking the 'small boat'. The small boat is a wooden boat that is about 7 meters long. It has no seats, just wooden planks where we placed some plastic chairs for the journey. There is an outboard motor which is so loud that we cannot have a conversation during the trip. The motor can push the boat along at 10 km/h but we were further slowed by the fact that we had to tow another boat that carried all of our medical supplies. At one end of the boat there is a 4 sided tin structure about 0.5 meter high and only enough room inside for a Cambodian child. One side is a door, and in the center, on the floor, there is a hole directly into the lake. This is the toilette.

The 9 hour (3 on land, 6 on water) journey is uncomfortable but much more beautiful as we navigate the smaller water ways covered with aquatic plants. There are a countless number of different birds along the way gracefully catching fish and flying away. In Pouveuy there is an old temple which has survived hundreds of years and will be the site for our clinic. We are greeted by the monks living there and they offer us some floor space to sleep. It is almost evening time so we quickly set up our mosquito nets and climb inside. Unfortunately, the mosquito nets cannot cover all of the cracks in the tiles so I am soon covered with tiny black ants. Monks, of course, respect all living beings so I just lie there and let the ants go about their business. Black ants don't bite, I think to myself, only red ones do.....

I am awoken the next morning at 5 am to the sound of screeching. As I look up, there are hundreds of bats all flying into the tower of the temple. My legs feel painful. I look down and see dozens of open sores. It turns out that black ants do bite.

Clinic in Poveuy was fantastic. One day, we saw a TLC record number of patients - 180 between the three of us. It's wonderful to see how much trust, and what a good reputation TLC has built among the communities. Several families also traveled from surrounding smaller villages to see us. It was so busy, in fact, we even a small group of women protest that they weren't being seen in order. This was the first time this had happened. I knew that with two generalists around, it would slow down clinic even more if I needed to look things up and ask Dr. James or Dr. Sambun questions anyway, so I asked Savanh to only send me pediatric patients that day. Savanh tried to explain to the women that the reason why some children were ahead of them was that this doctor only sees children. They looked at me confused/there was something wrong with me. I smiled at them as I held up a baby.  They seemed accepting and a few mintues later they were seen by Dr. James.

Entrance to Poveuy Village, Tonle Sap Lake, Cambodia

Although it is 36 C everyday and we are surrounded by water, I have resisted the temptation to jump in the lake due to the two species of crocodiles and several different kinds of water snakes that live in Tonle Sap Lake. This week, however, without even the simple fan we had on the larger boat, I decided it was time. The water was only about a meter deep and I quickly began sinking into the cool mud. It was quite refreshing. Savanh taught me how to dive for snails and how to choose the best ones which we later ate with lime and chili sauce. I had a quick bath and hoped out. It doesn't matter what color the crocodiles are, they will bite me.

Being here for a month, my Khamer has improved significantly. “Min ____ day?” is the basic question for "Do you have _____?" and I can fill in fever/cough/vomiting (gadou cloon, ke ah, go-od) etc. I know how to ask about age, time course of illness, sick contacts, and a few other relevant details. This has been quite useful as Dr. James and I often have to share one translator (our ‘translators’ are a nurse and a midwife who are busy doing their own work when we see patients). On the weekends when I am back in Sieam Reap, however, I have not found my language skills very helpful. "Do you have diarrhea"? will not help you locate a toilette, order food, or find a guest house.
I am sad to be leaving this weekend and truly wish I could stay longer. After working in several different countries, this has by far been the best experience for me. I learned a lot in 4 weeks and have been inspired to work on my physical exam skills that are so important when no diagnostic tests are available. I have also been thoroughly confused by some of the skin findings I have seen and would like to do a dermatology elective and read much more about dermatology when I return to Boston. If anybody is interested in working at The Lake Clinic, please let me know if you have any questions. They are especially in need of a dentist.


  1. Hasan,
    Yes, you are right. As always all good things come to an end. I am particularly glad you & your team were so helpful.
    You are right also about dentists. They seem to be in a short supply in all of the developing countries , it seems.

  2. What an incredible and meaningful experience! It is so nice to read about your adventures and start to understand how valuable basic physical exam skills can be in such a remote setting. Except, I'm not a fan of all those bugs....
    Great job Hasan!