My final long weekend is upon me and I am spending it, as usual, in Phnom Penh. We left Kampong Cham early yesterday morning to visit two DRTB patients in their remote countryside homes before the team delivered me to the station and watched me onto the bus. Two hours later I was on the crowded capital city streets being accosted by seemingly millions of tuk-tuk and moto-taxi drivers.
My day started with the familiar yet still engaging sights of Kampong Cham town where I shouted farewell to the family at Shackville as I cycled by. They laughed me all the way to the corner, presumably because of my hilarious yet comprehensible(?) Khmer. From the office the driver, Win and I drove to the busy national highway with it’s casual road rules and overloaded vehicles, bustling with chaotic agricultural activities. On arrival in Skun where fried tarantula, fried crickets, fried beetles and fried anything-else-you-never-imagined-as-edible are sold by the overloaded plateful, we turned onto a muddy country lane lined with fluorescent green rice fields. We bumped our way past cattle, water buffalo, bicycles and motos, to the first patient’s home where I was in charge, in the absence of my nurse, of ensuring the community volunteer knew how to administer the patient’s treatment.
Meeting the car on the roadside the patient’s young son greeted me in impeccable English, keen to practise his language skills. Guiding us inside the muddy yard past a rather loud and frightening goose, we joined quite a crowd on the muddy floor under the elevated wooden/thatched house. The usual sights of a swinging hammock hypnotising a sleeping baby, toddlers and small children standing on bamboo platforms unblinkingly mesmerised by the visitors, and many adults perched around us are all still as interesting today as they were a year ago when I first had the privilege of making such a home visit. After talking to the community volunteer and patient for a time, the patient lay down on a bamboo bed base to receive his daily (painful) injection into the buttock before standing off to the side to swallow his cocktail of tablets. We stayed a while to ensure there were no immediate problems, Win translating for me as we made small talk which is always difficult through a third person but the sense of welcome and friendship does not require translation.
From here we drove to the next patient’s home, on an equally beautiful rice-encompassed country lane on the other side of the highway. She arrived home after three months in hospital an hour before our arrival and was lying on a platform base on the mud floor under the house. Pots cooking on an open fire against the wall in one direction billowed smoke at us, small children played on another bamboo base nearby and a number of young adults worked around us, cooking, transporting grass to the cows nearby, or standing at a slight distance listening and watching as we spoke at length with her husband while preparing her anti-TB cocktail for the day.
This is the patient who has suffered severely with permanently damaging side effects of the anti-TB drugs she is on. After brief complaints of tinnitus the doctors stopped the Amikacin injections she was on (the likely culprit of her ototoxicity), but days later she reported profound hearing loss which will never recover. Ankylosis disfigures both of her hands which are painful, and she reports bad pain in her leg joints, probably courtesy of a second line anti-TB medication called Levofloxacin. She has a TB wound known as scrofuloderma protruding through her skin from a TB-diseased muscle and her weight has diminished to 29kg. She also has a dedicated and supportive husband who did not leave her side during three months of hospitalisation, attending to her every need from feeding to toileting and everything in between.
As we prepared her medication some loud bangs were heard outside and her husband explained it was “play do” (coconut) being cut down from a tree next to the house. Win tried to politely decline the coconuts, recognising that the family needed them much more than us, but they insisted we take them. The generosity extended by people who have nothing which is so common here, never fails to humble me. Her husband sat her up, fed the tablets to her and lay her back down again. We waited to ensure there were no immediate side effects, admiring the children, taking some family photographs which I will give them copies of once developed, and watching the workers in the fields nearby as we waited. Once we were confident that she was stable, the young men walked us to our car and placed the coconuts in the trayback for us. One of them then boarded his motorbike and led us through twisting narrow country lanes, to the community volunteer’s home a few kilometres away, where I delivered the next month’s treatment with written instructions to his wife.
Back in the centre of Skun, we hit the dust-choked highway and headed to the bus station. Insisting on carting my bag, Win and the driver saw me safely onto the bus, with the usual instructions to “call if you need translation”. I sat down the back of the nearly-empty bus with my earphones in situ, an injured and swollen leg elevated on the window ledge and eyes closed, no doubt missing many interesting sights but I wanted to absorb the morning’s experiences without adding anymore stimulus to my overcrowded thoughts.
Two hours later plenty of stimulus hit me. The first sign that we had arrived at the bus terminal was the sight of a tuk tuk driver “picking” me as his customer through the window, pointing at me and talking animatedly to the competition surrounding him. I closed the curtain and took my time getting off from the back of the bus, dreading the usual onslaught of desperate drivers hoping for a high paying customer, quoting me double the usual cost and refusing to take no for an answer. “Ot te” instead of “no” elicited a lot of laughter and excited conversation, followed by assessments of my language by speaking Khmer as they trailed me trying to find the words that would elicit a “yes”. I walked a few blocks away before engaging with anyone, and found a driver willing to quote a reasonable fare. He took me the short trip to Pasteur Institut, where my one-month follow-up blood test following the recent sharps injury at work was taken.
Leaving the gate of Pasteur, I staved off more excited over-quoting tuk tuk drivers and decided to walk, with the edges of the busy motorway my only space as footpaths are either non-existent or used as parking space. A few kilometres and dozens of hopeful moto-taxi and tuk-tuks later, I stopped to check in on my very flamboyant, lovely hairdresser at St 136. He was out for dinner so I’ll return today to have my Cambodian curls transformed. Then I jumped in a tuk tuk and made my way to the hotel where I’m booked for three nights of luxury.
After a few hours of rest I headed out to the streets and sat in a beautiful outdoor corner bar for dinner. Across the road impeccably polished Range Rovers and Toyotas were parked outside a well equipped fitness gym where bodies beautiful could be seen through the windows exercising on decent equipment in an obviously expensive facility. Tuk tuks putted past, the occasional moto-drawn trailer heaving with people and hundreds of motos. As I sat looking at the menu I was approached from over the hedge separating me from the road, by a tiny boy begging. I said no and locked eyes with his young father before they walked on. I spent the rest of my meal wondering about them. Organised begging rings do exist here, but obviously there are also genuinely desperate people and how is it possible to tell the difference? I sipped my pina colada and ate my chicken with rice in physical comfort while I pondered on the first world difficulties of being a privileged bystander in this beautiful country where desperation and indignity are so visible everywhere, from the poverty-stricken rural villages to the brutal streets of Phnom Penh.