November in Pictures or WPC long list...

When my folks came to visit and refused to go to the killing fields and S21 my carefully planned itinerary was thrown into disarray. Hence we spent a whole afternoon of 'acclimatization' - sat by the river in Phnom Penh people & boat watching.

Phnom Sampeau - incense

The flatness of Battambang province

Poppa-bear with wives number 2 & 3. He particularly like the arm holding and constant fanning but in balance decided to go home with his first wife.

Dried bananas & why travelers get sick

multi-coloured chickens - why not?

Tonle Sap lake - lots of water & sky

Parentals at Angkor Wat - my country, my beer...

Ta Prohm

Tomb raiders

The manic grin of a jet lagged, over heated mother who has had enough of seeing temples and reliefs of various hindu epic tales that all involve fantastical creatures and death by poles up ones bottom.

What the tomb raiders left...

A WPC possible entry

After beer for lunch and despite having last time sworn I would never go up any temple step's again (I couldn't walk for a week after) I found myself at East Mebon running up the steps like a mountain goat. Coming down as always was slightly more tricky.

Rubber plantation Kampong Cham province - all those lesson in geography 25 years ago about 'cash crops' suddenly make a lot sense. 

Fishing village - much chagrin from my mother that the sun was in the wrong place for photos

Sunrise over the Mekong 

Mondulkiri sunset - and my first experience of being too cold in Cambodia

Elephant Valley Project

http://www.elephantvalleyproject.org/ - check out the website - it is a great project and worth any donations you can spare.

Washing the elephants - an absolute highlight

Got to watch out for those flapping ears (elephant's ears not BFG!)

Sunset in the jungle

Washing at the waterfall

Second attempt of rice crop after flooding wiped out the first.

The parentals completely adapted to the habitat!

Welcome to Cambodia - we hope you enjoy your stay

More blog radio silence I’m afraid, this time because I have been acting as tour guide to my parents for the last 3 weeks.  They have now left and the consensus was that “a good time was had by all”. If capacity building doesn’t work out for me here perhaps I could establish a tour company instead.

A sample itinerary would be as follows and concentrates on using as many modes of transport as possible and purchasing many scarves;

Day 1 – Fly to PNH (mode of transport 1), parentals set the tone of visit by suggesting we start on the Angkor beer at 10am. Lazy jet lagged day with drinks and food at FCC. Icy-cold 5 star hotel accommodation.

Day 2 – PNH – tour guide has a meeting at URC office so clients go on a ‘walking tour’ to street 240 for start of scarf buying marathon. Visit Royal Palace, National museum and lunch at Daughters of Cambodia. Respect clients’ request to not go killing fields and S-21. Dinner at Ocean.

Day 3 – PNH – Boat trip to Mekong Island (mode of transport 2), lunch at Friends then walk along riverside (mode of transport 3). Dinner at Ngon.

Day 4 – Travel up to Battambang by private taxi  (mode of transport 4). Accommodation my salubrious house by Wat Sangker. Dinner at Flavours of India, pre-dinner drinks at Geordie’s Gallery.

Day 5 – BTB – Meeting at hospital so “acclimatization day” for clients. Happy hour at Café Eden & dinner White Rose.

Day 6 – BTB – Bamboo train & Phnom Sampeau with David by Tuk Tuk (mode of transport 5). Dinner at Chinese BBQ.

Day 7 – BTB – Trip to Banon and surrounding area (mushroom farm, vine yard). Happy hour & dinner at Bambu hotel.

Day 8 – BTB – Tour of BTB referral hospital and then Tuk Tuk trip to Ek Phnom district and ‘cottage industry’. Dinner at Bamboo Train Café and Circus show.

Day 9 – Travel to Siem Reap by Boat. Accommodation Smiley’s Guesthouse. Dinner at The Sugar Palm.

Day 10 – SR – Small circuit of Angkor Wat. Happy Hour and dinner at FCC.

Day 11 – SR – Grand circuit of Angkor Wat. Dinner Il Forno.

Day 12 – SR – Trip to Silk farm and markets. Cocktails at Elephant Bar & Dinner at Abacus.

Day 13 – Private taxi to Kampong Cham. Accommodation Mekong Hotel. Lunch at Lazy Daze, trip to Rubber Plantation, dinner at Mekong Crossing.

Day 14 – Bus to Sen Monorom (mode of transport 6). Accommodation Phanyro Guesthouse, dinner at The Greenhouse.

Day 15 – SM – Elephant Valley project for visit, dinner and accommodation (hammock).

Day 16 – SM – Travel back from EVP by moto (mode of transport 7). Rest day. Lunch at Chum Nor, dinner at Banana.

Day 17 – SM – Trip to waterfalls, coffee plantation and sea forest. 

Day 18 – Trip to Kratie by shared taxi/minibus (mode of transport 8). Accommodation You Hong, Dinner at Balcony bar.

Day 19 – K – Trip to Kampie and dolphin boat trip, tuk tuk ride to turtle conservation project. Accommodation & dinner at Balcony Bar.

Day 20 – K – Trip to Koh Trung, horse & cart  ride (mode of transport 9).  Lunch at Red Sun Falling. Afternoon trip to another Wat. Dinner and many drinks at Balcony Bar.

Day 21 – Trip back to PNH by shared taxi/minibus. Accommodation ridiculously overpriced 5 star hotel. Visit Wat Phnom. Dinner at Sovanna.

Day 22 – Fly out of PNH.

The cost of me organizing the tour, including all booking of accommodation, transport and meals and acting as a half-arsed interpreter is just the cost of all my lodging, transport & food. This I’m afraid will probably reduce the clients of my tour business to my family and possibly only my parents!

However the feedback from the tour has been good.

Ma Wilson’s top 5 highlights

1)   Boat trip from Siem Reap from Battambang through the floating villages on the Tonle Sap Lake

2)   The scenery – especially the paddy fields

3)   Balcony Bar in Kratie – sundowners and story telling on the terrace with Andrew (owner)

4)   Visiting silk farm in Siem Reap

5)   Seeing me – well she is my mother after all and clearly this should have been listed as #1

Poppa-Bear Wilson’s top 5 highlights

1)   Sweet and Sour Pork – White rose Battambang ranked first place with Balcony bar a close second and this is really his #1

2)   Trip with David the tuk tuk driver around Battambang to see local industry

3)   Having drinks and good conversation with various young female backpackers – Cat & Sarah I’d like to apologize for my father

4)   Mekong Island visit in PNH (before Mum bought the 14 scarves!)

5)   Visiting Banon Temple and obtaining two new wives

Tour guide’s top 5 highlights

1)   Washing the elephants at the Elephant Valley Project

2)   Staying in a 5 star hotel in Phnom Penh and using a duvet even with the AC switched off

3)   Horse and cart trip around Koh Trung & seeing a snake

4)   Breaking down in Tuk Tuk after seeing dolphins and entertaining local children for 2 hours

5)   Evening spent with Tania at Banana in Sen Monorom

There were however some complaints and annoyances;

1)   The Wat next door to my house caused unacceptable noise pollution with its new sound system at what was considered by my clients to be an antisocial hour.

2)   The shared taxi journey from Sen Monorom to Kratie with the 23 passengers and chickens was not appreciated as the ‘authentic Cambodian experience’ it was intended to be. However Pop Wilson regained his GSOH in time to enquire when we arrived in Kratie if it was Phnom Penh and where was the airport?

3)   The private taxi from Siem Reap to Kampong Cham was also not considered to be ideal by the clients who felt that the price and various requests to fit in ‘wives, mothers and sisters’ were both stretching the truth and taking the piss.

4)   The Mekong Hotel manager who tried to sell us shared taxi over a bus ticket wins the least liked Cambodian award. The two Australian women we met in Sen Monorom were less than impressed with paying more than a bus ticket to leave 4 hours earlier than the bus, have practically the same number of passengers as a bus which arrived at the same time in Sen Monorom despite the bus being an hour late. Gideon the tuk tuk driver won extra points for advising on the bus option and hence enters my top ranking Cambodian list.

5)   Sweating was an issue, however this has been a complaint from previous visitors. As this is the tropics, the management reserves right to ignore all sweat/heat related complaints.

6)   My clients were unsettled by the torture/khmer rouge routine at the circus. It was probably a good thing that I respected their request not to visit the Killing fields and S-21.

7)   Witnessed random animal & child cruelty unsettled my clients.

8)   The hospital visit was not ‘enjoyed’ but it was acknowledged that it would result in better understanding of my situation the next time I have a rant over skype.

9)   A series of emails from the UK caused a slight shadow over my holiday but as legal action is being threatened I shall remain cryptic.

The Kindness of Cambodians

I have a list - it is a list of my favourite Cambodians, sometimes when I am in a long and boring meeting, or having a day when some Cambodians are being less than kind, I play the game of trying to rank them. This is an impossible task because as previously discussed the good thing about Cambodia is you never know what it will throw at you next - so just when you have absolutely ranked one person as number one a outsider will do something spectacular and breath takingly kind which shoots them right up to pole position.

So in no particular order.

R is always high up. He is a doctor that works for URC - when the civil war was raging he worked in a hospital in Preah Vihear province - a khmer rouge stronghold, where the the only way to get in and out of the hospital was by plane (whilst being shot at). He is puzzled at the reluctance of hospital staff to take outsiders advice because in the 1990s he was happy to see any outsider brave enough to come to his hospital (MSF, Red Cross) and would welcome any advice they had to offer. Obviously things have changed. R is always high ranking on my list as he is one of the few Cambodians who has been openly cross with me (I think around sensitivities about his English - thanks UN for that - but I'll never be exactly sure), he has also told me what he thinks of me (mainly I am 'acceptable'!) and the only real difference between us is that I get to show my numerous frustrations and anger whereas R is imprisoned in the Cambodian hierarchy and saving face culture which means that when he snaps at me I could hug him. Last week he earned a medal of distinction for services to cheering up a disheveled capacity builder. I was in a meeting, before it had started I got cross, I went to leave, R intercepted me and calmed me down and made me stay, during the meeting he sat next to me - very close and leaning (a bit like our old Irish setter used to). Mid-meeting the obligatory snacks arrived - bananas wrapped in sticky rice and then a banana leaf and grilled - delicious. As I leaned over to take my second helping of delicious banana snack R whispered in my ear "you have me to thank for that - if you had stormed off in a huff then you would have missed out on the snacks" - very true and as I am sure you will agree nothing wrong with his sense of humour or english either!

Ry - another URC staff member - living proof that capacity building works although it doesn't necessarily mean they will stay in the Government system. Ry calls me "My doctor." He understands me when I attempt to speak khmer. He laughs (like a girl) at my jokes. He gives me hope that there are nurses here that care. He knows which part of the brain controls breathing. He calls J & G 'Mommy and Daddy' - his died when he was a teenager. J's job for 3 years now has been to capacity build him and mine appears to be to cheer him up by being silly.

S is my khmer teaching - previously blogged about. She tells me that she pities me (on a regular basis) which I have tried to explain is not so good but I think she only means it kindly. S has lots of advice about water, home security, food, how to work at the hospital, how to stop a nose bleed and other diverse and varied subjects. She gives advice (like her teaching) in an assertive and (as R describes me) aggressive manner. She tells me that I make her happy, grabs my cheeks and pinches them in a gesture of affection that makes my eyes water and I frequently get an urge to take her home.

Sk is a nurse that works in the hospital. On days when I am being particularly frustrated he would talk to me but in the absence of a translator I never really understood what he was trying to say. One particularly challenging morning I learnt that pii-bach-chet means stressed but other than that and sitting next to me at the presentation I went to (blog - living for the weekend) communication has been minimal. With V, my fantastic new VA, starting I have been able to have more in-depth conversations and so last week Sk told me not to take everything so personally. He could see it upset me when the nurses & doctors are rude or ignore me but through V he asked me to be patient and try not to take it as an insult. I was so stunned I had to ask V if he was translating or was that his own opinion. I was reassured that this was a direct translation and that it isn't just kind eyes that Sk has. I repaid him the nest day by telling him off for taking blood without washing his hands, re-capping a needle and not using gloves. The next day he told me - via my VA - that I looked beautiful. I replied - via my VA - that he could call me what he liked but I would still shout at him for re-capping a contaminated needle. Yesterday I saw him clutching his chest and a bag of GTN tablets - I only hope he is a victim of the some what questionable diagnostic and management skills here that I am meant to be capacity building.

Moto-driver - outside my house a man and his moto sits most days waiting for business. Every morning as I cycle to work he sits smoking his cigarette and gestures that I should get him to give me a lift. As I am already on a bicycle this causes him much hilarity. The highlight of this little daily exchange was a few weeks back when I came out of my house gates, crash helmet in hand and took him up on his offer of a lift to the bus station. He couldn't believe it and since this our morning exchange has been taken to a new level of hilarity and uncertainty.

N works for an NGO hospital and is a nurse. She is assertive, strong and feisty. I have spent time with her devising BLS courses and triage protocols but my respect and affection was cemented for her when I spent a week on a trauma course in Siem Reap. She ranks pretty high as the only Cambodian who I have told that I love! I suggested I should move in with her and she could be my Cambodian big sister (Bong S'rey) but she used some feeble excuse about her home being under 2 foot of water. In Siem Reap on the training the trainers course I gave a lecture on feedback. Now as I have previously mentioned positive feedback isn't a big (or any) part of Cambodian culture - so my suggestion that people need 5 bits of positive feedback before delivering 'constructive criticism' was a challenge. When practicing the new teaching techniques one instructor critiqued the teaching style and I critiqued the feedback given. When N gave feedback to one of the young male nurses she manages she was characteristically merciless & unforgiving. So this is the feedback I gave her, "N I really like and respect you, you are an excellent nurse, a natural teacher, professional, competent and committed but your feedback skills are useless!" I now find myself in meetings with her just putting up 5 fingers - her house, she tells me, remains flooded - funny that!

The entire family that run the Expresso Cafe - our friday evening haunt. The Dad is cute, the Mother is smiley, the daughter makes a wicked Pinu Caleda (sic), the sons have nice arms the grandson is gorgeous. When they increased their draft beer price to 75 cents they still give us, regulars, the old 50 cents price, you get free fruit platters and cakes, the people next door in the seeing hands massage place get concerned if I am sat alone and chat away to me in khmer - what's not to like?

Mr L runs the Cafe across the road from my house where there is the Thursday night film club, he is a natural host. When in passing I mentioned the rain had been so heavy that my roof had leaked he immediately wanted to go and speak with my landlady. I had to explain to him that talking about the weather was to an english person what asking you "where you go/been?" and "have you eaten rice/" is to a Cambodian for conversational tactics. When Mr L tells stories he does actions - I guess this makes him a natural children's TV presenter as well.

P from URC office is the cleaner, she has no english so helps with my mission to speak good khmer, but with the help of S I have conveyed the idea that P, S & I should have a girly session and all go to get our nails done together at the market. P brings the snacks and drinks to all the URC meetings and training events at the hospital. URC snacks are great, I think this may be one of the reasons I like her so much!

D the tuk tuk driver was immediately notable to Katie & I by his good english and non-hassling approach to acquiring customers. He has a fine collection of rhyming cockney slang that various tourists have taught him. He loves playing chess so when ever you are off doing something and come back to the tuk tuk you will always find him either near by watching a game or beating someone at chess. He is kind to children and tourists. He does a great trick with a seed pod and his brother has just taught him a new one with a piece of string. When you ask him how much? he always responds - what ever you think - which is working out quite well for him especially now my parents are visiting. He'll have that new tuk tuk very soon at this rate.

So I am in double figures and still could list the two great paediatricians from Siem Reap, the lady from the bicycle shed at the hospital, the giggling waitresses at the Gecko Cafe, the capitol bus station man, the anonymous woman that intercepted me at work about a skirt incident, allowing me to go home to change before an important meeting. The list goes on.....

I will continue to rank and re-hash the list to keep the positive thoughts going when the lower list ranking Cambodians are giving me a hard time and I am not feeling the love so much.

Remember to chew...

Today is blog action day and the topic is food, hence I am spoilt for choice as to what to write about.
I could discuss all the food that I love here and how long the gratification lasts after consuming certain comfort food stuffs (for the record dumplings from the noodle shop are pretty high up the gratification scale lasting a good 7 hours at least and thats with out the garlic repeating).
Equally I could talk about all the food that I crave or have fantasies about, better still the welfare packages I have received from home (and Australia) that even reminded me of things I had forgotten to miss (dorset cereal, tim tams, peppermint tea, green & black Maya Gold chocolate - the list is endless).
There is at least a whole blog on cooking with just a wok and a skillet with no sharp knives at your disposal.
I could discuss the recent floods in Cambodia and the destroyed rice harvest and threatened food shortage. Or the malnourishment wing of the paediatric ward and the shock of seeing a severe marasmus infant. Or how you feed yourself on less than $2 a day (not very well but two thirds of Cambodians have no choice).
But I am going to keep it short, sweet, tenuously connected to food and of course medical.....
Every morning there is a hospital meeting where new patient admissions, deaths and any other current management problems are discussed. Occasionally something is brought up that reminds you why you attend these meetings, despite the hours of 'ot mean' - 'don't have' conversations you have had to sit through.
Last Friday was one of those days, there had been a death on one of the wards and as my new VA translated the conversation I realized that going back to basics was going to need to be a lot more basic than I had bargained for.
The patient admitted to the ward the previous afternoon had choked to death on their evening meal; none of the nurses had known what to do, the doctor had taken 30 minutes to arrive by which time the patient had asphyxiated.
So I was left considering this scenario - you are Cambodian, you get sick, the traditional khmer medicine doesn't work, you are able to afford transport to the local hospital, you either can pay the user fee or have a letter to prove that you are poor so can have the UF paid for you, you are well enough that you don't die waiting for some kind of medical attention, you survive whatever medical attention or inattention you receive and you can either afford to buy food or receive the rice soup provided by the hospital. But then when you choke on your food in hospital nobody knows what to do. The irony of it is you will have probably spent most of your life hungry or working all day every day just to put some food in your belly so that one day it will go down the wrong tube and no-one will have any of the training or skills to help you.
This week I go to a fellow VSO volunteer's hospital to conduct some emergency triage assessment and treatment training, the week after we have a basic life support course in my hospital - both involve choking algorithms. It seems so basic but then again it is the simple things that save lives.
Capacity building is an expensive and slow process but ultimately I still believe it to be the most sustainable way of improving peoples lives and in the words of Student Community Action's motto (circa 1990s) "If you are not part of the solution, you are part of the problem". Although I'm learning it is possible you can be both!
Happy world food day - remember to chew......

Patience is a virtue...

A conversation I had with a Cambodian colleague resonated with me after certain events this week.

Dr C (x-ref 'suffering doesn't have to be fun bit it helps') works for an NGO hospital and also trains government staff at a hospital which he affectionately refers to as a 'hot spot'. Dr C is an excellent physician, would have preferred to studied english literature & be a teacher and is Cambodian. Sharing the common ground of us both being doctors that 'advise' in government hospital 'hot spots' I find myself looking to him for guidance to navigate these stormy waters.

The last time we met, a few weeks ago, I asked him how is was going at his 'hot spot' - he grimaced and told me it had been going quite well but 3 months ago something had happened to rock the boat. One of the nurses from the government hospital had applied for and got a job at the NGO hospital Dr C works for. This had caused a degree of consternation among the staff at 'hot spot' and one person in particular who felt that the NGO were deliberately poaching their good staff.

Now Dr C had been given fore-warning of this impending mutiny so the next time he visited 'hot spot' he was prepared. He told me that just looking at the disgruntled government doctors face and could tell that he still was angry at him & the NGO - so he did what any self respecting Cambodian would do - he saved face and ignored it.

My western sensibilities twitched at this - surely if someone had an issue with you, you would address it, confront them, put matters right, straighten out any misunderstanding, not allow matters to spiral out of control, fix the problem, find the solution etc. etc. etc........

Dr C went on to tell me that on returning the following month he found that the disgruntled individual was still angry with him and continued to ignore him. However other staff were still receptive so he carried on his course and continued saving face.

At this point in the conversation I expressed my desire that if I was him I would have to sort out the problem directly. He frowned at me then smiled pitifully. "Esther" he reassured me, "If this month there is still a problem I will talk to the hospital director and arrange a meeting."

"But it already been 3 months!" I exclaimed impatiently.

This is when I was educated in the virtue of patience. Dr C explained to me that if a person is angry the best thing to do is to just wait until they had calmed down, have had time to reflect and came to their own conclusion that it wasn't Dr C's fault the nurse had left. Addressing the problem head on would only lead to cross words which then can't be retracted. Dr C knows that he isn't responsible for the nurse leaving and with the disgruntled person in such a state of anger any conversation about it would just be fruitless.

"Sometimes Esther the best action is inaction - you should be patient." I was wisely told.

So this week after a rocky start I have decided to take Dr C's advice. I am going to sit back, keep my mouth shut, wait to see what happens, float rudderless and just try to be patient.....


n.b all boat references are subconscious and most likely due to Battambang's water festival.

The unbearable lightness of volunteering

The pinnacle of good emergency medicine & post resuscitation care -  ICU - my goal!

So I have reached the 6 month mark of my time here (8 months in Cambodia in total) and now is about the time that it is anticipated for volunteers to experience the "6 month dip." If my current mood is anything to go by I think that the 'dip' they refer to is probably born out of an overwhelming sense of futility, bubbling up of 6 months worth of frustration and the dawning realization that volunteerism is not valued or worse still completely worthless.

Now most people (not all) come out the other side of this dip and have long and fulfilled lives in international development but whilst I am in it I think it is probably worth exploring why it happens and what it means about us (as volunteers) and them (the reluctant recipients of our capacity building).

I came to the conclusion that people do not value things that are for free at about exactly the same time that a friend messaged me words of encouragement and support. It was powerfully well timed, his response to my exclamation of futility clarified I think the root of the problem. 

He works in Africa and empathized with my experience of not feeling valued by doctors or nurses that we  work with. He wisely told me to concentrate on the patients - the small child or parent - who are more likely to see the value of a competent, trained and caring health care professional. It got me thinking, we had worked together in the NHS -universal free health care - how the fact that something is free impacts on it's perceived worth. Patients do not directly pay for their health care in the UK and there is a high expectation of the right to have free health care and often a failure to value or see the true worth of something as precious as the NHS. As a salaried doctor in the NHS, although I believed in a patient centered approach and got much of my job satisfaction from my interactions with patients, many of my feelings of value or worth around my job came from the committed team of hospital staff that I worked with. The patients and relatives were why we were all there but their taxes paid my (overpaid) wages as they often like to remind us and I had to get accustomed to frequently failing to meet their expectations. The dynamics of private health care are of course different, when you are paying directly (not through taxes) for health care you value it more because it has a tangible worth. Having worked in countries where there is not free health care it always frustrates me how undervalued the NHS is and how the better something is the less people seem to appreciate it.

So value & worth - how do you get it? From my limited experience here it would seem that you have to earn lots of money overseas and then come out on short visits only. This way you are seen as a revered expert and very much valued. If you can not speak the language, make no attempt to understand the culture or context and ignore local experts this seems to be even more effective. 

Giving up a well paid job to come here for 26 months as a volunteer - well that's just madness and at best deserves sympathy and at worst contempt. My favourite piece of advice was from a colleague who works for my partner NGO - he told me not long into my placement here sincerely and with no malice intended, "Thank you for coming Esther, we really appreciate it, but there is absolutely nothing you can do here."

I sometimes think that if my hospital had to contribute to my living allowance, as they do in other countries, perhaps they would value me a little more. I'm not saying that they would listen to me or even take any of my advice but maybe there would be a sense of ownership and they may even consider letting me into the room. Currently I am left standing out in the rain wondering whether the plans for the new Emergency Room will ever be shared with me or if being a specialist in emergency medicine means anything at all because the moment I gave up my job in the NHS it appears I was rendered completely useless. 

And as for the reluctant recipients of my capacity building - they would just like lots of money and resources and not to have their knowledge challenged by training or for me to ask any difficult or awkward questions.

So why do I even need to feel there is a sense of value or worth to what I do? Maybe I'll leave that one as a rhetorical question for you.... 

The reality of Emergency Medicine in Cambodia - my starting point!

Siem Reap - Floating Village

Long time, no blog.

Jean arrived from the UK on the 8th and I have been too busy with this volunteering lark and host anxiety to blog. But now I find myself sat in Siem Reap waiting to see if a tuk tuk can get through the Tonle Sap (quite literally) and get us to our bus to PNH.

It has been a pretty full on couple of weeks with much non-volunteer dining out and excursions whilst still 'working full time'. The rainy season has really stepped up a notch hence the flooding and as Jean exclaimed the other day - she is having a "tropical nightmare". I am thankful that it has actually been quite cool for her because her 'nightmare' alludes to the heat and sweating which could be a lot worse if it wasn't constantly raining.

Last Sunday we caught the boat from BTB to Siem Reap - a 7 hour journey that could have only been improved by being 3 hours shorter. It was an eventful trip with many branches whacking the face episodes (me) and a boat attempting to pick up someone from a little boat and crashing into a tree with a wasp nest in it resulting in many wasp sting episodes (Jean). Ironically I found the existence of the people in the floating villages of the Tonle Sap lake very claustrophobic - water, water everywhere etc and no dry land - now I am in Siem reap which due to the Tonle Sap bursting its banks is also a floating village. As I waded back from Angkor Hospital for Children last night to the Guest House I felt the same claustrophobia rising in my chest. At least the floating villagers have boats - I am trying not to think about what is in the thigh high water but can't stop thinking about hook worm, leptospirosis, faeces and other badness. This anxiety stems from having an open would on my foot from a previous bicycle versus moto incident where my foot came off the worse. I have had an offer of amputation from one of the surgeons from BTB which I was hoping would not be necessary but after a day of flies eating it, then wading through raw sewage maybe I will have to take the winking surgeon up on his offer.

Jean was in Siem reap to spend three of the days in the rain seeing temples - wading at some points in thigh high water to reach temples that had no entry. The day after she visited Banteay Srei the road flooded and nearly 200 tourists were air-lifted out back to Siem Reap - I think 9 Cambodians have already died so far in this months flooding.

I have been having a drier and less dramatic week teaching on a Primary Trauma Care course - the first of its kind in Cambodia. It was a great injection of motivation, well timed for my 6 month dip. Suzi was the course director - an Australian anaesthetist with Cambodian heritage and she had press ganged another anaesthetist from Australia (Sathi) and a tiny trauma surgeon from the Philippines (Jovy) but also working in Oz to come along. Between them they had many years of international health experience and really buoyed my spirits - who knows perhaps my 2 years here may even end up being meaningful. Sathi told me a great story of going to Mongolia for 3 years and seeing no changes, just as his group decided to give up they received an email from the hospital in Mongolia to say that they had reviewed there mortality statistics from the last 3 years and could see that since introducing a recovery room the number of surgical deaths had more than halved. I have said it before and no doubt I will say many more times but capacity building is a slow and time consuming business but eventually there are results - that's what I have to keep telling myself.

The first course we instructed and then we trained 10 of the participants to be instructors including a surgeon from BTB. They then went on to train on a second course - by friday we were all entirely broken so wading home through raw sewage was just what I needed. Never has a trip to the beach been more needed. In reality Jean & I know that we will be sat in the rain playing yahtzee and backgammon in Kep whilst I eat crab to Jeans disgust. Although it is probably worth noting that sea-food hating-Jean ate fermented fish (Prahok) and liked it but she is quick to note that it was in a dish and 'not in isolation'.
So the question remains - will our tuk tuk driver a) turn up at 11 30 and then b) be able to get us to the bus station or c) will there even be a bus.

When I left home last weekend I knew I had forgotten something....I should have brought a boat.

Tonle Sap Lake - Water-world

Siem Reap - floating village - town centre

Bonsak & Chheng modelling the cambodian turn-up

Human mannequins