I travelled more than 6000 miles to do an elective in Phnom Penh. And, y’know, defied probable death and stuff. So when I arrive to find the hospital empty except for maybe one post-op patient and one receptionist (asleep), I can’t help feeling a bit let down. Ok, so perhaps medical electives are basically a glorified jolly for privileged white kids, but I’m here now, I flew a long way and I want to see something.
A busy elective
Ok, fine. Smile. Operation audacity.
A few emails and a long bus ride later, the elective fates have deposited me in Siem Reap, possibly the hottest place on earth. Google says it’s 37 degrees. My headache says 57. It’s a welcoming town though, all golden pagodas and motorised tuk-tuks, and women selling fruit I’ve never seen before by the roadside.
My destination: The Lake Clinic. Run by an ex-American nurse and staffed by local doctors, nurses, dentists and midwives, it’s a small organisation that provides basic health care to remote communities. They don’t officially take medical students, so I’m feeling pretty fortunate and happy to be here.
Siem Reap. Heat not shown.
TLC consists of two teams who travel to remote locations each week – one on a lake, one on a river – and set up pop-up floating clinics for three days at a time. People living here are some of the poorest in Cambodia, and getting to the nearest health centre or hospital is usually too far and too expensive. So TLC brings basic free health care to the communities, as well as providing health education and making referrals.
I’m joining the river team. We meet at 6am and load the minibus – waterproof boxes of drugs and medical equipment, mosquito nets, food and loads of bottled water. It’s a three-hour drive to the river, then a boat. The last hour is mostly dirt track – bumpy and narrow, winding between rice paddies, and mango trees, with chickens strutting beneath houses on stilts. I can see why we’re here – I wouldn’t want to get sick here – it’s an hour at least to the nearest health centre, and it’s… how can I say this… SO. HOT.
Eventually we stop on the river bank and transfer to the TLC boat for the next leg. Presumably this river was once shaded by lush rainforest, with birds and monkeys in the trees. Sadly we’re a hundred years too late. Most trees have gone to make way for farming, and the riverbanks are lined with noisy diesel motors pumping water up onto nearby fields. I’m reminded of a line from my Oxford Handbook (page 389 this time). “The world moves on, tarnished, tawdry and trashed”.
Start of the mission
The clinic is a large floating hut moored to the opposite bank. We’ve been travelling since 6.30am but there’s a morning clinic scheduled, so everyone sets to work hanging curtains, setting up folding tables and arranging the ‘pharmacy’. The whole thing is amazingly well designed, and within minutes I’m standing in a fully functioning, one-roomed, floating health centre.
I’ll be assisting the team doctor. Our ‘doctor’s box’ contains a BNF, stethoscope, auroscope/pen torch, thermometer, electronic BP machine, tongue depressors, a pulse oximeter, the Oxford Handbook of Tropical Medicine, and some documents outlining local prescribing guidelines. Most of the things you’d expect for a doctor in a primary health clinic… except with no hospital nearby, no easy referral.
We take a seat, the doctor and I, and await our first patient. And luckily we have a fan. Did I mention that it’s hot?