Transition to Vietnam!

Hello friends and family!

I write to you from a small river town in southeastern Cambodia a few miles from the coast, close to the Vietnam border.  This has been my recharge spot after my time in the hospital.  I arrived here planning to stay two days, and finally leave for vietnam tomorrow after being here 6 days.  It is a tiny town with a beautiful, friendly community.  A Colorado native who I met, who has been living in Kampot for nearly a decade, said that the biggest lie travelers say in Kampot is, "yeah, I'm leaving tomorrow.". I have been staying in a villa right on the river, swimming every day, doing some reading and writing, meeting some really interesting people, listening to live music at night (there is a rotating schedule with live music 3-4 days a week, but it is always the same band, the only band in kampot, playing the same music), and it has been glorious.  I went to an open house for an after-school art program for disabled kids in Kampot, which was incredible.  Half of the kids and staff were signing to each other, some were in wheel chairs, and all had the biggest, proudest smiles on their faces as they showed off their projects to their parents.  I biked back with my face painted and turned a lot of curious heads!

It has been valuable to have the time to reflect on my time in the hospital.  It was such a powerful learning experience being exposed me to a healthcare system that is worlds different from ours.  Mackensie, Lauren and I became friends with our translators, who taught us all about their families, childhoods and beliefs during our daily "cultural exchange" before lunch.  They were all so kind and hard-working, and I am grateful for their dedication to the project.

This also ended up being more of a career-defining trip than I could have imagined.  Arriving in Cambodia, I was geared up toward applying to medical school the following application cycle.  I finished all the prerequisites, took the MCAT a week before leaving for Asia, and began to look at schools.  Yet, I did not feel 100% committed.  A part of me was looking for some sort of experience that would confirm my med school path, but instead, it redirected me.

Two days after receiving my MCAT score (yes, I was happy enough with it!), I had a particularly challenging day in the hospital.  I saw a 13 year old boy die of Dengue Hemorrhgic Fever because he arrived at the hospital too late.  We interviewed his mother an hour later, heard her son's story, her grief and her regrets.  It was a humbling experience, and definitely put my life into perspective.

So...I have been inspired to apply to nursing school!  It feels like a much better fit for me personally and professionally.  I can envision myself in the nursing role much more vividly than I could ever envision myself as a doctor, and I am whole-heartedly excited about it.

I am grateful to have such a supportive family, who have encouraged me every step of this journey.  Much of it is just beginning.



Hello from Vietnam!
It has been an interesting transition entering into Vietnam from Cambodia, but so far I am loving it.  There is so hustle and bustle in this country, and Saigon is filled with energy.  There were food venders every ten feet selling amazing pho, fried fish, chicken,  noodles, sandwiches, etc.  Motorbikes travel through narrow alleyways hardly wide enough for two people to walk side by side.  There are fruit stands, flower shops, and more female clothing stores than I have ever seen.  The traffic is horrendous, but walking the city is fabulous.  A nearby park had dance classes going on similar to those in Cambodia that I talked about, only the Vietnamese women were thrusting their hips and looked way younger and more modern.  A group of local university students came up to me wanting to practice their english, and after chatting for a while invited me to join them playing a game.  It was similar to hackysack, except the object being kicked and tossed around looked like a badmitton birdie or something.  I was terrible at it.  They gave it to me as a gift after the game so that I could practice every day.

I spent a day on the Mekong Delta, visiting the floating market and some floating villages.  The scene is amazing and beautiful.  Every boat has a pair of eyes painted on the front.  The Vietnamese tell stories about huge iii that have eaten women off of ships and engulfed entire boats in the past.  The eyes are supposed to scare away the snakes and protect the boat.

I made a friend on the bus a few days ago, a traveler who had just finished two years teaching English in Mongolia with the Peace Corps, and it has been great to have a buddy for the first stretch of Vietnam.  We ended up meeting some other young travelers who convinced us to hire a guide to take us through the central highlands along the Ho Chi Minh Trail.  It is supposed to be an amazing route, far less traveled than the coastal route, and supposedly it's much easier to visit the small villages if you have a guide.  So we are on our way!  Today was spent at a small fisherman village on the beach, tomorrow we'll be at another beach town, and after that we'll head up to about 6,000 feet of elevation and spend a week in the mountains!  I am really looking forward to a change in scenery and climate.

The adventure continues!

My First Cambodian Kickboxing Dance Class

For some reason my video of us dancing won't upload, but I'll try again tomorrow!

Every day at about 5:30pm, when the sun dips behind the horizon and the balmy weather becomes bearable, the park lining the Sangkae River is filled with families getting their daily exercise.  While the men walk or jog and the children play, nearly one hundred women group together in various sections of the park for dance class!  Each class marks its territory with a set of large speakers booming hip-hop/techno music, and an energetic male instructor.  Mackensie and I tested out several different classes before we found one that seemed challenging enough, and after line dancing, arm movements, kicks and punches, we were sweating by the end!  Rachel, you would not believe the number of women wearing chocs-and-socks.  I totally blended in.  It's a hilarious scene, and clearly a major social event for all involved.  I think this may be a key reason why Cambodians are so happy all the time.  They dance on a daily basis!

Busy week in Pediatrics

Our first full week of data collection is complete, and we are on our way to Siem Reap to see Angkor Wat!  I feel exhausted, but am definitely learning a lot.  Most of my time is spent speaking with patients and their families in the pediatric ward, which I love.  On average this week, we spoke with 25 new peds patients per day. One of the doctors is convinced it's only busy when I am there, and jokingly scolds me when he walks past.  On Monday our hospital saw its first case of the "mystery disease" that has killed 60+ young cambodian children recently.  The two-year-old girl died within hours of being admitted.  The disease causes blisters on the body, fluid accumulation in the lungs, and brain swelling.  Super scary and sad.  They're calling it "enterovirus 71," and a "hand foot and mouth" disease, although specialists are still unclear on why it is so deadly for young children. On thursday, three young kids caused a commotion after eating their mom's antidepressant pills while playing.  They arrived only pain responsive, but after a stomach pumping and some rest they recovered quickly and were discharged the next day.   Many other patients arrive with a fever, cough, abdominal pain, shortness of breath, etc.  A majority of discharge papers have Dengue as the final diagnosis.   I am amazed at how incredibly patient and kind the parents have been to me.  I have begun to recognize many of the mothers who have been in the hospital for multiple days. They put their palms together, touch their fingertips to their nose and greet me with a wide smile and a nod.   Fun fact: there are murals all over the peds ward with one particular cambodian child featured and the initials "m.j.p" at the bottom.  Any guesses?  Hint: his parents are angelina and brad Siem reap update soon!

Case study #1: Life Saved.

Just as the outpatient department had packed up for its daily three-hour lunch break, and we were heading out of the hospital ourselves for a bit, a motorbike drove through the building entrance with three people on it.  A male driver in front, and a frantic old woman in back holding onto her limp, lifeless daughter who was tightly sandwiched between them. They began to lift her off of the moto when the nurses directed them to go to the ICU.  They drove across the campus to the ICU building, where it was clear that no one was ready for their arrival.  A man helped lift her off of the bike and cradled her waiting for a bed.  He set her down on one bed in the corridor, lifted her up, set her on another bed, lifted her up, and ultimately placed her on the initial bed.  The girl had overdosed on something.   Then, imagine a scene from any american ER drama series, with doctors and nurses running to help the serious cases, loud but confident voices, routine, deliberate decisions.  This was the opposite of that.  The nurses WALKED, slowly.  The girl's chest was still rising, but clearly she was not breathing enough on her own to sustain herself.  They brought out a cart filled with meds and some tools, one nurse did some chest compressions, three sporatic sets of maybe five compressions each.  The doctor had not even arrived on the scene.  After several minutes of this, Dr. Maha (the Stanford ER doc in charge of our research study), delicately stepped in.  He told them to bring out oxygen and a mask, and when it came, used the bag-mask to give her breaths. Meanwhile, a nurse was preparing an IV. Maha taught Darith (a cambodian man and former practicing doctor who is helping us with our project) how to apply cricoid pressure (to prevent gastric inflation and reduce the chances she will vomit) as he gave breaths.  When oxygen came, Maha hooked it to the mask. The nurses prepared an injection of a medication, but Maha intervened and told them to give her bicarbonate, quickly!  It took a minute for them to find bicarbonate from the supply closet, and when they did, the nurse gave the injection (slowly, of course). Faster, Maha told her. Maha showed Darith how to give breaths, and waved to me to take over applying cricoid pressure. At this point, a car pulled up in front of the ICU building and the doctor strolls up in slacks and a button-up.  Maha stepped aside to speak with the doctor.  He explained to him the importance of intubating her, and after some searching, the tools were brought out.  Humbly, he held the tools out to the doctor, careful not to overstep his boundaries and disrespect the cambodian doctor.  The doctor admitted being unfamiliar with the tools, and ushered Maha to go ahead.  Darith and I stepped aside. When maha tried to intubate, the girl (now pain responsive and with a gag reflex) squirmed.  When he tried again, her arms instinctively reached up and tried to pry him away.  "Good," Maha said.  "This is very very good.  The bicarbonate is working."  The girl was going to live.  Maha shook hands with the doctor and we left them to care for the girl.   Maha had us film the entire scene, footage that he claims is "golden," and will be a crucial teaching tool for this hospital in the next couple of years.  "This is why we are here," he said.  "This is why we are doing this research.  They are unprepared for this sort of emergency.  This project will help save so many lives."

My first blog: intro to the Battambang Hospital

Hello family and friends! The next 5 weeks will be so busy with research that I fear I will not have time to update all of you individually. So, you are witnessing the abrupt corruption of my internet blog virginity. Welcome! Pictures will be minimal, since only pictures taken on my ipad can be uploaded, but stories will be maximally entertaining. I hope to give you insight into Cambodian culture by taking you through my experience working in the country's second largest hospital in a very cool city called Battambang. I'll start with a description of the research study: I am working through Stanford Emergency Medicine International, and we are conducting an epidemiological study on emergencies presenting to Cambodian hospitals. The goal at the end of the study is to identify the most common emergencies and focus on them in future training of Cambodian hospital nurses and doctors.  To conduct the study, we ask new patients information about their illness or injury, and fill their answers out on an iPad.  We will then be following up with the patients (most have cell phones, or have a neighbor or family member with a cell phone) at 48 hrs and 2 weeks to see what their outcome was.  We have translators with us the entire time, and they are our key to communicating with the patients, their families and the doctors and nurses. The hospital here is worlds different from at home. A gate surrounds the hospital campus, which has buildings for the different departments scattered throughout a courtyard.  There is no air conditioning, only the occasional fan.  They are in the process of building the hospital's first emergency room, and there is no triage system at all. There is no such thing as "visiting hours", so the rooms are quite lively, with kids running around, hammocks slung up in the trees outside, and women cooking in the courtyard. It is quite a scene, and I am so excited to be a part of it. Enjoy, and feel free to email, facebook or skype call to say hello!