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!