Goodbye Cambodia

Today was our Cambodia swan song. We rose early and uniformly felt melancholy as we ate our final Cambodia breakfast. Eggs over easy, toast, fresh orange juice and mango.

We returned to our PIO orphanage site and easily saw the remaining 100 or so patients. We were used to the routine by now, and returning to the same site made set-up a breeze. Yet we all could feel it, exhaustion diluted by fulfillment and a growing sadness that we would soon leave our patients, friends and the confusing, frustrating and intriguing country of Cambodia.

I can't go any further without delivering the appropriate thanks to Bob Renner and Purobi Philips, who literally are, KiDS International dental services. Their absolute commitment to nurturing their 'baby' has not only produced a program that enriches children's lives throughout the world, it also delivers the highest level of professional satisfaction to those willing to step out of their everyday life and donate their time. I'm usually not at a loss for words, but nothing I say can ever express my thanks to them.

I talked to another team member, Ev, who described that despite the language barrier he needed to make his patients feel safe and well cared for. Doing so made his trip worthwhile. He used his limited time off from his Air Force stationing in Japan to attend the mission. Sherry, took a day off from the mission to deliver solar powered lanterns to a small village that didn't have electricity. She and her daughter had felt this was necessary so that the children could do their homework at night. Rich, our team leader is a young dentist beginning his career and a new marriage. Yet he found time to take on the responsibility of leading and managing our dental team. I could go on.... Suffice it to say that these people have discovered that opportunities like this mission bring out the best in us. Stop thinking about it........... Do it.

Our Site for the Last Two Days of the Trip

                                      Mom Waits While We Treat the Two Older Children 

Intrigued by the Dental Visit that Awaits Them

Dump Site Dentistry

Today we visited another PIO (People's Improvement Agency) orphanage. This one is located in Phnom Penh proper and serves as the main site for this orphanage.

I was happy to recognize several faces from our last trip. In fact, my interpreter was my old friend whom I wrote about last year. She has 2 young boys and also cares for her mother. Her teaching job allows her to provide her boys with a free education and a healthy lunch. Last year she had 17 students in her class, this year she has 96. I hope this reflects a greater effort at identifying those who need help versus an increased overall need for that help.

                                                            The Smoldering Dump

The orphanage sits adjacent to the former Phnom Penh dump. It was a logical location for an orphanage because many children were abandoned here. As I wrote last year, in the poorest families children are viewed as a source of income. Barefoot and half naked the kids would scour the dump site looking for anything that could be resold as a recyclable. If their economic usefulness waned, the lucky ones were abandoned while the not so fortunate we're sold into the sex trade.

The dump has since been relocated to another area of the city. It is less visible to the outside world because the government did not like the world knowing about their "children of the dump." Yet these children still exist hidden away, out of site.

The former dump is about 1 km from the orphanage. Though covered, the methane it produces has burned and will continue to burn for many years.

 

 

Our Clinic Today

 

 

Another Extraction for Jamie

I'm told told that our effort today resulted in 396 children being seen. A record number for one day. Fortunately, many were returning patients who only required fluoride, yet 131 patients required extractions. Despite our best efforts, oral hygiene is not well practiced and the Cambodians have an insatiable sweet tooth.

Tomorrow we'll return to this same site to see a few more children who we weren't able to treat today. It will be our last day, our flight leaves tomorrow evening. Already our group is talking about our next volunteer effort. I feel lucky that Jamie introduced me to these trips.

 

 

End of the Day

 

A Very Hot Day

If you think you know what 'hot' is, a visit to Cambodia may change your mind. With temperatures hovering in the nineties, today we earned "our stripes."

Our site was a PIO (Peoples' Improvement Organization) orphanage on the outskirts of Phnom Penh. As I mentioned yesterday a whole community was leveled by the government and the local people were relocated to a new site because AIDS was said to be endemic within this population. It's quite hard to believe that the government could have detected AIDS in this community because none of the poor people seek or have access to medical care; it's far too expensive for them.

The new housing in this site resembles the small storage cubicles where we at home place our unwanted items that we are not yet ready to discard. The government has basically done this, by storing this unwanted population in a remote corner of Phnom Penh. Interestingly, there is no facility to treat any illness in this new site, which probably makes sense, because no one there seems to be sick. The truth of the situation is revealed in the expensive, luxurious property which now occupies the former community. Sadly, this is the Cambodian way.

The children today were quite young and had very decayed teeth. There is a process called arrested caries, in which the previously decayed area turns into a hard brown/black stain which is extremely cavity resistant. Fortunately, many teeth had undergone this process and we were able to retain them as space maintainers. While these teeth are not pretty, they are the best space maintainers that these children will have.

 

 

The students arriving from a nearby orphanage.

Throughout the day, the chanting of Buddhist Monks could be heard from a nearby property. They prayed for a recently deceased individual. Their chants asked that all this person needs and wants be provided for them in their next life. It created an eery backdrop for our patients who waited in line to be seen. As the treated children walked past those who were waiting, they would inevitably scare the waiting children with tales of dental torture. I wondered if the children somehow thought the Monk's were chanting on their behalf; wishing them a safe and comfortable visit.

 

 

Todays patients.

I am told that our volunteer group is proving exceptional and I'm proud to be included in the bunch. The students are from Columbia University, as are the recent graduates, many of whom attended this trip as students. Our group comes from Brazil, Japan, Ghana and a smattering of eastern and western US states.

 

 

Better than Gatorade.

Tonight we are planning a group dinner at a beautiful outdoor restaurant. Last night we ate at a noodle house. Grand total with appetizer, entree and drinks was $8 per person. I felt guilty to pay so little. Tracy and Michelle who work in the Fort Lee orthodontic office joined us on this trip. They say that "they get it." They have been swept away in this beautiful country. It is hard to say what it is, perhaps its innocence or naivete, or maybe just the wonderful nature of the people. But we all feel lucky to be here.

Visiting Happyland

 

The clinic at Happyland Orphanage

 

 

Today we journeyed to the "Happyland" orphanage. It is located 37km from Phnom Penh. This orphanage houses about 400 children. Some attend the orphanage school while others attend the local public school.

The younger children had severely decayed teeth and most of them required multiple extractions. Many of the older children were brought in from another orphanage which we had visited last year. These children required little work, fluoride only, which was terrific because we were exhausted by 1pm.

 

 

Taking a break with my new friend.

 

 

 

The open market at the Phnom Penh Central Market.

Though we worked hard, the children were extremely well behaved and organized; quite different from the children that we saw in the villages the past two days. Much of this was a result of the orphanage staff helping us with logistics. The "Tom and Jerry" cartoons playing on a laptop didn't hurt either. It seems television has a universal hypnotic effect.

With another group arriving I will continue later.

Clearly I spoke too soon about being exhausted. Wow did we work this afternoon. We've just arrived back to our hotel. We have grande plans about what we want to do this evening, but may lack the energy to turn our ideas into reality. Jamie favors a massage then dinner. While the massage may be well deserved, I'd rather catch an early dinner. Looks like I better search for a snack........

Returning to Finish What We Started

Today is our second day of volunteer work. Because there were so many patients yesterday we de decided to return to the same village and complete what we started.

All the children look much younger than they are perhaps due to a lack of nutrition. We bring bananas to feed them, not being sure of what is available for them to eat at home.

Our leaders, Bob and Purobi Philips, have travelled the world scouting out venues for their childrens'' dental missions. Sadly, they are not optimistic about our patients' opportunities to have a fruitful life in this country. Schools, though run by the government, are not free. The teachers are paid $30 per month by the students family. This equates to about I/2 of a workers monthly wage. Many families can not afford to educate their children. We wonder too whether the Cambodian genocide, killing all intellectuals in the 1970's, may have destroyed their value in education. Most of the patients we are seeing are students, we know there are many more children not being seen, working in the fields.

Having completed our work early today, we have just returned to the hotel. We will venture out to see more of the city and prepare for the next few days. Tomorrow we begin our visits to the orphanages. On Thursday we will visit a housing project that houses families that have been moved out of the city. The official word is that these families have AIDS. Their former slum has been turned into an expensive large office building. It is hard to separate truth and fiction in this country.

Travelling to Cambodia and Work Begins

Yesterday Jamie and I awoke early and travelled by bicycle taxi to our waiting ferry which took us from the Vietnam port city of Chau Doc to Phnom Penh, Cambodia.

Though the distance from Chau Doc to our base in Cambodia was is not very far, the ferry trip was nonetheless 5 hours. Crossing the border by boat involves checking out of one country and into the other.

 

Speedboat to Vietnam

 We arrived in time for our team meeting and dinner but found ourselves exhausted to venture out into town.  We were ready for sleep as soon as the meal was finished. With little to report, I skipped a night of blogging. Apologies to anyone looking for an update yesterday.

Waking this morning at 5 am, we decided that our decision to go to sleep early was a good one. Today we travelled an hour outside the city to a village that we refer to as Chevanne's village. Chevanne works at the hotel that serves as our home base in Phnom Penh, Eureka Villas. He was very proud to bring us to his village, both for us to see his townspeople and also to be providing dental care to his people.

Michelle providing fluoride treatment

The small children in this town have teeth that are severely decayed. We have to be wise in choosing which teeths to remove. Excessive extractions will lead to very poor eruption of the adult teeth. And though many of the baby teeth have cavities, they are saving space for the permanent teeth. And most importantly, we must travel each day to another village making proper follow up very difficult. It is sad to have to practice this way but it is the reality of back country dentistry.

By the days end we had treated upwards of 200 children. Most of the younger ones requiring multiple extractions.

The talk today regarding the future of Cambodia revolved around a proposed dam which, if built, will severely hinder the Cambodians ability to produce enough food for its population. The dam which would lie in Laos will prevent the flooding which occurs yearly bringing nutrients from upriver into the Cambodian soil adjacent to the Mekong River. Though the prevention of flooding sounds good, the floods actually keep this soil fertile. As has been the case so many times before, in the worst case scenario, the rich will move away and the poor will starve. There is also great concern that the support from China will cease when Cambodia looses its ability to feed the Chinese.

Cambodia is a special place.  There is beauty in the scenery and the people which belies their difficult existence.

Day 2 Biking in the Mekong Delta

Our bike trip in Vietnam continued today as we made our way to the river town of Chau Doc. Tomorrow morning we will board a boat and make our way to Phnom Penh to rendezvous with our team and begin our dental mission. We are anxious to see the Cambodian children and determine if our work here last year helped them.  But for today, our biking and eating adventure continued.

The Mekong Delta is very flat and easy to ride. The houses are small by our standards and mostly raised on stilts due the inevitable flooding that occurs every rainy season. These homes have running water and electricity unlike the ones we saw last year across the river in Cambodia.

 

This man asked us to sit with him after we bought his fruit

Though this country is Communist, there does appear to be a "look the other way" attitude toward many things, including religion. Our guide tells us that the Vietnamese people are very non-political and that they only want to exist without the constant wars that have marred their history for thousands of years. In the last ten years they have moved forward economically and today there are very few homeless people and everyone is afforded a support system.

 

While we told the guide that we were adventurous eaters, 

the snake proved to be too much for us

 

The area in which we biked today provides most of the rice for the country and for export. Fruit trees of every variety dotted the landscape. We stopped at several roadside stands and sampled the various fruits. Due to the Lunar New Year, restaurants were closed. This proved to be no problem for our guide, who visited a local market and assembled the ingredients for a beef noodle soup. He borrowed the kitchen of a friend, and while Jamie and I lounged on hammocks, he produced a delicious lunch spiced with black pepper, garlic and lemon grass.

 

Enjoying the lunch that Hau made for us

Finished with our biking for today, we will rest until tonight, when we sample the local fish that Chau Doc is famous for. While we've enjoyed our free time, we're ready to begin the dental work that brought us here.