Say-la

Hasan Merali, MD

Tonle Sap Lake, Cambodia

This week our destination was Poveuy. Poveuy is the furthest village that TLC serves. It is located on a sub-lake of Tonle Sap, called Tonle Chma. Currently, a narrow, shallow channel of water separates Tonle Sap and Tonle Chma but in a few weeks this channel will dry up and create two separate lakes until the rainy season begins. To reach Poveuy, we must travel through Preambang, the village we worked in last week.
 
After passing through Preambang, we reach the channel leading to Poveuy. We go as slow as possible but after just a few minutes we are stuck in the mud. There is no one around to help so we all spend about 45 minutes using oares to get the boat free. Finally after much effort we are back afloat. The decision is made that we cannot cross this channel and will have to come back next week with a small boat to reach Poveuy. We turn around and head back to Preambang. Closer the village we get stuck again. Luckily this time we are in view of some of the villagers and few men come in one of their boats to tow us out. The sun is just setting and we decide it is not worth going on any further just to get stuck again, in the dark. We drop the anchor and rest there for the night.

Since we are already in Preambang we decide to see patients there. We set up our clinic in the 2nd level of the school. Since we were just in Preambang last week, we were not expecting a big turnout but we were pleasantly surprised when 123 patients came that day! This was the most patients we had seen in one day, and it was only Dr. James and I as Dr. Sambun had gone to another province for a meeting this week.

The most interesting patient I saw was Say-la, a very cute 12 month old girl with a systolic heart murmur. She had been seen two times previously, at 7 months and at 10 months. The murmur was noted both times, but she never had any further evaluation other than a physical exam. We have Cambodian adjusted weight for age growth charts and she was at the 20th percentile. I felt that she needed an echo-cardiogram to evaluate the structure and function of her heart and tried to explain this to her young parents with the assistance of my translator. Their main concern was that they had no money for travel, accommodation and food while in Siem Reap. I assured them that TLC and the Angkor Hospital for Children would provide everything at no cost. They assured me that they would go next month but Savannh, our nurse, told me that that's what they had said before. I tried my best to convince them that I thought it was important that she come with us the next day but her parents were unconvinced. I then had our midwife, Sri Mom try, and finally Savannh tried. After about at 30 minute conversation between them the parents decided that they would go and speak to their family and then return in the afternoon. Perfect, I thought to myself, but they did not come back.

I was frustrated that the parents did not return, but I could completely understand why. If a few complete strangers asked me to trust them to take my baby on an 8 hour journey to a city I had never been to (or any city for that matter) where I didn't know anyone, I would probably be scared as well. My plan was to return to Siem Reap and talk to others with more experience as to how I might convince this family to come with me.

The next morning I sat quietly on the bow of the boat as we slowly departed Preambang. Something wonderful happened. Say-la's parents were waiting outside their house ready to go! I was so excited. They brought one plastic bag with them and hopped on our boat. Say-la was happy and playful as usual and she made the 8 hour journey back fun for all of us. Why didn't I bring any toys? It didn't matter too much because when you're one years old, a lot of things can be fun. For Say-la it was water bottles. Between water bottle games and naps, she made the time go by much faster and soon enough we had her and her parents registered at the Angkor Hospital for Children. Hopefully she can get all of the testing finished before we leave again on Tuesday and then we can bring her back home.