Thursday, August 15, 2013

Making a Difference in the Cambodian Jungle

This whole journey started about one month back when I was still in my last houseman rotation in Anaesthesiology. At that time, PJ, one of my ex uni mate was gathering people for a volunteer trip to Cambodia and upon knowing that, without hesitating, I jumped on board. Ever since my last visit to Cambodia, both Phnom Penh and Siem Reap about 4 years ago, I had fallen pretty deeply in love with this country, mainly because I'm so touched and humbled by the kind and warm hospitality displayed by the Cambodians. Hence, knowing that I could now revisit the country and play a different role as more than just a tourist excites me. I found myself back in Cambodia at the end of last month.

The place that I went this time round, the Graphis Health Centre was neither located in a city nor town. The Graphis Health Centre, secluded within the Cambodian jungle and perhaps at the end of some 10 km dirt road is located in the Prey Proseth Village, somewhere between Phnom Penh and Sihanoukville. The nearest airport is the Phnom Penh International Airport and from Phnom Penh city, it is another two to two and the half hours ride. Yes, you heard me right. We had signed up to travel to a foreign land only to travel further into the middle of a jungle to try to make a difference.

The centre was built through the inspiration of Dr Peter Li, a Japanese American who gave up his life in Japan to lives in Cambodia since 1993. He is motivated to provide health services to the sick community, especially the impoverished, thus the idea of a health centre. He managed to get funding for the centre from humanitarian NGO and Side by Side International, a NGO that specializes in providing emergency response services in Cambodia.

In 2008, the Japanese student volunteer group called 'GRAPHIS' started to support the construction of the building of a clinic in Cambodia. Graphis Health Centre was named after the original construction donator 'GRAPHIS' by Dr Peter Li, the director of the center. (source from Side by Side International). Well, before the health centre, Dr Peter's activity started in year 1993 as the 'Cambodian Dormitory and Education Project', aim in supporting school fees and providing a safe dormitory for poor students in Phnom Penh.

As malaria is very common in that area, it is highly recommended by CDC for malaria prophylaxis. I was torn between the much cheaper and more commonly available doxycyline and the more expensive malarone. In the end, I chose malarone as it has more tolerable side effects (especially the sun sensitive part) and shorter course of treatment. Doxy needs to be completed up to 4 weeks after travel and malarone only 7 days. None the less, it was really difficult looking for malarone in Johor Bahru and after inquiring at various pharmacies, I managed to secure one last box of it at Caring Pharmacy in KSL City
Hyped up for my trip! Flying off from Changi early in the morning
Flying Tiger Airways on an early Saturday morning even before the sun came up


Upon reaching Phnom Penh, I bought a local sim card from the airport (Axiata phone company) with 1gb of data plan and phone credit for a total of USD 10. Shortly after, I met up with PJ and the rest of the group who flew in from Kuala Lumpur instead. We then took a van we had hired in advance directly to Graphis from the airport. Though called a highway, the highway of Cambodia is pretty much a one lane road and it can actually be thrilling watching the Cambodians drive for the very first time. How they can overtook cars and only cut back into their own lane when they are less than 5m away from each other still amazed me. 
Dirt road and lush greeneries greeted us as we made our way to Graphis. We actually got a little lost locating Graphis the first time round as they do not have any signage leading into Graphis but the people at Graphis were nice enough to send a representative out to lead us in


We reached Graphis at around midday and after a brief introduction to Dr Peter, the director and founding person of the whole project, Michie, his capable and kind Japanese assistant, Dr Michael Tien, a Taiwanese paediatrician and some other Taiwanese medical students who were all also volunteering at Graphis at that time, we were brought to our sleeping area to put away our luggage and freshen up. 
Our sleeping area which we shared with the rest of the Taiwanese team. It is a very simple sleeping area, with mats below and mosquito nets above to keep us safe from the mozzis. We brought our own sleeping bags, otherwise, there is no fan, no air con and of course, no proper mattresses. Laundries can be seen hung around and clean drinking water were provided. The sleeping area was kept relatively clean and the most beautiful part of it was, being au naturale, on nights that did not rain, we saw fireflies blinking away brightly above us at we dozed off to dreamland. That was a really pretty sight that we rarely get to see anywhere back home
Staying cosy in our hide out
The kitchen area
Our dining area where simple, home cooked Cambodian meals were whipped out for us every day. Rice is the staple food and we had them for every single meal except for tea. Vegetables were another staple on the table and on some days, we were lucky to have barbequed pork as well
Our toilet and shower area. The toilet area depended totally on natural light. Once dark, there is no lights on and it is very very dark at that area. We were kinda afraid of the dark on our first night as we had to get adjusted to brushing our teeth and visiting the toilet in total darkness albeit a small light source from our torch but soon we got used to the darkness and we learnt to brush our teeth before the sky turned dark
The Graphis Health Centre is definitely more than just a clinic. It is a mini hospital, an environmental friendly and energy efficient building surrounded by mountains and tropical forest. It is outfitted with water channels and slanted roofs for cooling (hence the no need for fans or air cons) and solar panels for electricity. Despite it being deeply seated in the jungle, they do have a pretty comprehensive list of medications that are constantly donated by groups from Japan, Taiwan and US and pretty much well equipped too with surprisingly some of the most sophisticated and top-line medical equipment like the VScan, a pocket size ultrasound scan which we had the opportunity to try hands on! Most of their equipment and services are donated by the Rotary Clubs in Japan and Cambodia 


However, during our visit, the defibrillator and hematology analysis machine had broken down, hence no investigations can be carried out at the centre for the time being. Provisional diagnoses are based entirely on clinical history and examination alone! And of course, understanding the epidemiology of the area greatly helps too. 

The Graphis Health Centre acts as the only medical facility around the area and anyone in need of medical services is welcome especially those that are penniless. Donated medications are free and they only charged minimal medications fees to cover for the cost of medications. And for those that are certified poverty-striken (yes, there is such thing as certification of poverty in Cambodia but then again, that certificate can also be bought via corruption) , they do not even have to pay for their medical services. 
Surrounding of Graphis health centre
Inside the centre, there are 5 inpatient beds with a baby cot and 4 other 'emergency' beds. Throughout our stay there, there weren't many outpatients as well, maybe due to the constant rain 

The health centre is open 24 hours a day and although their official time is from 8am- 5pm, Dr Peter and his team is always ready to receive any patients at any time. For our first two days, it was election weekend and the nurses were all away, hence we actually took turn to stay overnight at the health centre and it was certainly a challenge having to work in the dark with no electrical supply!

We spent our time at the health centre mainly, lending a hand wherever help is needed. 
A local ling zhi (a very expensive Chinese herb) given by one of the patient's family to the centre as a token of gratitude
Our 2 pharmacists who very dedicatedly helped rearranged and relabeled all the medications cupboards
The Taiwanese medical students helping out another patient who is recovering from meningitis with her rehabilitation
Modified sharp bin
Another upcoming project- this is the library that is build just behind the health centre so children from the village can come here to study instead in future 
The Taiwanese medical and dental students were also helping out with the construction of the library
Among our activities there- providing free medical check up for the children living in the village nearby. Peter sent out his fire truck and brought back like 50 kids
The children are so cute and well behave. Queuing up orderly in line while waiting for their turn
Identification process
Medical check up time for the children. Most of them are fine, except for a few personal hygiene glitch and being undernourished
The children also went home with a pair of new slipper each
Such adorable kids
The Graphis health team with the Cambodian children


That day was an exceptionally eventful day. After all the children left, we had an emergency case that required further treatment at a bigger hospital in the city. We managed to stabilize the patient and sent him over to Phnom Penh via Graphis very own ambulance. 
Ambulance ride to Phnom Penh!
After 3 hours, we finally arrived at this private hospital where the patient requested to be send to for his emergency dialysis. We were surprised though to find out that there is no emergency department at the hospital where we can alight patient, instead we were directed to alight the patient in the middle of the parking lot of the hospital
With Joe, my chatty and cheerful companion
Our driver and passionate nurse from Graphis
We settled for our dinner at this local vendor in Phnom Penh. My only non rice meal in Cambodia- fried noodle Cambodia style
Bayon bread with mince pork, sausage, cucumber and ham fillings. Not bad from a local street stall


Our stay in Phnom Penh was a very brief one but albeit that, I noticed Phnom Penh had grew up so much since my last visit about 4 years ago. The whole city is so vibrant and there are international brands boutiques, chain outlets, more malls and even KFC now (seriously there was no KFC 4 years ago). I'm seriously proud of how fast pace the development in Phnom Penh actually takes place and I'm sure they are growing rapidly as days past.
This is the daughter of one of the long term patient there, Sai Ya, a 26 years old who became paraplegic after a horrendous car accident last year. Sai Ya delivered this beautiful baby after the accident and as Sai Ya still needs to undergo rehabilitation now, both mother and daughter are still staying at the centre
Our team ♥
We were even handed certificate of appreciation. Really nice of Peter and Michie for that
With some of our Taiwanese friends
With Peter, Michie and their dogs. Honestly salute all the staff at Graphis especially Peter and Michie for their sacrifice and dedicated work in providing health and education to the impoverished 
Flying over the rainbow back to Malaysia


The 5 days stay in Cambodia this time had certainly given me a very different yet valuable traveling perspective. It was the first time I traveled abroad for volunteer work and it had surely given me very worthwhile insights. The people of Cambodia are as kind, friendly and warm as ever and I'm still really touched and humbled by their wonderful hospitality. Despite the fact that we were tucked away in a health centre in the middle of a tropical forest with plenty of mosquitoes, rambling elephants, limited electricity so much so we had to work with the patients at night in the dark, cold water showers in the monsoon season and in a very simple environment with nothing but the basic necessities, everyone was just so kind and friendly, it makes our stay really pleasant. Besides, the clear night sky with bright stars and buzzing fireflies as we dozed off to lala land was one of the most pretty sights. After all, some things in life are just simply indescribable until you see it, feel it and experience it personally and this is one such experience.

It's also inspiring to work with individuals like Peter and Michie who so voluntary commit their life in serving for the impoverished and individuals like Dr Michael and the Taiwanese medical and dental student volunteers. Graphis certainly still needs a lot of aid and volunteers from time to time to enable them to continue making a difference within the Cambodian jungle. :)



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2 fondue dips :

Hi there. :)

I love what did you write about your experience on your voluntary work abroad, really inspiring and I'm interested to somehow volunteer just like you! :)

How did you apply?

mt
Meitzeu @ Blog

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Meitzeu : Hi, thanks. You can try contacting them through the website here http://cdepcambodia.org/cn10/pg99.html or you can let me know if you are really interested and I can help you to arrange. :)