Khmer New Year Wednesday 14th April started with a bike ride to the market at 6.30am. A lovely red sun had risen through the haze and I had to go out to enjoy the morning. The market was buzzing with life and the truth of the Early Bird Catching the Worm is so apparent with lovely fresh produce that the flies haven’t gotten at yet. The world of Mongkul Borei is out shopping and the late risers will have to accept what’s left. It had rained in the night and the air was clean and fresh too, but the layer of mud on the unsurfaced road acts like glue and sticks to bicycle tyres. Very quickly my brakes and mudguards were clogged and the effort to pedal with no gears became more and more intense, like adjusting the resistance on the rowing machine or exercise bike in the gym. I made it home with great difficulty standing on my pedals at times to keep up the momentum. My landlord was washing the Lexus (outside the house, unlike those Southern Baptists who hose their car in the garage on a Sunday) and I was able to wash down the bike after digging the muck out of the mudguard with a stick at first and then a finger, which was more effective though it reminded me of dealing with severe constipation in the operating theatre.
I visited the ward to see a very sick lady with peritonitis and septicaemic shock after an abortion performed in her home by a traditional midwife. I felt yesterday she needed a laparotomy but the suggestion was vetoed by the senior doctor here as he has seen too many such cases where nothing is found at operation and the patient dies afterwards. She was so short of fluids I removed the wheel from her drip set to stop the relatives turning the drip rate down. I gave what advice on her care I could and left, not expecting to see her alive again.
I took the opportunity of the holiday and the empty office to write the account of Banteay Chhmar when I received a phone call to the operating theatre for a Caesarean delivery. My bus to Siem Reap was not due until 2pm so I had time to help out and as you now know, the poor lady had a ruptured uterus and the very big baby was salvaged from the jaws of death, literally. Repairing the uterus was really out of the question because of the extent of the tear and hysterectomy was the only course of action which would limit blood loss since we had none to transfuse. This is her fourth boy and she wanted sterilisation. Six days later I’m happy to say, mother and baby are well though he was jaundiced and the only thing we could do was put him outside in the sun. UV light deals with the jaundice very well.
I just had time for lunch prepared by my landlady for her visiting family, to discuss on the phone the lady with peritonitis as the duty doctor also wanted to operate on her and hoped I would come, I briefly joined the family around their makeshift altar and accepted the invitation to light some incense sticks at 13.12hrs precisely and to pray before I went off to the bus stop. My landlord gave me a lift with my bags which was most welcome as a 20 minute walk at midday is quite an ordeal in the intense heat and direct sunshine. The visiting family had enthused about Siem Reap and wished me well, offering to bring me back by car on Saturday night as they planned to go there for the day, as thousands of Khmai families do at New Year. I gratefully accepted and we exchanged phone numbers.
The bus to Siem Reap was comfortable, the roads metalled and smooth if a little busy with the holiday traffic, and the journey was swift and without incident. I spent a wonderful four days with a group of VSO volunteers and I will write about those adventures another time. On Saturday night as planned, having checked out of the guest house in the morning, I carried my rucsac and shoulder bag around the town, to the restaurant and through the night market afterwards, finally flopping to watch the fireworks and eat a last ice cream (there’s a recurring theme) while waiting for the 10pm phone call and the expected lift home. When it came the conversation was a little bizarre and confused. In addition to the language problem, it seemed that the sons had not communicated with the parents, the family plans had changed, and my landlord thought I wanted a lift back from the bus stop down the road. It gradually dawned on both of us that we were a long way apart in distance and expectation, and I bowed to the inevitable and trudged back to the guest house, this time booking into a $4 room instead of the $6 luxury of a wardrobe and writing-table.
Returning by taxi with VSO colleagues Sunday afternoon I was struck by the contrast in Banteay Meanchey province where New Year is celebrated on the streets by children and teenagers having pitched battles with plastic bags filled with water. Sometimes a small stone is included which is not funny. Every 50m along the street through town or village, groups of young people would be standing in the roadway showering the moto and cycle riders with water and flour or talcum powder. I was glad to be in a taxi though I did receive the white face treatment in my own street the following day – a real triumph for the kids to bag a barang and we all had a laugh.
I had no time to catch up on the happenings in the hospital on Sunday night. Monday was the last day of the New Year holiday and I went early morning by taxi to the Thai border at Poipet to renew my visa, meeting up with another VSO volunteer who had to do the same. This time I bought only one seat in the taxi because the prices are 50% inflated because of New Year – $3.75 instead of $2.50 – it doesn’t sound much but we live on $10 a day allowance so it is essential to save as much as possible. There were 4 adults and a child in the back, three adults including the driver in the front. Nevertheless it is safer than the minibus seat I declined when I saw how the passengers were packed in like sardines in the back. And vastly safer than the pickups which may have thirty people jammed in, riding in the open and so vulnerable in an accident of which there are many over New Year.
When I returned to work I found that the septic abortion patient had been operated on by a surgeon who found not only her uterus perforated, but her small bowel perforated as well. She had over 6 litres of intestinal fluid in her abdomen by this time. Two days later the signs were that the bowel repair had not worked and he operated again and brought the bowel loop onto the surface to drain. By Thursday she was no better and Dr Poly, the surgeon, was clearly distressed about her condition which is unusual to see as feelings are not often displayed publicly. He was relieved by my offer to join him for the third laparotomy. It didn’t take long. Her bowel was by now perforated in several places and the only thing to do was to leave the abdomen open with the small intestine on the surface covered in moist dressings and wrapped in a plastic sheet. Last I heard she was clinging onto life but it will take a miracle for her to survive even though she was young and healthy before all this happened. Septic abortion is one of the big five killers in pregnancy related deaths. It used to be common in the UK before abortion was legalised but we never see it now. Not so here. Throughout the developing world this sad story is repeated over and over and over…