Good Food, Clean Water

For the first time since I arrived, I haven't had any set plans, and the last few hours have been a much needed break.  The clinic isn't open today and I have the morning free, which I chose to use to catch up on some reading.  This afternoon, I'll go back to the school so I can get back to teaching a class or two.  Time flies when you're keeping busy and it's hard for me to believe I've been here for over two weeks now.  I have been settling into work nicely and feel like I have gotten into a groove.  The clinic was a little more routine this week and I have had a chance to do a little more thinking about ways to improve the workflow for Thea (Dr. Sokunthea), and about the various public health issues related to the region.

A group of us went out to lunch across the neighboring temples and Dr. Sokunthea joined us for the first time.  She took us to a roadside vendor who is a friend of hers.  A major perk was that we got a massive discount on the meal in addition to getting generous serving sizes. As I suspected, the locals get charged far less.  Fair enough though, I still can't complain about the prices.  During our lunch, Oliver, Thea, and I had a discussion about how we could streamline her workload since there are so many patients everyday. We decided a good start would be to put a desk out in front of the clinic where Thea's nurse could collect information on each patient first and we could triage by order of severity of illness/injury.  This weekend, I'll be working on creating a form for Thea's nurse to fill out.  Creating these forms, obtaining demographic info, and getting vital signs takes up at least 5 minutes per new patient.  Given that there are close to 30 patients per day, it adds up to at least two hours of time per day that she could save.  There's also some time spent on finding previous information for returning patients because currently the information is just written on a blank piece of paper and placed into a binder in chronologic order which makes finding a returning patient's info difficult and sometimes impossible.

It turns out that we can use English for an organizational system because much of Thea's medical notes are written in English.  Unfortunately, it's not quite as easy as alphabetizing the patients since not all have Anglicized names.  And for the ones that do, from what I've observed, the "S" binder will probably contain 2/3 of all of the patients if not more.  We thought about creating some sort of serial number system and handing out cards, but we're not confident that this is a practical idea given the population we're working with.  But perhaps we can refine this idea to make it work.

Public health has been an issue that has been brewing in the back of mind since I've arrived.  At the Savong Orphanage center, I actually haven't seen too much evidence of a problem with the water supply.  The water is pumped from an underground well water source, and an Australian group has previously donated water filter systems.  There is no particulate matter that I can see visible to the naked eye so the filter at least works on that level.  I have been unable to see anything under the microscope.  I do not believe that infectious agents in the water are a concern since we have only seen occasional cases of diarrhea and none were from the orphanage center.  I suspect it is actually a far bigger problem than I have seen, but it may also be a seasonal issue and I would venture to guess that this is less of a problem during the current dry season.

Toxic chemicals are a different matter though since their manifestations may not be as acute or obvious.  Several people here and that I've talked to have brought up arsenic which is a valid concern because it is known to occur naturally in underground water sources throughout SE Asia and particularly in certain regions of Cambodia.  There is a well established non-profit organization called Resource Development International (RDI) that operates in Cambodia.  They work on developing clean water systems and testing the water.  I will contact them this weekend to see if they have already tested the water in this region or can provide some help in doing so.

Beyond the common colds that seems to be mini-epidemic right now in Cambodia, the most pressing public health issue for the kids appears to be nutrition.  The orphanage kids are actually probably some of the better nourished kids in the region.  However, some of the children from local villages though come in looking far smaller than their stated age, having incredibly thin arms, coarse hair, bruise-like lesions on their shins, and protruding bellies.  Dorothy had brought over a couple of large bottles of children's multi-vitamins (essentially Flintstone vitamins) from BJ's Wholesale and they have been put to good use.  And if any future volunteers are reading this, that would probably be one of the more useful things you could donate and bring if you have room in your bags.  Costco or Sam's Club (or whatever your regional equivalent is) would carry the same thing.  The smell of grapes, oranges, and cherries have proven to be irresistible to Oliver and Thea as they snuck one for themselves.  I'm sure they were just making sure they were safe to give to the kids.

I'm still working on ideas to provide a more sustainable solution for better nutrition to the families in the villages.  One was to provide baby chicks and sapling fruit trees or hardy vegetables for them to grow.  However, Thea states that lack of education about nutrition is a big part of the problem.  She thinks that if we were to do something like that, the villagers would simply sell the chickens when they were big enough and buy rice and fish with the money instead of harvesting the eggs or raising more chickens.  Fruits and vegetables are not easy for everyone to grow because not everyone has access to enough water for the plants.  I would like to think some more about how we could modify this idea to make this work, but I really need to get out into the community to see how most villagers live and what their notions and priorities about nutrition are.