The water buffalo sprawled across the small switchback path into the village was supremely indifferent to our plight. As far as he was concerned, the lovely, sandy path in the sun, surrounded on the sides by lush, green grass was a fine spot for an afternoon siesta and our need to navigate around him was of absolutely no concern to him. A fact he let us know with a lazy swish of a tail in response to our beeping and enthusiastic yelling. All our yelling did was induce a bored snort. I snorted too, but it didn’t have the same effect.
When it was clear the buffalo had no intention of moving out of our way, Roza decided to try and carefully guide the dirt bike around him. I had visions of tipping over and winding up on the back of the bovine. Or perhaps going right over the top of him and tumbling into the rice paddy next to the patch. Having been tossed off the back of an elephant into a dung filled river on a previous trip to South East Asia, I had no desire to reenact the experience en route to Trang Village.
With the hectic, crisis filled week in Phnom Penh behind me, I’ve spent the last few days in the field triaging a new group of children with disabilities for our Safe Haven outreach program. The commute to “work” has been a bitch. Most of the homes are well off the beaten path on rutted, pitted, dirt roads that can only be considered ‘roads’ in the most generous of spirits. Frankly, my spirit, lower back and ass were in firm agreement that they were not feeling generous at all. Our souped up motocross style motor bikes are fantastic for handling the terrain but not so gentle on the body. Eight hours a day of bouncing around has rattled everything from my teeth to my toes. Waking up the 2nd day, every bone in my body felt shaken and stirred, without the benefit of an olive or a suave secret agent.
The visits with the children themselves rattled me in other ways. So many cases, each one presenting their own challenges. Yan is 6 years old and she has never spoken. Physically, she seems healthy but suffers from blinding headaches a few times a month. She chokes when she drinks water. Is it dysarthria? What is causing the headaches? Migraines? Tumors? It’s not as if there is a CAT scan machine around the next rice paddy. Theary is 8 and his legs are twisted. He can run and play with the other kids as long as he runs on his tip toes, which is the only position in which he can keep his legs straight. His parents tell me his friends like to hit him and tease him when he cannot keep up, so often, they will let him skip school and work in the rice paddy with them. We decide to add him to our surgical rotation roster which now has 4 ortho cases, 1 heart case and 1 3rd degree burn case. A 7th boy, Loma, at 16 is so badly deformed he is literally curled into a ball, his spine and back so twisted he cannot get out of a crouched position. His legs are folded underneath him in a stance like a catcher. Surgically, there is nothing that can be done. It is severe polio, or he has a neuromuscular disease, such as spinal muscular atrophy. The best I can aim for is to have our physio therapist work towards uncurling him enough to get him in a wheelchair.
By the end of the first day on the road, Roza and I have done assessments on 9 kids, 4 of whom cannot speak for various medical reasons. I send up a silent prayer that Dr. Karen Froud, one of Safe Haven’s board members, is here in Cambodia with a team of Speech and Language Pathologists from Columbia University. Next week, her team will be generously donating their time to do full work ups on all of Safe Haven’s Outreach kids who need assistance in speech, language, cognitive, neurological and feeding issues. They will also be providing training to my new physical therapist Pheak Dey in their field of expertise. It is badly needed here in Cambodia and I am beyond grateful for their expertise and assistance. Karen is pretty excited about diving in and working with our kids. Though Karen may change her mind after a few hours on the back of the moto….
At the end of a long day with only one child left on the schedule, Roza and I stand in his family’s yard and wait for them to return from the rice fields. Roza is impressed with the number of chickens they own. I’m impressed these chickens are even alive. They are the saddest, sketchiest chickens I have ever seen with barely enough viable looking body parts to create a McNugget. I’m mentally reviewing the evening ahead which I am envisioning involves a chicken free dinner, glass of wine and a fluffy, comfortable chair for my poor posterior, when it suddenly feels as if my feet are on fire. At almost the same time, Roza and I give a shout of dismay and start stamping our feet. We’ve been overrun with fire ants. The stinging, followed by the itching, is immediate and we both are slapping madly at our feet and pant legs. We quickly move to a more ant free zone of the yard. To take my mind off the madding sting and itch, Roza regales me with recipes for the larger, tastier red ants which live in the trees. He points out a colony scurrying into a nest in a branch above my head and says the best way to harvest them for mealtime is to cut down the nest and drop the branch into a bucket of water, where all of the ants will then float to the top. Then you can scoop them out and prepare them for a little refreshing repast. Since my previous insect experiences with cockroaches, tarantulas and crickets have all involved deep frying, I assume that is the preferred method of red ant. However, Roza informs me that they are best fresh. I watch one scurry along the tree branch and frankly, fresh is not a word I would apply to this particular cuisine. I like my fruit fresh, I like my veggies fresh. Hell, I even like my martinis freshly made. However, I am not sure fresh ant is very high up on the list. Apparently, when freshly chopped up and then mixed raw with rice, they add a delicious, sour tang. I also like sour tang. In an artificial, bright orange powder.
On the way back to my hotel, we stop in to visit little Lo Lith, my 7 year old boy who has been fighting for his life the last three weeks. Born with a congenital defect in his heart, Lith also suffered from oxygen deprivation at birth and has Cerebral Palsy. Three weeks ago, suffering from edema and a fever of 104, Lith was on the verge of death in the local hospital. Dehydrated, unable to eat food, his lungs were filled with fluid and his little heart was unable to keep up with the demands of his failing body. We could do nothing but pray he would make it through the crisis. He was too fragile for surgery, if surgery was even an option. There are no hospitals in Cambodia currently performing the type of open heart surgery he would need to repair his heart. For three weeks, it was a vigil, one we expected to end in his death. But our resilient little Lo Lith pulled through. Unfortunately, once he was stable he was released right back to his village, where his mother, overwhelmed and with a complete lack of understanding about what is wrong with her son, has been struggling to care for him again. The hospital had promised to send a nurse to help her, but no one ever showed up.
We promise Lo Lith’s mother we will do regular visits to the house to monitor his health and medication. I spend time with her explaining in the simplest terms possible what is wrong with her son and why she must give him his pills everyday. I compare his heart to her water pump outside which she must prime to keep the water flowing. I explain his heart is like this pump and he needs the medicine to keep the pump working properly. While we visit, Lo Lith plays with the balloon I brought for him, his lips, hands and fingernails a deep shade of blue. Every other breath is a deep, hitching gasp. In the next week, we hope to bring in our own part time nurse, get him set up with oxygen and have Karen’s team work with his mother on feeding techniques to bolster his strength. We’ve heard from Karen that a surgical heart team from Singapore will be part of a visiting surgical rotation at Ankor Hospital For Children in October. Our new goal: keep Lo Lith alive long enough for him to have a shot at seeing this team.
Sometimes there are so many obstacles that we face daily in Cambodia trying to help our Safe Haven kids that is feels like there is a water buffalo lying across every damn path we choose. But with careful navigation, perhaps we can continue to find our way around them.