Subconjunctival Haemorrhage

Little kid has a massive coughing fit and the result is ...

Subconjunctival haemorrhage. Apologies for the poor quality photo.

Pupils equal and reactive, no visual disturbances or abnormal neurological signs. And he seemed fine about it, although the parents were a bit freaked out.

Reanimation Room

Sounds like an important section of Frankenstein's lab ... turns out to be a fairly low-tech room where dengue patients are kept under close observation. Disappointing.

Cambodian Food #2

Another little selection ...

Food van with unintelligible loudspeaker

Case of Cambodia's finest

Durian stall (taken from a moving tuk-tuk and the scooter drove into shot)

Appetising platter including frogs, snakes and beetles

Baskets of creepy-crawlies at the market

Mekong fish

Suki soup with too-cute fishball

Plate of bugs that some friends and I actually *did* eat. Water-beetles are incredibly crunchy but don't taste like much. Silkworms taste like caterpillars (yes I know this for a fact). Crickets are pretty nice. Tarantulas are just plain creepy.

"Cafe d'doh gore d'goh" - iced coffee.

Huh? This is icecream.

Old Wound

An 8-year-old boy presents at Surgical clinic with an obviously old wound on his foot which hasn't healed properly. 

The doctor asks how long ago it happened.

"Mapay chnum" he replies, in Khmer.

Twenty years.

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Paediatric Dengue

Oops, almost forgot that I was here on medical elective!

I spent last week on the Infectious Diseases ward and learnt all about Dengue Haemorrhagic Fever from the Head of ID and Cambodian expert on the disease. So that'll be really handy if I come back to Cambodia one day. Otherwise, in my very un-tropical part of the world, I'll be lucky if I ever see it again.

Basically, there are four subtypes of Dengue (D1-D4). Your primary infection is the first time you get infected, and you'll develop "classic dengue" which isn't particularly dangerous. But then if you get infected with a different subtype, your body mounts a huge and inappropriate immune response, releasing histamine which causes capillary leakage. 

This leads to oedema, pleural and peritoneal effusions (and an increased haematocrit to >20% from the baseline from haemoconcentration). Platelet count drops, so you bruise easily and develop petechiae (little red spots), and risk DIC ("consumption coagulopathy") and massive internal bleeding. Your liver becomes painful and enlarged due to microabscesses. You get joint pains, headache, eye pain, lose your appetite and have no energy. You're treated with fluids and an almost-therapeutic dose of paracetamol to help with the pain (not too much because your liver is inflamed).

And to top it all off, you're four years old and people with white coats keep coming around making you cry.

And that's paediatric dengue.

Bayon

Bayon is my favourite of all the Angkor temples. We went there straight after watching an uninspiring sunrise at Angkor Wat, and there were only two other people there when we arrived (only a handfull arrived while we were there). As the Lonely Planet says, it does look like a "glorified pile of rubble" from a distance, but the carvings on the outer walls are brilliant and there's also something very special about all those giant faces gazing serenely out across the horizon.

Some more Angkor Temples

Before I came to Cambodia, a friend told me that the temples would be crawling with tourists - the best temples would look just like the photos, but covered in tourists. She was right - the temples of Angkor sure are popular. Some groups can be very rude and stand in front just as you're just about to take a photo, but most people are very friendly and will take turns posing for photos, keeping out of each other's way as best they can. It is possible to get lucky and visit a popular temple when it is practically deserted. And even at the busier times, you can probably find a quiet corner to sit and pretend you're the only one there.

Crowd descending on Banteay Srei

Garudas at Banteay Srei

Banteay Srei

Walkway to Baphuon

Ta Prohm

Ta Prohm

Terrace of the Elephants

Angkor What?

Ankgor Wat. The world's largest religious building and the most famous temple in all of Cambodia - and that's saying a lot; this country is practically made of temples.

We went there for sunset on our first day here - I was hoping to get to the Eastern side and watch the sun set over the temple, but it closes at 5.30pm so there was no getting across. The enterprising guards let us climb up to the very top to watch the sunset for $5 each, and even let us climb out onto the edge where reconstructions are taking place. The sunset was unspectacular, probably because there was just too much cloud. The view wasn't that great either. But we sat atop the great Angkor Wat for sunset, and that is special in itself.

We also came back for sunrise and jostled for position near the "left pond" within the walls. The sky looked lovely as we were arriving (see sunrise photo below), but then the clouds made another appearance and the sun sneakily rose up without anyone noticing.

We got lucky tonight ... for a while it looked like there might be too much cloud for a nice sunset, but then some magic happened and we had the most beautiful view of the sunset over the Western Gate from within Angkor Wat. Perfect!

Angkor Wat isn't looking very nice at the moment due to huge sheets of green shadecloth which are covering areas of reconstruction. On one hand, I was very disappointed that it was covered with ugly green. My photos look terrible. On the other hand - how great, they are looking after the place! Maybe next time I come back, I'll be able to see it in all its glory ...

Angkor Wat covered in green shadecloth

Crowd at the "left pond" for sunrise

Sunrise at the Western Gate

Western Gate in daylight

Finally - a nice sunset!

Sunset over the Western Gate from within the walls

The Racist Restaurant

Went to an all-you-can-eat buffet in Siem Reap with my boyfriend, his Dad, and their relatives' driver. Food was ok, range wasn't spectacular but there was a decent selection. Then we got the bill and discovered that my boyfriend and I had been charged $12 each instead of $6! 

Apparently there is a price for Cambodians and a price for foreigners ... and despite both his parents being Cambodian, the boyfriend just doesn't look the part. 

His Dad managed to talk them into giving him the Cambodian price, but I still got charged as much as two grown men. Overestimating the barrang appetite much?

The racist restaurant

Transport in Cambodia

Cambodian transport. 

It's a Lexus SUV, or it's ... one of these options.

Bike taxi

Splendid pink tuk-tuk

Small collection of scooters

Scooters don't work well once drowned

Testing the suspension

Securing the load (photo taken from inside a Lexus SUV)

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Cambodia - Monks

Yes there are monks in there - look for the orange

Young monks off to start their day

Wandering monk in Phnom Penh

Monks travelling by Tuk-Tuk, Phnom Penh

Cheerful pair in Phnom Penh with matching umbrellas

Socks and Thongs

Cambodia is hot. And it's muggy. I wore jeans one day and almost died (well ... not really, but I was uncomfortably warm). 

And so it shocks me to see locals wearing thick jumpers and even gloves in 30C weather. It shocks me even more to see them wearing socks with thongs (flip-flops). Worse still, they actually sell socks with a separate big toe so they can be worn more comfortably with thongs. Really? Really??

Internet Scams

"I have a colleague, a surgeon, who sent an email from Spain to everybody he knows. It said he'd lost all his money and he was staying at a hotel and the hotel owner had arrested him, and he needed everybody to send €2,900 to this man. But he was in Cambodia, working, this whole time! Somebody stole his email!"

The Chief of the Hospital teaches us all that the Internet is dangerous ... ten years after everybody else found out.

Culture shock

First day of Emergency rotation at the National Paediatric Hospital, Cambodia. A local doctor walks past and greets us with, "Bonjour!" We barely have time to register before he is out of sight. Bonjour?

People speak to each other in Khmer, and case notes and formal presentations are all in French. Two languages that I am only vaguely familiar with (I haven't studied French since I was 12, and have now been learning Khmer for 12 days).

So I need to work on two languages, as English is only used as third preference here.

Oh, and culture, I need to learn about the culture. Here, loud chewing and slurping is not rude and disgusting as I've been taught. Apparently, making lots of noise when you eat shows that you are appreciating your food. And I have offended my boyfriend's extended family by not bowing low and exclaiming "johm reab sua!" (greeting) every time I see somebody - yes, you need to do it for everybody, every time you see them. It's like a fancy handshake.

Fortunately, with only two patients in the Emergency ward and seemingly no emergency presentations throughout the day, there is time to work on the other things. 

Paeds can wait.

"Praying for Rice"

The second performance we watched at the Cultural Village was called "Praying for Rice". I think the story goes: plant rice, sacrifice a cow, pray, harvest rice? 

Maybe it was more complex than that ... or maybe it wasn't.

Possibly planting rice?

Searching for ... rice?

These are possibly rice people. They seem to like the fire made from sacrificial cow.

Sacrificial cow / fire

Rice man. I think.

"Choosing the Fiance"

We briefly visited the "Cultural Village" in Siem Riep over the weekend. There are performances running all day, and we watched two of them - "Choosing the Fiance" and "Praying for Rice". I thought they would be very serious, traditional performances, but they were more like circus acts - a very simple story, lots of dancing, some impressive acrobatics, and some toilet humour to please the crowds. It was quite fun.

Here are some photos from the "Choosing the Fiance" performance. The storyline goes something like this: the king holds a competition for the hand of his daughter. None of the local heroes can lift up the special bow, so a crowd member is called out, and he magically causes the bow to lift up and therefore he is the winner. And then everybody is blessed ready to fight in a war. And then there is dancing. Ok ... so I didn't really understand the story, but it doesn't matter. Here are some pictures.

Contender

Contender trying to lift the bow

Random crowd member performing amazing feats

Random crowd member, AKA the winner

Celebration dance

Now that's a strut!