2007/10/10

Pismo Beach

2007.10.07 to 2007.10.08 - Pismo Beach Camping


Michelle, Russel, Mark, Neal, Holly, Tommy, Abbie, and I all went to Pismo Beach last weekend for some general mayhem and madness. We camped, we ATV'd, we flew kites, we played Kubb, and Russel and I even swam in the 58˚ ocean. Michelle even surprised me with Birthday singing and Porto's treats. My wife is great! I impressed myself, and hopefully my wife, by not complaining about the sand in my shoes which is something I usually HATE. I got to teach Michelle how to ride an ATV and she did amazing. There's something about seeing my wife on a quad. I don't now what it is, but it's HOT.

My Mom got Married

MomWedding


Michelle and I went to Seattle to go to my Mom's wedding two weekends ago. It was really nice time at a really pretty location, so I took a few (hundred) pictures. Here are a few that I think are nice and capture the spirit of the day. Dave is a great guy and I wish them both lots of love and happiness.

2007/09/28

Cars and Kids

2007.09.23 - Car Show with the Wordals and Dad


We got to see Aunt Carrie and Uncle Erik and the cousins, along with my dad and Penny this past weekend. We went down to Orange County to a car show and it gave me a good chance to take some pictures of the cute kids. There was some interesting cars to look at too.

2007/09/11

More Cambodia Pictures

Cambodia Favorites


Here's the photos that I've been showing to everyone. There's about 800 more pictures on my hard drive, but this is the highlight reel. Enjoy!

2007/08/23

Cambodia Trip

Cambodia Highlights


I have posted a few pictures to give people an idea of what we were doing in Cambodia. I am still filtering through the pictures and choosing the best that tell the story of our trip.

I am happy to report that I am finally feeling healthy after another 7 days of antibiotics to kick the rest of the stomach bug that laid me up after we returned from our trip. I had a great time in Cambodia, working with my wife, meeting new people, meeting the Cambodian people and experiencing a different way to live.

More to come....

2007/08/20

Camboian Culture

In order to get academic credit for my trip to Cambodia I had a couple of papers to write. One is about my cultural experience and the other is about the differential diagnosis of acute fever in Cambodia. I thought some of you might be interested in my thoughts regarding our cultural experiences. Enjoy!

I departed LA for Cambodia expecting to be well prepared for my medical work. I had studied some Khemer words and greetings and refreshed my knowledge of tropical medicine. I assumed my experience at LAC USC Hospital with its various cultures and languages would have sufficiently prepared me. While this was partly true, I was humbled in my lack of knowledge when clinic began.

We traveled into the Northwest rural part of Cambodia for our clinic, an area where a Caucasian person was a novelty and merited a friendly wave from many we passed on our drive. At the clinic, each person was provided a translator and a work station. My translator’s name was Narith. We was a 20 year old high school student from a distant orphanage that traveled to the clinic site for the event. This was his first official time translating, even though he had been studying for years. Although I had used translators at LAC/USC before, they were either professionally trained or I understood some of the language as in the case with the Spanish language. This use of a new translator really helped me to improve the clarity and simplicity of my questions and explanations. In the beginning, I found myself asking complex questions or using compound sentences, which only resulted in frustration for myself and my translator. In order to communicate properly, I needed to speak to my translator instead of my patients. One of my pharmacy runners was able to critique my questioning style. At the end of the clinic, my vocabulary included less English slang, my sentences and questions were more simple and to the point. I even found myself using more body language to communicate with my patients, as I asked them the questions instead of, “Narith, would you ask her…”

One of the other challenges I found with the language barrier was that some ideas and terms had different interpretations in Khemer and English. For example, I had several patients come in with a chief complaint of typhoid. Without a through history and exam, I would have just given the patient some ciprofloxacin and Tylenol and sent them home. However, probing I found out these patients had neither fever, nor diarrhea, but did have some epigastric pain associated with meals. Other patients came in complaining of a tumor in their nose. Upon questioning I found they assumed that because they had some nasal congestion. The other component of language barrier I experienced concerns sequence of events. It seems that there was no specific verb change to appropriate designate present tense from past tense. I had to be specific about my questions to ensure that I used the words now or before instead of merely trusting the tense of my verb. I can know see that I have a more complete understanding of language and how to effectively use it. This skill will be allow to be a more effective communicator and medical professional.

There was more for me to learn in Cambodia than language. I had not interacted with many southeast Asian patients in my short time at LAC USC, so I had much to learn about the cultural aspects of health care for this rural Cambodian group. One of the traditional methods to approach health problems in this area involves the use of cupping and coining. The first time I saw a young man with perfectly round purple well-demarcated macular lesions on his back I immediately thought perhaps he has a fungus. My translator smiled and informed me of the cultural practice or cupping and coining. This process involves placing hot coins or strong suction cups on an area that causes pain. After that I more fully realized how much I had to learn.

One of the other cultural health practices among the rural population with limited finances is to bypass the doctor and directly ask the local pharmacy for advice. Many patients I saw reported having a problem, for which they received medication at the pharmacy. The patient would then report if the meds were helping. This created a dilemma… what to prescribe. There are no medical records to be ordered and the last thing I would to do is overload the patient with toxic doses or cross reactions of the medicine I distributed. I therefore had to be very specific to ask the patient to stop any home meds while them completed this course of antibiotics or Tylenol. It was both sad and inspiring the complete trust that the people of this province gave me as a health care provider.

In addition to the cultural health practices, this experience has helped to understand the great need to improve local systematic health problems. The major problem I saw was a lack of clean drinking water. In the hot, humid temperatures of Cambodia, amongst a rural group of hard working people, it seemed almost every patient was dehydrated. Upon questioning, many of my patients reported drinking one mug of water per day. I came to understand their horrible dilemma. If someone does not have access to a local well, they must rely on the dirty water that accumulates in the ditches and streams near their home. This resulting in less total water consumed and a systematic problem of dehydration and unfortunately parasites and worms. It appeared as if not all families will take the extra time or even are aware that they should be boiling their drinking water. There was a lot of time spent in our clinic advising the people that came about the proper amount of water to drink and the way to prepare it.

The second systemic problem I saw was a lack of prenatal and perinatal care. There were many patients I met whose wife or mother died in child birth. The most tragic story we experienced is of a small three month old boy named Moses who was brought in for failure to thrive and diarrhea. Mom had died during delivery and Aunt was feeding him only cow’s milk since birth. She didn’t know anyone who could breast feed him and couldn’t afford formula. Luckily, we were affiliated with an orphanage that could care for him as the Aunt realized she was not able. This systematic problem of perinatal morbidity and mortality is something I yearn to change, because I see what it is in the United States and because I am interested in obstetrics. On our trip we prepared for this problem by providing near term mothers with sanitary delivery kits to help decrease maternal and child infection during delivery.

It was with this Cambodian experience that I have stretched and grown as both a future physician and a person. I have expanded my understanding of language and communication. I have seen cultural differences in health care. Most of all, my heart has been touched by those systematic problems in Cambodia that I take for granted on a daily basis and my mind has started turning about how to approach these solutions. I now return to America, perhaps the same on the outside, but different inside.

2007/07/27

We're off to Cambodia, TODAY!

We're off on our adventure. We're excited and will be certain to post lots of pictures when we return from our trip. Please pray for Adam, he work up this morning with a sore throat! We don't want anything to prevent us from our work while we are gone.

If you are interested in seeing where we are going to be staying, the Cambodian church has posted some of the pictures from the scouting adventure on their website. Check it out. http://www.missionreports.com/medical_scout_apr07/

And if you just want to see what is going on in the Cambodian Foursquare church, here is their home website. http://www.missionreports.com/cambodia/