Cambodia: Angkor Wat

Since Kelvin and I flew across the world to the Philippines, we thought we'd visit Cambodia and one of the world's archeologic wonders, Angkor Wat, which is an amazing complex of temples (some Hindu, some Buddhist, some fusion) from as early as the 12-13th centuries outside and around the town of Siem Reap. The ruins were spectacular and reminded us a lot of Machu Picchu! Tomb Raider was apparently shot here, at the temple Ta Prohm.

Being in South East Asia also reminded me a lot of the time (age 8-10) my family spent in Thailand. Although the heat and insects are rough, the people are wonderful and the fruits amazing!

There are a few ways to get to Angkor Wat: via tuk tuk (a sort of motorized rickshaw) or bike. Since our villa offered free bike usage, we took the exercise-route and biked the 15 km there and back, as well as around the km and km of area where the other, and smaller, temples are scattered.

On bikes

Biking alongside another mode of transportation: the elephant

Greeting!

We were able to ride a hot-air balloon (fixed line, unfortunately, but a first for me!) and see the sunrise over Angkor Wat, which is the largest religious building in the world! It is still under reconstruction.

Into the walls of Angkor Thom and by Bayon, our favorite temple, and the "Temple of many faces"

Some meditative poses to fit the temple environment

Temple Ta Keo

Preah Khan

We stayed briefly in Phnom Penh, Cambodia's capital, where we visiting the Killing Fields of Choeng Ek and the Toul Seng prison/Genocide museum which documented the horrors of the mass exterminations led by Pol Pot and the Khmer Rouge in the late 1970s.

Cambodia had its firsts!

- First time in the country for both of us (add another to the country list!)

- First time in a hot air balloon for me

- First time for a nibbling fish (Garra Rufa) foot massage, which is just WEIRD!

- First time seeing a bat this close-- this kid brought this (toy) to our lunch table at Angkor Wat!

- First time trying "Lychee fanta," which is very very tasty!

- Also, first time trying a variety of other fruits, including dragon fruit, mang cau (or "custard apple," rose apple, and traditional Khmer food

Cambodia is highly recommended!

Philippines part 3: Palawan to Manila

We are back in Manila (well, Quezon City) from the island of Palawan, which was our most recent stop of the Medical Mission.

I cannot believe how warm and welcoming the Filipino people are! The hospitality has just been amazing. Each stop on this mission, we have been "hosted" by a local rotary group (or, in our last stop in Rio Tuba, by the Rio Tuba Mining Company). Other than seeing the bazillion medical and surgical patients that present to us, we have rarely had to worry about where we were going to eat or sleep for the nights on the road. Granted, this was a medical mission in a foreign country, and one traveling under such circumstances has to expect our share of the unexpected. When the surgical team was operating until 2 AM or, on another occasion 6 AM, we found ourselves almost without a place to crash and worried we may not eat (good thing for emergency snack packs! I have eaten a LOT of pili-nut-flavored snacks and prawn crackers). We left our "dorm" in Tarlac around midnight one night just to drive through the night to the next town, and had to hop from house to house before finally arriving, close to 2:30 AM, at the right one. I was about ready to just sleep in the van at that point, after stumbling around in the dark, well past my desired bedtime (9:30 PM) with my inflatable neck pillow trailing behind me at all times.

We had to be "evacuated" from the villa where we stayed on Clark Air Force Base (thought of you, JB and Wendi!) around Angeles City. Luckily, someone was there to collect our various belongings and send them to the "new" villa while we were off seeing patients! Due to flights being fully booked, we almost got stranded in Palawan (we learned that there was a 72 hour boat ride we could take back to Manila) but somehow, someone pulled some strings and we took a private 19-seater jet back to the main island! While Filipinos and the "Filipino way" to me seem very laid back (there is such a thing as "Filipino time" and, let me tell you, it is SIMILAR to Nigerian time), it continually impresses me that they can get things done, and done well. As the Filipinos say, "bahala na" (or "go with the flow"). One has to do that, in order to survive here! :)

Here are lots of overdue pictures from the past few stops:

Seeing patients around (Capas)/Tarlac.

Pre-screening surgical patients- Tarlac

Typical surgery day case list (I think they did 52 surgeries on one, very busy day!)

Us with Ems, the nurse in charge (doesn't Kelvin blend well into the Hospital Van [trailer] advertising also the Mayor, T.J. Rodriguez?)

one year old on whom we did a frenulectomy (very difficult with a willful toddler with teeth!)!

KV and Lei in "minor surgery" (lumpectomy!)

hordes of patients waiting for us (I think I saw 60 patients, mostly with complaints of cough, in one afternoon. Maybe this means my clinic productivity will go up on return to UCD!)

Nice to see some peds (I truly felt like a family physician on this trip-- some medicine, some peds, some minor surgeries, some major surgeries)

Then onto Pampanga

seeing outpatients

Man with very advanced gout

Milk Code (or sign put forth by lactation Nazis), which, admirably and very persuasively, encourages exclusive breast feeding

On the jet from Puerto Princesa to Rio Tuba, Palawan (that's Dr. Carbajal, the first Filipino specialist [ENT/ophtho] in the U.S., at the right)

This picture of a baby in the Rio Tuba hospital cracked me up

Sad case: 19 year old girl with ascites and abdominal mass of unsure etiology.

She is going to be taken to Manila for evaluation/treatment.

Kelvin kept talking me into helping him with excision of large lipomas, which tended to bleed like stink and which we had to do in the main OR.

Large lipoma- mmm

with Loreta, Stephanie, and a manicurist who turned the OR break room into a salon

While in Palawan, I actually got to do a lot of operating.

Here is me with Dr. Quevedo, the OBGYN on the trip, with whom I got to do some TAH/BSOs and tubal ligations (interestingly, which many people here [it is a largely Catholic country] object to performing)

A 20 cm (ovarian) mucinous cystadenocarcinoma (cancer) which we resected.

Me with Dr. Baron, the head of the whole mission operation

Postop checks

Despite the long hours in the hospitals, we were able to enjoy some aspects of Filipino life

I loooove the fruits here! I think I mentioned that I tried Star Apple for the first time. I have definitely eaten more than my share of awesome mangos, which always have been, by far, my favorite fruit. I haven't yet had the opportunity to try durian, apparently a real stinker, but I will try it if the opportunity presents!

Pictured below are, in sequence from left to right : 1) star apple, 2) mango, and 3) cashew fruit (I didn't know cashews came from fruit!) Can you see the cashew on the top? :)

Trying "balut" (duck embryo), which I was not such a fan of.

By a local "tricycle," one of the main forms of transportation

Some sightseeing we were able to do:

Cagsawa ruins (church buried in 1814 by the eruption of Mt. Mayon)

Mt. Mayon eruption (as pictured on a picture taken on 12/23/09). No, we were not caught in this eruption -- this is a picture of a picture!

Crosses atop Kawa Kawa mountain, a hill above Ligao City in Albay Province where we hiked a bit

Badminton on Palawan (some of the little exercise we have gotten a chance to do-- unless you count as exercise, as my sister considers, Olympics-WATCHING!)

Another thing about the Philippines which I find very amusing is their love (and seriousness!) of karaoke which you can read about here. While I love to sing, I don't really love to sing in public. I have maybe gone to karaoke about 3 times in my life (prior to this trip!). Since being here, where a karaoke (or videoke??- I'm not sure the difference) machine can be found in most restaurants, some streetcorners, and many living rooms, I have volunteered way more times than I would ordinarily found comfortable. Maybe I'm losing some of my inhibitions. and, not knowing the people here, I care less about what people think. Maybe I'm more confident. Who knows. However, despite my being willing to try, I have to say that it is INTIMIDATING singing karaoke with native Filipinos, most of whom (in my opinion) belong on "Filipino Idol," or at least the show "Filipinos Got Talent," which is similarly popular here. I dare you, someday in the future, to sing karaoke with a Filipino. You will be totally humbled!

Just a reminder: Yes, this is a work trip :)

Second Stop: Tarlac

We are now about 100 km from Manila in Tarlac.

Our last day in Albay province included a visit to My Mayon, an active volcano which last erupted on 12/23/09, as well as the town of Tabaco where we found cutlery made by banging men with hammers, and a church (Cagsawa) buried by Mt. Mayon's 1814 eruption. We had an awesome sendoff dinner at Lignon Hill, complete with gifts of certificates I won't know what to do with, and random t-shirts which are great because I may be able to stave off laundry for a few more days :).

We flew back to Manila and then drove here (it took us about 2 hours from Manila-- 1 hour to just get outside the city!). The traffic in Manila is so bad that I was told people have license plates (either ending in odd or even) which designate which days of the week they are allowed to drive!

We've been staying at the dorms at Tarlac Provincial Hospital, which is actually quite large. We are getting hosted and fed well by the Rotary Club.

We've been doing more minor surgeries, including (today), a frenulectomy on a 1-year old, sebaceous cysts up the wazoo, and lumpectomies on the breast! Seriously! They are time consuming but no one here is happy with fibroadenomas!!!

The surgical team is up to their ears in surgeries-- I think yesterday they did something like 43 (hernia repairs, thyroidectomies, etc.) and were in the OR until well after 10 p.m. I'm not sure what the count is from today.

We also saw tons of outpatients yesterday afternoon.

There is an indigenous population here, the aetas, who, per descriptions, are like dark pygmys. Unfortunately, we were too busy in our surgery trailers to get to visit and treat them today, although some of the medicine staff went.

I think we're jetting town again tomorrow... town to be determined!

Sorry no pics on this post. Am writing from the computer of one of the mayor's staff, in the building by our "surgery trailer."

Gotta go now... will probably eat some grub and fall asleep at the dinner table at 9 pm like last night :)

t

From East Asia: Kumusta (Hello)....

... from the Philippines!

We have been here just under a week.

Before flying over here (17 hours, plus a brief stop for gas in Guam), Kelvin and I spent a weekend in Westminster (Orange County), outside of LA, where I got to see the La Brea Tar Pits (!!), and where I was introduced to a bunch of So Cal, as well as Vietnamese culture, including tons of yummy foods (pennywort juice, salty plum soda drink, sugarcane juice), Korean bbq, pre-new year festivities (today should be recognized as Chinese and Vietnamese New Year, and NOT my hated V-day holiday), and swap meets (oh.. don't get me started --- I'd never heard this term for "flea market," but it is my new favorite place on earth!).

We are currently in Ligao City, which is about 45 minutes outside Legazpi, Albay province, which was an hour flight (but apparently a very bumpy 8h busride) SouthEast of Manila (main island of Luzon). We are 16h ahead of PST, so jetlag was a bit of a bummer, but, having slept for most of the plane ride (minus time spending playing "Bejeweled," which is rather addicting), we adjusted fairly well.

We have been spending our days at Josefina Belmonte Duran Memorial District Hospital serving the city, alongside a big team (at least 30!) of Filipino and other doctors, nurses, and other staff volunteers practicing in both the Philippines and in the states. There are a few medical specialists, but mostly surgeons, who have been "teed up" here to do major surgical cases (we have been doing more than 20 per day!), including hernia repairs, gyn surgeries, HEENT and cleft cases, as well as thyroidectomies (which, here, are done under local anesthesia, which is awesome to see!).

Kelvin and I have been bouncing around-- seeing tons of outpatient men, women, and kids, and dispensing the meds we have, as well as taking our hand at outpatient "minor" surgeries including lipoma, cyst, and other "lump and bump" procedures. We had a BOA (birth on arrival), a laboring woman (with her 10th child!) who was driven here by tricycle by her family, the first 5 minutes we were here in the hospital! Awesome!

Happy mom and baby #10

We are seeing a lot of advanced disease here-- strange skin lesions, and HUGE goiters. Hypo and hyperthyroidism are surprisingly very common, as are complaints of "dizziness" and blood pressure ("high blood"), which we can help treat in the short term with the free meds we brought. There are good pharmacies, including "generics" here. There are also tons of lumps and bumps which have grown out of control. I'd say that some of our "minor" procedures are not so minor!

A modest-sized goiter

Seeing outpatients

Char Lu was one of our awesome translators (while English is very prevalent here, I still feel that I need to learn Tagalog, which is interesting in its interspersed English and Spanish words!).

In Minor Surgery (this is like our SURG 2 rotation!)

A sebaceous cyst which I removed and, miraculously, did not pop in the process!

Having seen a few people with heavy vaginal bleeding (who'd bled down to hemoglobins of 3 and 5) who I felt needed surgeries, I've also scrubbed in (loosely meant here, where flies frequently buzz around the OR and people wear sandals most of the time... not so fun when blood drips on them!) on a prolapsed cervical myomectomy, and did part of my first hysterectomy since med school! Being here almost makes me want to be a surgeon, or go back and do an OBGYN residency.... almost :)

Me with the resected specimen-- a very globular uterus with adenomyosis and endometriosis (however, no pathology reports are available so we will never know!)

It's been wonderful. Great medical practice, great experience in surgery, and working with just great people. The town is really cute-- today, we visited a nearby hill, Kawa Kawa, and got to see some countryside (otherwise, it's been long days- 7 am till about 9 pm in the hospital). The people are sooooo warm, welcoming, and extremely helpful, polite, and accomodating.

The food is awesome! We have had tons of varieties of noodles (pansit), fruits (star apple and jackfruit, which I'd never tried), variations of banana snacks, and sweet rice wrapped in banana leaves. Ligao City is also home to the pili nut, which is heavenly, esp. when glazed.
Mmm. It's dangerous I'm largely wearing scrubs.. hope I fit into clothes later on in our trip.

Out and about

Riding a "tricycle" to mass in town

in the trike with Lita

Riding the "jeepney," the public transportation which is like a bus-jeep hybrid

Well- tonight we have a bit of a "conclusion" dinner.

We may do some exploring tomorrow before flying back to Manila on Tuesday. Then we head off to a few more villages in the next 2 weeks, including Zambales, Pampanga, and Puerto Princesa on Palawan Island.

This is surely an adventure!!!

Miss you! Hugs!

Take care ("Ingat" in Tagalog)!

- Tara (and Kelvin, or "Kevin" as everyone erroneously calls him, and "Dr. Yu" as his nametag erroneously reads :))