I was delusional in Siem Reap. My self-medication story.

The year was 2015 and I had come down with a terrible stomach bug or sickness. Probably triggered by dehydration. I was staying in a small guest house. On the tuesday night I went to bed at 9:00pm and I never woke up until 9:00 am, not 12 hours later: a full 36 hours later.  I still felt groggy, and I needed some kind of suitable medication, so I got dressed, went downstairs on wobbly legs, and found a tuk-tuk to take me to a Pharmacy.

Pharmacy Siem Reap

I didn’t speak Khmer and the staff were having trouble with my Kiwi accent. The answer was to let me make my own selection. I never expected the results.

When I went in the three staff were stocking the shelves and chatting lightly.  One of the young women came to the counter and asked if she could help.  I tried explaining about my upset stomach but also my headaches and the alarming 36 hour blackout.  In my rambling kiwi accent however, I probably sounded drunk, I couldn’t convey what sort of medication might help.  What did she suggest?

The assistant kindly invited me around to her side of the counter and gave me the freedom to find the medication that I needed. There was a whole wall of unfamiliar bottles and creams and boxes.  here’s where my problems multiplied.  I’d forgotten to bring my glasses.  The labels all looked like a blur.  I tried my best to make words from the fuzzy shapes.  I could see from the names that many prescription drugs were made in India, and reasoned that these were probably knock-offs of well proven western medicines.

I looked for anything that might relate to stomach, or head-aches or fever.  If you use Dr Google you’ll know the same feeling.  You start by typing in a brief symptom, a sniffle, and before you know it you’re scrolling through the awful possibility of leprosy or gangrene.

My fuzzy-eyesight obviously took me to these same uncertain places, right here in the pharmacy.  Still, after 20 minutes I felt I’d found two bottles of pills that would do the trick.  I paid the shop assistant and went by tuk-tuk back to the guest house.  I was dying for sleep once more so I took two of each type of tablet and drifted off.

Well 12 hours later I woke feeling very weird.  My stomach was settled but I felt, well, just out of sorts.  I felt – I can’t describe it – but somehow strange. An out-of-body feeling. What were those tablets I’d taken?

This time I put on my glasses. Bingo – one of the bottles contained tablets for the relief of upset stomachs.  Smart choice.  But the other bottle? Well it wasn’t what I expected and may well have caused my disorientation.  It was a bottle of female hormone tablets.

PS. Incidentally in 2017 the Cambodian Ministry of Health placed a ban on selling anti-biotics without a prescription.  It seems I was not the only one rocking up to a pharmacy and buying stuff without a prescription. The concern was raised by doctors that if the population kept using enough antibiotics, then the population would lose their resistance to serious infection: a case where less is better than too much.

For another true story from my Brush with Medicine files: click here.

For a local health issue see a report on Cambodia’s fight against smoking: click here .

 

 

 

 

 

Google translate and the miracle baby

Mr Sotha

Mr Sothy and I were a perfect match. We misunderstood each other in perfect balance – thanks to some technological randomness from Google translate.

Most people have one or two tuk-tuk stories and in my case I feel the collective of tuk-tuk drivers in Siem Reap make a huge and posotive difference to the visitor’s experience of Cambodia. Recently I met a treasure of a tuk-tuk driver, Mr Sothy, who waited for me patiently while I was processed in the arrivals lounge out at the airport. I was late joining a queue and got beaten to the line by a tour party that had just arrived from Korea. My flight was late as it was and outside Mr Sothy must have waited at least two hours for me, and without complaint. If I was him I’d have been fuming.

To make amends I asked him if he’d be my regular driver over the next three weeks, and over that time our friendship grew, and so did our level of organisation. Each evening we planned the excursions for the next day; trying to streamline the pick-ups and deliveries we each needed to make around town.  Just getting things like photos developed, or getting business cards printed involved trips here and there

MR SOTHY AND ME

That’s Mr Sothy and me. Wonderful driver – this day we were sampling mango smoothies at Blue Pumpkin.

My Khmer is hopeless – I can say thank you, and I know several of the food groups such as chicken, fish or pork – but with languages I’m put in the shade by my wife who can speak in English, Finnish, Cantonese and can get around Italy and France with some of the dignity that cloth-eared tourists like me don’t deserve. For his part, Mr Sothy is still learning English, and on many occasions we’d draw maps in the dust – to explain where we were heading.

Though wait. Mr Sothy had Google translate, and phrase by phrase we were able to work most things out. He proved an amazing detective who helped me find lost friends when I had few if any leads. We both enjoyed such quests.  Google translate really was remarkable.

But one day, Mr Sothy was visibly ill.  “What’s the matter?” I asked his smart phone. He waited for the translation and then spoke back into his Samsung mobile. He showed me the translation which reported bluntly: “I am heavily pregnant and I need to go to hospital.”

Sensing the arrival of a miracle child, I urged Mr Sothy to head to the nearest medical centre a block away.  We drove there. He parked the tuk-tuk and in visible pain entered the small medical unit. A number of patients lay in a ward that opened up to the street.  In a consulting room a small child howled and shrieked: she was getting a needle for some infection – and she wasn’t happy. Her stoic parents held her hands but to little avail.

Presently Mr Sothy was examined and found (to our relief) that there was no baby on the way – but there was severe stomach pain.  The medical staff gave him some medication and had him lie down for 15 minutes.  All the while the small child continued to put up a fight against all medical treatment with her piercing, yowling screams.

Still, in that quarter-hour the tuk-tuk driver felt some relief, and when he stood up once more he was given a prescription of various tablets and capsules. He had no money on him, or not enough, and I felt that in view of his patience at the airport it would be only right for me to pay the medical centre. So we paid up, then bumped our plans back 24 hours and agreed to meet next morning if Mr Sothy felt up to it.

He was in fine health from the next day onward and we treated Google translate with a slice of caution after that. I really enjoyed his company.

How did Google developed translation from Khmer to English?  The work goes back to 2012 – when they employed sheer computational horsepower to the task – comparing Khmer text to English version of the same web pages. Actual translators were not employed. see this backgrounder from the Voice of America – how-google-figured-out khmer-translation  

Click here: for a crash course in Cambodian Motorbike safety.

Got a tuk-tuk story or a Google Translate story? I’d love to hear about it it.

How safe is Cambodia’s airline?

Below average. The air safety infrastructure lets the ratings down.

Below average. The air safety infrastructure lets the ratings down.

You can find everything on the web, and recently a friend of mine, Dennis Weng, and I were discussing airline safety. He’s a statistician and we were discussing international standards. The conversation led me to the Airline Ratings Website which posts a safety rating out of 7 for every significant airline in the world. Cambodia Angkor Air gets a…er…3 out of 7.

Admittedly the audit was updated as far back as 2009, almost 6 years ago, so things have doubtless improved. What really pulls the safety rating downward is the poor Cambodian infrastructure. Should a plane go down there is inadequate air accident investigation resource, and as it stands, a weak air navigation network and emergency response at the airports.

Still things could be worse. In 2004 I flew out of Phnom Penh airport. They had an amnesty bin in which travellers could drop pocket knives or other items deemed unfit for air travel. Right there is the perspex container I saw it: an old hand grenade, found apparently by an American hippie tourist who thought it would make a great souvenir.

Imagine sitting on a plane next to that guy!

The 7 star safety assessment criteria for all airlines is as follows

Is the airline IOSA certified? If yes two stars are awarded; if not, no star is given.
What is IOSA Certification? The IATA* Operational Safety Audit (IOSA) certification audit is an internationally recognised and accepted evaluation system designed to assess the operational management and control systems of an airline. IOSA uses internationally recognised audit principles and is designed to conduct audits in a standardised and consistent manner. Airlines are re evaluated every two years. Registering for IOSA certification and auditing is not mandatory therefore an airline that does not have IOSA certification may have either failed the IOSA audit or alternatively chosen not to participate. *IATA (International Air Transport Association)

Is the airline on the European Union (EU) Blacklist? If no a full star is awarded; if yes then no star is given.
What is the EU Blacklist? A list of airlines banned from flying into European airspace due to safety concerns arising from alleged poor aircraft maintenance and/or regulatory oversight. Airlines banned by the EU may have a flawless safety record however the potential risk towards passenger safety is deemed by the EU as too high and a ban is put in place

Has the airline maintained a fatality free record for the past 10 years? If yes the airline are awarded a full star; if not then no star is given.
A fatality is deemed as the death of crew and/or passengers whilst on board the aircraft due to an accident. If deaths occurred through acts of terrorism or highjackings they have not been included. If an airline suffered a fatal accident through no fault of their own such as a runway incursion on the active runway (an incident where an unauthorized aircraft, vehicle or person is on a runway) this has also not been included.

Is the airline FAA endorsed? If yes a full star is awarded; if not, no star is given.
What is FAA endorsement? In the United States, the Federal Aviation Authority (FAA) has a list that bans countries (not airlines) from flying into American Airspace. The ban arises from a deemed inability to adhere to international aviation standards for aircraft operations and maintenance. According to the FAA Web site, “those that do not meet these international standards cannot initiate new service and are restricted to current levels of any existing service to the United States while corrective actions are underway.” An airline or airlines from a prohibited country may have a flawless safety record however the potential risk to safety is deemed too high by the FAA to allow operations in American airspace.

Does the country of airline origin meet all 8 ICAO safety parameters? If yes TWO stars are awarded to the airline. However, if the one criteria that is below the average is so by less than 15 per cent it is considered a pass. If 5 to 7 of the criteria are met one star is awarded. If the country only meets up to four criteria no star is given.
What is ICAO and what are the 8 parameters? The International Civil Aviation Organization (ICAO) was created to promote the safe and orderly development of international civil aviation throughout the world. It sets standards and regulations necessary for aviation safety, security, efficiency and regularity, as well as for aviation environmental protection. The 8 ICAO audit parameters that pertain to safety are; Legislation, Organization, Licensing, Operations, Airworthiness, Accident Investigation, Air Navigation Service and Aerodromes. For more information on a particular country visit: http://www.icao.int/safety/Pages/USOAP-Results.aspx.

Has the airline’s fleet been grounded by the country’s governing aviation safety authority due to safety concerns? If yes an additional star will be taken off the total for five years from the time of grounding

Does the airline operate only Russian built aircraft? If yes an additional star will be taken off the total.
– See more at: http://www.airlineratings.com/safety_rating_per_airline.php?l=C#sthash.AUhiB4NW.dpuf

Cambodia. The ugly tourists and the prostitute in the internet cafe.

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Night Market, Siem Reap. Cambodia has become better equipped for dealing with a wider variety of tourists

I’ve noticed over 9 years how Cambodia has evolved as a tour destination for an increasing variety of tourists and visitors. On my first flight into Siem Reap the flight was dominated by a group of middle-aged Americans (my age group) and we were all slightly adventurous by nature, but also seekers of comfort. Wewere here primarily to see Angkor, and besides these temples and the big hotels, the local visitor infrastructure was not well developed.

This month my Bangkok Airways flight was populated by backpackers from Spain and Mexico, a pair of Russian honeymooners, a conference of solar energy experts (from as far afield as Germany and Myanmar) and many others. I was quite the eavesdropper! The flight prepared me to expect some changes in Siem Reap.

The biggest single change, as far as tourists are concerned, is the development of the lovely Night Markets which offer god food, good artisan crafts and silks – and, being open at night, shopping at a lovely romantic temperature. Balmy but not sweltering. The walk from Pub Street is colorful and safe.

But what the night markets represent is the way that Cambodia has become more organised for tourists. Instead of being a single-sight destination (Angkor temples) Siem Reap is offering more to do and experience. This is vital because tourist spending is one of the economic lifebloods of Cambodia (cheap garment production is the main export earner) and the battle is not only to encourage tourists to spend more, but to stay more than the average – eight years ago – of just three or four days. Previously tourists would fly in, stay at an expensive hotel (whose profits went back to foreign owners) and apart from some tuktuk rides and some spending at local westernised restuarants, and tour guides – very few other dollars flowed into the economy.  These days there are more places to see and more things to experience.

Popular options aside from Angkor, include Quad Bike tours (these go out through Bakong where our school is) though I wish the owners would tell their young tourists not to drive so dangerously. Slow down around blind corners – don’t put kids lives at risk! They also include specialist visits to potteries and to the silk farm out past West Baray.

Today’s visitors fall into three basic types.

  • The wealthy Zen Experience. Temples. Spa treatments. An Apsara dance show over dinner. Some shopping.
  • The Backpacker. Guest house, wifi hot spots, photos and haggling over prices.
  • The middle-aged adventurers. Liberal, careful, observant – a world view but enjoy comforts too.

In the latter group I’d include an Oregon couple (he’s an attorney) with whom I shared a very entertaining conversation that ranged from the sad Trayvon Martin case to the development challenges facing Cambodia in the future. On my last visit one told me how he’d been approached at an internet cafe by a male student, soliciting sex so he could  continue at university. The man, an American was just so saddened by this.

“The boy had been reduced to the point where he felt prostitution was the only way out.”

I sense, when I meet these people  that there is a burgeoning desire by the 45+ to do something constructive in Cambodia. But what?  I feel there is a big gap for the development of organised ethical tourism. Over time I’ll add some links for this group.

The “Wealthy Zen” people don’t bother me. Cambodia is just another backdrop to their well-heeled life adventure. Next stop: the Maldives. In some way they are invisible as tourists.

The sector that worries me the most is the backpackers. Perhaps, to be fair, I should split this group into:

  1. The true eco-adventurers.
  2. The party animals.
  3. The emotionally ill-prepared.

The party animals and the ill-prepared threaten to ruin Cambodia’s tourist scene in part because it’s all about THEM. The young and in love backpackers on my plane were kissing and cuddling like there was nobody else on board.  She was already dressed inappropriately for Cambodia in her skimpy camouflage-chic tank-top and the two clearly had never spared a thought for the culture they’d be “immersing themselves” in.

These people whine about wifi (at the Blue Pumpkin the upstairs wifi lounge was populated by young facebookers who spent hours glued to their iPhones and tablets) and moan about prices. They play a role (on the surface they look like adventurers) but beneath the backpack beats the heart of what we used to call the Ugly American – only they’re from Germany, New Zealand, Australia and Singapore as well.

Maybe I’m just getting old and grumpy: but every time I see a Cambodian pandering to the needs or wants of these self-centered people I think of the boy in the Internet Cafe, resolving to sell himself so he can continue as a student.