October 1999 by Albert Repicci
We touched down in Cambodia last night coming through Bangkok and were immediately taken to quarters in Phnom Penh where we would rendezvous with the members of the team aniving from other parts of the world. It took four days of travel to get there and we wasted little time with orientation. Early this morning we piled into a van in downtown Phnom Penh, having no idea what the itinerary would be for the day. Our translators took us down to a bustling wharf on the outskirts of town and there, amongst an eclectic assortment of wooden junks, cargo, and small fishing canoes was a weary and tattered open wooden boat that we literally walked the plank to board. A romantic sense of adventure swept over us all as we chugged away from the rickety pier heading out toward the Mekong and another world.
Our small international team representing the Philippines, Romania, Canada, and the United States, consisted of two physicians, one dentist, two nurses and two helpers. With so scant a group, we braced ourselves for what we knew could be an overwhelming day, our task being, not only to provide health care but good will as well. Good will has a tendency to get lost when the number of patients seeking care far exceeds our manpower and some patients are left lamenting a lost opportunity to see a physician or dentist or have access to medication that may relieve some of life’s misery.
The specter of that happening, however, was soon swept away as we became entranced with our river journey up the Mekong passing through a civilization that has struggled to move beyond the armed conflicts that have left this country hemorrhaging on the road to literal implosion. Fisherman in their long wooden canoes, huddled in the partial shade of a domed canopy peer out sleepy eyed at the bone bobber cast from a bamboo pole waiting for it to signal a nibble. Families working in tandem from slightly larger, yet equally primitive craft cast their nets and gather them back into the boat picking through their catch. The river itself is a reddish brown, not at all unlike the color of the soil on the banks of the river. Passing small farms on the rivers edge, peasants are seen dislodging coconuts from their treetop perch with long bamboo sticks and harvesting rice from the paddies. Children are bathing on the shores while adults up river are gathering water in buckets for household use. Thatched roof dwellings abound with fences of bamboo lashed together demarcating animal pens and property borders and beasts of burden haul carts and plows. Our little riverboat, plodding along with a clunking engine that threatened to expire when we first left the landing, hummed along dutifully, under the watchful eye of our determined captain.
About an hour upstream we edged toward the opposite shore where tidy thatched houses, balanced precariously on stilts, hovered over the river. Again greeted by a narrow wooden plank, we made our way to land, albeit not dry land. We were still in the rainy season and the landing areas, as well as the trails, were mired in muck and mud. Our supplies were loaded onto a small horse drawn cart, which, without the benefit of several hefty shoulders along the way, would not have made it through the deep muddy ruts in the trail Our team of seven, however, had the luxury of riding on the back of motor scooters that veered from the trail as necessary to avoid the quagmire. The horse stopped in front of a trim compound neatly nestled under a canopy of palm trees where we unloaded our gear and surveyed the grounds to lay out our open air clinic.
I selected a small landing at the top of a staircase on a stilted house. It not only gave me a marvelous panorama of the whole compound, but it likewise allowed only a single access to the treatment area, reducing the likelihood of being surrounded by patients in curious awe of oral surgery. I am always touched by the enthusiasm of our local helpers who begin as interpreters and quickly expand their assistance passing out pain medication, placing gauze over a surgical site, and holding the flashlight on the operating area.
Looking down at the pharmacy area I can see Valerie surrounded and swamped with patients trying to get their prescriptions filled. I don’t know how she holds up. Alan and Nicolette are struggling as well trying to diagnose disease where the chief complaint is, “I hurt all over.”
Nancy and Janny are working the registration area and packaging medications as well trying to keep up with patient demands. I feel myself smiling as I enjoy the scene beneath my perch for the thousand things it says, not the least of which is the lesson in caring and compassion by my teammates and the sense of gratitude from these people that have endured Armageddon.
As the day winds down, I am again grateful that I successfully made it through the surgical minefield without something blowing up in my face… metaphorically, that is. I have never been able to get over that sense of anxiety when doing extractions in the bush that sooner or later one of the cases will turn into a surgical disaster so that I actually have the sensation of walking through a mine field. I’ve asked my assistant to remind me to breathe. As much as I rebuke myself for the seemingly insensitive agitation I experience when extra patients show up after I think I’m done, my psychological and physiological reaction is that of being asked to walk the minefield again. Hey… my problem… The patient’s problem begins, however, when you are pressed to treat more cases than you are both physically and emotionally prepared to manage. Concentration wanes: fatigue sets in: surgical technique falters: self-doubt lurks in the shadows. That’s why disasters happen at the end of the day. Patients sitting upright on a stool in the midday heat are prone to syncope and collapse. Sometimes, however, good judgment is overruled by the desperate look in a patient’s eyes. At each of these one-day projects you can’t help but get a sense of what that final day at the embassy in Saigon must have been like when people were crawling all over each other to get on that last helicopter. Near panic sweeps over the last few patients if they suspect they will be denied an opportunity for care.
After packing up we made our way back to the landing to pick up the ferry, however in our departure we were joined by the many patients and their families who came to see us off. I have bad farewell to villagers before from departing helicopters in the Himalayas, single engine aircraft from the plains of Mozambique and jeeps from the Andes and hills of the Caribbean projects but there was something serene and gentle about casting off in a boat where the departure was less abrupt and waves of gratitude and wishes for a safe journey followed us down the river until they became tiny specks against a setting Cambodian sun.
The days pass one very much like the other, and again very different, up the river, down the river, all around the town. Each day another she, a similar clinic but now we are becoming more aware of the reality Cambodians faced in their tortured history. Stories emerge from the translators and Cambodian colleagues that cast a sobering pall over the project. Slowly it becomes apparent that for us, what has been a journey through another culture, for them has been the desperate struggle of a people demonized and forgotten. A visit to the Khmer Rouge detention center in Phnom Penh and onto the infamous Killing Fields of Pol Pot on the outskirts of the capitol left no doubt concerning the macabre nature of this country’s history. It was almost impossible to imagine Phnom Penh being completely disgorged of its population as it was in “Year Zero,” the beginning of the new order on April 17,1975. Cambodia under this regime stood literally as a suicidal nation, with summary executions applied to former members of the military, government officers, intellectuals, and in general, anyone who as much as questioned the new regime. Even to question the daily work schedule by those reduced to slave labor marked you as an enemy of the New Order… and all enemies.. .were shot.
On our final workday we took the van to a country village of stilted wood and bamboo huts stretched out, lining just one side of the road while all else was submerged in the flood plains. Since the only dry ground for miles was the road itself, the clinic was set up in the middle of the road under a blue tarp, which gave the impression of an aniving circus. I was directed across a wooden plank to one of the huts, which served as my clinic. The unique characteristic of today’s project was the disposition of the kids. They managed to all gather in the hut and sit around me in wondrous anticipation while I anesthetized one compliant and smiling child after another before proceeding with the required extraction. Collectively the kids then all sang me a song under the directorship of my interpreter. The kids seemed to delight in each other’s experience as they waved their hand to be next. My surgical assistant, Ben then called my attention to the window where a black snake lay curled up in the water beneath our hut.
Before we left, Ben broke out bis bag of tennis balls and we had time for a little baseball diplomacy on the road as kids whacked the ball into the flooded fields with a broken stick.
With our work complete, Alan had arranged for all of us to fly up to ancient temple complex at Anghor Wat, one of the Seven Wonders of the World. These ruins had remained hidden for hundreds of years until French archeologists discovered them in the 1800’s. We had been cautioned about leaving the trail since the area was still not completely free of land mines. The harsh reality of that truth was evidenced by some of the beggars near the temple who had lost limbs due to these pernicious traps lurking in what might appear to be an innocent meadow or rice paddy. With all the daunting issues that confront projects such as these, and considering that people live under these conditions their whole lives contending with malaria, AIDS, cholera, yellow fever, dysentery, dengue fever, encephalitis, hepatitis, T.B., snake bites, etc… one would think that nature had been cruel enough to man without man heaping more misery upon Mmself by flooding the countryside with these lingering silent weapons designed to maim and kill.
After much anxiety concerning the acceptance of our project in Vietnam, we finally arrived and passed through customs without much ado. Initially our medical supplies were being held for heavy taxation; however, Alan explained that they were for humanitarian purposes and to be given away freely so we were allowed to retrieve our supplies. Those of us who were carry¬overs from the Cambodian project will now be meeting up with the new team arriving from the U.S. I expect some familiar faces from other projects in past years such as Barbara and Joyce from the Africa projects: Doug from the Dominican Republic; Valerie, Alan, and Nancy who stayed on from the project in Cambodia, and Ben who worked with me in Ecuador. Jenny, who assisted me in the Himalayas, returned home to Canada after Cambodia but I know I’ll run into her somewhere in the bush again…. maybe springtime in Mongolia. Mike, a new fellow who joined us for his first MMI project, had been a Vietnam veteran and had been stationed herein 1969.
We spent little time in Saigon passing by the location of the American Embassy and sped out of the city to the town of Bao Loc, about 4 hours northeast of Ho Chi Minh (Saigon) City. There were very few cars but plenty of scooters and bicycles. It was amazing to see the things they could pack onto a bicycle, using it as if it were a truck loaded with pigs in cages, lumber, furniture; you name it. Often the cargo was so bulky it necessitated attaching an extension arm to the handlebar so as to push and steer from more than an arms length from the bike.
If one had fashioned a vision of an industrious people churning out their labor in pointed straw hats, faces cloaked in scarves filtering the air, bamboo poles hoisted over the shoulder artfully balancing the produce hanging on each end, and farmers tilling the fields by hand, that image was certainly fulfilled in Vietnam
It was well after dark by the time we got to Bao Loc so we only had the energy for a briefing on the political realities of the country. Our translators pointedly tagged this gathering… an
introduction… not a meeting, which apparently may be characterized as potentially subversive. One of our translators spent three years in a re-education camp after the war with the U.S. for having been in the South Vietnamese air force. He remains under surveillance.
After several meetings with local Red Cross and government functionaries we worked our way up to the picturesque provincial Capitol of Da Lung. We gathered in a long meeting room with an imposing picture of Ho Chi Minh glaring suspiciously over the proceedings being chaired by the deputy Director of the Provincial People’s Committee. He was gracious and accommodating, acknowledged the distance we had traveled, and expressed his sincere gratitude for the offer to provide health care in the poor rural areas. He then proceeded to facilitate our access to several such communities.
Although we had some anxieties concerning crowd control at our first project she, the local Red Cross workers kept a fairly aggressive crowd under control with only a slight “run on the embassy,” when we started closing up. Ben was pulled off the project today, however. According to our translator, he had not yet been approved by the police and therefore had to vacate the clinic compound.
Now the tough part. My phase of the project is over and I’m leaving the rest of the team behind. I prefer to make the farewells quick and simple, which they were. But on the long dark bumpy road back to Saigon, my heart was with the team knowing they had a lot of work ahead yet and the absence of a dentist cuts deeply into a project. I honestly don’t think I had the physical or emotional energy to keep up our pace anyway.
I was gratified, however, that I was able to initiate another Fluoride rinse program similar to the ones left behind in Cambodia, Swaziland, Antigua and Nepal. Fortunately, the Deputy Director of the local Red Cross, who was familiar with the concept but had never had access to the material, was anxious to take responsibility for the program Although in reaching only 1000 kids, this is a much smaller project than the 10,000 youth programs in Swaziland and Antigua. But it is still a good start, a manageable patient population, and can be easily expanded. Wondering how much impact, if ever so slight, the daily clinics have, there is at least some satisfaction in leaving a project behind that has the potential for nudging general health up a notch.
After two hours on the road our driver pulled into a dimly lit roadside stand where he turned us over to a fresh driver for the final leg to Saigon as he set off by himself back to Bao Loc. The ride continues for us, quiet and somber, as we pass through darkened villages illuminated by an occasional candle or oil lamp propped up on a stool Food vendors huddled over their meager fires preparing traditional foods for those who had the extra $ (dong) to “eat out”.
With very few cars on the road we sped along handily with the car horn barking at everything that moved. As we closed in on Saigon the volume of motor scooters became intense and with almost no traffic lights in the city, every vehicle jockeys for position reminiscent of the scene at the base of a ski slope with ten converging trails. Somehow they manage to slither between and around each other with minimal disaster.
Exhausted, we finally arrived at our hotel and arranged for the following morning to go to the Cu Chi tunnels (a Vietcong underground network) not far from Saigon. The tunnels were so small and claustrophobic that it was hard to imagine them being used for much more than bomb shelters or for passage along very short distances.
While still at the tunnels, viewing artifacts from the war with the U. S., I spotted a small box containing the dog tags of American GFs. I was taken aback, wondering at first, if they were authentic, and if so, how they got separated from their owner. Of the three possibilities that came to mind, killed in action, missing in action, or just lost or abandoned tags, I hoped for the latter. In any case, I was uneasy with them being on display sensing that, as personal effects, they were deserving of reverence and should be retrieved. I negotiated for three that were legible and I am in the process of tracking down the owners.
From there we went to the Mekong Delta and traveled from island to island, making three transfers from one wooden boat to another, each smaller then the preceding. The clongs continued to narrow down to winding tributaries, navigable only by canoe. Because of its isolation and torturous path, this area became a favorite for the Vietcong, who took sanctuary in the thick jungle of these shores.
Our journey back to the piers took us past a fleet of fishing vessels that had just returned from their lengthy expedition at sea. The crews were hoisting buckets from the river and dousing themselves with water, displaying exhilaration that spoke of the relief of being back in port. A quick stop at the market revealed panoply of produce, livestock, fishes, and foodstuff that were peculiar to this part of the world.
Back in Saigon on our final night, a street urchin offered to shine my shoes. Both of his parents had been killed and he lived and scratched, alone, for a living on the street. He owned only the clothes he had on his back and each shoeshine provided money for his next meal. We invited him to join us for dinner and he reveled in multiple helpings.
Leaving Vietnam almost proved uneventful until Ben and I were summoned from the entrance to our departing aircraft by security guards who suspected something suspicious in our luggage. We went back to customs where they opened our bags and identified two packages we had agreed to transport back to the States for one of the project workers. I’d be lying if I said I didn’t begin to sweat a bit, wondering what, in fact, this fellow had stuck in the package that was about to get us thrown into a Vietnamese prison. Fortunately there were only a couple of video tapes that had triggered the radar and the authorities were satisfied that they were of a generic nature and not films of government buildings or objects of potential sabotage.
How quickly we landed in Hong Kong.. .too quickly. I have not yet had time to process. Hong Kong is San Francisco… only shorter. I thought, “One day of re-assimilation to the industrialized world should be enough after doing this for so many years,” so on to the U.S., New York, and home.
I have deferred writing a postscript for two weeks while I untangle my thoughts. Having traveled to some of the extremes, I begin to wonder, after 20 years of this, how much longer can I keep this up? I ponder to myself, “Am I playing the game… can you top this?” Where do I go from here? What if I run out of truly exciting places to visit? Is the location the attraction… or is there truly a purpose? Ultimately, I suppose it’s all about satisfying our own needs.
Upon my return home there was no one immediately available with whom to debrief or share the experience in any depth. I began to question whether or not these epic experiences were not in fact irrelevant. The eventual sharing of photos and stories passed so quickly that the event was placed behind me before I had even processed it in my own mind. So Albert, you went to Cambodia, cruised up and down the Mekong River, worked in the jungle, sped off to the Killing Fields, flew on down to Vietnam, discovered some dog-tags, did some oral surgery, flew home, raked some leaves, cleaned the gutters.. .Do you want ketchup with that hamburger, sir?
No matter how many of these extreme experiences one goes through you have to guard against making too much out of it. You go through the obligatory soul searching and become a bit too profound with the “why” and the “wherefores”. Once they’re out of the way, you sense sometime, that it’s about like having spent time on a movie set… and then it’s gone… so you waft for the reviews. Oh hell… Times up. Get your head back on straight. Just think of that poor little shoe-shine kid who lives an epic existence everyday.. .alone, and those Cambodians who lived through the reign of Darth Vader of planet Earth while you only saw it in a looking glass. Throw me a freakin’ bone here!
So here I am again… Thoughts for personal consumption only… Is there life after Darth?… Hmm…There’s the family… It’s autumn in New England… Halloween is this week… Coca Cola in the bottle… Yankees win in 4… Golf course is open… I’m back… Life is good.