Friday, July 31, 2009 – Day 7

**NOTE: NAMES HAVE BEEN CHANGED**

I get an email saying that my documents to an organization were not received. I mailed the documents a month ago via snail mail. Funny how a system that has a good operating mail system loses mail so often (2^nd time for me in the past 5 years).

I have a new task. Compile a table about each surveillance system, their case definition, data collected, etc. Harder than it sounds when there is missing info and info placed in many different areas and people and agencies.

10 AM – Dr. Funny asks me if I want coffee downstairs. I say no, thank you.

10:45 AM – Marlin comes in and says every Friday, there is a coffee break for all the staff downstairs in the meeting room. Coral (secretary) comes in with a plate of candy for Dory and me.

11 AM – Dory & I head downstairs and the secretaries and staff are putting away plates but bring them back out when we come in. There are huge trays of French croissants and another of Asian sticky rice, glutinous rice stuff wrapped in pretty bamboo leaves.

They bring out plates for us. Another staff person comes in who sat directly across from me at the staff meeting. He is Afghan, went to med school in the Philippines, and didn’t go to residency – but did go to the London School of Hygiene and Tropical Medicine. I know 4 people who have gone to this school and debated about applying but their academic year is very different and would offset my current projected schedule. I talk to this doctor and say I’m reading the “Kite Runner” and it’s about a change in a boy’s life in Afghanistan after Russia invaded. The doc says that he is related to this author, Khaled Hosseini. Small world. He tells me that the story tells Afghani life quite realistically.

I meet with Nemo to go over a rough draft of the report and we make more changes. We go to lunch at a Khmer restaurant, where we take off our shoes and sit on cushions. I finally try the much-raved fish amok. It tastes like Thai food because of the spices and curry but it is so good. It is like having a present b/c there are 9 or so lids to lift up and just when I thought I ate it all, I lifted up the center lid and there was another piece of fish. I also drink coconut milk out of a large coconut!!

Nemo and I talk about a lot of things, but mostly I ask questions about WHO organizational structure, hiring/intern process (he says I’m lucky b/c I’m working 4 weeks when minimum is 6 weeks), etc. I find out he’s married and he and his wife spent 2 years doing a long-distance marriage. We then talk about my bf and what our goals are and he said based on that, it will be difficult to be in the same place for the both of us – doable but difficult. He says that based on bf’s goals, the most he will move is 2-3 times. Me, probably a lot more. So much unknowns in life.

After lunch, we have a meeting at the Cambodian Ministry of Health. Nemo, Dory, and I are driven there by a WHO driver and on the way, I take pics.

We arrive and there are some familiar faces.

I am introduced by Nemo. There is a guy there representing the US CDC who is frustrated that things are not being implemented in a timely fashion, especially since the CDC is funding a lot of these surveillance systems. The deputy director, who I met earlier this week, assures him things will happen. Afterwards, I set up a meeting for Monday to go over data with Glenn. I then meet an American physician (pediatrician) who is going to be here in Cambodia working for a non-profit hospital providing free services to the poor. I ask if it’s possible to take a tour of the facilities and get his business card. We are stuck in traffic on the way back to the office.

I have at least 3 meetings next week to talk with people in charge of their respective surveillance systems. I leave at 6 and go home to run on the treadmill.

Buddha’s brother-in-law, his cousin, and sister-in-law are visiting and I meet them. The brother-in-law is from Korea and I say “ahn-oh-hah-say-oh” (how are you) and he says “we will speak in Korean!” I say that’s all I know in Korean, plus “gam-sah-mi-dah” for thank you. Buddha invites me to join them for dinner.

I go back inside and run on the treadmill for a few minutes with Chris Brown’s music video on TV. I almost fall because the treadmill jerks backwards every few seconds. I try holding onto the side bars and jogging. No luck. I decide to run outside. Buddha’s nephew joins me for a jog around the block and he asks what I study, about life in America, and if I will come back to Cambodia (probably not for a long time). He goes back in while I continue. I run past the Independence Monument and fight traffic crossing roads (no walk signals) and everywhere people are looking at me like why/how is she running outside/at night/alone etc? I come back in, shower, and see they finished dinner but saved a small bowl for me. Ms. Ray made beef that tastes a bit like Thai food and white rice.

Buddha also shows me his wine. He mixes Chinese ginseng wine with Angkor beer and ice.

He gives me a little and he pours some for himself and the other 2 guys (his nephew doesn’t drink) and we say cheers. We clink every time he pours a shot quantity into his glass. I take an hour to finish my little amount after 10 “cheers!” I chat with them about many things. Buddha tells me he has 5 siblings, how he learned to swim (he was pushed into the deep water to catch his buffalo from swimming away when the river flooded the paddy fields), religion in Cambodia, reading materials, etc. The nephew and his brother-in-law also ask questions. Highlight was my age question – they think I am 26, which is the first time someone has said a number higher than how old I actually am. I also find out that the nephew is 22, when I thought he was 18. It’s funny – because of mal/overnutrition, children/people look younger/older, respectively in developing and developed worlds.

The women are sitting off to the side watching TV, old Chinese martial arts drama shows. The sister-in-law’s 2-year old boy is so cute. He comes up to me and pokes me and runs away every few minutes. The dog Pushy keeps wanting attention. The women go to bed and mosquitoes are biting me despite the fact that I put 30% DEET on me an hour prior.

The following day, Buddha and his family are showing me the park and they are excited to show me, so I am happy that they don’t find my company boring.

Thursday, July 30, 2009 - Day 6

**NOTE: NAMES HAVE BEEN CHANGED**

Long day of revising the rough draft of the monthly report. Dory looks over it and has many changes to make b/c some data can’t be used in graphs. For example, we can’t use 2008 data because of incompleteness and inaccuracy of reporting and thus we can’t compare this year’s 2009 data to 2008 data.

Dory also gives me a guideline/book she wrote, like a Epi 101 manual. I read the chapter about charts and graphs because that is basically what I am doing. Then we talk about a lot of other things… I ask a lot.

Vaccine production – The reason I am doing this is because developing countries are often the source of influenza strains and virus strains need to be collected to produce seasonal flu vaccines. The samples that are obtained are submitted to specially-designated WHO centers around the world. Meetings are held speculating that upcoming flu season’s actual flu strain. There is a vaccine for the northern and one for the southern hemispheres. There were incidents where developing countries withheld their samples because they were not getting the vaccines and also the vaccines were resold to them at high prices. Negotiations occurred and a certain number of vaccines now goes to designated countries and there are fixed prices for some as well. Makes sense to me. The developed countries, while they try to help developing countries, often have programs and initiatives that would benefit them.

Tamiflu is given as a treatment in the US within 24-48 hours of onset of clinical symptoms. Here in a developing country, it is not preferentially given. People are told to drink fluids and get lots of rest and stay at home to avoid infecting others. I think about how lucky I am that I have ready access to Tamiflu, even though the US has a tiered system of who gets the drug first in a major pandemic outbreak. I am in tier 4, with the rest of the population. Health care professionals are in tier 1. So the main ethical issue with this is that all human life is valued equally – no one country has more value over another. But then again, money does talk. There was an article on CNN about an American student group in Beijing quarantined because one of the kids came down with H1N1 (I can’t find the article to post here). One of the girls’ mother (who is a writer and works at the White House) began freaking out and called all the politicians, state officials, friends, Beijing contacts, etc to make sure that her daughter was ok. She freaked out that her daughter wasn’t given Tamiflu when she came down with a slightly elevated temperature and went to the hospital. She demanded that Tamiflu be given to her daughter b/c that was the standard of care in the US. The girl texts the mom with messages like “they are letting me have pizza later.” The mom’s friends visit the girl and brings a DVD player and movies. The girl then feels well enough to run around the hallways of the hospital. I felt so ashamed for the mother. The only thing the kids missed was seeing the Imperial Palace. They had food, drinks, access to technology and communication, access to health care, probably the best health care in Beijing, considering all the public media attention on this. For the mother to go to politicians and use her network to make sure her daughter was safe by her standards was beyond ridiculous. It is basic common sense that you do not allow more people to be infected. Think about the throngs of tourists visiting the Beijing Imperial Palace. People from all over the world, thousands of visitors, imagine how quickly an outbreak could occur. I encourage people to stop, be cautious, and think rationally.

Then Dory and I talk about pressing issues in Cambodia. Malaria not as big a concern as dengue fever for me. Dengue hemorrhagic fever affects the young and healthy; the incubation period (time of infection to onset of clinical symptoms) is 1-2 weeks; no vaccine for this; basically not a good thing to get.

I leave work after 7 PM and then am too tired to work out, which I’ve been meaning to do since I got here.

Wednesday, July 29, 2009 – Day 5

PHNOM PENH HOTEL

Secretary of State being interviewed above.































































**NOTE: NAMES HAVE BEEN CHANGED**

Sorry - the pics aren't turning out well. Will try to be better next time.

I get up at 6 AM, way before my alarm goes off, supposedly at 6:45 AM. In fact, I haven’t heard my alarm at all this week – the birds wake me up. I finally opened my curtains and peeked outside the window. There are rooftops and windows so close that I’m sure whoever was in those rooms could see me. Beyond the rooftops, I see the first glimmer of sunrise and this is the first time in a long time that I’ve seen this. I begin getting ready slowly – taking an unusually long hour and by the time I’m through, the heat of the sun is on my skin in the bathroom through the decorated window. I look outside my bedroom window again and the sun has moved 30 degrees higher.

I go to work and shortly thereafter, Nemo rushes into a WHO van with me taking 2 steps for his every 1 step. (I forgot to mention in the previous day’s discussion with Nemo why there is all this money spent on influenza (mortality rate for seasonal flu is less than 2%) when there are so many other dire issues in Cambodia like dengue fever, measles, etc. His rationale is that this influenza work isn’t just for influenza, it’s to set up an actual working surveillance and public health system in Cambodia, a country of limited resources. When this system is functioning, other parameters and burdens of disease can be alleviated, hopefully. The first of many ethical discussions.)

He is a tall guy with a commanding presence and walks with purpose. The driver takes us to Phnom Penh Hotel, where there is a workshop today. I am dressed in a pink polo and dress pants with my sparkly, jeweled silver flats – I thought there would be walking and my black dress shoes already hurt after 1 day of use. We arrive at the hotel and it is breathtakingly beautiful. There are at least 4 large stone lions flanking a fountain with a large rotating ball outside the hotel. The door of the van is opened and I hop down. The front glass doors open before me by men dressed in red uniforms and before I could take in the elegant lobby, Nemo is five steps ahead. We arrive at the elevator and we go up. The clear glass elevator is decorated with stars on the ceiling and I wonder if they light up at night. After going up 1 floor, the blue wall behind the translucent glass elevator gives way to the shimmery blue of the Olympic-sized pool with elegant lounge chairs. This is a 4-star hotel I learn later…

I enter the meeting room and I am taken aback by the long conference style table with lots of men in military-like uniforms and the large sign at the front with tables and basically lots of pomp and circumstance. I see the WHO Representative, Dr. Lucky Charms, (head honcho of the WHO Cambodia office) sitting at the front with a few other Cambodian men. So this “workshop” is formally called “Workshop on Health Quarantine Measures Review to Prevent & Control Pandemic Influenza A (H1N1).” I’ve never attended a workshop with water glasses, water bottles, men in uniform, press, cameras, and suits. I thought workshops meant hands-on activities, small groups, lots of coffee to get through the boring ordeal, etc. And then I wonder if I should’ve worn a suit. So Dr. Lucky Charms and the other Cambodian men sit at the table facing the room and each make ceremonial speeches about how important this is. Marlin translates for Dr. Lucky Charms and there is a part where Dr. Lucky Charms says something not on the paper and Nora fumbles – it was a bit humorous but I could tell Marlin felt flustered and anxious about it afterwards. I try to comfort him by saying that he did a great job b/c the paper was written in English, not Khmer and translating on the spot is hard. So it turns out that this event was more formal than I thought and the people sitting by Dr. Lucky Charms are kind of important. Nora kindly assures me that my polo and dress pants are fine, though I feel like I should wear a suit (but didn’t pack one b/c I didn’t expect meetings with Excellencies of the State).

From left to right in the picture, it is someone from the National Committee for Disaster Management, His Excellency Secretary of State for Flight and Aviation, His Excellency Secretary of State for Health, Dr. Lucky Charms, and the head of the Communicable Disease Control Department of the Ministry of Health (MoH). Marlin tells me all this and informs me that the people in uniform and sparkly buttons are people from customs and border patrol. I just smile and do the Asian nod (short bob that shows deference or respect). Everyone (I think there was just 1 woman who was a reporter and the rest were all men) stare at me like I’m a zoo animal or something. I think being Chinese/Korean-looking in this country is quite peculiar in that people try to guess what I am all the time. When I say I’m from America, they respond with “no, where are you FROM?” and to that I reply, “my PARENTS are from China.” So the speeches go on and there is a group photo – such an Asian thing. The Chinese are all for group photos, I think the Chinese Communist Party spend half their time posing for pics. I know so b/c I spent 45 minutes getting into formation and 1+ hour waiting in my spot in 3.5” heels waiting for the 3rd-highest ranking party member to come out, make an elaborate speech in the thick Beijing accent, none of which I understand, and then we pose for a million photographs. I am motioned to join so I am in this ginormous group photo – too bad I didn’t take a pic with my camera.

Break time – I receive a phone call via vibrations when I thought my phone was on silent. Turns out I worked an older cell phone in Spanish than this Nokia phone in English. Hello? The faint female voice on the other side says, “…blah blah Namru blah blah. Dr. Waters would like to speak with you.” I get excited……

A couple months ago, I took a tour of the Holocaust Museum to learn more about the medical experiments/side of the genocide. The person organizing this was Dr. Navy, a MD/MPH, who also teaches at GW med school and works for the Navy. This was the time of the H1N1 outbreak in April and his phone was ringing off the hook and he was glad to take a break from it all to tour the museum. I mention that I’m interning in Cambodia doing avian influenza work and he immediately brightens up and says “excellent”, which was quite a shocker b/c he didn’t seem like the type of man to compliment often. He gave me his card and said that I should take a tour of the facilities in Cambodia and he’ll put me in touch with people.

Fast-forward to this week. I emailed Dr. Navy after packing his business card last minute on Monday and he responds immediately with contacts in Indonesia. I am mistaken for a doctor and people are surprised why my visit was unknown or unannounced to them in the corresponding emails. I correct them and say I’m a med student and the chain of emails and forwards continue. I finally get the email from the Director of NAMRU-2 of Cambodia and he is Dr. Water, who called me.

NAMRU is the Department of Defense’s US Naval Medical Research Unit, created during WWII to study infectious diseases of military significance. It makes sense b/c we have stations and military personnel in Asia. NAMRU-2 is based in Jakarta, Indonesia and they also have lab facilities in Phnom Penh. I am using their febrile illness surveillance data to include in my report. I think I might meet Dr. Water at the meeting this Friday but we schedule a tour for next Thursday for myself and Conchy, who expressed interest in going.

I find Nemo and tell him the news – apparently, they know each other but I’m glad that I didn’t ask through Nemo and found Dr. Water through my own contacts, just one less thing for him to do for me as he’s always rushing around. I drink some tea, sans sugar, and find Marlin by the fruit and mini French croissants table. All around are the men staring and trying to figure out who I am and what I’m doing there. The fruit are large pieces, cut like crinkle-cut fries, like how Chinese restaurants cut their carrots. I see pineapple and orange melon and dragon fruit (not tasty to me). Then I see papaya, which I never realized was bright orange/red and I decide it’s not that good either. I make small chit-chat with Marlin, who reminds me much of a Hong Kong guy b/c his hair is long, he wears black square glasses, his pants are tighter than I’m used to seeing in the US (and only see in Asia), and his affect/way of talking is hurried and accented. This is my first impression of him – I thought he was annoyed by having to explain ILI to me and impatient with my question about Tamiflu (I am slow sometimes). Today I realize that he is super nice and whatever data I need, he tries to get it for me and even offers help if I need it in the city - he even gave his number in case something happens. Some men smoked in hallways of this hotel and I remember that this is my first time experiencing cigarette smoke in this country – they’ve come such a long way. I met another global health leader of Duke University earlier this semester who actually worked on the tobacco campaign in Cambodia to eliminate smoking in temples, monasteries, and some public areas. He worked to increase awareness of the dangers of cigarettes and fought against big companies like Phillip Morris. He is such a modest man and only after talking to him do I realize how much he has accomplished.

End of break – Nemo gives a presentation – see pics. The International Health Regulations of 2005 (effective June 15, 2007) is repeated often b/c this document legally binds all member states to collaborate on ALL public health issues. There are confirmed cases of H1N1 (by lab) in over 150 countries – I think about how many more people are infected but not showing clinical symptoms. Two more long presentations and Q&A session and it’s lunchtime! I meet Dr. Soccer on the way out – he’s the head of the Communicable Disease Control Dpmt of the MoH. I also met Dr. Anchor – Deputy Director of MoH and then someone else I’ll see on Friday, who works at the Institute Pasteur of Cambodia in Virology (typing all the samples).

We rush down because we need to get back to the office, but we have time for lunch. I give my blue lunch coupon to the hotel staff and it is buffet-style. There are at least 7 different stations with international cuisines: sushi, Indian, pasta, salads galore, pate… double-take (pate??!!), bread, etc. People are the same with lines here as they are with driving on the road – no concept of it. There is no line to get in for your turn at each serving plate and there is no ladies first.

I eat a plate of Indian food and another of Caesar salad and a bit of pork pate with French bread. Their French bread is amazing here – one good thing about the French colonization. Nemo says we have time for dessert. I go check it out and have never seen so many colors in my life! I try a teeny bit of strawberry mousse, brownie, kiwi mousse, carrot cake, and my plate is half dotted with these tiny pastries when I see this man putting all sorts of stuff from a station of 15 bowls into his 1 small bowl. I stare and I guess he notices because he says “this is called 12-dessert. Put a little bit of everything in this bowl.” I thank him and wait until he’s done. I grab a little bit of this green worm looking thing, a couple of hot pink red plums, a thing of black jelly, dried sweet melon, some sugar syrup, some ice with water, and coconut cream. It doesn’t look that great, but when in Rome…. I bring the plate back to the table and Nemo says “you have a bit of a sweet tooth don’t you.” Marlin is chowing on fruit and he says "I don’t eat dessert – too sweet. I just eat fruit." I take a bite of something and he’s right – it is like sugar formed into a soft mousse with colorful dye. The 12-dessert delight is also not that appetizing so I leave a plate of rainbow desserts to waste.

We leave in Marlin’s silver Honda CRV, which is similar to the car I was thinking about getting, except his costs $7000 and he’s astounded that the car I was looking at would be $22,000 knocked down to $19,000. He bought an older version. He navigates the road well and in the car, Nemo and Marlin chit chat as I listen. They talk about good coffee shops in Phnom Penh.
Nemo lists some coffee shops and Marlin says, “Where is that? No one here goes by street names. We only know landmarks and then work from that.” AH-HAH!!! That’s why every taxi, tuk-tuk, moto, and cyclo driver never find the actual address I need. I should give them landmarks next time… like a true PP native.

We arrive back at the WHO office and there is a staff meeting with everyone in the WHO office. That meeting will be posted later as there is info that can’t be released yet publicly.

I decide to forgo the fried rice for dinner and find a cute café recommended by Belle, who is in Scotland now for a wedding. It’s around the corner but I get lost, but I didn’t know I would be lost until Buddha rescued me. Bruce tells me to make a right and the Garden Café 2 is on my right. Buddha tells me to make a left and go down 3 blocks. I get out the guidebook and it shows a left. So I make a left at the end of my street and hear “moto?” and “tuk-tuk?” and I keep walking and the streets are dark. The only light comes from the occasional house light or street sign pointing to a restaurant close by. “Moto?” No, I shake my head without turning behind. I notice it trailing slowly behind me and I pick up the pace. “Moto?” “No,” I said firmly. I finally turn and see Buddha on his black moto. “Buddha!!” I feel abashed that I was so firm with him but thought he was a moto driver and freaked out when he trailed behind. He apologized for sending me the wrong way and said that Ms. Ray, the housekeeper, told him the GC had moved to where Bruce said it was. So I get on his moto and he drives me to GC2. I was so relieved b/c the area I was heading to was pitch dark. The man is so endearing – I wish I could take him back to the US with me! And his adorable baby and family too. I was so touched that he came out to get me and was concerned about my safety.

I walk into the front of the restaurant and all heads swiveled. Here, I’m not sure if you just sit down or if you wait for someone to motion for you where to sit. I sit down and pore over the menu of select wines (no Riesling), 2 pages of breakfasts, 2 pages of salads, sandwiches, soups, Mexican food, Asian food, desserts, etc. I take forever to decide on a sweet & sour mixed vegetable with chicken dish. And then after looking at other tables, I ordered water, not from a bottle. It comes out in a pretty pitcher and it tastes quite good. Good thing I have my Hep A shot and know the treatment for cholera… it’s all a matter of getting the treatment here somehow… I write postcards while I wait for the food and it comes out in two plates. One plate of neat pyramidal-shaped rice and another of the main dish. The main dish has carrots, celery, cucumber, chicken, peas, pineapple, etc. I put the S&S dish on top of the rice and try it. It is quite good and I end up taking half to go. Expecting a box, I was quite confused when my leftovers came in a ziplock bag. The waiter asks, “where are you from?” I say America. He responds, “you look so Asian.” (Yes, we Asians live in other countries. We do not just live within our home countries. He means well but I wonder why my race matters so much every time I’m abroad). I pay $6 plus tip for dinner and walk next door to a mini souvenir shop with very overpriced items. I come home and figure that was a good choice b/c I can add the well-seasoned dish to my fried rice to make it more palatable.

Tuesday, July 28, 2009 – Day 4

**NOTE: NAMES HAVE BEEN CHANGED** (Can you guess where the names came from?)

Day 2 on the job went slightly better in that I had a better understanding of what I had to do… or so I thought. I need to compile influenza data of Cambodia from at least 4 different surveillance systems into a monthly report for the WHO. Trouble is, each system has different parameters, different ways of reporting, gathering, etc. I try to make sense of all the numbers thrown at me – thank goodness I took an intro epidemiology course this summer or else nothing makes sense. It’s great to see what I learned has a real life practicality to it. Specific/sensitive case definitions, case fatality rates, positive rates, incidence rates, etc. It actually all makes sense… until I realize how daunting the task is to put all this raw data into visually appealing and understandable pie, line, and bar charts. Dr. Nemo gave me a template of how to work the data but some requests aren’t possible given the data I’m given. So I pore over this for 2.5 hours with Nigel on GChat.

10 AM meeting with Nemo and he keeps asking me if I’m ok and settling in ok. He remembers that I wanted to find a gym and that I wanted to get a better understanding of how the WHO works. He says that whenever someone seems too enthusiastic, he gets worried. Haha… if only he knew how much energy I had. He begins to explain the WHO organizational structure and how politics is embedded everywhere. I learn that PAHO was established in 1902 before the WHO was established after WWII in 1946. In order to add PAHO, WHO granted PAHO much autonomy within the American region. That led to the formation of more independent regional offices – my office is under the Western Pacific office headquartered in Jakarta, Indonesia. WPRO, the acronym, includes all of SE Asia, East Asia, and the Pacific Islands. The main WHO HQ is in Geneva, Switzerland. Politics are at every level, drafts are written before meetings, and developed countries that provide a lot of funding (like the US) direct a lot of what is being researched. Nima understands that I have no idea what I want to do with my life, whether it’s clinical medicine or public health, but he thinks that the CDC’s Epidemiology Intelligence Service (EIS) or the STOP program would be good experiences. We’ll see… I tell him about my desire to do nonprofit medical mission work in developing countries and he says it’s hard work and very challenging. You need to hit the ground running, just like working at the WHO. Very little training involved. We move on to talking about this monthly report and what to include based on the raw data. Some of it is confusing to him too, trying to make sense of other people’s numbers. After this talk, I feel much better about my task and pick his brain about seasonal flu vaccine production and how vaccines are produced based on educated guesses of the flu strain that coming season.

I go home for lunch (7 minute walk) and meet Ms. Ray, the housekeeper, who cleans my room everyday and neatly places my stuff. This is my first time with a cleaner – it’s kind of nice to not clean for myself. I read a bit more of The Kite Runner, great book btw. After eating the leftover fried rice reheated in a pan, I leave in search of more gyms… hopefully at reasonable prices. After getting lost around the block, I find Goldiana Hotel with a mediocre outdoor gym with old machines. Next is Anise Hotel, which has no gym. I walk back to the office sweating profusely. I could sweat just standing still – it’s so hot and the sun just bores into your skin. I am sure my skin color is shades darker from the past few days.

I spend the afternoon creating charts in Excel and then leave after 5:30. I come home and talk with Bruce a bit. He is Lady’s boyfriend. I’m renting the room from Lady, who is in Lebanon doing work for CARE. Bruce also works for a NGO that helps drug abusers and sex workers in Cambodia. His many tattoos on his arms are reflective of his Californian upbringing. I reheat more of the rice, I think I only have 3 more meals left in it. Belle, the other girl interning for a NGO from Harvard law, joins me for dinner and we chat about our work. She lived in Africa for a year and she knows quite a lot about the frustrations of the bureaucracy and craziness of international organizations. She saw the war crime tribunal today which is pretty interesting. Pol Pot’s era of genocide is finally being recognized in court as some guards and leaders are being tried for crimes they committed decades ago. Pol Pot died in 1998 without ever being tried. She tells me that Hun Sen, the Prime Minister of Cambodia, was a leader in the Khmer Rouge – no wonder the movie only showed 30 seconds of the genocide and killing spree. I talk to her about medicine, health care plans, etc. We wonder if it’s good to raise taxes for those in the $250,000+ income bracket. I’m all for it, even though I will eventually be there (w/ a spouse’s income combined). She is too, except she thinks that there is a large difference between the 250+ and 1 million range. Our conversation is interrupted when Buddha hops in with a flashlight. Where’s Bruce? We don’t know. Buddha eagerly invites us to try his wife, Mei's, bok choy dish outside. We hunch around a single gas burner facing a small 13” TV playing Lady Gaga and Beyonce music videos and try the bok choy with meat and eggs. It is delicious and much better than the “fried rice” I attempted. I try this sauce on the bok choy that Buddha claims is mildly spicy. No – mild is a word for those who are experienced in spicy. This sauce was like five symbols of fire flames.

Monday, July 27, 2009 – Day 3

**NOTE: NAMES HAVE BEEN CHANGED**
Office hallway- stairs on right lead down to the patio/courtyard of the WHO office.
The A/C directed at me.
Nemo's desk on left and Dory's desk on right.

Entrance to Post Office.
Post office- if it weren't for the sign, I would've missed it entirely.

I wake up early and get ready for work, be there at 8 AM. I get to the gate of the WHO building and present my passport and WHO paperwork to the guards who finally let me in after Bunny helped explain. I sat in the receptionist area and Dr. Nemo, my mentor, swirls in. He is a former cardiac surgeon from the UK, now working on influenza surveillance in Cambodia. He was stationed in Beijing when my friend Kevin worked with him. He takes me to the Communicable Disease Surveillance and Response (CSR) office and I meet Coral (the secretary), Dory (field epidemiologist/pediatrician/Filippino/trained in US CDC EIS program), and Marlin (pediatrician/Khmer/in charge of influenza-like illness, ILI, surveillance, in the office. I am given a heads-up about what I’m supposed to do – compile a monthly report of all Cambodian influenza cases for the head honchos of the WHO. Weekly reports are made about influenza activity from at least 4 different surveillance systems but this is the first time that WHO and Cambodian Ministry of Health wanted monthly reporting because H1N1 is now a pandemic and the strategy is to mitigate it, and less on prevention, because transmission and infection are now inevitable. I research all the surveillance systems, NAMRU, ILI, SISEA, etc. Turns out the US CDC also has branches here and funds some of these. Have a hard time finding things and getting onto the intranet/email. So Nigel (bf) of course helps me from across the world.

Lunch break is 2 hours from 12-2 PM and I try to find a post office and bank to cash my traveler’s cheques. I walk for forever (maybe 1 mile) and am sweating profusely. The bank I had on my print out of Cambodia Asian Banks is now another store. I try looking for a different CAB and no use. I bump into a white girl outside Lucky Market and ask her if there’s a bank that wouldn’t charge a 2% commission. She is Russian and is learning English here. She takes me to another CAB on her moto; I am impressed she learned to ride one so quickly. She drives me to one and we exchange information, as we are both looking for gyms to join. I enter the bank and am hit with a 2% commission fee again, after paying 2% for the traveler’s cheques in the first place. The woman said that exchanging for Riels would be $0 fee but I don’t want to carry hundreds of thousands in foreign currency – too bulky. $1 is 4100 Riels, so $100 is 410,000 Riels. Imagine 2 times that. I get antsy carrying around $50! It’s now nearing the end of break and no lunch yet. I find a cyclo driver, he bikes with a mini seat/rickshaw thing in front of his bike gadget. He says $3, which is more than 3 times what he should be charging. After bargaining for a little bit, I keep walking. I find another guy in a tuk-tuk and he says $3 too. He is hard to bargain with too. I walk a few more meters and a couple of guys are hanging out in their tuk-tuks. Lucky market, how much? $3. No, 2000 riels. 6000 riels. No. $1.50. No. $1. So one guy takes me for $1 after I begin to walk away. I am sick of this bargaining for a ride. I just want to pay what is standard and not get taken advantage of everywhere I go. I decide to put a stop to that. I arrive at Lucky market and buy a couple of Asian buns while the tuk-tuk driver waits outside. I ask him to take me to the WHO office, only 1.5 blocks away and then pay him the $1 and walk quickly back to the office.

The WHO office gives me a cell phone to borrow while I’m here, which is nice because my cell phone needs some sort of unlocking code that AT&T needs 5-7 business days to process. Forget that now! I have a working cell! Dory and I have a long chat about medicine, Spanish, life, etc. Then I meet with Marlin to go over the ILI surveillance system. I took a tour with Nemo and met others in malaria, health services, child and maternal health, TB, dengue fever, etc. and picked up a couple of business cards. I also met the head honcho, though I didn’t know it until after I left. I left at 6:10 PM tonight and headed to the Place, a new flashy black building I thought was a club, to check out the gym. It is $100 for a month, which is 2x the rate in the US. The gym is on 3 floors and the cardio equipment face floor-to-ceiling glass overlooking the city and the Independence Monument. There are nice showers, free towels, and a sauna. Free Mac computers to use for the Internet, some gym classes, but the only people who can afford this are expats and foreigners. Natives work out in the park by the IMonument. The Place also has restaurants and a sky bar and clubs/discos. Everything just screams “I have money – look at me.” I leave to ponder if $100 is worth it because I walk a lot and there is inevitable sweating from the hot sun, even at 8 AM.

I go to Lucky Market to buy groceries and there is a limited selection of fresh fruits and veggies. Apparently, fresh broccoli is a delicacy in countries other than the US. I buy frozen veggies, overpriced and from the US, and a small container of tofu to make fried rice. I buy 2 bananas… or at least tried to. The guy rang up all my groceries and then held up the 2 bananas and showed them to a guy near me. They spoke and laughed and I noticed the price tag was on one of the bananas so I didn’t know what was going on. The other guy takes away the 2 bananas and returns with a bunch of bananas, about 8. I say sorry, I didn’t realize you had to buy the whole thing. So no bananas for me this month. They are short, and very green, and not healthy-looking. I get home, make food, and it is the worst fried rice I’ve ever made. Lucky for me, I made a ton to last me 4 days.

Sunday, July 26, 2009 – Day 2

**NOTE: NAMES HAVE BEEN CHANGED**

First full day in Cambodia and I woke up at 6 AM after 5 hours of sleep to chirping birds. It reminded me of middle school and high school when I would wake up to my parakeets screeching at each other on weekend mornings when I wanted to sleep in. So after laying in bed for a bit, I finally decided to get up and got on the internet via an Ethernet cord, a la college style.

I talk with Buddha for a bit and he takes me for a ride on his moto – I put on a helmet and it feels awkward. He showed me the WHO office, where I am interning for a month, and the grocery store, Lucky Market. The WHO office is very close – maybe a 7-minute walk from the house. At Lucky, I asked the clerks where eggs and hangers were. They don’t understand me. I was shocked that the price of everything is similar to what I pay in DC, and forked over $5 for a box of cereal. Everything is imported from the US – limited selections and inflated prices. I later find out this place caters to foreigners.

After eating my lunch of Asian bakery buns, I hop out for the Mekong River Restaurant, by the riverfront area to catch the 11 AM showing of Pol Pot’s regime movie. I can’t believe it’s only 11 – there’s so much that can be done in a day if only I could wake up earlier. The tuk-tuk driver (guy drives a mini rickshaw powered by gas?) takes me there but obviously is not sure where it is because I find the restaurant and he circles around and around to find it. I find that these drivers don’t know where anything is and just charge whatever price they feel they can get you. I’m overcharged by 500 riels at $2. I sit down because the movie starts in 10 minutes and get a mango shake for $1.75. I tip the rest of the $2. It was sugar water with some mango. A little boy comes up to me hawking books about Pol Pot and I shake my head no. He pats his stomach and makes a sign that he wants to put food in his mouth. He says “I’m hungry miss. I want some food.” It’s very hard for me to resist so I try not to look at him. I hear stories about this from friends in India – where children cling to you begging for money. I pray that this doesn’t happen here b/c I wouldn't have money to get home. Finally, the guy motions for me to go to the “theater” which is a dark room above the restaurant, entered via a steep narrow staircase. My eyes are not adjusted and fumble around for a seat. After 5 seconds, I realize I almost sat on the man sitting 2 seats down from me. The entire “theater” of this room is just filled with me and this guy. The movie begins with a history of Cambodia, 30 seconds about the genocide, and ends with the 1991 peace accord made in Paris. Cambodia has been occupied by the Chinese and French. Salazar (nom de guerre Pol Pot), through his relations with China (especially Mao Zedong and Zhao Enlai) of the Communist Party, decides to bring a cultural revolution to Cambodia. His radicalism ends with a purge of Phnom Penh’s population, sending them to the countryside to do menial labor. Many die and end up in the Tuol Sleng execution chamber (formerly a school) and then in the Killing Fields, which remain open to visitors today. The movie focused on the Prince of Cambodia and the Prime Minister, who both blamed Nixon and Kissinger’s politics for the fate of Cambodia, which tried to remain neutral in the Vietnamese War conflict. The movie credits roll and the sponsors of the movie are the Prince and PM… no wonder there was nothing negative said about them in the movie.

I wander down to visit the Royal Palace and am greeted everywhere with a “hello miss,” “tuk-tuk?”, "moto?", or a hand wave. Everyone just chills around asking if people need rides. At first I say no and shake my head but now I ignore it. There’s just too many people asking and it gets very annoying after awhile. I pass by a spa and decide to get my first mani-pedi in over 4 years for $10 + $1 tip. There are 2 Khmer women waiting on my feet and hands. They don’t speak English too well but they are diligent. After this session, I leave with a nail scratched. I walk to the Royal Palace and find that my stomach is growling and I check the guidebook for a place to eat. It recommends a Thai restaurant, Chiang Mai, by the Riverfront. 2 nails are now badly smeared. I walk back and the restaurant is next to the U and Me Spa I had my mani/pedi. I stop back in and get a touch-up. The front desk receptionist makes small talk in English and begins to ask private questions about my life in America and here. I get uncomfortable when she asks where I am staying, who I am with, did I come alone… etc. I keep thinking “what if she uses this information to give to someone else to stalk me and sell me into some slavery or worse, prostitution, which could be quite possible here. My housemate works for an anti-human trafficking NGO here. Luckily, the man who came for a massage needs to pay and I excuse myself politely. I go next door and sit down for “pat thai” as it was spelled on the menu and a can of Coke. I drink water but now will be forced to drink other things because the water is not safe to drink here. I even was cautious about brushing my teeth, making sure to gargle my mouth with purified cooler water after I had rinsed with sink water.

The pat thai was not good at all but it was only $3.50. The can of Coke was $1.25. I was overcharged for the can of Coke >2 times. It should be $0.50 max. But I didn’t see the Coke on the menu, so can’t contest the price. I pay 200 riels in tip because the Coke was so expensive. Tipping is not expected but nice if given.

I walk to the National Museum and pay $3 to enter. I take some pics and see relics from as far back as the BC era. A LOT of statues of Ganesh and Vishnu. Buddhism and Hinduism are so prevalent here. Monks are sitting in the courtyard, flanked by ponds with golden carps and lotus leaves, chatting with foreigners. I leave and make my way to the Royal Palace and Silver Pagoda. The fee is $6.25 and I am stopped at the gate because my shorts were slightly above the knees. I obtain a refund and it begins to pour. My first rain in the monsoon season of Cambodia – which goes from May – October. Not too bad though because it stops raining after 15 minutes and I walk home, seeing the Cambodia-Vietnam Memorial, Independence Monument, and Wat Lanka (a temple near my house). And of course, “tuk-tuk?” was heard all the way home.

I meet Belle, my housemate who has been here since the beginning of June working for the NGO to stop anti-trafficking. She is a Harvard law student and is very friendly. Training for the NYC marathon too.

Saturday, July 25, 2009 – Day 1

Something.... not sure what it is yet.


Independence Monument above.

Ad for Bath & Body Works & Victoria's Secret - thought it was funny
The university...


Traffic around every circle

2 guys playing hackey-sack by the Independence Monument.
This area is like a mini park.
Hackey-sack


Vietnam-Cambodia Memorial



French architecture from colonial times - I love it.




What is this? Dragon? Phillys baseball mascot?




Tuk-tuk... everywhere


Gate to Royal Palace - didn't go inside.

More French architecture.




National Cambodia Museum - has old ancient relics
National Cambodia Museum - courtyard with ponds full of carp, lotus

National Cambodia Museum - look at these ancient pieces just sitting out in the sun and humidity. People also touched them while taking pics... what a shame. A lot of old priceless treasures have been stolen from the country and smuggled to sell to ... collectors, including many Westerners.
Beautiful wooden piece - used to be painted.



Ganesh statue in the middle.


My "pat thai" and overpriced Coke



Riverfront boats. I could rent one of these by myself but decided that was dangerous given I don't know the guy steering and I can't swim.


Mango "shake"
Sign for mango and lychee shakes.


Pics from the tuk-tuk ride.

Expensive cereal and Asian buns and $0.75 strawberry jam.
Peanut butter and 1/2 of the jar was butter.
My mini nightstand with full set tea pot & cups. They love tea here.
Entrance to bathroom
Closet on left, door on right.
BIGGGG bed.
Urinal I can't use.




I am sitting here in Seoul, South Korean airport, still in disbelief about where I am and what happened the past couple of days.

Thursday morning - finished my Epidemiology final for the last MPH class. I was taking public health classes for the past 10 weeks and they were quite interesting and will supplement my medical classes well because they provide a broad perspective about health and policy issues. Then I packed and cleaned like a fiend until Friday 10:40 AM, when I had to depart for Dulles airport with Sally, who took me in her nice Lexus =).

Friday:

11:35 - arrived at airport to check-in one suitcase and carry-on another suitcase and backpack. Attendant begins speaking in Korean... all I understand is "ahn-yo hah-say-yo," which means "hello." Suitcase max weight was 23 kg - mine was 25.4 kg. Carry-on suitcase max weight is 12 kg - mine was 13.4 kg. Go figure... so I check both and my only carry-on is my pink backpack.

12:55 - I board the plane and say thanks to that same attendant who mistook me for a Korean girl. My seat is 39J, by a window, with no one next to me! The guy sitting on the aisle seat looks mean and I make sure I keep my bag with me every time I use the restroom, which I think was twice as often as he did =) He gave up getting up for me after the first few times.

1 - 3ish - my plane ride was 13 hours and 16 minutes. This was the best plane experience I ever had. Korean Airlines does a good job with customer service (everyone is so nice, friendly, smiley, and demure). The first meal was a Korean beef bulgogi. The snack was a banana or beef bread - I took the banana. The second meal was chicken & rice with the best potato salad ever. I watched "He's Just Not That Into You" and another chick flick.

4:55 PM - land in Korean airport, Korean time. Everything is in Korean Yen currency and I have no idea if my USD works here or what the exchange rate is, so I skip buying anything and use the free internet kiosks here. There are egg-shaped chairs with free music (Rihanna's Umbrella was blasting and now it's a Korean pop song) listening stations and mini tables with MacBooks and Sony Vaio laptops for use.

6:10 PM - board plane for Cambodia!
The flight into Phnom Penh was quite uneventful. One meal, 0 movies, a couple hours of sleep, and 5.5 hours later, I landed into the PP airport at 9:47 PM. No flashy skyscrapers greeted me, as it did in Hong Kong. Just flat land amidst the black night sky with the airplane landing strips neatly decorated with yellow lights. I passed through customs check easily and was checked by biothermal imaging for any signs of H1N1 or influenza, which is quite good, considering the US isn’t even doing that. I find it ironic. Most of the cases to other countries are brought from the US, Mexico, and Canada – shouldn’t primary prevention be to check those departing those countries to help mitigate spread? Just a thought for the Department of Homeland Security…

I asked a sales clerk if I may borrow his phone to call Buddha, the guard of the house I’m staying at, and say that I would be arriving soon. He said he had no money on his phone so I went to grab my suitcases, after which the clerk waved at me and pulled out his mobile phone and let me use it. I was very grateful that Buddha picked up and spoke good English. The last check before leaving the airport was handing a customs paper to a guy who asked me if I was American. I said yes. Korean-American? No, Chinese-American. He said something in Khmer (Cambodian language) and the other guys laughed. Given the history of the country’s relationship/political interactions with China, I don’t think they appreciate Chinese presence.

I left the airport and immediately a man walked over and said taxi? I nodded and another guy appeared and grabbed my suitcase (the large heavy one) and put it in the trunk of a labeled TAXI car, which was good, because I would not get into a car that was unlabeled, and as most taxi cars are unmetered, it’s hard to tell if a car is a taxi. The man said $10 and I replied “I thought it was $7.” No, he shook his head, $10. Ok ok. I figured he helped me with the suitcase, it’s late, and I want to get inside. We drive to the city and as I look around, I see paved roads with dust spiraling everywhere, motos zoom by, store fronts and buildings look old, and everyone stares at my taxi like it’s an alien. Everyone pays no attention to traffic lanes and red lights are quite optional, even though there is a countdown to when the light turns green. I note how similar this seems to some rural parts of China.

After driving around for 20 minutes, we spend another 20 minutes trying to find Street 288. We circle around Boeung Keng Kang I, a district known for expats and NGO-land. I see tons of people chilling outside and inside bars. The area is dark, except a few larger streets. We stop by a small store and the taxi driver opens his door, commands something in Khmer to a diligent young woman working inside the store, and she comes back with a mobile phone. He calls Buddha and is given directions. The man pays the girl some riel, the national currency. $1 is about 4300 riel. We take off again and circle back again to the same store/girl and repeat. We finally get to Street 288 and find the place we wanted. Buddha is waiting outside and immediately smiles and shakes my hand. I pay the driver $11 but he frowns because he sees the $1 and $5, but perhaps didn’t notice the 2nd $5 bill underneath. This was the first of many encounters where money exchange is not met with a smile, even if you tip them.

We open the green metal gate and immediately 2 dogs bark at me. I put out my hand for them to smell and they quiet down. Pushy has cataracts and is a golden-colored mix with a stumpy tail. The other dog has a Khmer name and is black and looks like the Tramp from “Lady and the Tramp.” I see a teenage boy staring at me – he is Buddha’s nephew. I smile and say hi and get a nod back. He’s shy I think. We pass a mini courtyard and Buddha opens the screen door to a tile floor that spans across the house. This definitely reminds me of the large 3 story houses in rural China. Buddha lugs my heavy suitcase up 3 flights of stairs and I huff behind with my oversized carry-on suitcase. I look into my room and I am quite impressed. Queen-sized bed, mini bed stand, large closet, marbled counter, huge personal bathroom with tub, toilet, sink, and mirror. I finally get the princess suite I’ve wanted since I was a girl. Better yet, I have air conditioning! I open my suitcases and my clothes are damp – the contact saline solution burst from the pressure and my light-colored shirts are stained with the navy blue of my pants. I spend quite some time washing them by hand and showering all the travel grime off. I hop downstairs to use the internet and then fall asleep quickly that night.