Island Medic by Tim Seel
Arriving on Koh Rong Samloem at M’Pai Bay
It was May 2019 when I first stepped off the ferry and fell in love with M’Pai Bay, a small fishing village on the island of Koh Rong Samloem in Cambodia. I was instantly struck by the beauty of both the scenery and it’s inhabitants. I spent a month working in a bar and built solid friendships with a number of the local people as well as many of the Westerners who have made this paradise their home.
With approximately 300 Khmer inhabitants and almost the same number of barang (Khmer term for a Westerner) residents, the village is a bustling hive of activity. Tourism has been a major boost to the economy of the area, and before Covid hit, it was the main source of income to M’Pai Bay.
As a nurse with nearly thirty years experience, I always take a keen interest in the provision of healthcare wherever I am in the World and it soon became obvious that it was sadly lacking on the island. It appeared that emergency care, and indeed the treatment of any illness was handled by a single Khmer pharmacist who, with all due respect, may or may not have held a professional qualification. He did possess many skills that benefitted the residents of M’Pai Bay. However, he would regularly leave the island for various reasons, leaving those in the village with no healthcare provider whatsoever.
In the event of an accident, villagers would have to make the arduous journey to the mainland Cambodia by ferry, if indeed they were running, or worse by long tail boat at any other time. There were no other facilities on Koh Rong Samloem. If weather conditions dictated no boats could operate, well then the villagers had to look after themselves until such time that they could reach hospital.
In 2018, a project to build a medical centre in the village had finally reached it’s fundraising goal. It was the brainchild of a British business owner who wanted to give something back to the community. The aim was to provide free healthcare to the locals. The Chief of M’Pai Bay donated a plot of land and the centre was built in a short time by a team of European volunteers. However, since a brief period in early 2018 when a British nurse spent four weeks volunteering there, the centre had remained closed with the modern equipment lying idle because of a lack of qualified staff.
As my month in the village came to an end, my thoughts started to turn to coming back to the village and the possibility of working at the medical centre. Once back in the UK, I contacted the charity and offered my services on a voluntary basis. Following a telephone interview, I was offered the role and quickly set about making the necessary plans to get back to the place that was so dear to my heart.
So, in October 2019, I boarded the plane weighed down with text books, medical equipment and also the thought of, “What have I done?”. This was by far the biggest move I had made in my career and self doubt was creeping in. Could I really handle the role of only member of staff at a remote clinic, responsible for the health and well being of so many people? Realising it was far too late for second thoughts, I settled into my seat for the long flight ahead and tried my best to relax. But, it wasn’t meant to be, as somewhere over Asia the call went out for a nurse or doctor as one of my fellow passengers had collapsed! Fortunately, the young lady had only passed out and I was quickly able to reassure both her and the crew that it was nothing serious. The staff later thanked me for helping out and gave me a voucher for free WiFi for the rest of the flight! It’s nice to be appreciated.
After a seemingly endless, terrifying taxi ride, followed by a thankfully, short, calm trip on the ferry, I disembarked once again and soaked in views of white sandy beaches, jungle covered hillsides and the mesmerising smiles radiating from the Khmer people of M’Pai Bay. Any doubts were soon long forgotten as I was greeted by old friends who had heard of my imminent return. Unfortunately, jet lag soon overcame me and I went to my bed to ponder the challenges that lay ahead, whilst listening to the waves gently lapping.
I awoke to a beautiful day and went to collect the keys to the medical centre, filled with apprehension as to what I would actually find through those doors. Upon entering, I saw a clean, modern, well thought out centre that was already fairly well equipped to deal with whatever patients presented themselves. I was surprised to see both a defibrillator and a sophisticated monitor of the same type that I had used on many wards in the UK. However, if these pieces of equipment are used, it usually means that your patient needs moving to a higher level care such as a High Dependency Unit. Again, the enormity of what I had taken on hit me hard. I would be running this centre on my own with no support from colleagues and it would be up to me to give whatever care was needed.
I quickly set about the task of doing a full inventory of dressings, bandages, intravenous fluids, medications, and then writing a wish list of items that would be needed to see us fully equipped. Thankfully, with support from friends and acquaintances around the World, many of the items I wanted were soon on their way to Koh Rong Samloem.
I clearly remember many faces peering in, an expression of curiosity etched across them. These people had seen the centre being built, but then lying unused for many months. You could almost hear them asking the question, “Was this bald barang really here to help them?”
The medical centre with opening hours and emergency number displayed, now fully operational.
My first real emergency was not long in coming. In only my first week, I was called to a serious accident when a 12 year old boy had fallen off his bicycle and was found unconscious with extensive head and facial injuries. With adrenaline pumping, I rushed through the village. He had been carried down to the pier by his family and that is where I found him. They hadn’t realised the centre was open and so hadn’t thought of bringing him there. As his condition was so serious, I took the decision to not move him and treated there in full view of many from the village. The pharmacist and I applied many dressings to stop the bleeding, but it quickly became apparent that hospital care was much needed. It soon hit me just how isolated we were as I was told the next ferry would be about an hour. I was faced with a young patient who’s condition was unstable and nothing could be done other than wait. On a Cambodian island, I realised, there was no such thing as ringing for an ambulance!
As the ferry arrived, I was in for another shock. My patient had stabilised somewhat, but was still in what I would describe as a serious condition. We carried him on to the boat and his family settled in next to him whilst I spoke to captain. I explained that he needed to be in hospital as soon as possible, but was met with a blank expression. The captain simply said that they had further passengers to collect and they took priority! I was stunned, but was powerless to change the course of events. Another huge lesson for me as a nurse in this country so far away from where I had spent the majority of my career.
This episode was to provide a positive experience though. After six days in hospital and unfortunately losing six teeth, the young lad was discharged back to the village. His family were so thankful for what I had done to help him, that they invited me around for dinner with them. A wonderful night was had by all, sharing food and a few beers, communicating in two different languages but sharing an easy camaraderie. It was such a pleasure to see this very brave young man tucking into his dinner, less than two weeks after suffering such awful injuries.
Life quickly settled into a routine. I ran a drop in clinic every morning Monday to Friday, 8am-12pm. Whilst slow at first, numbers soon increased, but was mostly Westerners, both tourists and those living in the village. The centre was never set up for treating tourists, but it soon became apparent that they would use it. Perhaps they felt more comfortable seeing a Western nurse rather than the local pharmacist? Whatever the reason, by asking for a donation from them, it meant that we could raise funds to achieve our goal of providing free health care for the Cambodian people.
Treating a young patient who injured his foot whilst at school.
From the very start of the project, the founder had been keen to involve the local health authority and get their support. His ultimate aim was to hand the centre over to them, so that they could run it as their facility. Whilst this looked a long way off, we did get the occasional visit from a Khmer nurse. Despite the language difficulties, we soon developed a respectful working relationship. I was able to assist him when giving the children of M’Pai Bay their vaccinations. I was very impressed to see the importance placed upon these injections and the programme seemed to work very well. Due to him being an ophthalmic specialist, we were able to hold special clinics on eye health and diagnose potential problems the villagers may have. Whilst these visits were infrequent, they really helped to build the confidence of the locals in our facility.
The clinic building was also to serve as a community centre, with a large room that could be used by groups for meetings. As nurse, I used it to offer first aid classes to teach people how to deal with emergencies. In this village miles away from a hospital, it is obviously important for as many people as possible to have these skills.
The main use for this space took place every Friday morning. Breakfast Club was one hour of, at times, total mayhem, but with an underlying important message. With the help of a team of volunteers and the teachers from the local school, we hosted up to seventy children. They were first taught the importance of washing their hands, materials were provided and supervision given whilst every child participated. Food was then given out, ensuring each child got a healthy nutritious meal. Next, the children were shown how and why to brush their and toothbrushes given out that had been kindly donated by our supporters. The rest of the time was taken up with various fun activities such as singing, dancing or relay races on the beach.
Enjoying a meal while attending Breakfast Club.
Unfortunately, just as we had started to secure sponsorship for this important weekly event, in March 2020, Covid-19 reared it’s ugly head and the World changed, possibly forever. The government of Cambodia announced that schools were going to close and so, in accordance with the new rules, our club could not go ahead.
Koh Rong Samloem Lockdown
The effects of this situation were to be far wider reaching than just stopping Breakfast Club. As inter province travel was banned by the government, ferries ceased to run to Koh Rong Samloem and M’Pai Bay went into a near lockdown. A daily supply boat was our only link to the outside world. Whilst safety is always paramount, the very livelihood of the village was taken away virtually overnight. The situation continues to this day and many of the businesses have had to close with a big question mark hanging over their future. A large number of Western owners have returned to their native country to try and earn a living. The Khmer owners simply don’t have this option and so have had to make dramatic lifestyle changes to survive, some turning back to fishing to ensure their families have food on the table.
As the nurse, I was faced with a very difficult decision. Should I leave Koh Rong Samloem and return to the UK? In a time of uncertainty, it can feel more comfortable in one’s country of birth surrounded by family and friends, but after much deep thinking, I made my decision. I would stay in M’Pai Bay and face whatever this dreaded virus brought our way. I had come to the village to help people and now, more than ever, that help would be needed.
With the virus spreading across the World, I monitored as best as I could. I used various sources to learn what I could, always finding that the World Health Organisation website gave the most reliable information. My role changed and I had to adapt to a fast moving situation. Many Western inhabitants, both long term residents and those tourists that were on the island as travel was banned, were scared. People looked to me to give advice and seemed to have an expectation for me to predict what was going to happen in the future. My time was taken up with regular temperature checks for those who were worried, stressing the importance of masks and hand washing, and helping in the co-ordinated effort to make the village as safe as we possibly could.
Yet, medical emergencies don’t stop because of a pandemic. I continued to respond to those in need and it was around this time that an unfortunate accident led to probably the worst injury I had to deal with during my time on the island. It was a Friday night and after a delicious dinner, I had retired for the night after a tiring week. I was awoken about half past midnight by a frantic knocking on my door. Still half asleep, I answered the door to a friend of mine who’s face told me this was serious. He thrust a phone in my hand and I was just able to make out a few panicked words from the caller. I was able to get her location, but other than that, I could only make out that there was a lot of blood.
I made my way to the medical centre to pick up the emergency bags that I had put together for just such an event. Predictably, a violent thunderstorm was currently directly over the village and it was like a scene from a movie and I stumbled and slid through the mud right up to the top of our village. I then heard a noise and it was with great relief that I realised my friend who had woken me was now joining me on this adventure. As a trained first aider, I knew that his help would prove invaluable and I will be forever grateful for his assistance that night.
We could see the light shining form the balcony a we approached the building and shouted to let them know we were here. “Get up here quickly!” was the response from the young lady who had made the phone call. This lady was also a trained first aider and her prompt actions had very possibly saved the life of the gentleman whose leg had gone through the glass door. By tying a T-shirt tightly around his leg, she had stemmed the flow of blood. But, I had to know exactly what we were dealing with, so that T-shirt had to be removed. Over the next half an hour, we were able to assess and clean a number of deep lacerations. With pressure dressings applied, I knew his condition had been stabilised, but these wounds were going to need specialist care and that meant evacuation to a mainland hospital. I had a very difficult decision to make, and one with potentially very serious consequences. Did I mobilise the entire village and get a long tail boat to make the treacherous crossing at night? Or, could I manage the patient on the island and evacuate him by the first ferry in the morning?
I decided that he had stabilised to such an extent that immediate evacuation was not necessary. This meant that myself and both of the first aiders slept on the floor next to the patient, checking regularly on his condition. That night seemed endless and it was with much relief that the first rays of the morning sun could be seen. However, we were still at the very top of the village facing a long walk with a seriously injured patient. We tried a stretcher with little success. Next he tried to walk, but was obviously slow and in great discomfort as well as feeling weak due to blood loss. Islanders always find a way to make things happen, and so within five minutes, our patient ended up on the back of a motorbike and was laid down on the pier!!! Then, once again we faced the agonising wait for the ferry which seemed to take forever.
After an eventful night, the injured gentleman waits for the first ferry for evacuation to mainland Cambodia.
Once in hospital, he had a number of operations but has since, thankfully, made a full recovery. However, it was a shock to us all when the doctor explained to him just how close he had come to losing not only his foot, but very possibly his life!
It is incidents like this one that will forever be etched in my memory. Learning to deal with serious, life threatening situations in a calm and collected manner. The islanders have taught me that often you don’t need all the fancy equipment, merely a positive, sensible attitude and sometimes a bit of luck, means you can cope with most that comes your way.
As the saying goes, all good things must come to an end. As time had moved on, we were seeing dramatically increased support from the local health authority in Sihanoukville, with the nurse now visiting regularly. Through fundraising, we had been able to purchase an extensive supply of medications and so he was able to provide more and more services to the villagers in M’Pai Bay. It seemed the right time to move on. The aims of our project had been met. Where there had been no healthcare facility at all, a modern, fully equipped medical centre has been built and run successfully, then handed over to be operated by Cambodian people to help Cambodian people.
I offer my congratulations to all involved with the medical centre. It was an absolute pleasure to be your nurse for fifteen months and I wish everyone in the village all the best in the future.
If you have something to offer the medical centre in M’Pai Bay Koh Rong Samloem, you will recieve a warm Cambodia welcome. This goes for most volunteering in Cambodia. It will change your life as much as it will change theirs.