Last Day of Class

Yesterday, May 1, was my last day of class as a Physician Assistant student at Touro University. My final exit exam is Monday.  PA school has been by far the  most challenging thing I have done in my life, but also the most rewarding. I am so grateful for all the support I have received from my friends and family. I couldn't have made it through this without ya'll. I am also so grateful for the amazing friends I have made in PA school and incredibly sad to be leaving. It has been an amazing 32 months, filled with a lot of stress, not enough sleep, endless hours of studying, many exams and papers, hundreds of highlighters, pens and pencils, laughter, joy, success and failure, delirium, and true happiness.

Beginning, Middle, and End

29 days

Thats right, less than one month until graduation...

"Graduation is only a concept. In real life every day you graduate. Graduation is a process that goes on until the last day of your life. If you can grasp that, you'll make a difference."
-Arie Pencovici

This quote speaks to me today, as I am not only preparing for graduation, but for my career. Applying for a state licensure, taking the national board exam, and searching for jobs are all on my table currently. Graduation is only the beginning on the road to becoming a certified PA.

PANCE

I have officially registered to take the PANCE (Physician Assistant National Certifying Exam) on May 21, 2014. This is the day prior to my families arrival for graduation. I am hoping graduation and family will serve as a much needed distraction after the exam. After any major exam, there is little relief that it is over, simply worry about performance and the pending score. 

As graduation approaches, life has been a bit stressful. I imagined this time back on campus would be filled with happiness and relief that school is almost over. But instead, I am stressed that my exit exam is in one month and now board exams are approaching. The reality of student loan repayment is now very present. I will be moving back to Texas right after graduation. I am leaving California, this amazing place I have called home for three years. And most difficult for me to process, I will be leaving all the amazing friends/family I have here. On the other hand, I get to be home with my family for an entire year. I get to be back with my Jezebel. And I will be able to save a lot of money as I begin to pay off my student loans. 

How transient my life has been for these past years, makes me realize how precious time is, and how it shouldn't be wasted. 

"The best thing about the future is that it comes one day at a time."

  - Abraham Lincoln

The Rain

As I sit in a coffee shop that I have spent far too much money in and endless hours studying, I am in my happy place. Sitting by the window with the water, ferry, a class of middle schoolers preparing to board the ferry, and the island shipyard all in view, I realize how I have missed this familiar place. It is a dreary, rainy day and I love it.

"Life isn't about waiting for the storm to pass...It's about learning to dance in the rain."

-Vivian Greene

Siem Reap Province and the Temples of Angkor

The second weekend of our stay in Cambodia I traveled to Siem Reap Province with Lauren and Christi to see the Temples of Angkor. We left Phenom Penh at 11:00 pm and traveled for six and a half hours via the night bus. The night bus is set up so each person gets a "bed," which is a reclined seat. The ride was very bumpy and I am pretty sure the road was a single lane for portions of the trip, and our bus driver might have been playing "chicken" with oncoming traffic. Once we arrived, we found a tuk tuk driver that we had booked ahead of time, dropped our bags at the hotel and went straight to the temples to try to catch the sun rise over Angkor Wat. After three hours in Angkor Wat, we had breakfast and continued exploring. As the day progressed I was not feeling so great, I was really hot, feeling dehydrated and my abdomen was distended. The next 30 or so hours were not great (see previous blog) and because of it I missed out on the National Museum, where I would have learned a lot about Angkor Wat. Therefore I have been doing the research on my own, and thus this post has taken a lot of time to complete. In addition, there are thousands of temples in Siem Reap, ranging in size from Angkor Wat (the largest) to small temples that are simply a pile of rocks in a field. We barely scratched the surface, but were able to see some amazing structures. 

Angkor Wat

This beauty is considered the largest single religious monument in the world. It is often called the temple mountain, as it was built to represent Mt Meru, the home to the gods of Hinduism. It occupies over 400 acres of land, is surrounded by a moat, and has three terrace levels. The temple was built under King Suryavarman II who ruled from 1112-1152. The temple is unique in many ways, it was the largest of the temples built during the Angkorian period, it faces west, and the bas reliefs are counter clockwise. West is considered the direction of death, most if not all of the other temples built during this time were built facing east. It is believed that the temple was built as a funerary temple for the king. The bas relief, which are sculptures that have less depth, allowing them to be viewed from many angles without distortion of the figures (another example is the face of a coin), are seen in many of the temples, most commonly in clockwise direction. The counter clockwise direction of the bas relief in Angkor Wat further supports the idea of this temple being a funerary temple. 

Ray, N., Bloom, G. (2012). Cambodia. Melbourne, Australia: Lonely Planet Publications Pty Ltd. 

Upper: Angkor Wat, with the moat surrounding it. Behind the first structure you can see the temple in the background. Lower right: Statue of the god Vishnu. Often depicted as a protector, stands in the temple of Angkor Wat. Lower left: the lions protecting one of the entrances. 

Upper left: a view of a god in the west portico from the library. The temples are designed so the gods can be seen from all directions (north, east, south, west). In this temple they were usually framed by a window or door, I think this was also common practice. Upper right: Angkor Wat viewed from the Sandstone causeway as the sun was rising in the distance. It was pretty hazy this morning, so the sun rise wasn't quite what we were expecting. Lower two photos show the intricate details of the temple. There was not a doorway, wall, or corner that did not have beautiful detail. 

Upper: some of the bas relief. Lower left: inside the actual temple. Lower right: monkeys eating fruit one of the tourists was feeding them. 

Left: from inside the temple at the very top, looking out at the main entrance. Right: the very steep stair case to enter the temple. Inside the temples it is required that the shoulders and knees are covered. In the above photo I am wearing Lauren's shirt so I could go up to the top after she did. 

Angkor Thom
Meaning "large city" or "great city" depending on the source, was the last capital of the Khmer empire, completed around 1295. Built under the rule of King Jayavarman VII in response to the surprise attack on Angkor by the Chams.  As you approach the city gate you are greeted by tower faces. There is question if these faces represent the king himself or are protectors of the city. Angkor Thom is not a single temple but instead a city of temples, covering over 10 square kilometers.

Ray, N., Bloom, G. (2012). Cambodia. Melbourne, Australia: Lonely Planet Publications Pty Ltd.

Upper: the faces as you approach the gate of Angkor Thom. Lower left: the gate of Angkor Thom from the tuk tuk. Lower right: Bayon, the first temple we visiting within Angkor Thom. 

Bayon
This temple has over 50 towers with faces looking down in all directions. It is also in the exact middle of Angkor Thom. Many faces are visible from any place inside the temple.

Ray, N., Bloom, G. (2012). Cambodia. Melbourne, Australia: Lonely Planet Publications Pty Ltd.

Within the temple of Bayon. 

Baphuon

The temple mountain sanctuary, was built in 1060 by King Udayaityavarman II (1056-1066).  It was in the process of being restored when the Khmer Rouge took control of Cambodia. Because of this many stones lay around the temple, and though they are clearly labeled, they will likely never find their places on the central structure again because all the documents associated with the restoration were destroyed. 

Upper: standing on the causeway leading up to the temple. Lower: standing in front of a closed stairway in front of the temple. 

Upper right: the view from the top. Upper left: the three of us exploring the top of the temple, there were many low archways to walk through. Middle left: resting in the shade in a window. Middle right: another shot of me in front of the stairway! Lower left: the very top, it was closed. Lower right: I enjoyed this sign, I think all of us bumped our head at least once while in this temple. 

Phimeanakas
Meaning celestial place. We walked past this temple and decided not to go in. We were out of water and it was really hot. The temple also had at least two steep stairways to climb to enter, we weren't up for it on hour six of exploring. Walking through the temples was a lot like hiking, the terrain was often unpredictable and there was a lot of climbing and descending.  This temple is within Angkor Thom and has been left mostly unrestored.

Ta Prohm
The jungle temple, is the last temple we visited and is not a part of Angkor Thom. It is called the jungle temple because over time the trees have grown into the still existing structure, and it is quite beautiful. It was built in 1186 A.D. under the rule of Jayavarman VII. Unlike many other temples, it has not been restored and has been left in the condition in which it as found. It was added to the World Heritage List in 1992 by UNESCO and is one of the most visited temples in Siem Reap.

Upper left: this massive tree was dead and was being held up by this structure. I assume the purpose was to prevent the damage that would occur to the temple if the tree fell. Lower left: approaching the temple. Right: inside the temple. 

Left: one of the trees growing into the structure of the temple. Right: many doorways. 

Home

Yesterday, I made it back to the USA! I hadn't really processed how excited I was to be home until I was waiting in line to go through immigration, as a citizen and no longer a foreigner. In my first 24 hours home, I am still recovering from the diarrhea that started 18 hours prior to boarding in Cambodia (a departing gift from the country), and I have slept a lot, 16 hours to be exact, and want to sleep more. I still think twice before using water out of the tap, then realize how grateful I am to be doing so. My sheets smelled of clean laundry upon my arrival at Makani's house (thank you Donovan), a smell I have missed. Walking outside without shoes on, letting my toes explore the grass was amazing. I have no idea where I left all my belongings prior to my leaving, some are in my trunk, some in Makani's garage, some in my storage unit, I need to find some clothing that is more appropriate for California spring. We start class again tomorrow afternoon and I am hoping that my body will catch up after a crazy 36 + hours with less than five hours sleep and moving through several time zones.

Welcome to Bali

We have finished our final rough draft of our write up for Mother's Heart, after a month of hard work. We decided a couple weeks back that we would like to take a holiday while on this side of the world, and what better of a place to be than Bali! Diana, Malaika, Sean and I arrived early this evening, making it to our villa just in time for the end of the sunset. Our fridge was stocked with cold beer and the owner of our villa bought us dinner from a few of his favorite places. We ate on the second story outside (about half of the villa is outdoor space, including an open kitchen) and the food was just amazing. We are looking forward to making our way to the beach tomorrow and getting a feel for the town we are living in for the next 10 days!

We do still have a lot of work to finish up our public health field study, including a presentation to community leaders and key informants from the target area we were studying, to get their feedback on our results. In addition, once our write up is complete we will be writing an executive summary upon our return to the states, and we will likely be able to publish our work!

Looking forward to a restful night of sleep in the quiet, with the sound of water running in the koi pond outside my window.

Traveling

Things I have tired of here in Cambodia:

• Eating out every single meal
• Deet: This is necessary pretty much all the time. See photo below, this is what happens when sitting by a pool at dusk for an hour, when all the mosquitos come out, without wearing deet. I had at least 45 bites on my right leg, and many elsewhere. 
  
• Sunscreen: This must be worn everyday for me. 
• Sweating: Although I am from Texas and am used to the heat, it is odd that it is winter and so warm outside. I do miss wearing sweaters...
• Acne: Using sunscreen and deet everyday, my face and chest were a bit in shock. I had to buy acne medication for the first time in several years. 
• Diarrhea: I have had this bad twice, but pretty much have had on and off regularly since my arrival.
• Waste: Drinking only bottled water creates a lot of waste. 
• Trash: It is everywhere here and typically not contained. 
• Tuk tuks: I actually enjoy taking tuk tuks, it is nice not to have to drive, but it is rare that tuk tuk drivers know where they are taking you, which means you have to know how to give them directions. In addition, it is not very common for people to walk here, but I do it daily to the coffee shop and from there to the office. During my morning walk to the coffee shop the other day, a 5-7 minute walk, I counted the number of times I was asked if I wanted a tuk tuk or a moto ride. I was asked eight times, and I was walking at 9:00 am, which is less busy than 8:00 am, when I normally leave. It is also incredibly amusing when the same tuk tuk driver will ask you three or four different times during the process of walking by them, if you want a ride. 
• Negotiating cost for everything: There has not been a day that I haven't negotiated tuk tuk rides or prices at a local market. We have been doing this for a while, so we have a pretty good idea how often people are trying to rip us off. When I enter a store here and there are price tags, I sigh a breath of relief, because I know there will be no negotiations. 
• Being followed in stores: I am not sure if we are followed by employees because we are foreigners or if they do this with all customers to ensure they do not steal, but it is really weird being followed while trying to shop. I have walked out of stores a few times because I had a close shadow that I couldn't shake. 
• Smells: See last blog entry.  
• Noise: I love visiting cities, but living in the middle of a very busy city that basically never sleeps wears on you. Even in my room with all doors and windows closed, with the AC on, I can hear almost everything that is happening on the street. In addition, everything echoes through the streets and up the buildings because most buildings are made of tile and metal. 

Things I am looking forward to upon my return to the US:

• Cooking
• Fresh fruits and veggies
• Eating/drinking without the fear of diarrhea
• Drinking tap water
• Not being looked down upon/laughed at for walking
• My pillow
• The smell of clean laundry: The other day we were at a restaurant and their napkins smelled like fresh laundry, and I had forgotten how much I love the smell of clean laundry. I wash my clothes every week here and it smells clean and fresh coming out of the washer, but then I line dry it outside and it loses that scent before it is even dry.

Things I am glad that I packed:

• Toms: they are destroyed but keep my feet clean and protected.  
• Turkish towel: packs small, is soft, and dries fast. 
• Wash cloth: nice to scrub off the grime. 
• Pillow case: packs small and is my only bedding that is soft. 
• Nalgene bottle: perfect for mixing with electrolyte tablets. 
• Electrolyte tablets: sugar free nuun tablets, taste good without all the sweet stuff. The only electrolyte mixes we have found here have been packed with sugar. 
• Fjallraven kanken backpack (a gift from Kat): I have carried this with me everywhere, and somehow it is the one item of mine that has stayed clean without being washed regularly.
• Sound canceling headphones (borrowed from Michael): these made the plane ride here much more bearable.

Thus far this trip has opened my eyes to the privileged life I lead in America and that I have been leading here. Many of the things on this list have caused phases of frustration and acceptance, but ultimately if I had to choose I would prefer to leave behind in Cambodia, though I am grateful to have experienced them. Making this list I also realize how fast 3.5 weeks has gone and that in a very short time I will be boarding my flight to return home.

"No one realizes how beautiful it is to travel until he comes home and rests his head on his old, familiar pillow."
  - Lin Yutang

Poop

Most of my friends who post about poop on any social media network have recently had a child and are dealing with more poop than they know what to do with. Well, I have not had a baby, but Cambodia has made sure that I am experiencing poop in ways I have never dealt with before.

1. The first full weekend we were here I experienced my first bout of diarrhea. Likely caused by some food that I had eaten the day before. It lasted about 36 hours, which meant I missed the first day of data collection for Mother's Heart because I needed to be near a toilet!
2. The end of our second week I went to Siem Reap Province to see the Temples of Ankgor. We took a night bus, arriving at 5:30 am and spent about eight hours trekking around the temples in the heat of the day. As the day progress I was feeling increasingly worse, and almost vomited while we were in the last temple. I made it back to the hotel feeling overheated and not right in my tummy. I took a shower to cool down and then it began. I started projectile vomiting, like there was a monster inside me trying to get out. I imagine the scene would have been appropriate in a Men in Black movie or something of the like. Next the diarrhea creeped up on me, and I was in bed for the next 30 hours, while my travel mates continued to explore Siem Reap and enjoy the pool at the hotel. I was happy to have a clean bathroom and a comfortable bed to spend my sick time. I was really nervous about the night bus back, but somehow my system knew I couldn't handle anymore. However, Christie developed the same symptoms half way into the ride, and spent two hours on the floor in the bus bathroom vomiting. We decided it must have been a viral infection, because we ate similar things before I got sick, so not the food.
3. The infamous Shitty Canal. This is not the actual name of this canal of human excrement, but was passed along to us by Katrina, who said one of her English friends calls it this. So "Shitty Canal" must be said with a proper English accent. This canal is basically filled with sewage water, I am not sure how it gets there, if it is stagnant or moving, I have never been near one long enough to make many observations, and I don't really care to. There are many shitty canals throughout the city, and they all smell something near death. The best is when it smells like you are near a shitty canal and there is not one in site to escape from. My favorite experience with a shitty canal occurred with one that is large enough to be considered a shitty river. We were on our way out to start interviews in the factory district and were, of course, in a traffic jam on the bridge crossing the shitty river. 

   

   This photo was taken from the tuk tuk in the area we were performing interviews. If it were an aerial view you would see the shitty canal we were driving along (it is no fun to drive ALONG side one, we usually simply cross one via a bridge and that is plenty of exposure), but the photo does show shitty water, coming out of the pipe in the wall into the shitty canal.

4. The bathroom connected to the room that I am living in, smelled like something curled up and died in the drain. There are also several parasite looking bugs that like to swim up from the drain anytime there is water one the floor. There happens to be water on the floor frequently because the bathroom is a toilet, sink, and shower head. There is no segregation between the three, when you shower, the entire bathroom gets wet. I was in search of a sandbag or something heavy to cover the drain, to try to prevent the smell of sewage water from coming up, but was unsuccessful. Last week the smell intensified, it was a sour sewage smell (similar to the shitty canal) and was strong enough it was creeping out of the bathroom into my bedroom despite the door being closed at all times. I had a baggy but couldn't find anything heavy to put into it to seal off the drain, then the lightbulb turned on, I have water. Since covering the drain with a baggy filled with water at all times, except when showering the bathroom smells normal, even pleasant with the air freshener.
5. There are many unpleasant smells in this city, sometimes identifiable, but often not. Malaika and I came up with a rule last week that we live by here in Phnom Penh. When you smell something that is pleasant, like food cooking, a flower, or some other sweet something, you must enjoy it for the one whiff you got that was nice. This rule stands because every time we have taken a second large whiff of the sweet something (because we so enjoy the smell of something pleasant), it instead becomes a large inhale of the smell of death (garbage, human excrement, etc...). So, we enjoy the pleasant smell for the one whiff we got. We named this the Double Whiff Rule and has been added to our survival tips for Cambodia. 

Week 2: Beauty

The first week in Phnom Penh I was in complete culture shock. My international travel has consisted of a week trip in Mexico and 30 days of cycling through Canada. After becoming accustomed to the smells, sounds, and sights, I am finally able to start appreciating the beauty this city has to offer. The architecture in many places is truly amazing, it is intricate and colorful. Last week Malaika, Diana, and I completed the data collection for our project. For Malaika and I this consisted of visiting the factory district to interview young woman during their lunch break, we did this daily from 10:00 am - 1:00 pm. Then we would find a gas station with an indoor table to escape the heat and dust, eat lunch and around 2:00 pm we went to the KTV's to interview the young women there. KTV's are places where men can pay for a room and hire girls to karaoke with and entertain them. During these interviews I have had the opportunity to be in an intimate conversation with many Cambodian women and they are stunning.  The week was long, hot, sweaty, and dusty, but it was a really great experience, and because of it I got to see parts of Phnom Penh and Cambodian culture I would otherwise never have seen.

Each day during our lunch break we would have about 1-1.5 hours in between when the factory workers lunches were done and when the KTV/Beer garden woman would be available for interview. One day Thary (left) and Somphors (right) decided to teach us the Khmer alphabet complete with 33 letters, excluding vowels, there are 22 more of those (not pictured). They then translated our names into Khmer. The characters used for our names is dependent on how we want our name to sound. There was a lot of discussion about weather mine should be Ka-saun-Dra or Ka-saun-Tra. Thary and Somphors work for Mother's Heart as social workers, but for the week were our translators. They are really great girls, and we adore them. Lower left photo, is an actual headline from the paper last week. Although rape is not legal here certain aspects of Cambodian culture make it acceptable. The last photo is a market we passed on our way to the factory district. 

Top left, a photo of Thary taken to show the: amount of dust in the area we were traveling/working in, the large truck behind her, and the dirt and trash on the side of the road. When traveling on the roads here there are massive semis, which are more common in the factory district, then the tuk tuks which are significantly smaller, and the motos. Top right, this is the best kept pile of trash I have seen while in Cambodia. Usually it is a pile of trash without a container to contain it. There are trash piles all over the place, big and small, and they smell pretty awful. Middle left, this is a common site throughout the city. it is a wheel barrel like cart, the top is covered in very small clams, that have been cooked and seasoned, they are sold by the can full. Middle right, another photo of the outdoor market we passed daily, pictured are bowels of cow intestine for sale. Lower left, this was an awful traffic jam we were in last week, imagine this traffic on all sides of you. Because there is no order/lanes of traffic, the traffic jams are basically a large crowd of all size vehicles, all trying to go in different directions. Lower right, this is a common sight when farther away from a convenient gas station. Gas here is sold by the liter. These stands use old Pepsi and Coca-cola glass liter bottles to fill with gasoline. When you buy they liter, you dont get to keep the glass!  

Cambodia: Week one (February 2-9, 2014)

Well we made it, and have survived our first week. We are living in the middle of Phnom Penh, it is a loud city and has taken several nights to get used to the noise. During our 24 hours of traveling (18 hours of total flight time), I only slept for 3-4 hours total. We arrived late in the evening, where there was a mass of people all trying to get a visa to enter the country. The men behind the counter took our forms and passports and simply shooed us with their  hands in the direction we were to go. This meant just about nothing to all of us (Diana, Lauren, and I), we had no idea which of the many lines we were to get into. So, we went to the next line to stand in, which was the wrong one. So another man shooed us into a new "line" which was just a crowd of people standing around the men with our passports. It took us several minutes to observe what was happening. The men behind the counter were simply holding up the passports as they received them, attempting to pronounce our names, and taking our money. We thought we were applying for a general visa, however we were only approved for a visitors visa, which was supposed to cost $20, however the men charged us $25. Lesson learned, only have out as much cash as I intend to pay for something...

Upon leaving the airport, we walked into a very humid, warm darkness. We found our tuk-tuk driver, who was a friend of Savin (our local logistics coordinator/care taker), who was holding a sign that read "Turo University.  Lauren, Diana, Kasaundra." We loaded all our luggage and began our 45 minute journey through Phnom Penh in the dark. We went through the "red light" district filled with KTV's, with many girls in the front. I only knew what these places were because of the work I will be doing with Mother's Heart in this area. After a hot, dusty ride we arrived in the front of our house. We were told we were on the second floor and given keys. We then dragged our luggage up to the "second floor," where we tried to break into someones locked front balcony, before we realized this was actually the first floor. We then lugged all our stuff up another floor (total of 4 full flights of stairs), discovered a note from our classmates, found our way into our apartment, found our beds a tried to sleep. We are in the middle of the city, I was in an unfamiliar place, and had no idea where I was in the city. The first night I think I slept a total of two hours. I was awake at 4:19 am, which would become a trend for me for the next several days. Around 4:20 am there is a flock of birds somewhere in the city that begins their daily calls. These calls echo through the buildings of the city, which makes them sound like they are just outside our window.

All of these photos were taken from our second story balcony. The two photos on the left are of the street we live on. Top right are the electrical wires, this one is conservative in volume compared to others we have seen around the city. The last is a photo to the north of downtown Phnom Penh. 

Sleeping has been interesting. The first four nights here I averaged 3-5 hours of restless sleep. Waking up every day at 4:20 am. It was a bit weird, especially since I had ear plugs in, but 4:20 was my time. Although I was getting very little sleep I didnt feel tired, I woke up everyday ready to go, and was grateful to feel energized. I think this was simply a result of jet lag/ my circadian rhythm being completely off and likely excess cortisol due to an underlying level of anxiety about being in a foreign place. I have progressively gotten more sleep each night, Wednesday and Thursday night a few beers and benadryl was effective. Friday and saturday night, I was just exhausted. Last night, I fell asleep with all lights on at 7:45 pm, woke up two hours later, brushed my teeth and went back to bed until 7:45 am. Feeling more refreshed today.

It is winter here, it seems the timing of seasons is similar to the US. However, the temperature here in the winter is still in the 90's during the day, with lows in the 70s to 80s. No joke, I have seen several people wearing fur lined coats and puffy jackets when it is 85-90 degrees out in the morning, when I am wearing a long skirt, and tank top and am sweating from every pore of my body. It is hot here, and is only supposed to get hotter during our stay as summer approaches. Our apartments do not have central air conditioning but each bedroom has a small A/C unit, for which,  I think, we are all grateful to sleep in a cool place, and not be sticky/sweaty for a few hours a day.

Traffic is crazy here. On the road there is a mix of vehicles (mostly Lexus and Toyota), tuk-tuks (per wikipedia, an auto rickshaw, it is a buggy type cart carried by a motorcycle), motos (motorcycle), bicyclists and pedestrians. At many intersections there are no traffic lights, but no one wants to pay for repairs of their vehicles and somehow there aren't crazy accidents. During rush hour we have approached a wall of traffic, 4-5 lanes in each direction, literally 10 lanes deep total. Our tuk tuk driver will slowly pull forward and somehow we make it all the way across in one piece. It is quite amazing.  I have learned to trust that we will make it across. We have had some close calls in other areas of town, but it isn't typically when crossing at an intersection. Often, at intersections without traffic lights, motorists will honk to let the traffic traveling perpendicularly know they are coming. There are so many motorcycles here. The other day we were in a traffic jam because 3/4 of the road was closed for construction and it got me to thinking, "what if all these people were driving cars like in America."

Tuk Tuks are our major form of transportation around town. A ride with 2-4 people averages $2-5 dollars depending on the time of day and the area of town we are traveling.  We have found after dark it is more challenging to find a driver that speaks English and it is best to have our map out to ensure we are traveling in the correct direction to home. Throughout this first week we have made some rules for ourselves when traveling on tuk tuks.

1. Our driver must speak some English.
2. When we show him on the map where we are going, he must have some recognition of where that might be.
3. He must be able to see, preferably out of both eyes.
   Yes, there is a story for this one. One day after work, Malaika, Diana and I got on a tuk tuk to go to a local market to pick up some stuff before returning home. The tuk tuk driver did not understand English at all (usually we just show them a map and where we are going and that is sufficient). However, after I showed him where we wanted to go on the map, he stood there and stared at the map for a good long time. Then, he went to the back of the tuk tuk, made Diana stand up and picked up a pair of glasses with only one lens. He then put them on and stared at the map some more. He continued to be very confused about our destination, which we found odd because it is a market catered more to locals and less to tourists. The girls at the office call it the second hand market. After crossing the "shitty canal" (more on this later), we realized he had no idea where he was going and we weren't even sure he could see, so we got out early, still paid him the agreed amount, and added this rule to our list. 

Top left, a photo of a tuk tuk, it can carry up to six passengers, with two benches facing each other. Top right, the best photo I have taken of the traffic we were trying to cross. The lower two are of  a traffic jam yesterday while traveling to The Kililng Fields.  There was a lot of construction in the village we were traveling through, all the motos and tuk tuks were pulled to the side to let the very large trucks pass by, with enough room to prevent them from hitting the power lines. Lower left: Lauren and Christie, with Savin, who is our logistic coordinator and a tuk tuk driver. 

The organization I am working for is called Mother's Heart (MH). It is an organization that opened its doors three years ago, with the goal to provide crisis pregnancy counseling for women in the area. There are many services available to women in Phnom Penh, however many woman do not know about these services. Mother's Heart provides counseling and referrals for woman to receive the services they need through out their unplanned or unwanted pregnancies. Katrina, the woman who started MH is an Australian, who did a lot of work in China before she was married. She has been in Cambodia for six years with her husband and three children. Emily, who is supervising our project, was born in Thailand where her parents met, her father is English and her mother is American, but she grew up in Cambodia, in a province north of Phnom Penh and also in the city. She went to Oregon for her bachelors degree and has returned to Cambodia to work at MH and be near her family. I am working with two girls from my class Diana and Malaika and our project is a needs assessment of a new area MH would like to expand their services to. The first week we were responsible for editing the tools we will use for data collection, learning about Cambodian culture, working with two social workers at the organization that will be our interpreters, testing the tools we created in house and in the field. The areas MH would like to expand their services to is the factory district, where thousands of woman work seven days a week to send money to their families who live rurally and the KTV/beer garden district, where the woman are responsible for entertaining men, their jobs include refilling ice, drinking with the men, singing karaoke, and touching/kissing the men. These areas house a population of woman who are not receiving services from other NGOs and are at high risk for unwanted pregnancies and therefore unsafe abortions (which make up a large percentage of the maternal mortality rate in Cambodia).

Yesterday (Saturday), Diana, Lauren, Christie and I hired Savin to be our driver for the day to visit The Killing Fields and The Genocide museum. The Killing Fields is now a memorial for all the people that died under the Khmer Rouge and Pol Pots reign in 1975. Entering The Killing Fields we were all given an audio player and head phones. We toured the grounds used to kill and bury over 20,000 Cambodians. The experience left us all with a heavy heart. It is still unclear to me how Pol Pot came to power, but it appears the people did not truly understand what was happening to their country. You can learn more here.

On our trip out of Phnom Penh to The Killing Fields. Top left, it is very dusty in some places requiring we cover our faces with a mask or scarf. Top right, the truck is fully loaded, this is a common sight on the streets here. When trucks travel with a load, the load is usually larger than the vehicle itself. Lower left, one of the two bodies of water we have been near that was not full of human excrement, and actually smelled nice. Lower right, rice fields. 

Upper left, another rice field. The others are photos of architecture we observed on our ride. There are many buildings here that are absolutely stunning. 

The memorial at The Killing Fields. Also called a stupa, which translates to a heap or mound, it houses the skulls of many of the victims of Khmer Rouge. The tree was used to hang a loud speaker to drown out the noise from the victims as they were being killed. 

Top the rice fields behind the memorial.  Lower left, a spirit house next to the mass grave used for woman and children. Lower right, the mass grave sites that were cleared and have filled in over time due to shifting of soil during the rainy season. 

Left and lower right, inside the stupa. The stupa now houses all the skulls from the mass graves that have been excavated. The skulls are organized by sex and age group. They are several shelves of them as depicted here. Upper right, Diana standing in front of the mass grave used for women and children. The tree behind the covered grave is called The Killing Tree, because it was used to kill small children. 

There are many more things about Cambodia that I will share in the coming weeks, there are so many things that are very different from the US. But life is simpler here, in a good way.

Clinical Year

Today is the last day of my last call backs. This is significant because it means I have completed my clinical year of PA school. Wow! That certainly stirs up some emotions. This week has been crazy busy, as are all call backs. I had an exam Monday, OSCE Tuesday, case presentation Wednesday and my CV is due tomorrow. In addition to school, I have been prepping to leave for Cambodia. As my mind is less distracted with school deadlines I am beginning to realize I am leaving in only two short days!

As I am completing my CV and reflecting on the past two and a half years of my life, I am so grateful for this journey. I have learned so much about medicine, life, and myself. As I watched Elizabeth (one of Dr. Fullerton's medical assistants, who also provided me a place to stay during my last three weeks in Austin and who I foresee will be a lifelong friend) prepare to take the MCAT and apply to medical school I remembered what it was like being on the other side of fence. I remember completing my applications, waiting to hear from schools, interviewing, being accepted to Touro, my first day of school, my first day of clinical rotations and all the fear, tears, happiness, and laughter that was part of the journey. It has been pretty amazing.

"The journey of a thousand miles begins with a single step."
   - Laozi

"As you move through this life... you leave marks behind, however small. And in return, life - and travel - leaves marks on you."
   - Anthony Bourdain

Cap, Gown, Hood

Today I ordered my cap, gown, hood and graduation announcements. I also received an email from a classmate announcing the time until graduation... 4 months, 5 days! Thursday will be my last day in clinic as a PA-S (Physician Assistant student). Thats right, next time I am working in a clinic I will be a PA-C (I will graduate as a PA, however I do not gain the "-C" until I have taken and passed the board exams and become certified). I will also be paid for my labor!!!  I will no longer be paying thousands of dollars for the pleasure of working.

Last night I chatted with one of my classmates I will be traveling to Cambodia with, I am so excited to be spending six weeks with several of my classmates. After a year of moving from place to place, being isolated from my family, classmates, and friends, and always trying to connect with a new staff, I am so excited to spend the next four months on campus and six weeks traveling with classmates. I will be doing work in Cambodia, but I will also be exploring the area and traveling on the weekends. As I prepare to travel abroad for the first time, I am a little stressed, but mostly excited. This time in two weeks I will be at the airport!

"The world is a book and those who do not travel read only one page."
- Augustine of Hippo

The Road

Quote for the day...

"What appears to be the end of the road may simply be a bend in the road."
- Robert H. Schuller

Journey

This week I had a meeting with the classmates I will be working and living with in Cambodia. It still doesn't seem quite real that I will be leaving three weeks from today. Three weeks.... So much still needs to happen in my life before then. We also received our contract from Mother's Heart, the organization we will be working for, which outlines our responsibilities and their expectations of the work we will be doing. All of which I am very excited about. We will be performing a needs assessment in an area the organization would like to expand its services to. This area houses several factories and beer gardens where many women and girls work. These are the women we will be interviewing and conducting surveys with.

In the coming three weeks I will be:

• completing my last clinical rotation
• traveling back to California for callback week on campus
• taking my last end of rotation exam
• completing an OSCE (objective structured clinical examination)
• giving a case presentation to my class
• completing and turning in my CV for review
• finishing all my travel vaccines
• packing for summer in Cambodia
• leaving for Cambodia! 

"It is good to have an end to journey toward; but it is the journey that matters, in the end." 

 -- Enerest Hemingway 

Experience

Today as I sit in a coffee shop in Austin, well not just any coffee shop, but my favorite coffee shop, I am working on my CV. As I am writing about all of my clinical experiences from the past year, I am reflecting on what a crazy year it has been. I am excited to be completing my last clinical rotation this month, but I am also fearful of what this means. In less than six months I will be a graduate of Touro University and preparing to sit for the PANCE (Physician Assistant National Certifying Exam).

Here is what I have been up to for the past few weeks.

I moved to Austin for my last clinical rotation with Dr. Fullerton, the physician I worked for during the two years prior to starting PA school. I had the luxury of having a week off for Christmas, which was really nice. I have been gone from Texas long enough that I forgot how big Texas skies are, I love every sunset I have watched over the past three weeks. They are just stunning. I am so proud to call this place home.

I am also preparing for my public health field study, which will be from February to mid March. I will be traveling to Cambodia to work with an organization that provides crisis pregnancy counseling. This will be my first trip traveling abroad and I am so excited! It is certainly proving to be expensive to prepare for, but I know it will be well worth the experience. I am also hoping it will be the first of many trips abroad for public health and medical missions.

I applied for graduation! Which makes it a little more real that I am nearing the end.

A quote I find appropriate as I continue to realize how little I know about medicine, but am excited by the prospect that medicine will always be teaching me more.

"Experience: that most brutal of teachers. But you learn, my God do you learn."
  - C.S. Lewis