As many of you know, we have recently faced a significant challenge here in Cambodia. Each day brings us a little farther from the intensity of it. But it is still hard to think about.
In late August, Janaya’s knee began to swell and started becoming painful. We couldn’t think of any significant injury she had suffered, but yet she was not running a fever, so it didn’t seem like an infection either. We went to the family practice doctor that the MCC team uses.
She prescribed rest and ibuprofen, but when that didn’t help, she prescribed an oral antibiotic. There was only gradual improvement during that time, after which she recommended we see an orthopedic doctor at a hospital / clinic close to us, associated with a hospital in Bangkok. These doctors told her to get off her feet and prescribed a stronger anti-inflammatory medicine. Here things got worse, she began running a fever, at first at night, and then all day long – and the swelling got worse. Finally, on September 14, we saw a young Cambodian internal medicine doctor who knew the fluid on her knee had to be removed. I knew that to be true too. I was so glad to have found him. He was bright and explained everything well for my inquisitive, western mind. He also began Janaya on IV antibiotics. So, for four days in a row we went to see him. He withdrew fluid twice, and the pain during this procedure was terrible. He used some local anesthetic, but not enough for Janaya. He told me that he had done the procedure without any anesthetic – to which I responded – well then, you Cambodians must be tougher than us westerners!
After four days, and no big improvement, except that the fluid he was removing was beginning to get thinner, we decided to head to Bangkok for arthroscopic surgery. I don’t know – we probably should have gone sooner. It was so hard to know how serious her condition was, and whether she was getting the care she needed.
We were scared on that flight. Fifty minutes in the air and we got fed a full meal, but we could hardly eat it. But with Janaya in a wheel chair, we were led through the Bangkok airport– the bathroom, passport control, money exchange and right to the public taxi, which we took straight to the hospital. We really didn’t even have to think – a very good thing. We checked into the emergency room at Bangkok Nursing Home Hospital, where they soon recommended that she have surgery yet that evening. But problems soon arose. They wanted a confirmation for coverage either from a credit card, or my insurance before they would do surgery. No one was up yet in PA, so we struggled to reach our provider. Not knowing we were in Thailand, our credit card company suspected fraud, and wouldn’t process the bill either. Fortunately, the SE Asia MCC team leaders were in town for work, staying very near by, and bailed me out with their credit card. This was a very hectic time, trying to cover the details, while Janaya was being examined. A frantic email to the entire HR department at Messi
ah College from a computer in the ER room got the ball rolling with insurance, and before Janaya moved into surgery, approval had been given. We were eventually moved up to our room, where we met the orthopedic surgeon, an infectious disease doctor and her anethesiologist. All spoke English and it soon became time to walk Janaya down to the operating room, and leave everything up to the Thai doctors, and God.
I was so thankful for Andy and Lana Miller, our SE Asia team leaders who sat with me throughout the entire surgery – first in Janaya’s room, and then outside the door of the operating room. Lana told lots of stories to distract me – I don’t know if I can remember many of them. It took longer than they had told me it would. She went in at 10:30. Finally at about 12:40 am, they let me into the recovery room. Andy and Lana went back to their guesthouse at about 1:15.
From there began a much longer than expected two week hospital stay. When Janaya came out of surgery her knee was wrapped in a huge watermelon sized bandage, and they had left in two tubes for fluid drainage. For several days, the knee was so painful that even we could hardly move it for her. Janaya’s fever dropped immediately after surgery for a couple days, but then started to creep up again. Her dose of antibiotic was doubled in Bangkok. Unfortunately, because of the early oral antibiotics, they were never able to culture the organism, so while there were markers of bacterial origin, the infection had to be treated with a broad spectrum drug. The doctors were waiting for her fever t
o be completely gone, and for the fluid from the drains to run clear. Every few days they changed the drainage lines so that they could better see this. The drains were left in for 12 days.
As it became apparent that we were going to be there for a while, we started marking each small improvement: movement to the bathroom with help, independent movement in the room with a walker, the ability for Janaya to move her leg herself, the use of crutches, less reliance on Tylenol for pain... The hospital was very nice and Janaya’s room had a sleeper sofa for me, and a small refrigerator and sink. I relied on food that friends brought, the leftovers from Jan
aya’s meals and eventually made a couple trips to a nearby grocery store. I really didn’t want to leave her alone. At least one of her team of 3 doctors came to see her almost every day – sometimes in their street clothes. Physical therapy began 4 days after surgery and soon occurred twice a day. We really liked our physical therapist, who spoke very good
English and knew the physiology behind what needed to be done. She was fun too! Communication between us and the nurses was not always perfect, but they provided excellent care. We were on a pediatric floor, so the nurses were especially good at putting in IV needles into small veins! That was one of the things Janaya hated the most, as every 3 days the line had to be changed. Our room overlooked a central garden, and I took Janaya there in her wheelchair. But now spoiled by air conditioning, she thought it was too hot. We were encouraged by a traveling display, from the UK, of a life-sized knitted gingerbread house. The hospital had a charity projec
t while we were there, asking people to knit small squares to be put together as blankets for needy families in Thailand. I learned to knit at the very end – never suspecting we would be there so long.
Despite being in Thailand, we had visitors! On the morning after surgery, Andy and Lana brought Dunkin Donuts, conversation and laughter. (For reference, there are sadly no Dunkin Donuts in Phnom Penh.) Cindy Blount, a Messiah College recruiter, also visited the morning after surgery, bringing us all sorts of groceries. We had planned to host her in Phnom Penh, but alas we were in Bangkok and missed her there. The parents of one of my advisees from Messiah College, a Thai student, visited us many times. Their visits made a world of difference. Sunee brought us fresh fruit – western and Asian, flowers, Hershey’s chocolate, many o
ther things and one day – sticky rice with mango and coconut milk. One day they took home some of my clothes, washed them, and brought them back the next day. (I washed most of my clothes in the sink. I had planned for that, and brought detergent.) Each time the Lorganpai’s prayed for Janaya’s recovery. They were such a blessing to us. One week after surgery, the MCC Asia Director, Joe, showed up at our door. He was traveling through Bangkok before meetings in Indonesia. What a wonderful surprise! And during the second week, Ron and Acacia came for several days. They had a chance to learn a bit of Janaya’s hospital routine and therapy, grocery shop for u
s, allow me to rest a bit, and encourage us. On our last night, the Lorganpai’s and Cindy were there again – happy to hear that we were being dismissed! Pretty good when you are halfway across the world from home!
And we used technology to its fullest. Each hospital room had free wifi. I had begun to second guess our bringing two computers to Cambodia, but not after this. We skyped with Ron and the kids regularly. A talk with Aunt Wendy in Minnesota got Janaya laughing right before her first physical therapy session, almost every morning. Wendy’s a late night person – so that worked perfectly and she had plenty of Sachs family stories to tell us. We talked to Grandpa and Grandma Kroeker several times, a couple times when they were driving down the freeway in the US. By the end, we also talked with Grandpa and Grandma Sachs. When Ron visited, we talked with Austin every day where he got home from school. What a world of difference this made! One doesn’t feel quite so alone when you can video chat with family. I also used the internet to understand Janaya’s illness, and follow her treatment and medications. Several times the nursing faculty at Messiah College provided me feedback when I asked them questions. By the end, I think the doctors and nurses were accustomed to me wanting to understand everything, but I don’t think that is part of the Asian culture. Joe, who grew up as an MK in northern Thailand helped us to understand some of these differences.
Two weeks later we were dismissed. We stayed for one night in the Bangkok Christian Guesthouse. Janaya had really wanted to see Bangkok – but not easy to do from a wheelchair. We plan to go back again. We immediately returned to our Phnom Penh hospital where they continued outpatient IV antibiotics for another week. Janaya started school the following Monday, and is finally getting close to catching up on her work. But we aren’t finished yet. Janaya lost a lot of range of motion during this illness, so with the guidance of a French doctor in town, we will continue with physical therapy – one good session each day. There is still pain, so she has been using crutches. There are a lot of stairs at school, so Ron and I went in often at the beginning to help her manage that and her heavy books. Last week we set up a temporary storage place for her books in the main office, so I think our days of assisting her are coming to an end. Still, her friends and classmates help her with her backpack between classes. We hear that complete recovery from bacterial arthritis in the knee can take anywhere between a month and 6 months.
We don’t know exactly where this came from. Bacterial joint infections are rare in youth. But it seems likely that the bacteria entered through an open wound in her leg – she did have a few of these. There are a lot of new bacteria for us to contend with here.
Hard to travel such a rough road so early in our time here in Cambodia – no denying it. Some have told me that they aren’t surprised, as Satan tries to thwart our work here early on. That doesn’t make it any easier. We have so appreciated the prayers that have been said on our behalf. Please keep praying as we continue to work through what this means for our experience in Cambodia. Our doctor here, in commenting on this illness so soon during our time here, said, “very unlucky.” After thoroughly examining Janaya’s knee during surgery for damage to the cartilage and ligaments in her knee, and finding none, her orthopedic surgeon said to us “very lucky.” Luck, and fate, are very much a part of the culture here. But it is different for us – not luck, but God.
Oh, by the way, Janaya wrote the title for the blog. Translated it means, “I don’t like hospitals.”
hree majors: Chemistry, Biochemistry and Food Technology. There are a lot of students in each class, who take a prescribed set of courses from beginning to end. They study many advanced topics in chemistry, but have limited laboratory experiences, and no electives. For all the college students reading this...classes here start at 7 AM!
g with several students on a variety of projects. While Janaya’s illness has set me back a little, after looking through all the stockrooms here, I am preparing to order the reagents and supplies I need to study how market vegetables can be used to do chemical reactions. This area, called biotransformation, is of increasing interest as chemists look for ways to do chemical synthesis in a “greener”way.. In addition, we have written a proposal for funding to look at the amounts of PCBs and DTTs in the shellfish that is eaten widely here in the city. The latter project is part of a bigger body of work in which the chemistry department has looked for the presence of these toxins in both soil sediments and fish. We have both a GC, and potentially two HPLCs for this work. But not unlike the US, it is hard to keep these instruments up and running at all times.
year, the best graduates go abroad to gain master’s degrees, and perhaps Ph.D.s. The hope is that these students will return. Right now many of the best recent graduates are out of the country, so it is a challenge for the department head to get all his courses covered. (Same challenges at home...) In recent years, there have been foreign visitors who have worked with the biochemistry, analytical and environmental chemistry programs. I’m the first to come with an expertise in organic chemistry. The department has enjoyed a long relationship, perhaps 8 years, with an Australian chemist, who works full time in the department to improve every aspect of the program: research, curriculum, infrastructure, building needs, computers, translation of textbooks into Khmer, you name it. There is a group of foreign workers who have coffee together each day. While never part of my routine in the US, this is a wonderful way to meet people and better understand many aspects of Cambodian culture.
