readers' submissions

Tibia Fibula Cambodian Style

A firsthand experience with local medical services

It was mid November 2004 my wife and I decided to take a short break from running our guesthouse in Sihanoukville “AUSTRALIAN APSARA” and travel to Kep for a well deserved rest. We rode to Kep on my out-of-the-box Honda XR250 (I started riding motorbikes at the age of 10). The ride from Sihanoukville to Kep was just as interesting now as it was when I first did it six years ago. This time I was taking it easy on the road because we were in no hurry. We left Sihanoukville at 9 am and passed the toll booth an hour later. Soon after we arrived at Veal Renh to refuel and have something to eat and drink before carrying on to Kep (there was still more than half a tank of fuel, but better safe than sorry).

As we left Highway 4 and headed towards Kampot and Kep the scenery and traffic became more enjoyable, no container trucks going hell for leather, just chickens, dogs and cows playing on the road ( these obstacles are much easier to negotiate). As we passed the turn off to Phnom Bokor, I mentioned to my wife we should go and have a look at the casino on our return trip to Sihanoukville. I had been told it was well worth the effort. We both agreed.

As we crossed the bridge into Kampot, we turned right and decided to take a break and sit on the grass along the waterfront. Within five minutes we had a local Khmer approach us asking if we needed a guesthouse. I replied in Khmer that we are OK and are on our way to Kep. With me speaking his native tongue he knew I was not a easy target so he left.

I refueled the bike once again and headed off to Kep. Upon arrival my wife and I decided to sit by the seaside and eat mud crabs purchased off a local Khmer woman. The sun was setting so we decided to look for a guesthouse. There are not many to choose from, but by chance we found a guesthouse which was the same name as my wife.

The following morning after breakfast we left the guesthouse at Kep and headed back to Kampot. My wife was hungry because she cannot eat Western food early in the morning. While I was refueling the bike, my wife went over to a local food vendor and ordered a Khmer breakfast, three tablespoons of rice and five strips of beef. She returned with a smile which meant the food was cheap and good.

We left Kampot and within half an hour we were at the ranger’s hut at the base of Phnom Bokor. My wife approached the guard and said we would like to enter, the fee was $5 for Westerners and free for Khmer. It took one and a half hours to reach the top (City of Ghosts did it much quicker). The view was amazing. After walking through the old casino we ventured over to the wat which houses the three legged monkey and the attack geese. My wife prayed and I looked at the magnificent view over the ocean and wondered if anyone was living on the tropical islands in the distance. It was approaching mid-day and we still had the one hour descent and the drive back to Sihanoukville ahead of us. The ride down the mountain was much easier than climbing it, we did it within one hour.

Riding back to Highway 4 from Phnom Bokor was very relaxing, there was very little traffic and there was not much wildlife to contend with. As we rode into Veal Renh, the traffic was starting to become congested and was moving quickly. We were about half an hour from home and travelling at about 60 km/hour when a car in front of me (Khmer taxi driver with five locals inside) decided to do a U-turn in front of me. Instead of pulling off to the side of the road to U-turn, he did it in the middle of the road, I had nowhere to go except straight ahead. I swerved to go around the front of the car and he just kept on coming, the bumper bar caught my leg and the next thing I knew I was on the ground wondering what happened. I looked around to see my wife, she was laying on the road 20 meters from me not moving, I removed my helmet and went to stand up, I walked two paces and fell down. I got myself up again and fell down again. I looked down at my leg and knew something was wrong it was facing backwards and I could not move it. So I crawled to see how my wife was and she assured me she was fine and got to her feet. I could see she had severe gravel rash, but she did not complain. I told her that I thought I had broken my leg. As the local farmers appeared at the accident scene they tried to help me to my feet, I told them not to touch me but they would not listen (I fell down again). I looked around to see the car who hit us had left.

Thankfully my wife stopped another taxi which was heading towards Sihanoukville and asked if they could take us with them. The driver said yes but we had to pay $15 first (this man was all heart). The local farmers lifted me into the back of the car, my wife sat beside me, and said ”you look fucked up”, I tried to smile but I couldn’t. It took half an hour to get to the local clinic in Sihanoukville, and by now the pain had become worse. The doctor at the clinic told me to get out of the car and come inside so he can take some x-rays of my leg. I told him he should splint my leg because I couldn’t move. His reply was,” What is a splint?” I saw chicken wire on the ground and asked my wife to make a splint and bandage it to me.

While my wife was making the splint, the doctor proceeded to pull my boots off. The pain was indescribable. The boots were removed and I was on the x-ray table getting my wounds dressed, while the nurse attended my wife and dressed her wounds. The doctor x-rayed my leg and told me it was broken. He wanted to operate and told me it is an easy operation but I politely refused and said I want to go to a hospital in Phnom Penh. The clinic offered to take my wife and I to Phnom Penh in their ambulance for a fee of $200 (again all heart) we were in no position to bargain.

The journey to Phnom Penh in the ambulance was the most painful experience I have ever encountered. I felt every bump in the road and I was only given an asprin for the pain. We arrived at Bayon Hospital in Phnom Penh four hours later (Bayon is a private hospital).

The staff at the hospital were very good and attended to my wife and dressed her wounds. They took me to the operating room and told me that I have to wait for the doctor. The doctor arrived two hours later (during this time nothing was given to me to ease the pain). While I was waiting I thought to myself this can't be the operating room, there is no equipment and why are people sitting in the corner eating dinner? Finally the doctor arrived, he put a needle in my arm and I woke up the following day with my leg wrapped with bandages. My wife was in a bed next to me also wrapped in bandages.

Since we both hold Australian passports, I decided to phone the Australian Embassy in Phnom Penh and tell them what happened. The lady who I spoke to came to the hospital a few hours later .She suggested that I should be evacuated for treatment in a western hospital. When I told her I didn’t have travel insurance, she replied, “No insurance you stay here” I was in no condition to argue. I asked if the Australian doctor attached to the embassy could come and see me (all embassies throughout the world have their own doctors). Again the answer was no, the hospital would not like Australian doctors treating their patients.

In total my wife and I stayed eight days in Bayon Hospital. The nurses were excellent, everyday I was given nine needles for the pain and hooked up to a permanent IV. With the amount of needles I was given, my veins started collapsing, so the nurses started injecting through my toes (this was very painful to say the least). My wife was receiving four needles a day. I asked the doctor why we both had so many injections and what was in them, and he told me we both needed the painkillers.

On the eighth day, the doctor said he could not do any more for us, all we needed was to rest at home. His advice for my leg was to stay in bed for a month and don’t put weight on it for at least three months. He gave me a week’s supply of painkillers and said I was OK. The bill for eight days in the Bayon Hospital was $1500 for my wife and I (the average income for a Khmer is $60 per month). We hired a minibus so I could lie down and keep my leg straight for the four-hour journey back to Sihanoukville. For the next three months, I stayed at home and did not put weight on my leg and kept it elevated. Within two weeks of being home, my wife was back operating the guesthouse.

Three months had passed since the accident and I was doing everything what the doctor ordered - no weight bearing on my leg and keeping it elevated and clean. We decided to go to a local clinic in Sihanoukville to have another x-ray to see if my bone had grown. To my surprise, the bone had not grown. The doctor who took the x-ray said it was normal because of my age (I’m 39 years old). I was not happy with this comment because the bone was not growing and my leg still looked a mess. I realised it was time to go back to Australia and see a professional doctor (a doctor who has not paid his / her way through medical school or bought his / her certificate).

My wife and I arrived in Australia several days later at 2.00 am. I saw my family doctor at 3.00pm and was admitted to hospital at 4.00pm. The family doctor told me not be surprised if they amputated my leg. In hospital several weeks later, the doctor told me I had “ Staph Aureus + Strep Pyogenes Cellulitis + Osteomyelitis “ In plain English, I had an infection in my leg which was "eating” my bone away. With both bones broken (tibia and fibula) and the infection, the doctors were very concerned. They pumped my system full of antibiotics and hoped for the best.

Recently I have been released from hospital and the doctor has said to wait and see if my leg responds to the antibiotics before deciding what to do. There is a slim chance I could lose my leg from the knee down. I still cannot walk and the doctors say if my leg responds to the antibiotics I should be walking again in 12 months time.

I will never have the full use of my leg.

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