OznAsia

I arrived in town late on Friday afternoon. At the airport I was besieged by tuk-tuk drivers offering to take me to town for $7. (US dollars are semi-legal tender in Cambodia.) I said, no that was too expensive and they quickly pointed out that car taxis charge $9. I said last time I was here I travelled by motorcycle and paid $2. They pointed out how difficult it would be with my bags on a motorcycle. But I've done it before. It can be done. Then a motorcycle driver who looked like he was blind in one eye turned up. He offered to take me. "How much?' I asked. '$5.' 'No way. I paid $2 last time.' Eventually I got him down to $3.50, so off we went. I'm sure if I'd actually walked out into the street outside the airport I could have found one to take me for less. But the one-eyed driver seemed a nice sort of guy so I went with him. He even knew where International Guest House was and while he tried to talk me into accommodation where he might get a commission, he was happy to take me there.

I first visited Phnom Penh early in 2005. At that time I remember one of my challenges was the fact that many of the motorcycle-taxi drivers knew the city hardly better than I did. Since then, whenever possible in Phnom Penh I walk where I can.

During this visit to PP I have several agendas. I want to visit a dentist who worked on my teeth a few years ago. I want to catch up with my friend, Vana, who is now working and living in Phnom Penh. On the plane from Australia I sat next to a young woman named Erika who was heading to Cambodia to do volunteer work on a similar basis to what I do. We agreed to try to catch up. And I needed to go to the Australian embassy to vote. To communicate with all these people I also needed to get a Cambodian SIM for my phone. I needed Vana's help for that. You need citizenship ID to get the SIM. I got my last one in his name.

Before I left Australia I emailed the Australian Embassy and asked if they would be open for voting. I got a quick response saying they would. I borrowed a phone from the reception guy at the guesthouse on Friday evening, called Erika and arranged to meet her at the Oz embassy at 10 am. I left the guesthouse at 9 am. This allowed me plenty of time to visit the dental surgery and walk to the embassy. I knew where it was. I'd been there before.

At the dental surgery they told me the dentist was now working elsewhere. They checked the number I had and said yes that would find him. OK, off to the embassy.

When I reached the corner of the street where I expected the embassy to be I asked someone for confirmation to make sure I had the right street. He said that the embassy had moved but he couldn't tell me where. I went on anyway. He had to be right because it certainly wasn't where I expected it to be.

On a corner there were two motorcycle drivers and a tuk-tuk driver. They offered to take me somewhere just as every other motorcycle and tuk-tuk driver had done on every corner I had passed. I asked if they knew where the Australian embassy was. One guy was very confident. He searched my map for about two minutes and then pointed to a mark on the map where it clearly said US embassy—and this was in the other end of town. One insisted that it was further along roughly in the direction I had been heading and the third vaguely described how to get to where it was before. Despite their inability to convince me they knew where it was now located each of them thought I should still go with them. I decided to continue walking but in the direction that seemed the most probable.

At the next corner another tuk-tuk driver asked if he could take me somewhere. I asked if he knew where the Australian embassy was. He described the direction that I thought had the most potential which suggested I was heading the right way. I was concerned because I was supposed to be meeting Erika. I didn't want to be late. I was prepared to get this guy to take me so I asked the fare. '$3'. He quoted. "No way.' I said.

To put this into context, you need to understand that the average income in Cambodia is about $50 a month. So, if he was quoting this fare to a Cambodian how many fares do you think he would get? Obviously this is a special price for foreigners. And having been raised in a country where all taxis have meters and therefore everyone, no matter who they are, pays the same fare. I find this attitude unfair. (No pun intended.)

He dropped his price to $1.50. I said 'no'. He asked what I'd pay. I said '2,000 reil' ie 50 cents. He rode off.

I simply kept walking in the direction I believed the embassy to be; stopped here and there to ask directions; spoke gruffly to any tuk-tuk or motorcycle driver who dared to approach me and eventually found the embassy at 10.30 am. There was no sign of Erika. When I signed in I checked the list of previous visitors and Erika's name wasn't there. I did my democratic duty, went outside and waited until a little after 11 am. Still no sign of Erika.

I walked back home dodging the motorcycles and tuk-tuks as much as possible, had some lunch and during the afternoon went to the National Museum where I was to meet Vana. He was almost an hour late which meant I sat in the shade on the opposite corner and I noticed the motorcycle and tuk-tuk drivers. Most of them never moved. It became obvious, if it wasn't already, that there were far too many of these guys so that very few of them can make any sort of living out of it. They sit around all day doing nothing, thinking they have a job but complaining how little money they make.

Compared to my first visit in 2005 the number of tuk-tuks has increased greatly. There are probably more motorcycles too but proportionally, the tuk-tuks have increased far more. My guesstimate is that there has to be about 10,000 tuk-tuk drivers in town—maybe more than there are in Bangkok, a much bigger city. There must be far fewer tourists than tuk-tuks. I certainly don't see as many Westerners as I do tuk-tuk drivers. Most have a spot where they sit all day and return to if they are lucky enough to get a fare. I guess they pay someone for this right. Whether such a payment is official or not I don't know. This being Cambodia I suspect it's not. Those who don't have such a spot cruise.

The cruisers can be more persistent. They come along beside you as you walk, engaging you in conversation. One guy was quite good. He saw me going to a statue to take photos and waited where I had to pass coming back. He started chatting and was a good conversationist, drawing me out. In fact, I dumped a lot of my feelings about his profession on him. He didn't disagree but during the conversation pointed out, as they often do, the costs and other challenges involved in running this business.

I can sympathise but the reality is they have got themselves into a business that simply can't make money. There is far too much competition. In most of the world of business competition means lower prices but not in Cambodia. The way they figure it is that because they can't get so much business they have to charge more to get the same income. Elsewhere they would go out of business but somehow they hang in there and it is simply a crazy situation. If other travellers feel the same as me they are actually having a negative impact on tourism. I don't recommend anyone visit Phnom Penh unless they are prepared to put up with constant harassment from these guys. Come to Cambodia by all means but go elsewhere.

I want to end this on a positive note. I love Cambodia. The Cambodian people are the friendliest I've met anywhere. They are so generous with their smiles it is a delight to be among them. Please come to Cambodia and enjoy your stay anywhere outside of Phnom Penh.

Labels: Asia, Cambodia, dentist, Phnom Penh, tolerance, travel

To put these present tooth issues in perspective I'd like to go back to the beginning.

I had teeth that were giving me lots of twinges, thermal aches and such. This dentist in Mahasarakham was recommended. He removed a couple of old fillings and replaced them and told me to come back in three months. Up to that point everything was fine.

Apparently most Thais don't come back for follow up if they feel fine. He was surprised to see me back. The teeth were not bothering me, at least way less than before. In retrospect, I think he saw this as an opportunity to 'make business'. He told me that the second tooth had a crack and that I should get the root canal treatment and a crown or I would end up with continued troubles. He's the expert, I thought, I took his advice.

After all the troubles (see earlier blogs) I got a second opinion from a dentist who said that my continued pain was coming from the tooth next to the one that had been treated. She suggested I not go back to the first dentist but return to the specialist in Khon Kaen.

I did. She checked it all out and I put my case that I wanted either her or her husband to put the crown on the tooth and also to do the root-canal treatment on the next tooth. She called her husband to take a look, for a second opinion. He was reluctant that they should do this for 'ethical' reasons, ie I had been referred to them by the dentist in Mahasarakham and it was unethical for them to take his patient from him. I've encountered this before in Australian medical practice. The ethics towards colleagues are higher than the ethics to the patient.

I explained that I'd been upfront with the dentist in Mahasarakham and told him I was going to get it finished in Khon Kaen and that he should call him and get his OK before he went ahead.

He spent ten minutes on the phone and came back in to say they had agreed that I should return to Mahasarakham to finish the treatment.

During this discussion I mentioned something about them having treated the second tooth and I was corrected. No they had treated the first one. It took me a little while to wake up. It seems that somehow they'd got the wrong tooth. I didn't think of it while I was there or I would have asked to see the original referral document (if they still had it). Did he tell them the wrong tooth? Did they get the wrong tooth? Or am I still confused?

But one thing they all seem to agree on is that the second tooth is the one with the crack and that is the one from which I am getting pain at times (thankfully not now).

Someone recommended another dentist in Mahasarakham. I caught a sorngtheau into town one night to pay her a visit but I backed out. I found the clinic but I changed my mind. Somehow all of this has undermined my faith in dentists. The temporary crown is still in place. The tooth is not bothering me. For the moment I have decided to leave well enough alone.

About a week later I was riding my bicycle home from the night market. My phone rang. I stopped and took the call. It was the wife of the dentist in Mahasarakham. She told me my crown was ready could I come in and have it fitted. I said that I didn't want to do that. 'OK. Thank you,' she said. And that was it.

Labels: Asia, dentist, pain

This follows on from my previous dental report.

I needed to go back a few times for the dentist to make and fit the crown. The next time I returned he said he would give me an injection. I said OK. I wasn't concerned if I had an injection or not. I had decided that I would use some relaxation techniques and control the pain on my own.

He jabbed me several times but I wasn't aware of any numbness. He didn't seem to take too long before he started working on my tooth, preparing for the crown. There was some pain as he worked but I did not complain. I used my own techniques to keep it under control. He took a cast to prepare the crown and then put on another temporary crown.

On the way home I could feel a little pain and I was aware that there was no wearing off of the numb feeling. There was no numb feeling! Had he put any anaesthetic in that injection or was it a placebo?

By the following morning the pain was quite intense. It lasted for about a week. I wasn't sure what to do. I didn't want to go back to that dentist, not if he believed my pain was psychosomatic. If that was the case, he'd discounted the possibility that there could be some dental reason for the pain.

I decided I needed a second opinion but I had a complication in that my throat was also sore. A friend had H1N1 swine flu and was in hospital. (Perhaps an overreaction.) On Friday we were chatting online and he said that his symptoms were just a sore throat and a temperature. We've had a lot of hot, humid weather lately and it feels like you have a temperature whenever you are out in it. I decided I needed to be sure. On Saturday I went into town to do my shopping and I bought a thermometer. When I came back I checked and it was exactly normal.

I went to see the doctor on Monday and he said he thought the throat problem was caused by the tooth. He recommend I see a dentist who comes to the university clinic on Tuesdays. She was able to demonstrate quite convincingly that the pain was coming from the tooth next to the one that had been treated. She tapped the treated tooth, I felt nothing. She tapped the next tooth—intense pain. She shot a burst of air at the treated tooth—nothing, the next one—intense pain. She squirted cold water on the treated tooth—nothing, the next one—intense pain. It was pretty convincing.

So, how incompetent is my dentist? Has he been treating the wrong tooth all along? I have no way of knowing but I'll give him the benefit of the doubt. What I'm sure of is that he certainly wasn't able to diagnose the real source of my pain this time. The clinic dentist advised that I go back to the root-canal specialist in Khon Kaen and get all the work done by her and that's what I'm doing. The pain has since subsided I might add.

I wasn't able to get into my usual Sunday morning appointment this weekend as the dentist is going to Bangkok. I took a Saturday afternoon slot. But I didn't make it. This morning when I took a sorngtheau to the bus stop there was a bus there when I arrived. But they wouldn't let me on. It was already overcrowded and there seemed to be a quite a few students waiting already for the next one. I joined them. When it arrived about half an hour later it was seriously overcrowded already and there were about 20 or 30 students who were attempting to get on too. I decided to give it a miss. I rang the dentist and booked my usual 10 am Sunday slot next weekend.

Labels: Asia, dentist, pain, thailand

When I was a kid if I needed dental treatment my mother took me to the dental hospital at South Brisbane. Some of my friends went to private dentists. But my family could not afford that. At the hospital you did not get to choose your dentist. Some were good with kids. Some should have been banned from working with kids. I remember when water drills came in. They were so much easier to handle than the old mechanical ones we used to be subjected to. I also remember one cranky old dentist threatening that he would use the mechanical drill if I couldn't keep my mouth open wider. As a kid all of my fillings were done without an injection.

At the age of 18 I went to live in Sydney. When I needed dental treatment I discovered Dr C. He was wonderful. I know it is not common to hear people say they think their dentist is wonderful but compared to what I grew up with I found him to be a kind and gentle man. He would take time to explain what was needed and give me choices about how that was done. He seemed to be impressed that I didn't need an injection for a normal filling. I remember one time he got his nurse (he always had cute nurses) to take a look at how much drilling he'd done without an injection. I had tried injections and I decided I preferred the short-term pain of the drill that stopped as soon as he stopped drilling to the longer-term discomfort and numbness created by the injection.

When I moved away from Sydney I tried other dentists. None of them came up to Dr C. One refused to accept my decision to not have an injection and immediately injected me without waiting for me to disagree. I never returned to him. Nor did I return to others I tried for one reason or another. When I was living in Brisbane I had to go to an annual conference in the Sydney area. I would usually arrange to go a week early so I could visit Dr C for a check up and any work needed. Eventually he said I didn't need to keep coming as at the stage I had reached my teeth should stay good for some time.

When I decided to retire and move to Asia over six years ago, I had one or two little problems with my teeth. I decided to visit Dr C and get them fixed before I did. I didn't know if he'd still be practising but he was. By this time he was about 70 years old. I expressed surprise that he was still practising. He said he had fewer patients these days and it suited him. He'd slowed down rather than retiring. 'And what would I do if I retired?' he asked. I could think of a thousand things but obviously he is happy with dentistry.

He refilled one tooth for me and recommended I get a crown on another. I had a choice of a post and crown or just a crown. He said the post should be better but there were no guarantees. As it turned out I did not have time for the post before my flight to Asia so I settled for the crown.

It didn't last. It fell victim to some sticky rice in Thailand. I didn't do anything about it at the time. I was still able to chew and I found I had less trouble with food becoming trapped. Some time later, when I was living in Cambodia a filling came out. This one was causing some problems so I decided to have it fixed. You can read the story here.

I got the same dentist to replace the missing crown too. I was wary at the time about getting such work done in Cambodia but that was September '06 and I'm happy to say that it is still there and in that time it has been responsible for assisting in the chewing of many kilos of sticky rice.

Having had such success in Cambodia I was not concerned about finding a good dentist in Mahasarakham. The dentist I was referred to was recommended by several people. His practice is clean and appears to be professional. I assume you've already read my previous two posts. Now I'll carry on from where I left off.

Since the first root-canal treatment the tooth stopped hurting and has given me very little trouble. Last Sunday I made my final visit to the lady dentist in Khon Kaen. (Lots of Khon Kaen pics now on my flickr page.) She gave me the final treatment which lasted about an hour and was done without an injection. But I still had to return to my dentist in Mahasarakham to get the crown added. I got someone to ring and make an appointment for me. It can be a little frustrating communicating via someone else who may not understand fully what you want. I usually make an appointment for 6 pm and don't often wait too long. She made the appointment for 5 pm. I made it there by 5.20 knowing that there was no way I'd go in straight off at 5. I waited until 6.40 before I finally got into the dentist chair. I thought they'd forgotten me. Before I left to head into town I noticed that if I bit down on the problem tooth there was a slight twinge there. I tested this a few times on my way to the dentist and sometimes it twinged and sometimes it didn't. I mentioned this to him when I got into the chair. He just said 'Hmmm.' After he removed the temporary crown he stuck his drill into my mouth. I guess he was polishing the tooth but whatever he was doing it was quite painful. 'Relax. Relax.' he said. 'I can't,' I answered. 'It's hurting.' He said it shouldn't be hurting as there was no nerve left in the tooth. I understood that but I know pain when I feel it. And it was painful. So, he put another temporary crown on it and told me to come back in two weeks. I'm not impressed. I wanted to be over it. I've had enough of this. I want to be able to eat whatever I feel like instead of having to eat omelettes and curries all the time. I want to eat sticky rice again. But it seems I have to wait another two weeks—at least. It has been sore to bite on since then but today, not quite so bad. Let's hope it gets better this time.

Labels: Asia, dentist, health, Mahasarakham, pain, Phnom Penh, thailand, tolerance