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Rather than present the usual FAQs, this is a compilation of email Q and A's with colleagues in the health field.


Hal Kussick, DDS: "How much money will it take to get the clinic to be operational?"


**We have to talk in terms of “Phases”. Phase One can be accomplished with the purchase of a fast, shallow draft boat that would provide the means to bring volunteers to outlying villages without having most of the day spent getting there. Traditional “long-tail” boats may require a four hour trip just to go one way. With a different boat we can bring that trip to under an hour and thus maximize the time actually spent providing care. The cost of that kind of boat, second hand is about $10,000.00.


**Phase Two would see a houseboat, or houseboats that would provide specialized care. Each houseboat dedicated specifically say to dentistry or ophthalmology or to pediatrics and such. This would allow us to have staff/volunteers stay on board for several days at a time and remain in one location for a period of days. Presently friends in Australia are looking into the possibility of having such a houseboat donated to TLC. At the same time we are looking into the possibility of constructing locally along more traditional lines.


**Phase Three, of course, is the clinic ship that will serve as a poly-clinic; being able to provide treatment and education in a variety of specialties. This is a big project. The ship itself will cost over $500,000.00 and almost a full year to construct.


**Note, the present overhead of the TLC office and its minimal staff is $1,500.00per month.


Hal: "How often will the clinic be treating people, and for how much of the year?"


**The demand for service is constant. Ultimately, with Phase Three we will be able to maintain an accessible presence Monday through Friday.


Hal: "How big an area, with how many people will it be able to cover?"


**The Tonle Sap covers approximately 2,500 hectares (6,200 acres) at the waters’ lowest point. It actually quadruples in size during the rainy season. There are about 1.1 million people living on its shores with 60 floating villages on the lake itself.


Hal: "Why bring dentists instead of a boat full for physicians?"


**Dentistry holds a unique place in medicine as the basic concepts and principles are easily explained and understood by uneducated people. They know that they have pain. They go to the dentist and pain is taken away. There is a sense of immediacy about this; something that other medical fields do not have. For people who have never had contact with modern health care, Dentistry is an access point.


**Until will have the clinic ship, our ability to provide medical care will be restricted to those conditions that can be diagnosed and treated with a single visit. This isn’t optimum, but it will be the best that we can do without the possibility of follow-up.


Hal: "Why are teeth in Cambodia in such bad condition?"


**Ignorance and poverty. There is a general lack of awareness and access to preventative dentistry such that many children have never seen a toothbrush, never mind how to use one correctly. There is also a lack of knowledge of the direct link between general diet and tooth decay


Hal: "Will there be a medical doctor on board?"


**When possible yes, either a pediatrician or a general practitioner will be along. By “possible”, I mean as volunteers. The Clinic Ship is being conceived now as a nursing-centric project that will provide care comparable (and better) than what is found at the government health centers where nurses provide all the care, including diagnosis and treatment. These nurses can prescribe medication. An equally important component of their job will be in the identification of medical conditions that do require a physician and to make referrals to an appropriate hospital or land-based clinic.


Hal: "What if you encounter a person with a true medical emergency?"


**We would medically stabilize that person to the best of our abilities, and then provide transportation back to town and an appropriate health center.


Hal: "What will the public health mission of the clinic include?"


**Education, education, education. Early diagnosis of chronic and or severe illnesses. Immunization, and of course oral health.


Hal: "How will you continue to finance operations one the clinic is afloat?"


**A review of the clinic ship’s plans will show that we have included four “staterooms” that can be rented out to eco- and adventure tourists. They are also available to paying volunteers as well as researchers from other NGOs or academic institutions. The income from these rooms will go towards the physical maintenance of the ship.


**As the average daily income in our target area is roughly $0.40, the idea that the populace being served will somehow pay for their care is not very realistic. As TLC-Cambodia grows and matures we envision ourselves becoming more adept and sophisticated at fundraising and grant writing. In the end, TLC, like so many charitable organizations will have to rely on the generosity of others to help.


Caroline Dueger, MD, FAAP, MPH, DTM&H: "How will you integrate or coexist with government clinics, which we were once told float up and down the river with the seasons. Do they still exist? I'm sure there is no dental care but do they object to you giving immunizations? Maybe vitamin A and zinc would be useful and you could do Hbs screening, and give iron if needed."


**The plan now is that TLC will be serving a given area from Monday morning until Friday afternoon, and during that period a staff person from the Health Center that is supposed to be providing coverage will be aboard--providing the immunizations; updating the famous “yellow card”; and just being a member of the staff for that time period. Of course that person will receive a per-diem for their involvement. There is only one “floating health center” and it is permanently based at the Port of Siem Reap. For many of the floating villages, the nearest Health Center is 40-50km away by both boat and motorcycle. Involving a staff member from THAT Health Center will keep the Ministry of Health involved as a partner.


Caroline: "Will you have medications? Keep records? Do you plan to have regular staff with you most of the time (dental hygienist? maternal/child nurse? MD?)? Eventually you will probably have a motorized dinghy to use as an ambulance!"


**That’s a lot of questions! I am confident that the Ministry of Health will supply TLC with “essential drugs”; the same drugs that are available at any government health center I want the basic drugs that can be administered by IMCI trained nurses, as that level of nurse will be permanent members of the clinic staff.


**Records will be both paper and on computer. The Ministry of Health has been trying to create a basic DB for their hospitals and if that does get developed then that will be used.


**Staff, as opposed to crew, will be comprised of three dental nurses, 2 IMCI trained nurses, and a “clerk”. Everyone will have to multi-task as much as possible; meaning even the volunteer dentist will have to help scrub and sterilize instruments and nurses will all need to be involved in housekeeping and maintaining the clinic area. These positions will all be permanent with a “competitive salary” (they will be required to live aboard for 4 nights each week); they will be well fed--the cook is the most essential member of the crew--and hopefully feel very satisfied with the work and the adventure of it.


**Staterooms will be reserved for paying volunteers or guests, such as ornithologists, biologists, sociologists, anthropologists who want to use the Lake Clinic as a base.


**My mailing list is rather heavily loaded these days with dentists.


**The budget is actually calling for a couple of fast, Boston Whaler-type boats; shallow draft and high speed. In addition, there is an Australian project that is bringing hovercraft into the region. These boats fly--literally, and have the potential to also provide ambulance and rescue service as well.


Caroline: "Will the gardens float up and down the river with the house boats? We saw these in Myanmar and were hugely impressed but I think they were anchored."


**The gardens that Osmose and others are promoting are anchored and tied off alongside each houseboat. We will not be setting up such gardens, but encouraging the local community to take interest in, and to take part in these projects. As you know, approximately two-thirds of Cambodian children are clinically mal-nourished. Home-gardening, even on the lake, is one intervention that we know can work.


Caroline: "Are there families who live on the banks of the river (not necessarily on the boats) who are also accessible? How far will you range?"


**The Tonle Sap increases 4 times its dry season size at the height of the rainy season. There are numerous communities that live along the banks of the lake at some point in the season as the lake rises and falls. They all share the same problem of “access to health care” as the families living on the lake.


**I’m envisioning that the range will be determined not only by water levels but by Ministry of Health priorities, and want to negotiate with them perhaps 12 locations; one per week, and then repeat the cycle so that each area is visited 4 times in one year—roughly. That provides some follow-up as well as some measurement of our effectiveness. The LAKE CLINIC will be moved from one area to the next over the weekend when the clinic staff is on-shore.


Caroline: "Will you be able to operate year round?"


On the lake for 11 months. Probably the month of April--Khmer New Year--we will bring the boat down to Phnom Penh for overall maintenance. During that time the staff will have their New Year holiday, and be available for additional training either in Siem Reap or elsewhere.


Caroline: "How often do you expect to resupply in Siem Reap (and pick up/drop off the paying guests/ volunteers)?"


**Hopefully, just once a week for resupply. Each time the staff and volunteers go out to the LAKE CLINIC the needed supplies will come along with them. This is particularly feasible if I can contract with the hovercraft people.


**Paying guests will be brought out and in whenever they want--they’ll be paying for that service.


**Another scenario is that the resupply logistics could happen over the weekends.


Caroline: "Will you have telephone or radio communication?"


**The Country Manager for Cambodia’s biggest ISP, "Online", has promised to provide the LAKE CLINIC and the land based office with FREE internet access, thus internet phone access as well. He is also a… "gas engineer" and has agreed to design a "small, 2000 degree waste incinerator". This (medical waste) was actually one of my biggest headaches.


Caroline: "How soon do you expect to be operational?"


**We're planning to start operating the land-based clinic and a limited ship-board (on a small houseboat) service early in 2008. We hope to build our ship during the course of the next year, and launch it in 2009.


Caroline: "How much money do you need?????"


**It’s going to take approximately $500K to build the craft from the hull up. Another $250K per annum to operate.


Caroline: "As you know many NGOs charge volunteers and in this situation I think you will want to do that. After all it's a boat tour. We did this once on the Amazon with a group that kept medical records on patients in all the different little villages - stored them on land until they were headed to that area. Every doc who volunteered wanted to go on the boat trips."


**The idea of paying guests and paying volunteers was to create at least partial sustainability, even if it’s only to maintain and improve the boat from year to year. If the staterooms can be kept occupied, then we can even talk about paying additional overhead.


Caroline: "Times like this I wish we were richer."


**Times like this I wish I had been more motivated by earning money in my youth as well. Thus in my middle years I find that the price of service and adventure is to be forever holding your hand out.


Which leads me neatly onto the last question:


"HOW DO I GIVE MONEY TO TLC?"







SPENDEN: Helfen Sie TLC mit Ihrer Spende über Angkors Kinder e.V.*


Angkors Kinder Spendenkonto:
Sparkasse Hanauerland Kehl
BLZ: 66451862
Kontonummer: 104224
Empfänger: Angkors Kinder e.V.
Verwendungszweck: TLC



*Spenden über Angkors Kinder sind für Staatsangehörige und Ansässige der Bundesrepublik Deutschland steuerlich absetzbar. Bei Spenden bis zu 200 Euro, genügt Ihr Kontoauszug als Bescheinigung beim Finanzamt. Eine Spendenquittung sendet Ihnen Angkors Kinder e.V. ab einem Spendenbetrag von 200 Euro natürlich gerne zu. Bitte übermitteln Sie uns in diesem Fall Ihre postalische Adresse an: spenden@lakeclinic.de