Helping amputees and phantom limb pain


Treating phantom limb pain with free mirrors and mirror therapy ...globally.

The Importance of Being Frank

on Feb 21, 2014

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In all earnestness, I think being Frank is serving me well. I’m not beating about the bush with these people and I believe they appreciate it. Lots of times I’ll put my hand on a super-mutilated guy and just say, ‘I can’t help you man. You’re fucked.’ They usually give me a shy smile and a nod of resignation. And, of course, people of all stripes are likely to be more honest right back at you. Reciprocity.
I gave a workshop a couple nites ago at Battambang’s nicest café, The Café Kinyei (also called the 1 ½ St. Café).
They do all kinds of good things for the Khmer community here and are involved with many of the more valid NGOs. The room was mostly expats, a couple doctors and therapists, a few Khmers who mostly spoke English well, and Untac (!!!), my translator for the evening. It’s relatively rare for me to have such a gathering of educated English –as-a-first –language people, and so nice to be able to get a little more technical and maybe a little more expansive. Well, I kinda blew it. I mean, let’s be frank; I’m a bit of a chatterbox and boy can I digress. I was apologizing afterwards to my new friend Andrew who’s a Brit and a doctor for the Brangelina people, MJP (the Maddox Jolie Pitt Foundation).
He laughed and said, ‘No, no, it was OK. It was good; it IS clear though, that you, um, CARE about what you’re doing.’ He went on to say that he’d recently told his boss about me riding around on this goofy bicycle with a giant load of mirrors on the back, and the boss the asked him, frankly, ‘Is the guy a nutjob?’.
But I’m getting through. Getting through to the clinics, the NGOs, the community and, of course, the amputees themselves. I’m being aided enormously by the fact that public interest has really swung to neurology or even, in more layman’s terms, the mysteries of the brain. Even in the small room at KINYEI there were at least two or three people who had read and been fascinated by Norman Doidge’s “The Brain That Changes Itself”. That would be highly unlikely even a couple of years ago. That book was a huge bestseller and did a solid pull on the NYT list. So people have heard of Ramachandran; they’ve heard of Oliver Sacks (whose books have also sold extremely well), and consequently I have a lot less trouble explaining myself and an easier go of it getting credibility. Here, for example, is an article written by Michelle Fitzpatrick for AFP, one of the biggest news agencies in the world :
In an email thread between Michelle and Dr Eric Altschuler, who is another Big Gun in neurology and who was clearly pleased, said, ”That article will be seen by 10,000 more people than ‘Nature’ ‘Lancet and ‘Brain’ (all academic periodicals) put together.” And he’s right, and I have to be happy with that.
Two great complimentary articles have come out in the last few days. They’re in French, though, so put on your thinking caps : – Un miroir pour oublier les douleurs fantômes – Un miroir pour soulager les amputés atteints de douleurs fantômes

I rode up into Thailand just the other day to renew my Cambodian visa. It was about 110 kilometers all in and pretty tough riding as it gets hilly up there. It gets pretty pretty too though. The border town is called Prum on the Thai side and Prom on the Cambodian side. Fair enough. It’s about 20k NW of Pailin, the last holdout of the dreaded Khmer Rouge. By the looks of it, Pailin is still filled with sympathizers so I elected to focus on the landscape which rears up and gets real beautiful as you approach Pailin and then again as you wind up to Prom. It’s cassava country. Cassava, cassava, cassava. The harvest is on and it beggars description to say how much of the shit is lying around and how much damn work it takes to get it into some kind of final product. Cassava is a slender tree maybe averaging between 2 and 3 meters tall, but, as most people know, the primary use is for the root itself which undergoes dozens of transmogrifications to finally become, become, become what? Flour, I suppose, and, erm, tapioca?
All this hard work and industry for tapioca? There’s a market out there? I mean, when was the last time YOU tied in to a really satisfying bowl of tapioca? In South Africa I know they make beer from it, which captures my interest a little more than pudding. The tree is kind of embarrassing looking. A nerd tree. It has a goofy tuft of leaves on top and the skinny trunk is covered with Adam’s Apples; like a Dr. Suess tree. They chop the tree off about 6 inches above the ground and so the first thing you see are stooks of the trees themselves teepeeing away right to the horizon. Then they whack the leaves off (I believe animal fodder – nothing, NOTHING, is wasted in Cambodia), then they buck the tree into lengths for both paper manufacture and to re-plant (again, I THINK, I’m no agri-guy ). By and by they get to the roots themselves and – all this is done with a machete, so do not, under any circumstances, get on the wrong side of Cambodian with a machete, they are very handy with them – and, oh ya, they chop the root into big chips about the size of the biggest french fry you’ve ever seen (and a lot less tasty)… then they lay it all out in the sun to dry. Then it goes thru 700 hundred more laborious steps before you get your pudding.
Massive groves of mango trees too, a much more noble tree, and paddy rice everywhere. Much like the crazy pink of lotus flowers, your paddy rice, when it’s at its greenest is a green so green it shouldn’t be found in nature. Then you hit the border town and it’s Triple Butt Fugly. Coyote Ugly like so many border towns. Gambling is illegal in Thailand, so there are Casinos blemishing all the crossings into Cambodia and they are filled with low-end Thai punters. Frankly, I’d rather light the money on fire, so I stepped in to check it out in all its grimness and stepped out and down the street to a quaint outdoor restaurant where I had the best Tom Yam soup of my entire life. I rode back South as far away from the casinos as possible and found a great little bungalow guesthouse for 5 bucks. I was woken early by shrill super-loud electronic beeping and was up and standing there buck-naked on just the one foot, with a cup of Nescafe in my hand before I realized that the beeping was not the alarm on my Nokia but a big Gecko-like lizard on the wall. It was 4 am.
Coming back was pretty and all, but I was flat as yesterday’s beer. What the French call ‘un jour sans’. Just couldn’t get the pedals going around and uncomfortable, weak, hot, crabby and sore. I’m glad I rode through it, but man, I was looking over my shoulder for a nice ol’ cassava truck and a ride back to Battambang. By the time I was 30ks out and passing the base of Alligator Mountain (so-called because it looks like a big old alligator just laying down for a snooze), copping a ride seemed pointless so I stopped at a drink stall – a pool of shade in the heat shimmer – and had an iced drink and resolved to ride through this candy-ass event. I had been riding through little hamlets and occasionally hearing an absolutely Deafening roar emanating from the roadside forests and sloughs. I frankly couldn’t tell if it was crickets, cicadas or frogs, some other thang , or all three together. Sitting over my drink in the stall I looked out over a field of cricket traps, a veritable cricket ranch. The farmers erect a vertical sheet of poly framed by sticks or bamboo maybe 3 or 4 feet square on average and then place any old kind of container full of water beneath it. So at night, when the crickets stop just laying around scratching their legs and making an infernal noise and actually bust a move in addition to making an infernal noise, well they smack the plastic, fall in the tub full of water and, voila! Lunch. Thinking on how ingenious this is, I had a sip of icewater and looked up to see the proprietress’s young daughter brochetting fried frogs on little sticks. 4 or 5 to the stick, depending on how fat the little froggies are. So I guess the noise was a symphony of both. I hate to dwell on the bug thing and all, I mean, I’m cool with the odd bugsnack, but I didn’t know that bugs would be, like, a primary dietary constituent. My new Khmer friend Henry says cricket ranchers get 10 bucks a kilo for AA large crickets. Pure protein, so it makes sense. The other thing I suspect is that it’s a habit formed during tougher times when many Cambodians were starving to death in the border camps in Thailand or reduced to foraging in the woods like goddamned animals because of the Khmer Rouge or the many years of civil war that followed the KR chiefs’ expulsion to golf clubs and pinochle games in Pailin and paid security and pimp penthouses in Phnom Penh… Sally sells seashells too .
Let’s get clinical. I’ve seen the Emergency Hospital, TPO (Transcultural Psychosocial Org – now there’s a handle for you) the Trauma Foundation, The Khmer Community Development Society and the Catholics. A number of them are working in the Samlot area and in the coming days I will organize a veritable mirror therapy jamboree up there; workshops or sessions galore, with everyone in attendance who can rustle me up some amps. Blair says it’s gonna end up a tug o’ war with various foundations yanking the amps by their various stumps in various directions. ‘Let go of my gimp!’ But, of course, the more the merrier. The Brangelina peeps are active up there too. They are going to get started holding traffic safety classes at the local schools. A great idea and maybe I can help scare the students into looking both ways and not playing ‘Angry Birds’ while blasting around on a step-through with 3 family members and a brace of live chickens and a step-ladder onboard. Say what you want about Angelina nipping around and nicking unsuspecting kids and holding them hostage in the Hollywood Hills, but her foundation is definitely doing real demonstrable good here. They have a small bunch of expat doctors and therapists here, an office in Battambang, a clinic, I believe, in Samlot, and are also invested in sanitation, water quality and other meritorious projects. Kudos. Mind you, she probably doesn’t get out of bed for less than 15 mil per film, so this is small beer. And people donate to MJP just cuz she has unbelievable lips.
I’ve had a great breakthrough with another great outfit : The Cambodian War Amputees Rehabilitation Society.
Again, it was at least partly thanks to the neurologic zeitgeist that’s happening now. I met one of their (maybe their only) expats at a bar and he said, ‘Oh, so you’re the mirror guy’. That’s happening a lot now – which is a good thing, I mean I don’t believe it’s EVER said with rancor or scorn. John too has read ‘The Brain That Changes Itself’ and so was naturally credulous of what I was up too and willing to promote me to his colleagues. CWARS, too, are the real deal and they are fast and effective and flexible – all of the qualities that I’m trying to achieve too. Their principle thrust is in getting amp vets back in the work world by training them in one of a number of vocations. At their compound here in BTB they have trainers and dormitories where amps from the villages can stay and learn to earn an honest buck. A tough row to hoe in an agrarian country that’s dirt poor.
I’m working with Henry, their talented project manager, and Ceo (sounds like), his assistant, and a driver. I’ve left the bike behind, cuz if I roll with these guys, in the back of a car or on the back of a moto with a quiver of mirrors across my hip, well we can get a lot more done. These guys know the area like the backs of their hands and we are going to places I would NEVER find in a million years. It’s not far off the main road and never more than (so far), say, 20k SE from Battambang. Believe me, you don’t gotta go far to find an amp in this province. I told Henry (who speaks Perfect Idiomatic English) that I intended to get up into Bantay Meanchey and Prea Vihear and all the way over to Lao, and he just looked at me incredulously and said, “Why on Earth would you do that when we have well over 10,000 disabled here in Battambang province alone?” Shit. It’s not like I got either 10,000 mirrors or 10,000 man-hours to give to this beautiful tragic place. I believe him, though. We met a real card in a straw fedora with a snazzy shirt and a fresh pair of sneaks who was the village leader of a small commune of villagettes. He’s an AK way up high and rolls on crutches, like a lot of them do, cuz with a short stump it’s just too hard and too painful to use a prosthetic. He told me, “I have 21 amputees in my commune alone, 22 including myself”. Ceo and Henry and I treated a small handful of them that day and promised to come at 8 sharp the following morning to pick up a list of the other guys (all, or mostly all, blasted soldiers who fought the KR). The next day he gave us the list and then, on second thought, snatched it back in order to cross off a bunch of guys who’re already dead. Sombre stuff. In the last 2 days we’ve treated 12 or 13 guys and half of them said they had seriously considered suicide in the first handful of years. Years, not Months, and that’s what Phantom Pain will do to you; I only wish I could have got to Them, could have gotten to myself, a whole lot earlier.
3 guys had their wives and families leave them too, inside of the first few months. That sounds pretty hard-ass, but I get it. In a country THAT poor (especially between ’83 and ‘93, when all these guys were whacked), if you can’t somehow help put something on the table, or if you’re a financial burden on the family or the community, it’s hasta luego, sucker. It’s the Law of the Jungle here, man; raw survival is not a very sentimental enterprise. Me, I get sentimental; my skin’s maybe a bit too thin for this action. I try to be tough but don’t think I’m too convincing. I felt a little maxed-out and said to dear Ceo, “Can we call it a day here? I don’t feel so good.” He just looked at me, Earnestly, and said, “Muoee thiet?” Namely, “One more?” What can you say?
Fortunately, these guys are, by degrees, all flourishing or at least making it through and though you often see sadness roll across their eyes like morning fog, they’re a happy enough bunch. CWARS has given them a skill, a vocation, and they can make a go of it. I got to two barbers, a bean farmer and a brick maker, courtesy of CWARS’s training. Now, I know that all or most of them will shortly be able to live without phantom pain and at least have one less thing dragging ‘em down.
When it all starts to drag me down I jump on my bike and beat it to Blair’s farm. I Bunburry. Do you remember, in Oscar Wilde’s ‘Importance of Being Earnest’, that when one of the perps needed to get out of London, he always resorted to his dear invalid friend, ‘Bunbury’, who lived in the country. So I ‘Bunbury’ to Blair’s. Sometimes, if you can’t be Frank, you have to Bunbury. The ride’s only like 25ks and it’s lovely every inch of the way. Go SW along the river and you’ll get there soon enough. I was there last Saturday overnite and spent all day in a hammock reading smutty poems by Voltaire while occasionally letting a languid hand drop down to scratch behind a doggie’s ears. Another nite sleeping in a stilted house and woken – early – by the insane cacophony of Cambodian country daybreak.
While it’s on my mind, I need to send out a Giant Shout to my new good friend Mr. Blair Armstrong, (from Canmore, Alberta). He’s been super-helpful, patient and generous with his time and energy in helping me get relief to people. And while I’m at it, the oft-mentioned Wild Billy Irwin deserves bottomless thanks for the same sort of qualities and assistance. Blair and Bill are both good friends and both old SE Asia hands and, between the two of them, what they don’t know about Cambodia and Cambodians ain’t worth knowin’. Thanks guys.
I’m looking at another bunch of mirror material leaning against the wall, but, frankly, I’m going to put it off for a spell. It’s kind of tedious work. I don’t mind it much though, I kinda boogie through it. I put my i-Thing on and slap-dash to da beat.
The tuktuk drivers often wear t-shirts that say ‘Same, Same’ on the front and ‘But Different’ on the back. I really like that blurb; it strikes me as a profound philosophical statement. Making mirrors (as well as treating with them) is always same,same but different and so is going down to Suvette’s drink stall for a sunset beer. It’s almost 5 pm now and golden hour is coming on. Suvette will be sailing through her chores with both the Buddha’s detachment and his smile and I have learned to count to 5 by listening to the Jazzercise across the river: ‘mouie, bee, bai, boon, bram’, or something like that. It’s got a nice euphony to it. With a nod to impenetrable, if not irrefutable French logic, the Khmer for six is, I think, ‘bram muoee’ or ‘5 plus 1’. In the way that in French, just for example, ‘97’ is : ‘4 twenties plus 10 then 7’. Doesn’t matter to me; I rarely get beyond, say, 20, which is how many mirrors I can make in a nite and a morning and how many people I can see in 2 days w/out wanting to throw myself in the river which anyway is getting too low to produce the desired effect before you no longer desire the effect at all. Ooops, it was just an affectation. It all comes around. Same same, but different.
Down to Suvette’s the same ol’ bums try to shake you down, the same old played-out she-dogs troll by with spent and pendant dugs hanging to the ground like hockey pucks. The same mommies try to bump start their step-throughs with tiny children trying to hang tight on to their pregnant bellies, and double amp crips roll up to you with fat roaches (the marijuana kind, not the kind some peeps eat) couched in their drive-hands petulantly lookin’ for a hand-out. I go soft for the gimps but, allthesame, give once and only once.
It’s all same same, but different and, to be frank, that works for me. Same same but different is pretty much just enough.

PS : It’s nice to close on a humorous note. The following is a posting from ‘Battambang Connect’ a GOOGLE-driven social networking site:
Dearest Friends,
I regretfully must announce the loss of my favourite hen. Last seen
close to the Provincial Hospital of Battambang.
She is quite large, western style chicken, light brown in colour and
missing a few feathers on her breast. Answers to the name of Cluck Norris. Can be enticed with corn, bread
and chicken scraps, cries of “Chickidy Chuck” may also get her
A small reward is offered for her safe return, as she is more than
just a pet, but a friend and potential meal should the hard times hit.
Thanks in advance,