To the doctor's

I went to see a doctor yesterday for some, shall we say, female problems. I am saying this up front for the sake of queasy male readers who may wish to stop reading. But I am going to write about it because women readers may find it useful.

The clinic I visited here in Siem Reap was recommended to me by an English woman friend. It is called Ly Srey Vina 2 and is located on National Road number #6, just before the junction that turns into Salina Hotel. The clinic is an associate of Singapore's Raffles Hospital.

I was very lucky to have been able to see Dr Ly (pronounced Lee) herself since she is usually in Phnom Penh. Initially, I was asked to wait 15 mins for a male doctor, but Dr Chubby didn't exactly inspire confidence and looked kind of pompous, the kind of doctor who expects nothing less than deference from his patients. No doubt I am just finicky since there were Khmer women there who saw Dr Chubbs. Because I am a troublesome "jon jiat" (literally "nationality" but is another Khmer term for "foreigner") I asked for a female doctor, and the receptionist called Dr Ly who came over in 15mins.

Dr Ly was extremely friendly and greeted everyone the moment she stepped into her clinic, unlike the other doctor who did not even glance at us patients. Dr Ly was very nice and patient and spent so much time with me. Alan, who accompanied me to the clinic, remarked how we would never get so much time with a doctor back in Singapore. Ten minutes, tops. Or you pay through the nose.

At 37, I am apparently at the age where "hormones are strong" (I think she means out of whack?), and Dr Ly suggested I do a full body check up, including blood, urine and stool tests to assess my problem. It was USD62 which I found very reasonable. I did the Essentially Hers package when I was in Singapore in April this year and it cost me about SGD220 (USD152). The package included a pap smear but not an ultrasound because, the doctor explained, government polyclinics do not have the ultrasound machine, which I found shameful in wealthy Singapore.

So I did an ultrasound here in Cambodia, which cost only USD15. The machine is a Honda (they make everything!) and looked ancient (it had that yellowish plastic shell you see in very old 486 PCs). But it worked which was all I cared about.

Another doctor operating the ultrasound machine (they call it an "echo" here in Cambodia) put some gel on my stomach and moved the probe around my stomach. Lo and behold they see something. It is a fibroid in my uterus. I was not surprised because the women in my family have the same problem.

According to the US Department of Health and Human Services, "about 20 percent to 80 percent (what a strange statistic - do they mean "up to 80 percent"?) of women develop fibroids by the time they reach age 50". It seems fewer than 50 percent of women who have fibroids develop symptoms, so many don't even know they have it. I have a very minor symptom but a symptom nonetheless which is why I took action.

(I guess the male equivalent would be the enlarged prostate, where there is a 50 percent prevalence after 50. "By the time you get to men in their 80s, nearly 80 percent or more have some degree of BPH (benign prostatic hyperplasia)", CNN reports. Like the fibroid, you only do something about BPH if it causes you problems.)

One problem is fertility. Dr Ly said with the fibroid it will be difficult to conceive, although I read this pamphlet (PDF) which says it is rare for fibroids to inhibit pregnancy. Dr Ly was amused at my happy exclamation, "Really?", upon hearing this. "Why you don't want children?" she asked. "You still can."

It's not something I think about, I said. I'm not alone. In my country, I told her, the government has resorted to offering us cash to have kids. It was recently reported the Baby Bonus programme hasn't worked despite a record SGD230 million (USD159.6 million) given out last year, up from USD55 million just five years earlier.

Dr Ly who was last in Singapore in August 2008 to attend a medical conference told me she knows about the country's low birth rate. Dr Ly has five (!) children herself and told me although kids can be a handful at times, they make her " see the world in pink colour". I guess the English version would be looking at the world with rose-tinted glasses. Dr Ly spoke to me in perfect English so I had to ask Thyda afterwards what the Khmer expression is. She said Khmers say when you have children, "jivert sroh tlah" ("everything in life is fresh, beautiful").

Chhun Hy tells me Khmers like children because there will be people to pray for you and celebrate festivals like Pchum Ben (the festival to honour the dead). By the same token, they feel sorry for people who have no kids because no one will be there to pray for and honour you when you are dead.

I am sure it will change though. I am sure as the country develops and women have financial independence and higher education, they will have fewer children. (Of course just because you are educated and well-off doesn't mean you won't want kids. Dr Ly is a perfect example. What I mean is that these things give you options.) Already some of my Khmer women friends are saying they don't want any. This is the story with my family: grandma 11 kids; mom 3; me and younger sister, zero--each. Haha. (My parents do have one grandchild - my Greek sister-in-law gave birth to a supercute baby girl).

Anyway, Dr Lyna called in the very evening of my tests to give me the results. So efficient! It takes two working days in Singapore. I am in the pink of health! Except for the fibroid of course.

Dr Ly suggested I go back to Singapore at my earliest convenience to get the fibroid removed. The male doctor who ran the ultrasound mentioned a hysterectomy which I thought was a bit severe. Dr Ly says full hysterectomy is easy and can be performed in Cambodia. Partial hysterectomy, which she thinks is more appropriate for my case, is more difficult and not many doctors in Cambodia are skilled in this, so she suggested I go home to Singapore. I guess because I indicated I did not want kids, a hysterectomy was proposed.

Because my fibroid is only 30mm or 3cm, I was thinking keyhole surgery could be the answer.

But then I get an email from an American friend, a registered nurse with decades of experience and who herself had a fibroid. She told me hormones can sometimes shrink the fibroid. Since I am still in my reproductive years, I could also consider a D & C or a Dilation and Curettage, to remove just the fibroid.

I am going to do a bit more research since there is no urgency. My concern now is insurance. I am covered for accidents and "critical illnesses" and I'm guessing my fibroid is neither.

In that case, I will check out hospitals in Malaysia's Penang or Thailand's Bangkok, places that are trying to promote medical tourism.