I am the “same-same but different”

Phnom Penh is changing at an incalculable rate. It is evolving so quickly that even from my last visit four years ago, I barely recognize the streets I once shuffled my well-worn sandals through. Now, the streets of my old neighborhood are proudly adorned with a new facade of artistic, stylish restaurants and a collection of boutique coffee shops. Bigger buildings and prime real estate positions are now occupied by logos of branded international chains. Indeed, the very apartment from which I am writing this letter is situated between Domino’s Pizza on one corner and Starbucks on the other, both institutions newly arriving since I was last here.

Walking through the streets was once a crazy game of avoiding high-speed motos and low-speed tuk-tuks that whiz on by, but now one has to avoid the multitude of 4×4 vehicles and saloon cars bumping and grinding into each other in the already minimal gaps left between the pedestrians and motorcycles. The cars are old and dusty, but rarely one may see an outrageous display of wealth when a Bentley, Hummer or Rolls Royce honks its way through the traffic, demanding attention and right of passage.

The skyline, too, is becoming unrecognizable. Tall and taller buildings are popping up like a troop of grey and cream mushrooms in a smoggy sky, with many immature mushrooms still clad in a green tarp waiting to ripen in the sun and soon be ready for human habitation. Each day, the clunking and clattering of bare-chested builders fill the noisy air. From morning until dusk, heavy construction machinery grinds into your dreams waking you up earlier than you had hoped.

The night sky is beautiful from my rooftop, as the incessant activity of the streets below is sparked into colorful animation by flashing lights from the buildings, monuments and large digital billboards frantically advertising Cambodia’s latest products and services. The road junctions now have traffic lights, blissfully ignored by experienced Phnom Penh drivers.

But despite the changes, there is much about Phnom Penh that is the same. The early morning gongs of the temples — designed to be a traditional alarm clock for pious monks — still dominate over all other noises. The old wooden coconut carts are still pulled through the potholed streets by weary sellers, and there are still makeshift fruit markets on many corners displaying the colorful array of Southeast Asian produce that is in season currently. There are still mopeds carrying entire families — a husband, a wife with two younger children in between them and another toddler balanced expertly on the handlebars.

Beyond the changing skyline and new facade, underneath it all, it seems the lives of the people in the city have remained static since I was last here. The same tuk-tuk drivers I once knew still occupy their designated corners as four years ago, easily recognizing us upon our return to the neighborhood, waving and shrieking loudly and happy to see us. Within the restaurants are the same waiters, only four years older, working the same shift, over and over, day and night, seven days a week.

I was humbled and reminded of how privileged my life has been when one restaurant waiter, working the same monotonous shift, remembered my old apartment address, including the exact door number of my flat — a meaningless fact I had forgotten long ago, whilst I was away enjoying my recent and rich experiences all over the world.

And the hospital remains similar to when I left, the staff and patients very much the same. The poor still come to this small charitable surgical hospital, unable to afford the rising costs of surgery in the government or private hospitals, while others come having already been bankrupted by previous surgical care elsewhere. The cases remain as neglected and extremely heartbreaking as I remember.

Since I have returned, one young woman has presented with a tumor on her face so large she has gradually become blind in both eyes and now struggling to breathe. Another woman, working as a farmer for many years, now in her forties, presented with a neglected clubfoot, never seeking treatment before for her severely misshapen foot. She said she did not get married because of the deformity and is now finding life difficult. I asked why she was seeking treatment so late, “Because this surgical center is here,” she replied.

I enquired if correcting the foot would help now with her relationship prospects, “No, it’s too late for that,” she sighed, “but I want to be out of pain.”

There is a popular phrase that is said here in South East Asia: “Same-same but different.” Although there is no true definition of this catchy phrase, it is often used when describing something that may appear to be different but ultimately is the same.

When I left the surgical center in 2013, I left a cute toy monkey with my name badge pinned to its chest in the clinic room in a symbolic gesture to tell the staff I was still there with them. When I returned, I noticed that same soft toy, hanging in the same place as where I left it many years ago, now somewhat dusty and bedraggled.

After four years, Phnom Penh truly is the same-same but different. I imagine too, how much I may have changed over this period of time. Since completing my higher surgical training, maybe I have become more confident in myself, or maybe I am now more acutely aware of the vast depths of surgical knowledge I am still missing.

I have now published my most heartfelt words in a compendium of my surgical diaries for the world to read. I feel more assured of myself and at peace with all the encouragement I have received. But sometimes, I fear my writings have made me more vulnerable, more afraid of what others may think of all I outwardly express.

Perhaps, over the last four years of my life, there is now a brand-new shining facade that is papering over my old cracking skin and creaking joints. I wonder how much I have changed physically and in spirit over the last four years or if I have become dusty and bedraggled like my soft toy, forlornly displayed in the clinic. Perhaps like Phnom Penh and our impoverished patients, I too am the same-same but different.

Saqib Noor is an orthopedic surgeon who blogs at his self-titled site, Saqib Noor.  He is the author of Surgery on the Shoulders of Giants: Letters from a doctor abroad.

Image credit: Saqib Noor

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