Continued from Part One.

BATTAMBANG

The next day we took a tuk-tuk tour around Battambang. We stopped for tea ("Western tea?" asked 'James', our driver. "Local tea," I told him. It's a hobby of mine to go places and ask for caffeinated beverages such as "tea" or "coffee" without giving any further instruction just to see what I end up with. In this case it was hot, sweetened, green tea.) and went straight on to the Bamboo Railway, which (after some initial misgivings on the part of The Master) was a huge hit.

Last time we took the same tour around town by moto. When we got to the end, we took the "small train" - they hadn't yet reached a consensus on the English-language name - back to town. I remember standing beside a cow shed, watching as a few men lifted wheels and a platform onto the track, and joking that this must be the "small train" coming in to our "station". Our moto drivers agreed, but they laughed too, so it took a few minutes to realise they were actually serious. The "small train" - now known as the bamboo train - is a bamboo platform on two sets of wheels, propelled by a little motor. It runs along a single track and can be put together or dismantled in a couple of minutes. Last time, we met a groups of villagers coming in the opposite direction, piled at least a dozen of all ages on to the same platform, and the two "trains" negotiated to see who would have to be removed from the rails to let the other pass. They had more people, including elderly women and children, together with sacks of rice and other food, but we had two motorbikes, which were deemed less moveable. Everyone pitched in together, though, and their train was soon loaded back onto the track behind us. Then we bid each other farewell before puttering away. Last time, that was the only train we passed on our way back.

There are a lot of tourists and (as far as we saw) no locals using the line now, and a tourist policeman is stationed permanently at one end of the line to oversee the operations. Handicraft and drinks stalls mark both ends of the ride. The policeman shook hands and introduced himself, directed our driver to a parking spot, then gave us the run-down whilst our train was being organised. The kids got on famously with the village kids at the far end of the line, and one girl, not more than 50% bigger than the The Young Miss, took Miss onto her hip and carried her all around the village pointing out all the animals and naming them in English and Khmer. Everyone was delighted with the way Miss mimicked either language with equal "proficiency", as one-and-three-quarter-year-olds will do. They showed us their brick factory and invited our kids to climb the pile of rice husks they use to fuel it and jump up and down with them. The pile of rice husks, it turns out, is springy like a trampoline. They made us grass rings and bracelets. They found The Young Miss a dog who was "safe to pat" and made sure she didn't touch any of the others, even though she wanted to. We bought some cool drinks. It was nice.

The Bamboo train may or may not exist in the near future. There is a big project afoot to upgrade the line so it is safe enough for real trains to run across the country once more, and in the meantime, the roads seem to have taken over as the main form of transit for the locals. It's great to see progress being made for the sake of Cambodia and its people, but I hope there is still employment for those who work on the bamboo train in years to come - and fun to be had for us tourists, too. If you get the chance, you should take a ride. It was a highlight of both trips.

The rest of the tour went just as well. We saw a temple, some temple ruins, villages, a winery (that was new...) and The Young Master (much to his delight) had his first ride on a motorbike. The Young Miss did, too, strapped into the ergo, but she seemed to view it as a rather ordinary event, whereas the Master was so excited about his ride that it didn't even bother him when we visited The Killing Caves at the top of the mountain, and he spent the next two hours breathlessly telling every child under ten years old he could find that he had just ridden on a motorbike, which brought some strange looks from the local kids.

Eventually, the Miss and Master started showing signs of having had enough for the day, so we asked our driver to cut it short and take us back to town, where another quick romp back by the river brought us to dinner time. The next day, we ate a hearty breakfast, took one last stroll along the river and through the central market, then piled into a taxi - with seatbelts - and made our way to Siem Reap.

Siem Reap and Surrounds

Last time we went from Siem Reap to Battambang by boat. This service still exists, although the locals who live in fishing villages along the lake and river have started complaining about the speed, noise, frequency, and general disturbance. In any case, it's a long trip in a little dingy, especially in the dry season, and with the improved road situation, it made more sense to take the three hour trip by car. And the car was a much better price!

I was glad the second road trip was the shorter one, as everyone was starting to get a bit scratchy by this stage. Our taxi driver canvassed the local tuk tuk drivers in Siem Reap until he located our hotel, where he dropped us with (no doubt) a sigh of relief. We hit the pool, followed by the hotel restaurant, followed by our beds - all of which helped us feel better, but not better enough. The next day, therefore, we decided it was time to split the party and get out of each other's pockets. The Earl stayed at the hotel with The Young Miss, and they did a bit of swimming, some eating, and some much-needed catching up on sleep. In the afternoon, he took the Young Miss to pick up his bib for the following day's half-marathon around the ancient temples of Angkor.

Wait, did I mention the impulse for the trip originated with The Earl's new-found fascination with running?  Yes, he's into running now. He could probably sit down with Serenity and have a good old chat about it. In any case, the idea of running, at dawn, around the ancient temples of Angkor appealed greatly to him, so he decided to step up his game and do his first half-marathon. But first, he took the day off sightseeing to rest up and eat well. Meanwhile, The Young Master and I grabbed a tuk tuk and headed off to Kampung Pluk, a nearby fishing village.

Kampung Pluk

Much has been said on message boards about boat safety in Cambodia, and most of it is not favourable. But in a country with stricter safety standards, would they let a four-year-old drive the boat? Probably not - and The Young Master loved it. I asked our boat driver if it was usual for the local kids to be driving boats by four years old and he shrugged and said, "Of course." Some of the other tourists didn't seem convinced, however - one woman in particular looked aghast as her boat passed ours, going in the opposite direction. At our speed (walking), depth (waist, on the Young Master), and distance from shore (less than ten paces) I didn't feel especially threatened, however, and our driver sat nearby, offering verbal and physical course corrections as necessary. We puttered like this for quite some time, until we got to the village on the water.

And when I say "on", I don't muck around. Most of the buildings were on stilts, and some were floating. We saw the police station, doctor's clinic, town hall and temple. There was also a school, with kids outside, waist-deep, playing a game of water-soccer, whilst others came or left by canoe. There were houses and houseboats, floating piggeries, and enclosed fisheries. We stopped in the "restaurant district" and swapped into a canoe, which wound through and around the mangroves. Then we returned the way we'd come. On the way home, The Young Master asked to stop and "help" some boys who were fishing in a creek using a net. They let him hang around, but in the end I had to point out that he was half their age or less and that braving the current and trying to wind and cast the net was harder than it looked. He returned to the hotel disappointed that he hadn't been able to go fishing.

Marathon

We were hoping to watch The Earl run his half-marathon on the Sunday morning, but it was not to be. My plan was to let the kids wake up at their normal time and eat breakfast before heading out to the sidelines. However, for the first year ever, the organisers decided to close off the course to traffic, leaving our tuk tuk driver stranded where he'd dropped The Earl off by the famous Angkor Wat. We were forced to potter around the hotel grounds until he turned back up again, which didn't take long. The Earl not only finished the run (he was afraid he wouldn't be able to) but finished in the top half of the runners, making a time he was happy with.

After a swim to cool off and a spot of lunch, he and The Young Miss took a nap together again, whilst The Young Master and I went into the central market for some souvenir shopping. The Young Master found another friend at the market, and bought a gift for his classmate back home. Then we all joined up next to the river, where The Young Master found a man casting the same type of net as the boys had been using the previous day. He asked if he could have a go, and the guy showed him how to wind the rope around his thumb and gather it in his hands, but he was really too little to hold it all together, much less throw it out. In the end, he accepted that even the local kids don't start using that kind of fishing gear until they are much older, and contented himself with "helping" the man retrieve fish (or debri) from his net after he'd hauled it back in. We bought sandwiches from a street seller for dinner, and returned to our hotel to rest up for our big day at the temples.

Temples of Angkor

Oh, the temples. They are certainly an impressive site, although also a much more cultivated one these days. The first difference we noticed was at the ticket booth. Last time, we found a single booth, manned by two people, beside a dusty road. Now there is a bitumened slip road containing about a dozen booths with staff everywhere. The grass is green and tended, the icecream vans have proliferated, and the whole enterprise has become safety and conservation-conscious. This is all great news, but it didn't impress The Young Master, who immediately decided he wanted to return to the hotel. I must say, I was surprised at this - I thought the temples would have a certain "wow" factor all their own, but I guess he hasn't hit his Indiana Jones phase yet. I thought he'd like hearing the stories told in carvings, like enormous, stone, picture books, but I musn't have been telling them right. Luckily, I had a flash of brilliance and drew up a list for a scavenger hunt*, which seemed to interest him enough to keep us going until lunch time, when he finally worked out how to express what was troubling him: in a nutshell, he found the temples kind of spooky. Once we worked this out, we were able to come up with a simple compromise - he would just stay on the outside. He was happy to do this, and romped around the ruins happily like he would in any old park, whilst The Early and I took turns having a closer look, and occasionally discussing an exterior feature of interest. The Earl and I were glad we'd seen everything in reasonable depth before - it took the pressure off this visit, and we were happier to potter around in a way that suited the kids.

Both of them slept very well that night. The next day we took a swim and then packed our bags for home. Our flight didn't leave til evening, so we took a stroll around the Royal Gardens, a walk along the river, and grabbed a bite to eat before piling into a couple of tuk-tuks for the airport. The Siem Reap International Airport was our last big double-take, having been completely overhauled since its days as a dusty building with a bit of an immigration bench and a handful of moto drivers waiting around outside. (In fact, Siem Reap seems to have relatively few moto drivers these days. The ones who tout for tourists, at least, have all gone and bought trailers for their bikes, thus upgrading themselves to the status of tuk-tuk drivers - a rarity on our last visit.) In any case, it's not so modernised that you can't still stroll across the tarmac to your plane, which we did with that mixture of satisfaction and reluctance which marks the end of a great trip.

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Next Up: Observations about travelling with young kids in Cambodia.

*This is our list for the scavenger hunt. Each of the speaking members of the party contributed to the list. We found everything except the danger sign (I guess they've replaced their danger signs with actual safety measures since our last visit), and it took us the whole day to do that. Even The Young Miss found a couple of items, although I'm not sure she was aware they were part of a game.

Lots of the finds opened up discussions about history, culture, or the local environment. For example, the water wheel provided a lesson in both local agriculture and Buddhist symbolism. The statue with the head (most of them are now headless) provided an opportunity to discuss the history of the temples and ancient kingdoms. And there was an interesting discussion about how the trees grow like that.

• Working water wheel
• Statue with its head still on
• Boat (we saw one being used by a bridal party on their wedding photo tour of the temples)
• Fishing net 
• Fishing rod
• Carving of dancers (apsaras)
• Tree growing out of ruins
• Tree that forms a tunnel with its roots
• Aeroplane (actually seen after we left the temple grounds - they weren't flying over the temples)
• Carving of wheel
• Carving of elephant
• Hot air balloon
• Flowing river
• Giant face on gate
• Big stone lion
• Danger sign
• Stone bridge with stone railing

This story has been discussed on Mel's blog. Thanks to Alexicographer, I have a copy of it, which I want to comment on briefly.

Alexicographer suggested (via the comments to the first link, above) that the study would cost about 4 hours' worth of a post-doc's time plus a mac-book (which I assume can be substituted for any kind of equivalent computing device). All I can say to this is, obviously I am not yet a post-doc. I am pretty sure it would take me four hours to work out whether I was supposed to be running a Cox regression or (let's be honest) any other form of statistical analysis you might care to name. As it happens, I'm in the middle of studying up on this as we... well, I should be doing it right now, but this counts, right? In other words, if you are a post-doc, and you have feedback or corrections, please leave them - I would be grateful!

My first comment is that, as suspected, everyone should start using the firefox add-on which redirects every Daily Mail link to pictures of tea and kittens, because honestly - you are not reporting science to the public so much as blatantly trolling. In fact, if your (I'm talking to you again now, not the Daily Mail) Aunt Jane tells you to adopt as a result of having read the Daily Mail article, my recommended response is to give her a sympathetic smile, and gently explain to her that she has been trolled.

The Daily Mail [that is not a link to the Daily Mail, it's a link to Dan and Dan's song about the Daily Mail - I refuse to link to The Daily Mail directly and I thoroughly recommend the song] reports that,

"Scientists say the study throws new light on the age-old question of whether life fulfillment provided by children can actually extend your years. The answer appears to be yes – but only compared with people who want children and are unable to have them. In these circumstances, adoption may reduce the risk of early death, according to Danish scientists."

Bollocks. Wow. They really had to put their best spin-doctors on the job to draw that message out of it. First of all, we don't know whether the differences in mortality are due to "life-fulfillment" - a possibility I would list as number seventy-hundred-and-eighty-seven, under such things as "leading a less adventurous life-style during your forties" or "less likely to have an undiagnosed clotting disorder which prevents successful IVF treatment and at the same time increases the chances of death". As it happens, the scientists specifically state that the study does not provide evidence that having children, even after infertility, extends your life years.

They specifically state that. I guess The Daily Mail reporter got sidetracked looking up big words like "exogenous" and never made it through the whole article.

With regards to the second sentence of the quoted paragraph, it is true that, in this study, adoption was found to be associated with a reduced risk of death amongst those for whom IVF didn't work. However, the authors feel that this is not because adoption "reduces the risk of early death" but because being able and eligible to adopt is associated with a range of other factors which, together, reduce the risk of early death.

Again, they specifically state that, and it is an even stronger statement than the one I described above, which merely tells us that the study is not designed to prove a causal link (although there is a lot of speculation in the statement).

Correlation, you must remember, is not causation. (This reminder is given three times in exactly those terms - once in the abstract, once in the box-summary, and once in the discussion of the results. I can understand how the Daily Mail missed the latter, but honestly... they couldn't read a box summary before writing a newspaper report? Or they did, but they decided it would be more fun to forgo scientific reporting in favour of trolling?)

Mel complained about the division of parents vs non-parents, stating that the idea of being "childless until proven parenting" is noxious. And I don't disagree. The way society divides parents and and non-parents based on whether they are raising or have finished raising living children ignores a wide range of circumstances. This was always a beef of mine (and not just mine) when Mother's Day rolled around (and it still is). Society is yet slightly divided on the question of whether an expectant woman should celebrate or not, but those in the trenches of infertility tend to be more or less excluded - which doesn't seem right, when you consider how much more parenting some infertile men and women have done (both in a physical and emotional sense), when compared to their expectant or newly-minted counterparts. 

However, the scientists make clear that their distinction is between those who registered a birth after IVF treatment and those who did not, during a followup period of three to fourteen years after the start of treatment. They openly admit not only the possibility but the probability of "unobserved comorbidity*" given the available data (which was taken from publicly-available registries) whilst pointing out that adjusting for the factors they could observe had not really altered the results. They do consider number of IVF treatments in their analysis. One could still argue that they should have used different terminology, whilst admitting, to be fair, that the debate over the alternative remains unresolved, even within the community. Possibly, to be accurate, it should have been an acronym such at PRB (parents, or patients, or people registering a birth) vs PNRB. In any case, you can be sure the Daily Mail would still have come out with "mothers" and "childless".

A few things must be brought to and taken away from studies like this. Firstly, note that the outcome under observation is rare. The Daily Mail will tell your Aunt Jane that you are FOUR TIMES MORE LIKELY TO DIE if you don't have kids, at least through adoption, but actually, almost everyone they followed - regardless of category - survived. Put it this way: if one person dies, on average, from cause X in one year and in 2012 you happen to get an extra person, that is a DOUBLING OF DEATHS FROM CAUSE X THIS YEAR according to the Daily Mail, or a single extra death to everyone with an ounce of common sense**. And if your unlucky statistic from 2011 happened to hang on til the first of January 2012, giving no deaths in 2011 and two in 2012, then it is still one death per year according to those with common sense, or an AN INFINITE INCREASE IN DEATHS FROM CAUSE X COMPARED TO LAST YEAR AND POSSIBLY THE BEGINNING OF THE APOCALYPSE according to the Daily Mail. So tell your Aunt Jane that either way, things will probably turn out just fine.

Secondly, these data tell a story about a population. They can't tell you if you are going to die soon (which you are probably not - see above). Statistics, as everyone who has ever sat down at a fertility clinic already realises, is not a crystal ball.

Thirdly, just because science tells you X, doesn't mean the right choice is necessarily Y. We make our decisions against a background not just of medical facts, but of values and circumstances. Context is everything when it comes to forging our onward path. This doesn't devalue scientific research or the input it provides, but we must remember to limit its use to its proper purpose.

This study should be a welcome report to infertility patients - especially those who for whom treatments fail. It may turn out that there are concrete steps which can be taken to improve your chances of surviving into old age - medicating with aspirin, perhaps, or increased screening for certain cancers. However, it should be recognised that this is piece, maybe, twelve of a one-thousand-piece scientific puzzle - and the authors are not only aware of this, but are at pains to emphasise it to their readers. We don't yet know why IVF patients who never end up registering births or adopting have an increased rate of death in the immediate followup period after starting IVF, compared with those who do. The authors claim that "because [their] study is based on a natural experiment, the results are less likely to be due to reverse causation" - an assertion which doesn't impress me much, under the circumstances, based on my limited knowledge of statistics, epidemiology, and reproductive medicine. "Less likely" seems (to me, here) a far cry from "impossible". We - and especially your Aunt Jane - must remain open to the idea that death coinciding with infertility treatment may be a cause of childlessness, rather than the other way around***.

In conclusion: this is an interesting, if somewhat limited study, which has been over-reported in what must have been either a slow news week or a please-distract-them-from-the-real-news week. The authors themselves deserve to be thanked for their efforts and encouraged to dig further. The Daily Mail deserves to be forever transformed into pictures of tea and kittens***.

Part two of our trip to Cambodia is coming.

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*I'm not sure exactly what sort of "comorbidities" the authors had in mind here - my assertion is the fairly vague one that they knew they didn't have all the info.

**There are valid statistical techniques for handling rare outcomes. What you learned about small numbers leading to unreliable results is an oversimplification which borders on an outright lie. Note that over twenty-one thousand couples were assessed.

***The authors do raise this point when talking about the group of adoptive parents who, they speculate, may have a decreased death rate owing to "survivor bias" - given that Danish laws do not permit parents to concurrently pursue adoption and IVF treatment. On the other hand, it must be noted that they have adjusted for the number of treatment cycles.

****I had to repeat both links again, just to encourage everyone to follow them.

I really enjoyed Mel's recent series on her family's Literary Tour of London and Oxford (I think I missed one there... but that'll get you pointed the right way). I'm a sucker for a travel blog. (If you are too, the other series that comes to mind is Vee and Boo in Thailand. Remind me how old he was then, Vee?) This travelogue is planned in several parts. Parts one and two describe our itinerary. Part three covers some general observations about travelling with kids of this age in Cambodia.

Phnom Penh to Battambang

We recently returned from a trip to Cambodia, with the young Master and Miss, who are now nearly-two and nearly-four-point-five. We last (and first) went to Cambodia in 2002 - a whole ten years ago - and there have certainly been a few changes. The first clue came when, just before the trip, a friend described Phnom Penh as her favourite city in Asia. "Really?" I thought. "Phnom Penh? That dusty little hicksville? Big enough to be mildly unfriendly and noticeably more expensive than the country's more regional areas, but without any more wealth or sophistication to show for it?"

Last time we came to Cambodia, we started out in Siem Reap, travelled across to Battambang, and finished in Phnom Penh. I admit this probably gave Phnom Penh a tough assignment - Cambodia is, without doubt, one of my two all-time favourite travel destinations, the other being Turkey. In both places we were able to rock up with no definite plans except a return air ticket from a different city*, and in both places we found the locals to be genuinely interested in making our journey a pleasure. There was no hassle and no hard sell from those who were also interested in making their money from tourists. Everyone was full of general conversation, and it was also easy to get travel suggestions. Organising stuff was a breeze. So of course, when we got to the less-welcoming big smoke, Phnom Penh, and sensed our return to the status of cashed-up strangers, it was bound to be the kind of let-down that paints an unfair memory.

Our guide-book described Phnom Penh as being "back", and they were right. The place has changed, and I might want to live there. Mind you, we saw it but briefly - we had only an eight-day itinerary, and we had decided we needed to ease The Young Master into it, as he tends to get a bit overwhelmed by new experiences, so we went straight from the airport to the hotel by taxi, hung out by the hotel pool and ate at the hotel restaurant, then packed up our bags fresh and early the next morning for our road trip to Battambang.

Phnom Penh to Battambang

Yes - road trip to Battambang. This was a new one for us. Last time we did the reverse trip, we did it by plane. You could technically get between the two places by road, but it was a fourteen-hour-plus trip - not including the time it would take you to dig the car out of a bog if it had rained recently - and that's if you made it past the land mines and bandits. The train service was worse, if a little safer from land mines. Nowadays, you can accomplish the 300km trip in five or six hours, along a sealed (though somewhat potholed) road. The train service and airline no longer exist.

We piled into our minibus at 9am after a hearty, western-style breakfast. We'd originally ordered a whole taxi since we filled one anyway, but the hotel could only locate a minibus, the exclusive use of which was offered to us at the same price but without most of the seatbelts. We used the one we did have to strap The Young Miss into her car seat, whilst The Young Master experienced the delicious thrill of travelling completely unrestrained. None of us were nervous about this - despite the newly-sealed roads, the traffic meanders. Our bus driver not only had to avoid the potholes, but also motorbikes, some with various trailers and ridiculous loads, bicycles, motorbikes towing bicycles, hand-led horses and cows, usually pulling carts, stray dogs, and people trying to hail minibuses from the middle of the "highway".

The Young Master spent the morning getting used to all of this from the safety of his vantage point behind the windscreen, which was just as well because the first time he actually had to interact with Cambodia directly - when we got out for a lunch stop - an elderly woman carrying a basket on her head bent down in his face, pinched his cheeks, flashed a toothless smile, and offered him some deep-fried tarantulas on a stick. He held up to this well, managed to decline the tarantulas politely, and even started playing with two of the local children whilst we ate lunch. When it all got too much for him, he asked to return to the minibus so he could hide out whilst everyone else finished up. The Young Miss, meanwhile, was in her element, having found a swinging chair, a playmate her own age, and more doting fans than she knew what to do with.

We got back on the road for the next big push, and the kids were just coming to the end of their attention spans when we pulled into Battambang. The hotel of our choice was unfortunately full, but we found a room with three wide, single beds in another one just across the road. We reshuffled our stuff and went out for an aimless walk around town to stretch our legs. The Young Master decided he was going to wave and say hello to all the under-ten-year-olds he saw, and he did. Before long, he'd found a group of them to play with, and he and Miss easily cobbled together a racing game despite the lack of mutual language. When it was finished, we walked on by the river - wow, such a lot of new buildings by the river since last time - where the Young Master was enthralled to discovered a game played with a shuttle-cock-like device, the name of which temporarily escapes me (lakeh? something like lakeh?). By this time, it was getting on for dinner. We grabbed some buttered corn cobs from a street-seller to tide the kids over, found ourselves somewhere to eat, and then headed straight "home" to bed.

Coming in Part Two: Battambang and Siem Reap
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*Side note: I think Mel is a great person and everything and I really was interested in reading about her travels, but I have decided to NEVER, NEVER go on holiday with her family. This is for mutual benefit. I like to arrive informed, but thoroughly unscheduled. Mel... likes to arrive scheduled. We would kill each other.