Kindred Connections

People have to decide whether they live in an economy or a civilised society. Unfortunately too many First Worlders have chosen the former.  ~ My friend Steve

I like Steve’s quote a lot.  He’s a difficult guy for me to have a conversation with because he says it succinctly and I rarely find anything to disagree with, expand upon, or add.  He’s a kindred spirit.  They can be hard to come by but I have a few kindred spirits around me and yesterday here in Phnom Penh I had three of them around me at once, making for an extraordinary day.

Bernadette is a Belgian woman with a unique story of work, travel, artistic bent and philanthropy.  I met her in Phnom Penh when I contacted an organisation she is connected with, offering to volunteer with them during my holiday.  We clicked immediately.  Maria and Berta are equally like minded Spanish women who I met on holiday with Kim (a like-minded MSF expat) in Mondulkiri around the same time as I met Bernadette.  Yesterday the four of us converged and I had an amazing day worth recording here.

Bernadette picked me up early in her tuk tuk and we spent a few hours with an NGO at a Cham (Islamic) community on the shores of the Mekong River.  This landless community live in destitution, housed in boats on the river or shacks on the shore, reliant entirely on the fish they catch to survive.  Bernadette volunteers as a photographer and attends with the NGO who are trying to implement social programs to bring the community opportunities, such as providing each family with easy-to-maintain filters to ensure safe drinking water, ensuring the children are registered at birth, enrolling children in school and paying the otherwise-impossible school fees.  Yesterday we visited the school to pay the fees before attending the shoreline community where two family assessments were conducted.  One small child had a lymph node in his neck and reports of an accompanying cough and fever – possible Tuberculosis, so we discussed ways to ensure he is seen by someone who can diagnose and treat his illness.  This can be very difficult as transport alone is a barrier, along with the costs associated with visiting most health facilities.  Stories are very common, of people with life threatening conditions being discharged from hospital once the money runs out; families going into exorbitant debt to try and save ill children; and treatments which are officially free (such as Tuberculosis) having illegal charges attached to them by the practitioners in charge of the medications.  Health care in this environment is very difficult for very many reasons, with cost being just one of the obstacles.

NGO workers at the mosque in a Cham community, Phnom Penh

NGO workers at the mosque in a Cham community, Phnom Penh

View from the mosque over peoples' homes on the Mekong

View from the mosque over peoples’ homes on the Mekong

Nets drying on the shoreline in a Cham fishing community

Nets drying on the shoreline in a Cham fishing community

Soon the shoreline will rise with the waters of the Mekong, when shacks will be dismantled and moved further uphill.  The community have been told they cannot live here though and are at constant risk of eviction, particularly once plans for a tourist resort are completed, at which time the need to evict these unsightly citizens will become imperative.  In these waters I saw dishes being washed, teeth being brushed, men and women setting fish traps, children swimming and people bathing.

From here we tuk-tuked our way back to the life of plenty where an overdue hair cut and colour was followed by socialising.  Bernadette met Maria and Berta and as expected, there was a lot of common ground.  Bernadette even has a photograph on show in an exhibition showing with Through Waters overseas.  Maria and Berta are showing a different set of photographs in the same international exhibition on display here in Phnom Penh.  Bernadette also exhibited her work in the cafe where we had lunch, chosen because it is run by friends of my mother’s friend in New Zealand.  So the connections  yesterday seemed endless.

From our long and leisurely lunch we headed to the Through Waters photographic exhibition.  Maria and Berta were cycling around Cambodia when my American fellow-expatriate MSFer Kim (who has since returned home) and I met them.  Their journey was for the purpose of a water awareness project with villagers and school children in communities along the way.  Kim and I took a bus to Mondulkiri, mesmerised by the previously-unseen sloping, forested highlands in an otherwise exceptionally flat and tree-less land.  Maria and Berta had cycled the same route, an adventure not without tears as they ascended to 800m above sea level on the first hills they’d seen during thousands of kilometres cycled.  They had traveled with a deaf friend who was helping them to hold the workshops, a large number of which were held with deaf children and adults and also some workshops with blind groups.  Their stories of the differences working with general Khmer groups compared to deaf groups and then compared with blind groups were not only interesting but also highly entertaining.  As well as the beautiful artistic photographs on display, the exhibit showcased this journey with Through Waters, the workshops they held and some of the art created by community members during these workshops.

Three themes emerged when working with Cambodian children on the topic of water and it’s significance to their lives.  These were on display in the beautiful studio space as below:

???????????????????????????????

Landscapes

??????????????????????????????? ???????????????????????????????

Cambodian Homes

??????????????????????????????? ???????????????????????????????

and Pigs on Dolphins!

??????????????????????????????? ???????????????????????????????

The journey that Maria and Berta cycled on behalf of Through Waters and the space where the exhibition was showcased, adorned with visual art by Cambodian artist Vollak Kong:

754 753

??????????????????????????????? ???????????????????????????????

Some of the photographic art displayed at Through Waters Phnom Penh exhibition which closed on Friday.

Children on Waterfall, Bali Indonesia 2013, by Pimpin Nagawan

Children on Waterfall, Bali Indonesia 2013, by Pimpin Nagawan

Life on Water, Bangladesh 2011, by Rasel Chowdhury

Life on Water, Bangladesh 2011, by Rasel Chowdhury

784

Life on Water, Bangladesh 2011, by Rasel Chowdhury

Silence, Rio de Janeiro Brazil 2012, by Anna Kahn

Silence, Rio de Janeiro Brazil 2012, by Anna Kahn

Laundry, Kairouan Tunisia 2008, by Memaile

Laundry, Kairouan Tunisia 2008, by Memaile

I’d love to share more but I guess there’s an element of “you had to be there” and I think this shows the general gist of the exhibition.

On our way home we stopped at a bookshop and found fifteen English fairytales for the English students at the orphanage.  I also found a collection of simple fairytales for a 25yo patient from a riverside Cham community in Kampong Cham who weighs 23kg and is probably going to die due to a combination of serious health complications with drug resistant TB thrown in for good measure.  She is a most beautiful young woman whose face has somehow escaped the sucked-in skeletal look most severely malnourished people develop.  A keen English student, when I asked her the day that her father carried her onto the ward if there was anything she wanted to break the boredom of lying on her wooden bed base, she told my translator that she would like an English book.  I have given her a few now, but the fairytales with accompanying illustrations and reasonably simple sentences will hopefully help her to practise her reading.  She listens to me with what appears to be comprehension of what I am saying, but always relies on my translator to repeat what I have said and apart from “hello”, “thankyou” and “bye bye” she never dares to utter English to me.  The fascination people have with English language is often so strong that they don’t feel brave enough to speak to native English speakers.  Even Maria and Berta talked yesterday of their admiration for my English ability, the words I choose which they would never think of using, and the hilarity that confusion due to pronunciation regularly causes.  I understand why young and inexperienced people find it intimidating, even though it need not be.

Last week I travelled with one of my nurses and the social work team plus a driver, to the Cham community where this patient lives.  Parallel with the Mekong is a raised bitumen track, either side of which elevated houses sit on ground sloping down about two metres from the road.  With the rains having started, their yards are already transformed into green-brown muddy ponds which must surely be breeding grounds for all sorts of unwanted creatures, not least of all Dengue and Japanese Encephalitis-carrying mosquitoes and any number of diarrhoeal-causing bacteria and parasites.  As we stood beside the road speaking with the family about how they will manage the patient on her return home and the nominated Home Based Care Nurse who will be responsible for administering her daily TB medications by DOT (Direct Observed Therapy), small children shouted “Hello” from front doorways in the vicinity and laughed uproariously when I shouted back my replies.  I tried to imagine how it would feel, growing up in such a destitute environment.  It wasn’t possible and I soon gave up.  But I hope that next weekend once she is home, some of my fellow expat-MSFers will join me on a 70km-round-trip cycle through beautiful countryside to her home to visit her, so that I can stay in touch and let her know she is not forgotten despite the lack of medical assistance available.

Finishing on the theme of kindred spirits, probably the main focus of my interview with MSF last year related to my ability to live and work alongside a wide variety of people, not all of whom I would necessarily like or get on with.  I was confident that this was something I could do, but actually living the experience has been an incredible challenge at times.    I was told that upon return from missions, the main reason people report for either positive or negative experiences, has to do with the expats they live and work with.  I silently thought to myself that surely the work and the cultural experience would have a much more significant impact.  It turns out that the experienced interviewer knew what she was talking about, however!  Our house is always filled with expatriates, plus the occasional visiting Khmer colleague.  An eclectic mix of nationalities, each and every one of the long term housemates is now a kindred spirit whose company I thoroughly enjoy both at home and at work.  The remaining four months of my mission should be an interesting and happy time.  In the past eight months I have made some strong friendships.  But I have also been challenged at times in ways that have taken me by surprise and taught me a lot about myself.  For the next four months I will be with a recently married French Project Coordinator and his wife; a Slovakian doctor; Phillipino Laboratory Manager and Australian Nurse, all of whom I share a lot in common with.  Despite missing some of my departed friends, I feel it’s an incredible stroke of good luck that my year-long mission will end on this very high and happy note.

Then there’s the young little spirits I have come to know and love at the Orphanage and beyond, who attend English lessons with Bea and I, soaking up everything we try so badly to teach them.  Some of them are picking it up so quickly that I am surprised to find myself having raw conversations occasionally as they string abecedarian sentences together to ask me my nationality or if I will take them out one day for a treat.  Bea and I agreed to this and have planned for a trip over a few hours this weekend, after making various arrangements with all the relevant people and causing an uproar of excitement amongst the kids when it was announced.  From 17yo down to 6yo, these young people are very special souls who I hope to spend more time with once my mission ends, who I have started to miss on the days when we don’t have English class.  Our classes are highly entertaining, featuring laughter, dancing, wide eared fascination, story telling, pronunciation practise, homework, eating fruit and lots of varied fun.

How to end a post like this without sounding corny?  I will end with some photos of our English students in class!

Working on a written activity in class

Working on a written activity in class

Getting set to dance in the rain during English class

Getting set to dance in the rain during English class

Watching Workers on the River

As I left home a few moments ago on my bicycle the thought crossed my mind, “whenever I leave home without my camera I regret it”.  It didn’t stop me from leaving home without my camera.  So now, as I sit at the open doorway of a riverside restaurant with wi-fi, ceiling fans and a stand-alone fan blowing on me, good food and ice cold water, I am regretting it!  Although thank goodness for iPhones.  Over the road from me a group of around twenty workers that I can see, more on the embankment below, are working around huge piles of sand and gravel laid along the roadside.  Without a decent camera I’ll see how I go at describing the scene before me on this Sunday afternoon.

The weather includes temperatures of 37C, reported by World Weather Online to feel like 45C, humidity of 83% and thunderstorms in the area predicted to hit town later this afternoon.  So it is officially hot and in my balmy comfort I feel decidedly warm such that without the fans blowing around me, the sweat beads would be imitating large cockroaches bounding from scalp to earlobes at a drenching rate of knots.  As I finished typing this paragraph a light rain set in.  Three hours later heavy rains began to pour and the workers I’d watched all afternoon strolled home, some pulling wheelbarrows, some carting tools, others with loads on their heads, all drenched in the warm waters which I am sure washed away many sweats.

Directly over the road from me is a wide riverside promenade with a short wall leading over onto the dirt embankment which currently leads about ten metres down into the slowly-rising brown waters of the Mekong river.  Eventually, near the end of the just-beginning Monsoon season, the river level will predictably rise the full ten metres up to the wall beside the promenade.  Last year, shortly before I arrived here, the water threatened to break over this wall and I believe that in previous years it has.  It must already be raining extensively north of us as the river level has risen visibly, concealing lower pylons of Kizuna Bridge which previously rose quite a distance out of the water.  The much loved bamboo bridge further downstream was dismantled a couple of weeks ago in anticipation of the rising waters and the seasonal ferry reinstated between the mainland and Koh Paen Island.

Photographed a month ago, the 16 lower pylons under each main pylon of Kizuna Bridge are now underwater.

Photographed a month ago, the 16 lower pylons under each main pylon of Kizuna Bridge are now underwater.

Over the road from me two noisy concrete mixers are whirring constantly on the newly-extended riverbank which has been widened by about two metres very recently, changing the embankment from a gradual slope to a steep-ish climb.  The twenty-plus chain gang of workers are all covered from head (hats or traditional checked kramar scarfs) to toe (workboots at best; thongs with or at worst, without socks), including long sleeves and some even have tracksuit jackets or cardigans on.  It is difficult to identify anyone but I can see that at least three of the workers are young women.  When I have asked (usually women) why they dress in such hot clothes in this torrid heat, they explain that they want to protect their skin.  There is a common admiration in Cambodia for light skin.  Dark skin represents poverty as it is acquired by outdoor work such as farming and labouring.  Skin lightening products are common in pharmacies here, the way that tanning products are seen in places like Australia, England and USA.

Thongs, jeans, jumper, sunhat and shovel - work attire on a scorching Sunday

Thongs, jeans, jumper, sunhat and shovel – work attire on a scorching Sunday

Despite their winter-like, sweltering attire, the team are working steadily.  A group of three very young men are responsible for the metal framed wheelbarrow which travels empty along the road, past me and beyond the corner.  A few moments later it returns, loaded with sacks which I guess are filled with concrete sand.  All are dressed in filthy denim shirts and jeans, one in a blue cap, another with a kramar wrapped around his head and the other in a traditional checked sunhat with a matching flap off the back which buttons up around the neck, obscuring his face with just an opening for his eyes.  One walks between the handlebars pulling them, while the other two are hunched over the back of the barrow, pushing.  When they get to the area in front of the concrete mixers, they drag the heavy sacks off the barrow where another team, working in pairs, open the sack, pour it’s contents into a large bucket, lift the bucket jointly and position it onto the shoulder of one who then carts it to the mixer, where another worker receives and pours it into the rotating barrel.  Meanwhile men and women are shoveling, digging, carting mixtures of sand and gravel in big buckets on their shoulders to the mixers in a steady stream, standing to the side for cigarette breaks, wiping brows with the loose flaps of their kramas and hats.  I’ve never really been exposed to such organised and backbreaking toil, which I guess is why it’s so fascinating.

Riverside restorations in action

Riverside restorations in action

Riverside restorations in action near Kizuna Bridge, Kampong Cham

Riverside restorations in action near Kizuna Bridge, Kampong Cham

Labouring in thongs

Labouring in thongs

About 100 metres from where we are all spending our afternoon in such contrasting endeavours, is a small wooden shacked village which arose on a patch of bare land near our large palatial home at the beginning of the year.  Perched on the embankment between the river and the Night Market, this village consists of maybe 40 people including women and small children who are often seen running naked on the shabby raised wooden verandahs and regularly shout out “hello!” excitedly as we cycle past.  The adults also regularly smile or say hello as we pass by, as interested in the foreigners as the foreigners are in them.  From the irregular observations I have been able to make of these neighbours, they seem to be workers who moved here to work on the riverside restorations which have been taking place for months now.  As soon as the shacks appeared, so did a new wide bitumen road (their first project as part of the riverside development unfolding before us), followed shortly after by some pipes leading from the river, up the embankment, across this new road and into the village of shacks.  The pipes are secured by slats of wood and rocks running parallel to them, which seem to have the purpose of protecting the tubes from damage by the traffic constantly driving over them.

New shanty town, Mekong embankment Kampong Cham

Rains roll in towards a new shanty town, Mekong embankment, Kampong Cham

According to reports I have read, the average labourer in Cambodia earns around $4 per day.  There is a lot of energy expended for this meagre income which explains the typically thin and lithe Cambodian physique.  In contrast, my colleagues are on considerably “high” pay, from between US$300 to US$500 per month depending on qualifications and role.  But this is not a guaranteed income, with MSF projects always being of a temporary nature.  Some months ago one of our projects came to an end and most of the staff from this project remain unemployed as work opportunities are limited, even for qualified professionals.

Another common Cambodian experience appears to be that of living in shared accommodation.  Many of my colleagues, as I regularly mention, live far away from their dependent families and in order to increase the amount they can provide home, they share small rooms with friends and colleagues.  This communal living, the hard physical labour and the good natured collaborative teamwork which I witness from my western, individualistic position is another fascinating observation which not only teaches me about Cambodian life, it equally causes me daily, to speculate about myself, who I am and the cultural norms which built me.

Meanwhile, many stories are emerging from events in Thailand following the military coup last month, with an exodus of illegal workers crossing the border back to Cambodia after an army spokesperson called illegal labourers a threat to Thailand, promising to arrest and deport anyone found without papers.  In comparison to Cambodia where 20% of the population live on less than $1.25 per day and there is no minimum wage, Thailand have a minimum wage of $10 per day and industries which have relied on migrant workers in jobs shunned by Thai workers.  Around 200,000 of the estimated one million illegal workers in Thailand are thought to be Cambodian, the rest Burmese and Laotian.  Another two million migrant workers, many of them Cambodian, are reported to be legally registered to work in Thailand, but they are not considered safe from the military junta if reports are to be believed.  The real numbers are not known and if this estimate is correct then most illegal Cambodian workers have returned home in the past two weeks amid reports from Thailand of violent house raids, destruction of legal workers’ documents, beatings and shootings resulting in at least nine deaths with more than eight other deaths and even more serious injuries following accidents en route to the border.

There are also numerous reports of extortion by military officials only assuring safe passage on receipt of payment of up to $66 per person, leaving people destitute and with no way of returning to their homes from the borders, as well as other human rights abuses.  Thousands of workers have been abandoned at the border having been repatriated without warning or collaboration with Cambodian authorities who, along with various charitable organisations have had to scramble to the border to try and assist returning citizens.  Hundreds of thousands of families who have until now relied on the salaries being earned in Thai industries such as fisheries, agriculture and construction (some of which have been heavily criticised for running a modern day slave trade despite the official minimum wage), are now without income.  I continue to visualise the appearance of both parents of the homeless girls who I talk about but as yet this has not happened and I wonder at their fate.  The vulnerability of the world’s poorest people could not be more evident than in this single set of events occurring in a single month in one small patch of the world.

Slaves forced to work on Thai fishing boats for no pay and under threat of extreme violence (The Guardian 20 June 2014)

Slaves forced to work on Thai fishing boats for no pay and under threat of extreme violence (The Guardian 20 June 2014)

In Thailand, the Guardian investigation found that slaves forced to work on Thai fishing boats are integral to the production of prawns sold in the UK, US and EU.  (See more at US demotes Thailand and Qatar for abysmal human trafficking records – Corruption impedes progress in Thailand and workers die in both because of conditions, Friday 20 June 2014 http://www.theguardian.com/global-development/2014/jun/20/thailand-qatar-downgraded-human-trafficking-report)

Scenes in Poipet as >200,000 workers return to Cambodia (Phnom Penh Post, 21 June 2014)

Scenes in Poipet as >200,000 workers return to Cambodia (Bangkok Post, 21 June 2014)

Despite the horrors being reported, there are glimpses of good news.  For example, the Cambodian government have slashed passport prices from US$135 – prohibitive for many – to US$4, effective from last Friday, in a move to provide Cambodians with a means to apply for the documents required to work in Thailand legally.  This may reduce the power that human traffickers currently hold over illegal workers.

Perhaps most staggering of all is the fact that amidst this extreme situation of mass human degradation, violence, poverty and corruption, a wealthy neighbouring country (Australia) has set it’s sights on Cambodia as a place to resettle a few thousand refugees who arrive by boat each year, seeking protection.  Opposition to this plan has come from Cambodian NGOs, the UNHCR and the Refugee Council of Australia.  I can only hope that common sense and justice will prevail.

Pulling The Wings Off Insects

About a month ago an Australian friend sent me money for the express purpose of purchasing a bicycle for Paint’s daughter.  He is the disabled carpenter building his own home out in a remote village an hour or so from town, whose adopted daughter died from TB early this year.  On Thursday we (me via my translator) rang him and arranged for him to travel to town on his moto contraption to purchase a bicycle.  Yesterday morning as arranged, he arrived with both older daughters (the baby was home with her mother).  We caught up briefly and then went in convoy – my translator and I on our bicycles, Paint and his daughters on the moto-trailer contraption – to a bicycle shop at Central Market.

Central Market is a haze of semi-organised and very polite chaos, with trucks, cars, motorbikes and horses all mingling in together, no real road rules necessary as everyone watches out for everyone else and traffic slowly but surely moves through the crowded streets around the central building.  Outward-facing market stalls are connected to narrow laneways leading to the packed inner market area, where one slightly wider laneway leads motos and cycles to a staffed park area under shabby tarpaulins.  The narrow laneways are like a maze winding through this huge block-sized undercover market with crammed stalls spilling out into the alleys with all sorts of produce on sale, much of which is unidentifable to me but including fresh meats and vegetables as well as processed packets of foodstuffs and all kinds of non-food produce.

At the bike shop the girls picked a bicycle each, my translator bartered the price a little for me, liaising between myself, the family and the seller to ensure the tyres were pumped, the price was right, the colour was what the girls wanted, etc.  The bikes were then taken to the trailer and lifted on, from where Paint, perched atop, secured both bikes with a long nylon strap, leaving enough room for the girls to sit beside their new bikes.  After some more discussion about my plans, when I might see them next, etc, we all headed off in our respective directions.  A woman was sitting at a large steel bowl filled with live crickets, pulling the wings off them and disemboweling them with a quick pull at the tail, before throwing them into another bowl ready for sale.  Fried crickets are a popular delicacy (which I have no intention of trying!).  A motorbike with two dog passengers, their heads poking through the sacks carrying them, drove ahead but thanks to the constant gridlock, I managed a photograph before he stole through a gap in the traffic.  Win thought the dogs were pets and not headed towards someone’s barbecue plate, but could not be 100% sure because dog is eaten here, although not to the same extent as in other parts of Asia.

Paint securing bicycles to his moto-trailer contraption for the long drive home

Paint securing bicycles to his moto-trailer contraption for the long drive home

Pulling the wings off crickets in preparation for frying

Pulling the wings off crickets in preparation for frying

Pillion passenger dogs on a moto, Kampong Cham Central Market

Pillion passenger dogs on a moto, Kampong Cham Central Market

We talked on the way home about our cultural differences and I suggested that Cambodians have to be open minded, because of the realities they are exposed to.  For example, I had never seen the wings being pulled off crickets before today, nor pigs being transported to their deaths (let alone being transported upside down on the back of a moto!) before coming to Cambodia.  I go to the shop and buy my meat with little thought as to how it got there.  Whereas Cambodians are well aware exactly where their food comes from and what it suffered in the name of feeding them.  Cambodians are also exposed to extreme poverty which is obvious wherever you look.  This provides them with a deeper understanding (not necessarily empathy) about the realities of hardship which is difficult to grasp when it is too far removed from our reality.

Last month Thailand’s military forces overwhelmed the government in a coup de’tat which has had harsh consequences on immigrant labourers from Cambodia, who can earn three times as much in Thailand as they can here, for the same work.  This explains why the parents  of the homeless girls I speak of, spend years at a time in Thailand while their daughters are being brought up by homeless grandparents in dire circumstances back in Cambodia.  I wonder if, along with the 200,000 Cambodian workers who have already fled Thailand in the wake of the military takeover, the girls’ parents may reappear?  So far about half of all Cambodian workers in Thailand have returned, which is an enormous strain on an already struggling economy as people leave their only income to return home.  Sadly there are many reports of violence and arrest by the Thai military towards illegal workers.  Due to the prohibitive costs for Cambodians, of moving to Thailand legally, most labourers move there via illegal channels in order to make money which they can use to support their families.  It is not big money in Western terms, a few hundred dollars per month, yet the sacrifice made in order to earn this money is beyond most westerners’ comprehension.  The sacrifices made by my national colleagues here in Cambodia also regularly shock me – a large number of whom live away from their often very-young children for weeks at a time in order to earn a few hundred dollars per month to support their families.

Some photographs of workers returning to Cambodia, taken from the Cambodia Daily newspaper, are here:

A woman carries her daughter on her lap after getting off the truck at the Poipet International checkpoint.

A woman carries her daughter on her lap after getting off the truck at the Poipet International checkpoint.

Migrant workers arriving at Poipet international checkpoint where a steady supply of food and water has been supplied by NGOs

Migrant workers arriving at Poipet international checkpoint where a steady supply of food and water has been supplied by NGOs

Migrant workers being transported home after returning from Thailand after the military coup.

Migrant workers being transported home after returning from Thailand after the military coup.

 

The Mortification of Many Sweats

A couple of months ago I was in Siem Reap for my third visit.  One morning my usual tuk-tuk driver Rav, drove me out to Angkor Thom, the ancient walled city of temples.  He parked near Baphuon Temple and explained where he would be when I walked out at the other end.  I went into this amazing 11th century complex and wandered around, visiting both Baphuon and the ancient Royal Palace of Phimeneakas.  The grounds these temples are set in are as beautiful as the amazing temples they house, with beautiful tracks through shaded natural forests of huge archaic trees, reminiscent of a fairytale.

It was only about 7am but the humidity was high and the temperature was in the 30s.  Climbing a few storeys up steep ladder-like staircases into the heights of Baphuon temple in the blazing morning sun I soon found myself sweating and no matter what shade or breeze I found thereafter, it was not possible to control the perspiration which falls off me so readily in this sweltering thick humidity.  I’ve discovered that my scalp is a cone shape, wider at the top and narrowing down to my ears, because I begin to sweat on the top of my scalp and beads of sweat drip onto the tip of my ears, sometimes landing inside my ear.  It is a natural form of waterboarding – torturous in that I am constantly checking that the heavy drops are not some sort of insect.  So I am constantly patting my soaked temples to reassure myself that there is not a giant cockroach perched atop my ears.  Not everyone sweats like me, from the head.  Bee complains about the backs of her hands and that people stare at them when they break out into sweat.  I would far prefer it to manifest on the back of my hands, than on my head with dripping hair and irritating earlobes.  But it’s a torture I have come to bear as there is no other choice.  I did try psyching the sweat off my head and onto my hands but it didn’t work.

Walking out at the other end of this magical experience smothered in my own salty water, I found Rav in the sea of tuk tuks and we headed over to the next temples, the much smaller but equally impressive Thommanon and Chau Say Tevoda, two temples of almost identical design across a small track from each other.  They were beautiful but it did not take long to view either of them, especially as the hotel pool was beckoning loudly.  I reappeared at the tuk tuk in record time, frightening Rav out of a relaxed slumber across the back seat of his vehicle.  He jumped up in surprise, looked me up and down and said with emphasised shock “Helen!  You are SO hot!  You have MANY sweats!”.  It was a bit mortifying as he, dry-as-a-bone, stared in fascination at the hot sweating foreigner who, as one of my staff tells people, “cannot support this weather”!  When I got out of his tuk tuk at the other end and the seat was drenched in my body-shaped sweat, the mortification went up a few notches.

Thommanon Temple, Angkor

Thommanon Temple, Angkor

My “many sweats” were unremitting until about a week ago when the rains finally broke.  Now there are many sweats, then a heavy downpour evaporates much of the steam, evaporating the sweats to something reasonably tolerable, before slowly building up into the next tropical storm which currently takes a few days.  Once we are in the throes of the Rainy Season the storms will be daily.  So I continue to have many sweats, but now with regular remission.

Yesterday was a colleague’s birthday and a group of us went to an outdoor riverside restaurant to celebrate with her.  There were about twenty of us at a long table with sunken sections along the centre which the waiters filled with hot coals over which a metal barbecue frame was placed.  Plates of fresh meats, vegetables and seafoods were placed beside each burning barbecue and we cooked our own food, supplied with various sauces and dips.  As the only expat with them, I was as always looked after, with English translations, explanations of the food and dressings, my glass topped up, birthday cake brought to me.  Sitting right in front of one of the barbecues on a hot night, my many sweats broke out and I was informed (in case I was unaware) that I was sweating!  Every day I am told “you are sweating”.  I usually thank my informer politely, chuckling inside at the thought that I might not notice the soaked state of my burning head or the waterboarding torture aimed at my ears!

Suddenly a breeze began to blow at my back and I turned to see the waiter and waitress aiming a fan they had brought to the table in my direct path from behind!  I guess it’s yet more evidence of being treated like a Queen in Cambodia.  A big, white, sweaty mess of a mortified Queen.

What Starts Here Changes The World

Basket shop on it's way home after a busy day at Central Market, Kampong Cham

Basket shop on it’s way home after a busy day at Central Market, Kampong Cham

These guys changed my world just by being there!

University of Texas (UT) graduate, Admiral William H McRaven of the US Navy Seals, gave an inspirational commencement address to 8,000 Class of 2014 UT graduates on 17 May this year.  You can watch the speech at this link, which went viral after it was uploaded to YouTube.

http://www.youtube.com/watch?v=pxBQLFLei70

He says that the average American will meet 10,000 people in their lifetime.  I’m guessing that is similar for most of us living similarly to Americans, in the Western World.  If each of us changed the lives of just ten of the people we meet, and each of those changed the lives of ten people, and another ten, then in five generations – 125 years – the class of 8,000 graduates he was speaking to, would have changed the lives of 800 million people.

He further argues that it is not difficult to change the lives of ten people and describes some military experiences in this regard, of one person making one decision, in a single instant, which lead to lives being saved and the impact this had on so many other lives.

He states that regardless of who we are, where we come from, our gender, social status, religion or ethnicity, our struggles in this world are similar and that the lessons to overcome our struggles and move forward, to change ourselves and the world around us, apply equally to all.

It’s a resonant message for me at this time as I encounter the struggles experienced by many if not most Cambodians.  Everyday I face reminders of the incredible stroke of luck afforded me at birth.  While I played with siblings, cousins and friends on bicycles, trampolines and in swimming pools around receiving a decent education, oblivious to the possibility of any other type of childhood, my counterparts in Cambodia were living in constant fear of a barbaric regime, facing starvation, unimaginable brutality and deprivation.  This could sound melodramatic except the history books confirm what various colleagues tell me they lived through and many continue to be tormented by.  The younger generation who did not experience this continue to reap the consequences of a country that was torn to shreds and whose civil war only came to an end less than 15 years ago, with autocracy and corruption now dominating, often with violent force.  I regularly pinch myself that I am the one hearing about these things from the safety of a privileged background and existence.  Only recently did I come to realise that on a global scale, I belong to a charmed minority.

I grew up in a home where helping others was considered the right thing to do and thanks to the direction of  a mother, grandmother, some aunts and uncles and various other influences, this is a guiding principle in my life, which is not only the right way for me to live but also makes my life happy and fulfilled.  During my childhood we occasionally had a sickly, neglected and abused boy spend weekends at our home; an elderly man being nursed in his home by Mum spent Christmas Days with us and I often went on the “District Run” with Mum when she visited patients in their homes as the local nurse, which were some of the most interesting times of my most formative years.  Mum’s sister and her husband who we regularly stayed with also often had “strays” at their home and to this day all of them have an open door policy for visitors.  It’s a rewarding existence for them and they are young spirits because of it.  I credit them with my journey into public health and all of the experiences I have had which ultimately led me to this year in Cambodia.

Prior to 1943 there were no known anti-TB medications and TB patients received supportive therapy only.  This included such things as being nursed in high altitude locations where the clean dry air was considered curative; being nursed in TB sanitoria on open verandahs (for ventilation) in direct sunlight (which kills the bacteria) and various outdated medical procedures such as collapsing the lungs.  In 1943 a drug named Streptomycin, derived from a species of bacteria called Actinomycetes was discovered to kill Tuberculosis bacteria in doses that were reasonably safe to the human host.  The first human to receive Streptomycin, 21yo “Patricia T”, had a severe case of Tuberculosis and had been a sanatorium inpatient for over a year when her doctors approached her in late 1944 with the offer to trial this new drug.  In the first experimental treatment trial she received three hourly doses of the drug which proved very difficult due to side effects and she eventually ceased the treatment with little improvement.  The second trial with an improved formulation and dosing schedule cured her TB and saved her life.  The scientists credited with discovering Streptomycin went on to receive awards and royalties under circumstances which led to a very public rift between them.

Despite the breakthrough that Streptomycin provided in treating Tuberculosis, it was a short-lived success due to the bacteria’s ability to produce enzymes to combat the antibiotic, which led quickly to Streptomycin resistant forms of TB which could no longer be cured.  Hot on the tails of Streptomycin other anti-TB drugs were thankfully discovered and the use of multiple drugs at the same time was found to combat this resistance, providing a long standing cure for the disease.  Despite it’s ability to treat TB, the use of Streptomycin was ceased as a standard first-choice treatment, which I understand is because of the need to administer it as an intramuscular injection (the other first line drugs are oral) and the many possible side effects of Streptomycin which can be severe, the most significant example being ototoxicity, leading to possible deafness.  It is still used as part of treatment regimes where resistance to other drugs is suspected or known.

On Wednesday I went on a field visit to a remote village with some colleagues to meet with a patient who is not complying with his TB treatment.  Known as “retreatment”, the drug regimen he is on includes daily injections of Streptomycin for the first two months of an eight month course.  This is because the patient was already treated for TB once and his TB recurred, suggesting a possibility of some level of resistance to the standard drugs used during his first treatment course.  Streptomycin is added in the retreatment of such patients to strengthen the chances of a cure.  However use of Streptomycin comes with some complications.  Because it must be administered by intramuscular injection, the system in place here requires patients to remain in hospital for their first two months of treatment in order to receive the Streptomycin by trained staff.  Due to the high number of TB patients and the various supports put in place to assist them through treatment in an environment where very few supports are available, whilst seeming to First World eyes to be an unnecessary strain on the patient as well as the hospital system, this arrangement is considered the most practical to ensure good adherence.

Should retreatment patients not wish to remain in hospital, they can go home and have the Streptomycin administered by a Home Based Care Nurse who their local Health Centre will nominate.  However these nurses require financial assistance to carry out the work, to cover the cost of petrol getting to their patient each day and by way of acknowledging their time.  It costs between 3,000 (75c) and 5,000 ($1.25) Riel per visit, ie per day – money which many Cambodians cannot afford.

The patient in question is 42 years old and has an amputated leg which I have not asked about but it would be safe to assume he is one of Cambodia’s many landmine victims.  He decided to return home and have his Streptomycin injections via a Home Based Care Nurse.  However, within about a week he realised he could not afford the injections and while he continues the oral medication reliably, he ceased the Streptomycin.  This places him at high risk of developing Multi Drug Resistant TB (MDRTB).  So my team were deployed to locate him, discuss the matter and convince him to return to hospital to continue the Streptomycin free of charge.

It was about an hour’s drive out of Kampong Cham through some very rural areas, to the patient’s home.

Village Wat in rural Kampong Cham

Village Wat in rural Kampong Cham

Visiting a rural patient

Visiting a rural patient

He cannot afford to pay the HBC Nurse and he also needs to be at home to care for a young child while his wife works in a labouring job on the rural land where they live while she is employed here, to pay off a debt that is weighing them down.  We sat with the patient, his wife and two of their children for over an hour, hearing why he doesn’t feel able to stay in hospital but also cannot pay a HBC Nurse for the injections.  The nurse and social worker spent considerable time and energy explaining the risk he was putting his own health and that of his family at, by taking this approach.  My nurse gave an excellent analogy to them, of mixing cement and sand together but not using any water and expecting to make concrete, comparing this with treating his TB with the oral medications but ignoring the injectable.  After an hour or more of discussion he seemed unconvinced that he would follow our advice.  Unlike Australia and other western societies where there are laws in place to force non-adherent patients to follow advice when public health is considered at risk, there are no such protections in place here.  It was suggested that I say something and so I talked about recognising him from his recent stay in hospital, but that now I know his story I would be able to support him more than I did last time (I did not actually meet him last time).  That the burden of debt seemed foremost in his mind right now, but that when his health deteriorates this debt will seem insignificant.  That we work as a team with our patient as a part of that team and that we would support him and he can talk to us about his problems and we can try to find solutions together so that he can recover his health.  That two months is a short period of time, is going to prove negligible in the overall time it will take to repay their debt and that once he is well he will be able to contribute more than simply staying at home with the baby.  He listened but we left not knowing if he will follow our advice or not.

It was quite an experience, sitting under a hole-riddled rusty tin roof on an elevated bamboo floor in this wall-less hut, trying to convince someone from a world so far from mine, that I could remotely understand his predicament.  A young woman bathed her toddlers by pouring pots of cold water collected from a nearby well over their tiny brown bodies as they jumped and skipped to one side of us and some young teenagers walked past and stopped to stare intently at me for a moment or two.  The patient stated matter-of-factly that the debtor had told him that if he died his wife would be cleared of the debt.  My staff talked further about the possibility of a healthy future but I wonder at how much influence it had.  As we left I said that I would be very happy to see him oneday soon at the hospital.  He smiled back.  We drove home through fields of workers harvesting cucumber, school children cycling home along dusty tracks in their blue and white uniforms and crazy overladen vehicles transporting all manner of agricultural produce.

One of the most concerning patients I have encountered yet, is a 25 year old woman who weighs 21kg.  It is difficult to describe what this looks like.  Many online BMI calculators are unable to calculate her BMI because her weight and height are such an improbable combination.  Everyone is aware, not least of all the stunningly beautiful and  highly intelligent young patient, that she is teetering on the edge.  She had a tumour removed from her abdomen a few years ago, and without being too technical, developed a number of different complications which led to her requiring further surgery.  She now has a colostomy on one side of her abdomen and an irreparable wound on the other side which her mother dresses many times per day as it oozes faecal matter.  Despite eating very well she is absorbing about 50% of what she should be and so in front of our eyes, is fading away.  Since admission to hospital where we are watching her intake, providing nutritional supplements and can see she eats well, she lost 800g in a week.  We cannot say for sure that there is no hope because she may somehow beat the odds, especially if she starts to absorb some of the nutrients going into her emaciated body.  But it seems as though the inevitable outcome is also the unthinkable outcome.  She has a 3yo son who she asked one of our doctors to adopt one day and the following day told me she would like me to take care of him “so that he can learn the way that you have learned”.  This is the value placed on western education.

When I asked her if there was anything that she needed to make her stay in hospital more comfortable she said that she would like some English books to read.  I asked her in English “do you speak English?” and she replied in Khmer to my translator that she did learn English but she can no longer speak it because she has forgotten much of it, but she would like to practise with some books.  I provided some basic story books to her.  This morning when I visited her room, her mother became visibly emotional and said via my translator “when I see you coming it uplifts my heart”.

As she is Muslim there have been some issues regarding nutrition for her and she has eaten rice and eggs for over a week now which is not enough to turn the tides of malnutrition despite the added protein and vitamins supplied.  So today I went with her mother to a Halal restaurant to arrange meals she will eat.  Perhaps this will increase her chances of absorbing some protein and nutrients.  As we were leaving the restaurant, having put some arrangements in place to ensure that she will be nourished during her time in hospital, her mother repeatedly thanked me and then said that she had decided to take her daughter home to die until she met me, and that she is keeping her daughter in hospital now because she feels there is some hope with me involved.  She then stated she hoped that even if her daughter dies, that I might sponsor her family because she has five other children and a grandchild, their lives are a struggle and she would love to see them educated.

When I came home from English lessons with my small homeless charges the other night we were joined near their hammock by a small and grubby, almost Dickensian-looking homeless boy who knows the girls.  He was curious as to who I was and why she was with me.  The next day she approached me wanting to tell me something in Khmer.  Her grandmother seemed embarrassed by whatever it was and refused to engage with her about it.  I had an inkling that I knew exactly what it was.  We found an English speaking Khmer colleague who translated for me that there were some other children who wanted to come to English classes with me.  I could promise nothing because a) it will not be possible to bring anymore children than we already do, to the orphanage and b) this means committing to yet another English class!  But I did not say no either.  The son of my cleaner who has joined us for almost two weeks of classes now, had apparently asked his mother if he could do English classes which was not an option due to the cost involved.  So finding a free class with me was a solution (of sorts in my mind – apparently of epic proportion in theirs!).  There is a serious disparity between supply and demand in these parts!

There is a block of prison cells near where I work and recently complaints were received that the guards are causing a lot of noise at night.  One of them slung his hammock strings around one of the barred cell windows and broke the bars, so that now there is a gaping hole through which the prisoners may escape.  The guards apparently drink and play cards.  They also allegedly accept payments from women who wish to visit their imprisoned boyfriends or husbands, and when enough money exchanges hands, the women are allowed into the cells!  When I almost choked as this story unfolded, someone translated for me that the guards are government employees who make very meagre wages which they have to supplement to feed their families, that they are on the lowest rung of the ladder in a corrupt system and that it really is not a very shocking story if you understand how the system is.

It’s clearly not possible to change the whole world but that doesn’t mean you should not try to make a few small changes in your little corner of the ring.  Many now successful places such as New York and Sydney have dark and corrupt histories, which eventually unfolded into mainly-good places with prosperous economies.  The third world as it is now can also evolve successfully and there are many signs in many places, including Cambodia, that this is slowly happening.

Kindness random

Notes on Voluntourism

Although it’s exhausting, the best times in my week are spent teaching English to a group of 15 children.  This takes place at a home for HIV+ children which was established by local colleagues who worked in the medical field with families of the children, the parents of whom have either died or are not able to provide adequate care for their children.  Previously the partner of an expatriate colleague living with us was teaching English to the children.  When he left, the orphanage asked if I would consider continuing the English lessons.  I happily agreed and began teaching a month ago.  Since then two homeless girls who I have mentioned previously and the son of one of my staff members have joined us.  Chom, a local tuk-tuk driver and friend, takes us so as to avoid the children cycling on busy roads while in my care.  He stays and acts as translator and support during the class.  We always arrive to the excited greetings of 12 more children who have welcomed and included without question, the three extras who come with me.  Friendships have formed quickly and easily.  For two of the three classes we are also joined by my colleague Bee who shares the lesson planning / teaching responsibility with me and enjoys the experience as much as I do.

We have a routine of purchasing fresh fruit at the market on the afternoon of each class, which we offer to the kids as a part of the lesson.  The class starts just as the older children cycle in the gate from school in their uniforms, so they are undoubtedly ready for a snack.  The cook is always there preparing dinner, which is served just as we are leaving, an hour later.

At our most recent class the children immediately began rough-housing and chasing each other as soon as we arrived.  To settle them down I decided to feed them immediately so I asked them to sit down and placed the plates of Jackfruit and Mangosteen nearby.  Once they were in a circle I called out “Who is hungry?!”.  Those who understood the question shot their hands into the air and the others quickly copied.  Then I called out “What will we do?!”.  With 17 pairs of eyes studying my mouth I slowly articulated “We… Will… Eat… Fruit!”.  They understood each word in the sentence from previous lessons and repeated after me in unison.  We repeated the exercise a number of times until they were forming the sentence spontaneously, then I asked each of them individually “What will you do?” and supported each to reply “I will eat fruit”.  We then placed the fruit in the centre of the circle and many hands grabbed excitedly for it.  Then we repeated the exercise using the current tense of “We are eating fruit” and “I am eating fruit”.  Once the fruit was eaten, we repeated using the past tense “We ate fruit” and “I ate fruit”.

As soon as this exercise was over the craziness recommenced and my lesson plan was looking rather dishevelled.  As the lesson plan is just a guide and we don’t have a timetable to stick to or an Education Department assessing us, I went along with their mood and ran a freestyle session led by the children, during which I managed about half of the planned lesson once they settled down a little.

Neither Bee, Chom or myself are qualified teachers and so Bee and I have spent a fair amount of time online working out lesson plans and advice on how best to introduce English to children learning it as a foreign language.  I’ve learned a lot and we have lesson plans to guide us courtesy of an online website which I joined so that we can have structure to our classes.

During my online searches for this purpose I have learned about the concepts of  “Voluntourism” and “Orphanage Tourism”, which a wealth of information has been written about and in which Cambodia features strongly along with other developing countries.  It is reported that many orphanages exist simply to meet the demand from foreigners wanting to volunteer for a few days or weeks while on their overseas holiday.  This is a lucrative business with many negative impacts.  It is alleged that many families are enticed by financial incentives and the unmet promise of improved educational opportunities, to send their children to these “orphanages” where children are kept out of school in order to be available for English lessons taught by usually young and unqualified volunteers whose only asset is knowledge of English.

The more reputable orphanages I have read about employ local staff to do the work that foreign volunteers might otherwise do, in order to provide constancy to the childrens’ lives.  This has the added benefit of providing local employment.  Volunteers are only considered useful in certain situations when they can commit to 3, 6 or more months and it is important that they have relevant vetting (ie police checks) and qualifications.  I now have a better understanding of why my offers to volunteer later this year when my MSF mission comes to an end, were not met enthusiastically.  The one organisation I applied to required an online application with submission of my Curriculum vitae.  They have offered me two hours of work per week directly related to my professional qualifications.  An initial reaction to such strict criteria could be an assumption that your willingness to spend time helping people is not appreciated but in fact there is a very strong element of child protection and responsible service provision to this approach.  It would seem that those places who offer positions to volunteers without any checks or conditions attached, are in fact involved in the world of voluntourism, which can significantly harm an already-vulnerable population.

Teaching English without qualifications to children can also be considered in a negative light and I have pondered on my involvement in this way.  However we were specifically sought out by a legitimate local organisation for the purpose in an environment where English speakers are highly sought-after.  The children are receiving these lessons in addition to, not instead of, their regular schooling and we have sought materials and resources to help us make the lessons structured and useful.  Given the value placed on the English language I also think it can only benefit the children to be around English speakers for a few hours each week, regardless of the lessons and homework we provide.  The children clearly enjoy themselves and have taken to asking for extra lessons and at risk of sounding very much like a voluntour, the lessons are certainly the highlight of my week.  We also have our own conditions in place, which include not posting pictures of the children online, not inviting people to join the class who do not have a specific role to benefit the children, we have all relevant checks allowing us to work with children and we can provide a long-term commitment of over six months.

Some interesting reading on the subject of Voluntourism can be found at the links below and/or by Googling the subject.  The last article on myths about the developing world was particularly interesting for me this week as I experienced an East-Meets-West phenomenon when a tiny 6yo homeless child was heart broken and sobbing.  I was unable to fathom what was wrong with her but it was apparently serious.  Eventually her grandmother explained to me via sign language and the universal name of “Coca Cola”, that the reason she was crying was that she was trying to insist on her grandparents (who were beside themselves about her prolonged tantrum) buying her a can of Coca Cola!

For anyone interested in knowing about some more reputable organisations, I have also posted links to three NGOs in Cambodia with genuine programs that do not exploit the children in their care. This is not an exhaustive list and there are undoubtedly other equally needy and deserving organisations.

Article from the Huffington Post, Orphanage Tourism Should Be Stopped, International Activists Urge, 27 October 2013 http://www.huffingtonpost.co.uk/2013/10/25/orphanage-tourism_n_4162222.html

Blog Post on Volunteering in Cambodia http://www.movetocambodia.com/working-in-cambodia/volunteering-in-cambodia/

Children are not tourist attractions website http://www.thinkchildsafe.org/thinkbeforevisiting/

Global Citizen article 27 myths about the developing world, 30 May 2014 www.globalcitizen.org/Content/Content.aspx?id=2925b243-a89c-48a4-ae86-8e2f84a3b92f

https://www.cambodianchildrensfund.org

http://www.phter-koma.org/joomla/index.php?lang=en[/

http://www.scv.org.au/

Hope in a Colourful Country

Everyday I marvel at the colours of Cambodia.  It is difficult to believe that the carrot coloured robes of Buddhist monks, glossy gold and tangerine tiles of temple roofs, dusty bright orange dirt roads and vivid flowers of Poinciana trees in bloom are not deliberately coordinated.  White storm clouds strike impressively against deep blue skies and white oxen plough fields which turn radiant green as soon as the rains arrive.

A Monk's Robe drying in the sun on the shores of the Mekong

A Monk’s Robe drying in the sun on the shores of the Mekong

Golden roofed Wat, Kampong Cham

Golden roofed Wat, Kampong Cham

???????????????????????????????

Blooming Poincianas line the highway south of Kampong Cham

???????????????????????????????

Rice field, Kampong Cham

Rice growing in Kampong Cham

Oxen take a photo break en route to work in the fields of Kampong Cham

Oxen take a photo break en route to work in the fields of Kampong Cham

More than the visual colours, are the beaming characters I have the privilege to know and encounter here.  I work with articulate professionals, some of whom have hilariously incorrect English grammar.  As a boring mono-linguist I have absolutely no right to laugh, yet every day I do so heartily in the pit of my stomach while forcing a straight face.  Everyday I am greeted by people I don’t even know, with delighted smiles and “hellos” which buoy the rest of my day.  I encounter people at every turn who want to practise their English or simply have an experience with a much-revered Westerner.  When I first came to Kampong Cham a colleague told me that I would “be treated like a King in Cambodia”.  Whilst I prefer the title of Queen, he was right – the mere fact of being from the Western world affords me undeserved attention and respect.

Last week I spent some time observing members of my team in a number of different health promotion / health education activities.  It was an opportunity to learn a little more about the expertise of staff under my supervision.  Animated, engaging and extremely well-informed, they can hold an audience on what might otherwise be considered a very dry and boring topic.  Except that the subject of Tuberculosis in Cambodia is one which has touched most people’s lives closely, with over 40,000 newly diagnosed cases occurring per year and at any one time >760 cases in every 100,000 head of population (probably closer to a rate of 1% per year if all undiagnosed cases were included).

Oneday we traveled in convoy out to a remote community experiencing very high rates of Tuberculosis and emerging rates of Multi-Drug-Resistant Tuberculosis (MDRTB).  We drove for an hour along dusty dirt tracks through tropical villages of thatched straw huts, abundant banana plantations and newly planted rice fields (referred to by a colleague as “the baby of the rice”) waiting for the delayed rains, past many moto-towed trailers piled high with firewood upon which at least one khromar-covered worker sat high above each moto driver.  Arriving in the village we entered through a typical ornate archway into the centre of the walled campus of a beautiful village Wat (Buddhist Pagoda).  Situated in the central garden area, we set up in the community hall and with a microphone one of my colleagues summonsed all available villagers (ie those not working in the fields), to join us.  Approximately 50 people attended, most of them elderly and many supervising young children who frolicked on the edges of the group of adults sitting on the floor of the hall to listen to the 40-minute-long presentation.

A methodical education session ensued, introducing the audience to the presenters, our organisation, our work and the disease, symptoms and treatment of Tuberculosis.  This led to a discussion with current and past patients speaking of their experience and others asking questions.  At the end of our session myself and the other expatriate were asked if we wanted to say anything and we declined.  Later we asked the national staff if they thought we should say anything when asked and we were informed that the Khmer people like to be addressed by foreigners as it gives credence to what has been said by their fellow-Khmer.

Upon returning to the rural office where some of my colleagues are based, we sat under a thatch-roofed sun shelter beside the dirt track leading to the house to listen to feedback on the session.  As a colleague with years of health promotion experience delivered his assessment of how the session had gone and how future sessions could be improved upon, I sat behind the fence and watched the local world go by.  A decrepid moto towed a rusty trailer upon which a large brown penned pig stood silently looking straight ahead towards his fate at the nearby market.  An elderly man whose arms ended at his elbows, presumaby another landmine victim, leaned over the handlebars of a creaky old bicycle and pedalled slowly past us.  Another old bicycle ridden by a teenage boy with a cigarette hanging from the side of his mouth cycled past.  Two water buffalo sauntered by.  Somehow I also managed to catch the gist of the feedback being delivered by one colleague to another!

On the way home we made a quick detour to the family we had visited a week or more ago whose financial debt was weighing them down due to various ill health.  After writing about it, two friends each donated money in the hope of wiping the debt completely and I had this money with me in an envelope.  We arrived unannounced and were greeted into the dirt floor area where the TB-ravaged husband sits on his bamboo bed base, with Sampiahs, thanks and stories of having paid the debtor.  My colleague translated for me that some friends from Australia had heard of their situation and wanted to help, and I passed the envelope with the remainder of the debt plus some extra, to the wife without stating what was inside.  Once more she hugged me repeatedly, saying she didn’t know what was inside but that if it was enough to pay the debt entirely then she might afford her blood pressure pills and so she might go to the Health Centre.  I left knowing that this week she would get her blood pressure medication and have less stressful days, which can also only reduce her hypertension.

The next day one of my staff delivered education to some newly diagnosed TB patients.  Although I had done nothing but sit and listen, as the session ended the patients stood up at the same time as me and bowed low before me in Sampiah gesture, as a way of thanking me.  After returning the respect with a bowed head and reciprocal Sampiah, with a few brief words about the level of care they can expect to receive from my team, I turned to walk away and was immediately approached by a young hospitalised patient who spoke directly to my translator.  He wanted to thank me for traveling to his country from my country to help Cambodian people because Tuberculosis is a terrible disease and there is much suffering in Cambodia.  Again, following the advice I had received the day prior about having something to say, I replied with a brief comment that I appreciate the suffering I have seen and am honoured to be here to help make a difference.

Another session I observed was that of a TB Nurse delivering a Powerpoint presentation to a young village nurse being employed to provide Direct Observed Treatment (DOT) to an MDRTB patient.  The presentation was informative and compelling and the young nurse was clearly interested.  Predicting that I would be asked to say something at the end, I made notes through the session related mainly to questions the nurse asked along the way and when the time came I had some relevant comments to make.  I mentioned that Cambodia is, despite the continuing high rates of TB, considered a success story by World Health Organisation, as the rates of TB are decreasing thanks to the work of Health Centres such as that where this nurse comes from, highlighting the importance of the work he is undertaking.  He was surprised by this, asking for clarification that TB does not just occur in Cambodia, but also in other places around the world!

After a riveting work week, this weekend was spent playing tourist with a couple of friends, one of whom visited us from Phnom Penh for two nights.  We visited temples, ate at local restaurants, kept a local tuk tuk driver / friend gainfully employed, took a long cycle in the countryside, joined colleagues at a local village home for a drink after coincidentally being spotted by them as we were running for cover during a brief rainstorm, laughed, drank and were merry.

One of the people my “reluctant altruist” Phnom Penh friend is involved with is a young woman from a background of poverty and ongoing struggle, who against all odds passed the exams for Medical School, a goal she could not afford to consider except for the lucky break of meeting my friend in tragic circumstances.  My friend successfully arranged sponsorship of her university fees via personal contacts, getting her through four out of six years of Medical School.  For different reasons the first benefactor, then very recently the second, both had to withdraw sponsorship and it was looking as though she may have to stop her studies as the fees are not affordable and certainly not something most people could consider assisting with at thousands of dollars per semester.  A few weeks ago I approached another friend overseas with a penchant for philanthropy.  I shared some of the girl’s story and explained her plight, fully expecting my friend to decline the proposition of helping, but it was worth asking.  Tonight this arrived in my inbox:
Just wanted you to know that I am going to sponsor the young girl. Just have to know how to get the money into your friend’s bank account. Will put it in a semester at time.  Took a while to think about it. It would have been easier for it to come out of my foundation but that was not going to work. She has come so far and to not finish it would be tragic. So very happy to help out.

Tonight, in my little corner, the colours of Cambodia look hopeful!