A few weeks ago Paint, the disabled carpenter I’ve talked of, called my number while my translator was on holiday. Conversation was not possible and so upon Win’s return we called him back. A short conversation ensued before a pause for translation. Poker-faced, Win stated “Paint is not home at the moment because he has gone out to collect grass for the buffalo. He will not be home until this evening”. Given the grass-collecting I see everyday, it was inevitable for this line to be thrown at me eventually I suppose. Such a foreign activity spoken so matter-of-factly, and about a man who walks on his hands, floored me initially before the absurdity made me laugh. Buffalo care is a perfectly ordinary pursuit to the average Cambodian, even one as educated and western-seeming as Win. In fact, buffalo ownership suggests a certain level of wealth as they are valuable animals.
Oneday recently a driver, nurse, social worker and myself were driving through a very remote area when a man wearing only a traditional checked kramar wrapped around his waist like a skirt, appeared across a field, chasing a buffalo calf which was threatening to run into his rice field and trample it. As we drove by I couldn’t get my camera quick enough (see the first photo below) and my colleagues were far more amused at my alarm as I grappled for the camera with my eyes glued to the scene, than at this amazing sight. Once an admittedly less-than-ordinary photograph had been obtained they explained that buffalo have to be kept out of the rice fields which is why we see so many people collecting grass at this time of year. Once rice planting begins the animals are moved from fields into yards and under houses. This is only one example of the daily fascinations I experience in Cambodia while my local colleagues, many of whom have worked in the fields, take absolutely no notice.
Working for almost a year now with Tuberculosis in a Third World country, you would think that the situations I am constantly exposed to would no longer surprise me, yet they continue to do so. My most heart wrenching patient at the moment has developed permanent hearing loss and permanent disfigurement in her twisted-up hands, caused by the medications being used to kill her drug-resistant TB. Weighing just 34kg, she has onset of severe nausea as soon as the drugs are delivered to her bedside each morning (who wouldn’t?!). Patients dying from cancer without pain relief, their diagnosis nothing more than an educated guess once other diagnoses (including TB) are excluded. Children with spinal damage caused by hard physical labour in the rice fields. Old people permanently bent at right angles due to decades of stooping in the fields. Unrelenting hunger and the malnutrition that trails it like a shadow. Babies who weigh a third of their recommended weight. This week as I cooed and cuddled one such “TB Baby” her father asked me “If we were to offer her to you, would you accept?”. Having never known such hardship, I cannot attempt to comprehend the kind of suffering that would lead someone to consider this question – even if it were rhetorical – of his clearly very-loved youngest child. How Win translates these things to me so straight faced I don’t know but he is as affected as I am by the desperation, which prompts many interesting conversations between us.
I doubt that adversity comes any more magnified than for a homeless widow co-infected with Hepatitis C virus, HIV and Drug Resistant TB. Looking tearfully in my direction she told me that she doesn’t know where she can live because her only housed relatives are 84yo and 87yo and “very poor”, so if she moved to live with them she would not have any food. She also told one of my nurses that if we commenced her on the drugs for DRTB and she experienced side effects, then she would immediately stop the treatment. She prefers to die than to endure an ounce more suffering. But the treatment for DRTB is guaranteed to increase her suffering, as nausea, dizziness, joint pain, vision, hearing and psychological disturbances are all common enough that she is unlikely to avoid at least some of them. This is without mentioning any of the interactions between HIV medications and TB medications or the various symptoms of all three diseases. These factors combined make our medical and social management of her disease very complicated.
The little guy at Shackville remains immobile due to the bone of his lower leg growing through his amputation stump, causing pain and making his prosthesis unwearable. Last week the stump became infected and he was hospitalised for five days. Ironically, given my previous ruminations, with his mother’s permission I photographed the stump and emailed a brief paragraph with photos to a friend in Sydney with orthopaedic contacts. The next day this reply arrived: “I showed to our ortho guys who didn’t think this was an emergency but said it should be revised mostly as he isn’t walking or using his prosthesis. They said it could be revised with a fat pad“. I answered: “Thank you SO much. This gives me something to work with – I will encourage Mum to come with me to Handicap International and see if I can advocate for him to get a “fat pad” for the prosthesis. If they say no, then it sounds like something I might be able to create myself using sponges or something similar. I will let you know what happens.” A very short time later I received this response: “Bless you but the fat pad means an operation! Sorry I wasn’t very clear! The orthopaedic guys would need to shorten the bone then make a flap to come under the end with lots of fat in it“. That’ll teach me to assume I know what someone is taking about! This is advice his Mum was told around the time I met her, before being informed more recently that they will not act “until the bone stops growing”, which is another 15+ years of pain and immobility! This cannot be right and I plan on advocating for them somehow, but am nervous about the kind of advocate I make, going by current evidence!
This week some European friends were in town and I hooked them up with Chom, my tuk tuk friend who acts as our driver-translator in the English classes at the orphanage. Oneday I invited them to visit my workplace as they were very interested in some of my anecdotes. As arranged, Chom’s tuk tuk appeared laden with Spaniards. Fluent in English, Chom has been hurling Spanish phrases at me ever since! After announcing to some stunned Spanish faces that most Cambodians have encountered TB in their lives, I interrupted Chom to ask as an example if he ever knew anyone with Tuberculosis? “Tuberculosis? I don’t know this word, what is it?”. Maybe you know it as TB? “No”. I guided him to the Departmental sign which is written in English and Khmer and he suddenly understood “Oh! Yes! My father in law died of this disease two years ago. He came here all the time to get his medicine but it was in his body, like everywhere and the medicine could not cure him. He died in 2012 when he was only 43 years old”. There could surely be no better illustration of the proximity Cambodian people have to TB than that single random sample!
While the Spaniards were in town we ate three evenings this week at my favourite riverside restaurant which doubled as their hotel on my recommendation. One evening as we were preparing to order, the young waitress who I’ve known for almost a year now, approached our table and interrupted with “Hello Helen? My boss needs me to speak with you”. The smiling boss was standing behind her, holding a pink paper gift bag with a teddy bear face pasted on it. “She wants me to say thank you very much because you always come here, you bring your friends, you are such a good customer, and she wants you to have this gift”. The pink paper bag was ceremoniously presented to me with sampiah gestures and more words of gratitude. I was speechless to find the most beautiful carved wooden statue inside! The boss then spoke to me at length in Khmer, with her waitress translating many words of appreciation, many sampiah gestures exchanged between us and just a very unexpected, cheerful interlude between four Spaniards, two Cambodians and an Australian! All because I happen to like their menu and free wi-fi!
Another thrill this week was receiving the below photograph of myself with some of my English students who are homeless and stay in hammocks under trees (during the dry season) or a shanty shelter (during the wet season) with their grandparents who earn US$40 per month as cleaners while the children’s parents live and work in Thailand to send money home. These children belong to quite a community of homeless domestic staff and variously connected children. Three times per week six of these children come with me to the orphanage for English lessons and I am regularly approached by new children and parents wanting to enrol their children into the classes. This is not possible at this stage as we are already teaching 18 children, six of whom travel with us by tuk tuk, squeezing in with sometimes three adults! The only reason our overcrowded tuk tuk draws attention is because of the Barang traveling with Khmer children – the overcrowding factor is neither interesting nor unusual! The children have started speaking basic English since classes began three months ago.
Now that they are on school holidays these kids plus some visiting children are around every day and have taken to following me around when I’m at this particular work site. I regularly hear my name shouted in unison by six or more little voices who often run at me, chase or jump onto the back of my bicycle, peek through open barred windows while I’m in meetings, hide behind trees or around corners to jump out at me, falling about in hilarity when I get a fright, and generally just make my work days so much more fun than they would otherwise be. On this particular day they were pushing a 3yo who has learned to shout at me in exact imitation of the older children, on a little tricycle, when I passed by and stopped to say hello. A colleague was watching from a nearby building and took this photograph of our encounter. Despite the many and daily laughs and tears during my time here, I expect the stolen moments with these children to be the most poignant memory and one of the biggest privileges of my Cambodian MSF experience.