The Difference a Little Can Make

It’s now over a week since I saw the homeless lady with her baby.  I like to think that she was able to find a safe alternative and has gone onto better things, kick started by the money earned from selling her hair.  In reality it’s just as possible that she has been trafficked to somewhere.  I will probably never know.  The living standards and risks associated with being a young Cambodian female (and to a lesser extent, a young Cambodian male) are highlighted in this BBC3 documentary which I watched yesterday, recognising many places and similarly horrific stories from impoverished young people trying to navigate a very cruel world.

This is the same Cambodia which the Australian government have just signed a deal with, to resettle persecuted refugees who we currently keep imprisoned like criminals on Nauru Island.  In my opinion this policy merely highlights the corruption and depravity of power and privilege.  Over the next four years the Australian government have pledged to give $40 million to the Cambodian government who are mired in nepotism, corruption, extreme wealth and power, gained from the siphoning of public funds for personal gain and maintained by often violent means.  At the same time Australia plan to transfer refugees who landed on our shores hoping for a chance in life away from persecution and poverty, into the already distressed and destitute Cambodian population.

When I leave Cambodia (soon), I will be away for a few months.  By the time I return my little friend Dara will probably no longer be at Shackville, which appeared out of the ground about six months ago on a derelict patch of land.  The construction work responsible for Shackville’s existence is drawing to an end and so his parents will move on.  As I hope to see Dara again, I arranged to travel with him to his home village on Saturday to meet his grandparents and extended family, so that I will know where to look and who to look for if he is not in town upon my return.  Astoundingly I was able to explain my wishes to his mother when I saw them briefly the other day and she agreed to us taking a trip together.

On Friday evening I cycled past Shackville to the sight of Dara with his 2yo sister in the front yard.  He was completely naked, wearing only his little prosthesis.  His sister was dressed in a red and white polka dot top with a bright green pair of shorts.  They were standing together at the old steel frame on wheels used by the construction workers as a wheelbarrow, which was parked in front of one of the lean-tos in the dirt.  It was a breathtaking and quintessentially Cambodian scene.  Dad saw me first and turned to speak to Dara who immediately put his hands over his groin and smiled at me.  He promptly forgot about his modesty and ran towards me to say hello, nodding happily as I stuttered on in my broken Khmer about going to his village together in the morning.

Our new manager has arrived from France and so on Friday night we welcomed him with drinks and takeaway fried rice on the balcony about 50 metres from Shackville.  It was a fun and interesting night as he told us of his experiences with MSF in Haiti, Ethiopia, Syria, Congo and Sudan.  It was also thought provoking as I wondered if I am made of the right stuff to cope with places much more formidable than my experience in Cambodia, where the crushing poverty has impacted me so strongly without any concerns of my own personal safety, as is the case in so many locations where MSF has a presence.  With thirteen months of holiday ahead of me, there is no real hurry for me to come up with an answer to these lingering First World Problems (FWPs).

Five of my national staff will finish their contracts this week, some of whom remain unemployed.  One in particular is very stressed by what the future may or may not hold.  He can’t stay here without an income, so is returning to a remote part of the country to live with elderly family members.  Yesterday when we were talking about this, my first world mouth said “if it doesn’t work out, just come back”.  He looked at me with a gentle smile and over the next few hours it slowly dawned on me that “just” doing anything is not an option when a $10 bus trip is unaffordable, let alone paying for accommodation and food outside of the family safety net he is traveling to.  This young man has model good looks, decent qualifications and an engaging personality.  But none of that removes him from the luck he was born into, crippled by systemic poverty.   As I booked my online tickets for Christmas in New York with friends later in the day, an acute awareness of my entitlement-by-fluke cut through my excitement like a knife.  Some might accuse me of having “privilege guilt” but they would be very wrong.  I have no feelings of guilt, only of solidarity for fellow human beings.

On Saturday morning after a lazy lie-in and equally lazy breakfast, Chom met me with his tuk tuk and we headed to Shackville.  Dara, his mother and his very cute 2yo sister climbed aboard and we made our way via a couple of detours, to their village.  Around 15km away but on winding, narrow, rough and fractured country lanes it took almost an hour to get there.  I had no idea if they were expecting me but the greeting from his grandmother who jumped out of her hammock under the stairs at the front door and ran to the tuk tuk, grabbing my upper arms and squeezing them repeatedly, talking animatedly at me and guiding me out of the tuk tuk and up the ladder-like staircase into the elevated home, suggested they must have been.

We sat together in their bamboo-floored, banana-leaf-walled, tin-roofed home for about two hours, Chom translating for me, with many children coming and going, staring into the doorway wide eyed at me, or saying “hello” and then running away in hysterics when I replied.  They told me about Dara, his three sisters, their home life, some family history, asked me some questions which Chom vetted (eg “They want to know if you have a husband but I told them they should not ask things like that”) before translating!  Dara’s 14yo sister is beginning to drop out of school, citing a number of reasons but the main one being that she has to walk the distance now as her bicycle broke.  I asked Chom how much it would cost to fix the bike so he went downstairs to investigate, returning a short while later and listing all of the things that were wrong with it before saying “probably about $10”.  I said I would like to fix it for them and Grandad quietly left the room, which I found out about an hour later was because he was wheeling the bike to the repair shop.

The women then told me that they have no toilet and they have to squat in the surrounding fields etc, which Chom explained to me was a big problem especially for teenage girls and young women.  I asked how much a bathroom would cost to construct and was told Dara’s parents would be able to make it themselves for around $250.  Chom and I discussed this together in English and determined that due to circumstances I should not give them the money without some way of ensuring it would be used for it’s intended purpose.  As they have been without a toilet for years, we plan to arrange a new bathroom for them upon my return in January.  At this time Dara’s parents will not be working in town and so they should have the time to focus on the bathroom.  As I will be here we will be able to put arrangements in place such as viewing the bathroom, to ensure they use the money as intended.  This will be my first project with Chom when I get back.  So far the family do not realise this is our plan, and we won’t let them know until we are ready to set the ball in motion.

View from Dara's family home, looking across the road at similar homes

View from Dara’s family home, looking across the road at similar homes

Chom talks a lot about his childhood including memories of his mother’s kindness or fishing on the river with his father who was a doctor, and the impact that losing them both as a young boy had on his life.  This is often in the context of our discussions about the orphans who he assists us with during English class.  He has bonded with the children and we often laugh about little things they say or do during class.  Chom regularly says that he “feels pity for them but still they are luckier than I was because now they are learning English very young and this means they will have good opportunities”.  After the death of their parents Chom’s siblings tried to put him into an orphanage in order to reduce their responsibilities and increase his chances at education.  Because he had older siblings, the orphanage would not accept him.  His siblings could not afford to pay school fees and so he received a very sporadic primary education before starting work in his early teens.  He taught himself English during a very disorderly introduction into the workforce and he often wonders about the “what ifs”, had he received an education.

Now in his thirties Chom is married with a young son, who he hopes will have a brighter future and many more opportunities than himself.   The value he places on both education and the need to help others as much as possible, combined with his delightful disposition, have seen us become firm friends.  He sometimes mentions his hopes to send his son to language school from an early age to give him an advantage in the world knowing an international language and he has asked me a number of times for my opinion on English vs Chinese.  Recently this topic came up again and he said that unfortunately the school fees are not possible for him to pay but that he would dearly love to see his son learn a language.  Assuming a first world interpretation of “expensive”, I asked how much the fees would be?  His reply, “about $100 every year”, saw me almost fall off my chair!  I immediately suggested that I had been wondering what I could do for Chom after all of the help and friendship he has offered in the past year, and that perhaps I could cover these fees so that his son can go to language school?  His initial reply was a downcast “No because it is not just for one year, he would have to go to this school for years to learn properly”.  I explained that I could help him with the annual fee for however many years it takes.  This led to a few “really, are you sure?” checks before an excited acceptance of my offer, followed by days of texts with thanks from his wife and her mother and messages that I will be like a second mother to his son because his mother gave him life but I am giving him opportunity and combined he has two mothers.

The extreme gratitude he expressed began to concern me as I wondered if he had mistakenly said $100 instead of $1000.  Then I became convinced that no annual school fee would be a mere $100 and he must have surely meant $1000 and how was I going to fix this situation I had gotten myself into?  One morning last week we came across each other in the street and he said he went to one of the language schools to find out some information and maybe we could speak about it sometime soon?  I agreed and then I asked “Is it really only $100 per year?”.  Chom looked off into the distance and said “No, it’s not, it is more”.  My heart was in my throat as he continued “It is $130”, looking at me as though he was as nervous about the information as I was.  How different our perceptions I thought, as I confirmed with a sigh of relief that I could uphold my end of the bargain!

These are all tiny plates in the armour of poverty that is wrapped suffocatingly around Cambodia’s population.  Cambodia is itself a miniscule sample of total world poverty.  80% of the current world’s population live on less than $10 per day.  The poorest 40% of the world earn 5% of global income while the richest 20% earn 75% of global income.  22,000 children die each day due to poverty, most of them quiet deaths in remote villages such as Dara’s, hidden from the scrutiny and conscience of the world.  Inadequate access to safe water affects half of humanity.  The figures of hardship and suffering are never-ending.  I have been hearing these statistics for years and taking little notice.  But now they are not numbers.  Now they are names, people, children and families who I know.  Which is a constantly startling thing to my First World brain!  While the underlying causes of this poverty and deprivation are complex and enormous, the good news is that there are small things which I can do to make small positive differences.  Equally, while there are small things which can be done to make differences, it is also important to consider the underlying causes and how they might be addressed.  Certainly the Australian government’s latest behaviour is adding to the problem and not to the solution, not just for Cambodia, but on a global scale.



Hair Apparent

This afternoon I was invited to visit one of our cleaners in her village a little way out of town.  With 75% humidity and 35C temperatures I decided to be lazy and booked Chom’s tuk tuk for the journey instead of cycling the c.20km round-trip.

Just before Chom picked me up I was out on my bike and I stopped along the roadside to say hello to the homeless lady with her baby.  She was trying to tell me something which I didn’t understand so I returned with Chom to translate.  As we drove towards her tree a moto-sidecar pulled up before us for no apparent reason.  I’ve always just assumed these sidecars sell food and so I wondered why he parked next to a homeless woman with no money, but figured he must have decided on that particular bit of shade to take a rest.  We parked next to him and began conversing with her but Chom stopped speaking when a moto pulled up alongside us.

A brief conversation ensued with the moto driver and Chom said “Oh, she is selling her hair”.  I then realised that the sidecar was not a food shop, but a mobile hairdresser with the equivalent of a salon trolley of paraphernalia in his sidecar cabinet.  The second moto driver was the cutter.  Confused, I repeated “selling her hair?” and he said “Yes, to get money”.  How short will they cut her hair?  “Maybe like yours”.  The cutter knelt behind her on the pavement and released the band holding her hair back, which fell in a thick cascade down to her shoulders.  As the cutter began sectioning her hair Chom informed me that she would make around $35 and her hair would be used to make “I don’t know the word in English but you know for weddings?”.  Hair extensions.  In shock I suggested we leave and return to speak with her later.

As usual the visit to rural Cambodia was filled with fascinating sights, not least of all the 20+ buffalo being herded along the road towards a muddy damn where they bathed as their shepherds, ranging from young boys to older women and everything in between, sat on the banks above them.  My friend the cleaner is a strikingly beautiful woman about two years younger than me.  We have been communicating in broken Khmer (me) and English (her) for a year now, and despite the absence of a common language we always manage to make each other laugh.  It came as quite a shock for me to see her humble abode.  She is yet another shack dweller with almost no assets to her name!  If you met her in the street you would think this attractive, dignified, confident and happy woman had a very prosperous existence.  I’ve spent a year assuming so!

She saw the tuk tuk arrive and was at the gate to greet us.  Clothes were drying along the fence line.  We walked down a muddy slope to the front of the house which is a ground level wooden shelter with dirt floors, patches of which are dried mud moulded into shoe, foot and other odd shapes.  Slabs of tin are strategically placed around each other to make a loose roof.  Under the outdoor shelter area a typical bamboo base tripling as table, chair and bed depending on the need at any specific time sits along the wall in much the same position as my home in Australia has an expensive day bed.  Sitting at the front door on this base, it was very hot under the tin roof and when she noticed me fanning myself she ran inside and moved a wooden board across the so-called window (a hole in the wooden wall), which she then clipped a three-bladed contraption to and the three blades began rotating.  It was not like any fan I’d ever seen before but it did a kind of a job at circulating some air!

After a time sitting with her 10yo daughter who learns English six days a week, looking through her exercise book and hearing her read to me, we went for a walk and she showed me her rice field.  We then walked through the village, accumulating children like the Pied Piper as we went.  A seven year old boy joined us whose father has died and mother lives in another district, who my friend is raising.  He and all of the children were beyond cute and it was hilariously uplifting to watch our crowd of followers grow like a snowball as we walked along, all wanting to join in on the Barang Bandwagon!  One of them asked if I was a man or a woman which shocked me until she motioned to my short hair – rural children are not used to seeing females with short hair so I looked confusing!  We strolled through the dirt tracks of the village, lined the whole way with verdant rice fields where workers carried over-sized loads on their shoulders, a baby buffalo pranced away from it’s cowbell-adorned herd before being driven back onto the track by a tiny but skilled arm-waving shepherd of no more than about eight years old.

Tiny but skilled

Tiny but skilled

Chom had disappeared quickly to run some tourists between a couple of temples and so we sat down under a tree to wait for him, with many villagers passing us by on motos and bicycles loaded with all manner of stuff from boxes of beer to bales of hay, many of them calling out to my friend in amusement at her keeping company with the Barang or shouting “hello” to me.  The buffalo who were being shepherded towards the dam when I arrived, sauntered back home past us as we waited, allowing for plenty of photo opportunities.  I met my friend’s husband on this return saunter and learned that this is a communal village routine each afternoon.  Learning that they own a buffalo, I recognised that some of the moulded dry mud at their front door was actually buffalo hoof shaped.  It also explained the hay scattered about their front yard.

Chom finally reappeared to pick me up and we said our farewells.  We made our way back to town past many more typically Cambodian sights.  Families packed onto motos for their evening cruise.  Travelers sitting amongst luggage strapped to the roof of overloaded minivans.  Three cows on a lead attached to the hand of a motorbike driver clopping their way along the side of the busy highway.  Sidecar shops playing their tunes or broadcasting their recorded announcements.  Trucks loaded to the clouds with piles of wood and charcoal, and so many other sights I haven’t remembered.  Once in town we made our way to the “homeless pavement” but the lady wasn’t there.  She had told Chom that in the rain she sleeps undercover at a nearby location, so we putted around the bend and immediately found her sitting on a bench, the baby playing at her feet.  She had been to the Pagoda and received some food from the monks, still had milk left for the baby and said she was safe to sleep there tonight.

A young man appeared and stood near us, apparently listening to the conversation but clearly not an English speaker.  Chom told me that if I need to speak with her I must call him and he will come “as your bodyguard because some of these people they don’t care, they will steal from you and it can be dangerous.  If anyone is near her when you see her, do not stay for too long.  Also make sure you do not give her money because if you do then these people will find out and they will steal it from her.  Only buy her food or help her without money”.  Her hair was not shockingly short, perhaps cut in a way such that a section has been kept long which she can wear up in a bun, masking that most of her hair is actually short.  This calmed my horror on that score.  As Philip Coggan suggested to my previous post, I will see if there is an NGO who might be able to assist her in some way.  Chom suggested one NGO but they aim to return people to their homelands, and she made it clear that she intends to stay in town, as she is trying to escape her husband who Chom translated to me “is crazy”.  Domestic violence Cambodian style – stay and face the consequences or leave and face the equally dire consequences?

A Hungry Ride Home

This afternoon one of my colleagues came to the house and brought his young children to meet me.  The cycle home before our meet-up was – as always – interesting.  I stopped in at the bank on a corner where crowds were gathering on the road at the roundabout.  Through the masses I could see an upturned truck on it’s side and a small car behind it with a smashed in front bonnet.  Two soldiers with guns were sitting on a moto inside the circle of people watching over the scene and a policeman was wandering  between the vehicles.  It didn’t appear that anyone was hurt.  Trying hard not to look in case something gruesome was about to come into sight, I continued on my way.

Around the corner I heard a baby cry.  On the pavement beside me was a raggedy lady with a naked baby sitting on a mat under the shade of a tree.  Without knowing a thing about the baby I could see he was malnourished, with a fat little tummy sitting atop stick legs, little stick arms poking out from his shoulders, ribs all protruding and his little head looking over-sized for his frame.  I waved to his mother and she smiled and waved back.  About 50 metres up the road I arrived home.

Upstairs in my bedroom I drew the curtains and as I did, looked out in the direction of this woman and her child.  As I wondered if I might have a wine with my dinner, images of that little malnourished elf crying just out of earshot possessed me.  I grabbed a pair of shorts and a t-shirt that I’d been given months ago and was saving for the right child, and rode back to them.  Able to ask how old he was, she replied one year and some months (I’m still struggling with numbers!).  I tried to ask for some detail about why they are there and where they are from but with language, it’s fine to be able to ask a question but not so fine when you don’t have enough comprehension to understand the answer!  She lives over the river is all the information I understood.  Perhaps they have come to Kampong Cham for Pchum Benh?  I have no idea but I might get the chance to ask when Chom or someone else is with me.

When I asked if they were hungry she said she had no milk for the baby.  I popped to the market nearby and ordered two serves of fried rice, then I whipped around to the corner store and bought a box of long life milk.  $5.00 later they are still sleeping on the street tonight but they at least have full tummies.

I’ve since realised that she has no way of accessing clean water so I am about to head back out there with a bottle of water.   Meanwhile my colleague turned up with a bag of bananas and we had a nice catch up with his three little girls speaking to me in English phrases and me replying in equally unfluent Khmer phrases!  When I take the water I will also take a tub of yoghurt and some bananas.


It’s half an hour later and I delivered the water, yoghurt and bananas.  A number of other homeless people are on the pavement near her now, including a small group of men who have slung hammocks a few trees along from her.  This doesn’t make me feel confident about her safety but perhaps she is safer than if she was alone on a street at night.  There is also another family with skinny children on the corner, who have parked their scavenging barrow for the night.  Quite a little community of homeless!

The little boy is now dressed with an empty cup of milk beside him, sound asleep on the mat.

That’s as good as it will get for her tonight I suspect.

Dealing with DRTB

As my project with Medecins Sans Frontieres draws to a close, reflections about the year laid out behind me prevail.  I am only leaving Cambodia briefly but my departure and the end of my work commitment here have me feeling very philosophical about this beautiful and catastrophic nation and the incredible experiences I’ve had here.

When my predecessor left in October last year I was present for his farewell speech during the weekly all-staff meeting in the foyer, when around fifty of our almost-100-strong team stand around for a briefing of anything important that needs to be shared.  What struck me most about his parting words was the cherished memories he would forever hold dear, of working with Cambodian people.  I hoped then that I might have a similar experience but I had no idea how powerful an effect the people of Cambodia would have on me.  The gentle, humble, unassuming and fun loving nature of my colleagues, the national members of the orphanage board I am now part of, the children, the patients and their families, is really something that western culture could learn from.  I hope that I have learned from it and I suppose the challenge will be retaining my sense of “calm amidst calamity” upon landing back in the ego-centric culture that I come from and belong to.

That’s not to say that Cambodia is without problems.  You only need to read a little about the Khmer Rouge and their contradictory gentle yet murderous nature, to know that gentleness is not necessarily all that it appears.  Cambodia’s military and police forces are corrupt, dictatorial and can be extremely violent, as the front pages of national newspapers here illustrate almost daily.   Yesterday I cycled to work on a high after my encounters with Dara and his Shackville community.  As I approached the boomgate, the young man operating it who is usually friendly seemed reluctant to let me through and was looking across the driveway at something I had not noticed yet.  He let me through and I was immediately confronted by a very stern soldier with a rifle slung over his torso who ordered me off my bicycle and motioned me with attitude to keep away from a formal ceremony which was taking place in the driveway.  I was knocked off my high very quickly!  The use of military force to protect dignitaries here is a visible and common sight, with said dignitaries usually living very wealthy lifestyles beyond that which most Australians can imagine.

Almost twenty years ago a friend instructed me that I absolutely “must” watch the Quentin Tarantino film Pulp Fiction.  I rented it one afternoon, watched it alone and felt very disturbed by my own laughter.  In fact what I was laughing at was cold blooded violence and I was conflicted between laughter and wanting to press the Stop button.  I’ve since discovered that Tarantino’s skill lies in causing internal conflict in his audience.  A similar but far less concerning disturbance occurs here on a daily basis.  One of the most significant features of my year has been the realisation of my naivety as a monolingual English speaker.  The exposure I’ve had to Khmer and European people speaking and working in English has been a surprisingly profound lesson.  I am constantly entertained by the hilarious invented modifications of English, but it disturbs me at the same time because I have absolutely no right to find humour in someone else’s multi-lingual talents.  I try very hard not to appear amused, but as a native speaker it really is comical to hear your language mangled, especially when the mangling is perfectly comprehensible despite being so wrong.

Working alongside a translator with an academic interest in English and language in general, has been a new and novel experience.  I’ve learned so much, not just about the English language but also it’s global domination and the power it possesses.  Win calls Generation Y “The English Generation” and often nudges me if we are in a remote place and a young person suddenly speaks to me in English, proving his point.  When we have attended schools and universities for health promotion sessions, he always says to the crowd when introducing himself as my translator, that anyone who wishes to practise their English on me should do so instead of relying on him for translation.  Most young people have spoken to the crowd in Khmer but we always drew a small private audience afterwards, wanting to speak and ask questions in English with me.  This always seems like an extension of the daily bike ride ritual of being pursued by young people on bikes or motos wanting to practise with me, or children shouting out excitedly “Hello!  What is your name?!” or “Hello!  How are you today?!”, usually laughing uproariously when I shout a response back to them!

There are two young volunteers working at the orphanage for the next few months, who have given me a respite from the English teaching.  The timing was perfect as I am busy with my final weeks at work and the lessons have been time consuming.  The “extra” students who travel to the orphanage with us are not benefiting from these volunteers though so I am unsure whether to continue a small class with them or wait until my return, when my sole occupation will be teaching English.  I continue to be approached almost daily by parents and children wanting me to teach them English so it’s a high-need occupation.

In ten years working with Tuberculosis in Australia I encountered one patient with DRTB.  Here however, I have encountered dozens in a single year.  It is a complicated disease with many facets to it, not least of all the social problems faced by patients who are almost always impoverished.  This week alone we became aware of a problem with a young 20-something woman with DRTB whose mother is, like so many other Cambodians, crippled by an un-payable debt connected to health care costs (not related to her daughter’s TB as TB care is free).  This young woman has been under constant pressure from her mother to get a job and help with the debt repayments.  The first time I heard this story we were at her home, a small elevated hut on the edge of a dusty main road with bamboo strips for a floor which I was afraid to walk on in case they broke under my weight.  Looking around her hut which contained a hammock, a bed mat and not much else, this was one of the first exposures I had to what it means to be actually, genuinely “poor”.  Since then this level of poor has permeated my reality as I visit patients’ homes regularly and lifestyles like this are the norm for most rural Cambodians.

This particular young woman has raised concerns within our team as she has given conflicting accounts of how she is now spending her days.  She should ideally not be working at all, as she remains potentially infectious and could spread her drug resistant TB to colleagues.  However, as she has expressed her lack of choice in the matter, it was agreed that she look for work based outside so that good ventilation would reduce the risk to others.  She has given conflicting reports though, and asked questions which have raised our suspicions.  She claimed to her community volunteer that she was selling in an outdoor market but upon quizzing by our social work team it was suggested she was actually working in a factory.  We interviewed her community volunteer last week and I quizzed him extensively, recruited to do so because of the influence I hold as a Barang.  Along with my nurse, we felt he was being truthful, in that he continues to treat her as he is contracted to do and that he is not complicit in her work activities.  In past cases, the volunteers can agree to leave medication with the patient so that they are not observed taking their medication, which goes against the principle of Direct Observed Treatment which is recommended for DRTB patients in order to ensure all medication is taken correctly as prescribed.  We are still in the throes of investigating her situation in order to try and protect the public as much as possible but in such a low resource setting it is a difficult task.  The next intervention we plan is to attend on a “surprise visit” to see her unexpectedly – we often find out a lot of information during surprise visits.  In Australia a patient like this would be isolated in a hospital room with many resources in place to ensure adequate treatment adherence.  The possibilities here are so much more limited, and tend to require very creative interventions which has been a steep learning curve for me.

This week another patient went home after months in town because his rural location meant there was noone able to provide him with his daily injection.  The injections have ceased and he could finally return home.  One of my nurses attended his home the next day to meet and obesrve the practice of his community volunteer.  He returned and told me “I am very pity for this patient because he is so poor.  The house is made from leaf and everything will come through the roof – the sun comes and he gets very hot and the rain comes and he gets very wet”.  This patient hopes to find work in a nearby rice field, and if that happens he can feed himself instead of relying on his neighbours to feed him, as is currently the case.

I’ve written all of that from the air conditioned comfort of a local restaurant where I’ve sipped diet coke, munched on rice paper rolls and watched my beloved construction workers out there in the 34C (“real feel 42C”) , 60% humid weather.  The chef went out and returned with an orange gas tank strapped to the back of his moto which he then lugged through the restaurant out to the kitchen.  A moto-drawn trailer pulled up at the front with empty sacks covering a pile of produce packed into sacks on the trailer.  The driver lifted a full sack of what looked like potatoes off the trailer, heaved it onto one shoulder and carted it through the restaurant to the kitchen.  A woman covered in the traditional checked sunhat with matching face covering cycled by with a plastic basket hanging from each handlebar and a large cane basket on the back carrier, all filled with produce for sale.  A man wheeled his bicycle drawn carriage loaded with green coconuts past.  The construction workers pulled their archaic barrow filled with sacks of concrete powder past.  An untold number of sidecar shops attached to the side of motos slowly puttered by.  Teenagers, some even questionably that old, drove past on their motos with three to four pillion passengers lined up behind the driver.  A bicycle rider held onto the side of a truck, speeding along without any effort.  Children on bikes, pillions sitting on the handlebars or standing on the edges of the back wheels.  A father on a moto with two children holding on behind him – the c.2 year old sandwiched between Dad and big brother of about 5yo who had his arms around little brother, clutching onto Dad’s shirt.  Utility trucks with passengers crowded onto the tray back drove by.  A large old wooden boat meandered past on the Mekong with jeans and shirts hanging from the outside walls of the wooden deck shelter.  A woman with a large round flat tray balanced on her head, selling breads and nuts calling out a catch phrase to attract customers sauntered by.

To finish, if you want to know how DRTB is dealt with in Australia, take a look at this very entertaining article.  Even TB can be funny when the right person is inflicted with it!

Ghosts and Giving

We only have what we give ~ Isabelle Allende

This morning I cycled into Shackville en route to work and the mother of my little amputee friend called to him that I was there.  In a flash at high speed from around the corner of their shack he appeared and sprinted up a small hill to greet me excitedly on the roadside.  Life doesn’t get any better than thrills such as that!  I will give him the pseudonym of Dara, which means “star” in Khmer and is a popular boy’s name here (although most names are not gender specific).

This weekend is an extended (five day) weekend in celebration of the Pchum Benh annual festival across Cambodia.  In short, the past seven generations of ancestors are commemorated, at a time when ghosts of the dead are believed to be especially active.  Most Cambodians travel to their homelands for this festival, to be with family.  As I understand it (and I am by no means an authority on the subject), the festival culminates early on Wednesday morning with food offerings placed on small homemade boats of banana leafs and floated on the Mekong.  I may even have to wake early on Wednesday to see this spectacle?  At least I can go outside in my pyjamas without looking out of place!

Before I even knew the ghostly reference of the Pchum Benh holiday I passed comment the other day that as the only expatriate at the MSF guesthouse this long weekend, I hoped the house wasn’t haunted.  This comment elicited a lot of interest from a Khmer colleague who “didn’t think westerners would believe in ghosts, but I can tell you from experience, they are very real”.  This one nonchalant comment stirred a lot of discussion about ghosts and ghostly experiences.  Now that I am home alone for five nights I hope not to regret my ghost joke!  I am thrilled to be home alone – with all the comings and goings at the house, this is the first time in a year that I’ve had the house to myself.  Expect many blog posts as writing dominates my Me Time!

I didn’t know it at the time but my connection with Dara began when I first became obsessed with the construction workers laying concrete near my workplace.  It was an astounding thing to watch them, as I have written about previously, using almost archaic tools and laboring relentlessly in the heat, covered from head to toe in the most unlikely attire.  I was regularly mesmerised and we came to know each other by sight (sometimes based on head coverings or pyjama colours alone if I only ever saw them wrapped up!), never able to converse but always calling out in friendly terms when we saw each other.  I am unclear if it is the same group or another group who have been building a concrete embankment and widening the walkway at the riverside over the past three or more months, but this riverside group, who I began photographing long before I met Dara, work and live with his parents.

Cycling to work in the morning now that I know these hard-working, poorly-paid, rag-wearing, shack-dwelling men, women and children, is an affable journey of waves, smiles and hellos which despite it’s extreme contrasts, nevertheless has comparisons with my experiences in the town camps and remote communities of Central Australia.  They contribute in no small way to my life, despite the fact that we understand very little of what each other is saying.

This morning Dara asked me to buy him a “dukkaw” (which is my personal phonetic spelling of the word).  A milkshake with fresh fruit, sweet milk and ice, at 3,500 riel (more than 75c) per serve, it is considered a big treat.  I managed to promise in Khmer that I would return with one later in the day, before heading to a riverside restaurant about 200 metres up the road for breakfast.  I parked my bicycle, left my sunhat in the front basket, sat down inside and ordered breakfast.  I then looked out of the window to the sight of Dara’s mother pulling the antiquated wheelbarrow, and suddenly Dara himself appeared, presumably having hitched a lift in the barrow.  He had clearly spotted my hat and bike and he played over the road for the twenty minutes or so that it took me to order and eat breakfast.  When I appeared outside he excitedly ran over the road to join me, as I dashed to the roadside in horror that he was about to get run over in his excitement.  I explained that I was heading to work, put him on the carrier of my bike and walked him back over the road to Mum, promising to return with a dukkaw later on.  Around the same time I received a text from Chom, “Good morning Helen, how are you?  I saw your bicycle at the restaurant, enjoy your breakfast.  See you later”.

Children in barrows are a common sight

Children in barrows are a common sight

The barrow used by Dara's parents in their construction work

The barrow used by Dara’s parents in their construction work

Forming connections with and helping people who live with extreme struggles in life is the most rewarding experience of my life.  Not out of any Mother Teresa-Ghandi-type selfless motive, but because it makes me feel useful, good and positive to be able to interact with people who are destitute and/or marginalised.  So my motivations are purely selfish.  It is also very easy to give when you live in a third world country because you are surrounded by pressing need and I am not comfortable “lording it” as a well fed, well financed foreigner around people who deserve the same comforts I have but due to circumstance do not and probably never will have, the lifestyle that I take for granted.  It’s surprising the tiny amounts of money which can make a big difference too, as costs in Cambodia are miniscule compared with costs in the western world.

Many others I know agree that their lives are enhanced by giving.  I have a friend in Phnom Penh who has done all kinds of truly generous and life saving things for people in collaboration with her husband, just because she sees the need and is in a position to help.  From such unknown individuals to high profile people such as Bill Gates and Warren Buffet, I don’t think it’s any secret that a meaningful and rewarding purpose in life can involve helping disadvantaged people.  Our privilege also determines our ability to help and I know that if it were me who was hungry, homeless, unable to pay a hospital fee or in need of income generation assistance, I would hope that someone who saw my need and was in a position to help, did so.

Over the past year I have parted with thousands of dollars, in small doses, to some of the many worthy causes which have looked me in the eye daily.  This is money I could have saved, living in a low cost country.  But saving for such western “needs” as travel or bathroom renovation has seemed much more like hoarding from here, than any kind of westernised “common sense”.  And as much as I embrace the practise of giving, I equally reject the practise of hoarding.  I also believe very strongly that there are many ways to invest, which don’t all involve accumulating monetary wealth.

In the meantime, from afar, Bea’s family are talking about donating to Cambodia instead of giving each other Christmas presents and have approached me as one of the possible “conduits to a cause”.  I am thrilled because it would certainly be put to good use.  But I am also reticent to some degree as experience has taught me that acting as a conduit to charitable contributions can have negative consequences.  I continue to distribute toys and other gifts to children from the myriad boxes which arrived from overseas over the course of a few months earlier this year, which has been an enormous and at times overwhelming task.  The outcomes of this well-intentioned but chaotic endeavour included many more negatives than I ever could have imagined and I vowed I would never get involved in such an undertaking again.

In the past year I have also received monetary donations from people who wanted to help and which I’ve been able to put towards certain causes, making a small difference to a number of different families.  I have also learned from my mistakes and I know now, that provisos need to be discussed and considered before accepting contributions from “outside” the situation.  Sitting on the orphanage board I have learned that it is not uncommon for people to offer to donate to specific concerns, such as school fees.  When those costs have already been covered but other needs exist, these conditional offers can be problematic and create a lot of work for the fundraisers involved.  Medecins Sans Frontieres refuse to accept conditional money for similar, albeit bigger-picture reasons.  In fact MSF were in the news this week for rejecting an offer of money from the Australian government towards the Ebola epidemic, claiming that government resources and personnel rather than money are required.  Conditional contributions, or contributions with political or ideological affiliations are regularly declined due to the risk that they may threaten MSF’s independence and neutrality.  So charitable concerns are complicated, and despite the level of need that exists, it is not always wise to blindly accept offers of help.  This is probably why child sponsorship is so popular – it gives the charity control over how they spend their money whilst maintaining transparency to donors about how their money is spent.  A human connection to donations is very important and child sponsorship provides this to donors.

Speaking of donations, today we donated a bicycle to a patient who came to the office to collect her wheels this morning.  She is a young woman with HIV-DRTB co-infection, who contracted a shocking systemic case of Chicken Pox whilst hospitalised with us a few months ago.  The Chicken Pox smothered her whole body including her eyes and the lining of her gastro-intestinal tract, causing a multitude of painful and life threatening symptoms including diarrhoea, dehydration, malnutrition and vision disturbances.  Since being discharged from hospital she has been walking a few kilometres each way to access her daily treatment from the designated community volunteer.  She now has a means of getting to her treatment quickly and the smile on her face as she cycled out of our gate this morning was priceless.

The farewells have started and today I said goodbye to one of the doctors at work who wrote me this priceless note:
Thank you, what your kind
Wish you good travel, good luck and healthy
All your action, I’m going to take in my heart for ever.
At my farewell party last night, amidst failed attempts to teach me how to dance with the grace of an Apsara, insistences were made that I must make contact upon my return (at which time I will be traveling independently), and a number of offers were made to “volunteer for you”!

The gratitude and friendship, laughter and kindnesses that Cambodia has given to me far outweigh anything at all that I could ever give back and I just hope that I can remember as many Cambodian Moments as possible because my Cambodian year has been beyond special.

Crashing With Courtesy

Living in a house full of people has it’s joys and it’s woes.  We have a big beautiful home with a balcony overlooking the Mekong, our own cook and cleaner and a very comfortable home life.  A joy!  We each have our own ensuite bathroom – another joy.  Except for the poor soul who happened to look up one morning to a pair of peeping eyes (belonging to an overnight visitor) looking down on her naked body through the vent leading into the ensuite next door – that was a definite woe!  In my year here we have had many interesting colleagues visit from Phnom Penh, Australia, USA, Japan and France – mostly a joy.  Except for the aforementioned peeping tom and the time a (very nice) manager arrived from Tokyo to inform me that five of my team of 14 were about to lose their jobs – an obvious woe.  A house full of certain friends from all over the world – that’s mainly been a joy.  Except the times when it was more of a woe.  But thankfully those times have been few and far between in the big scheme of things.  I have been exposed to a previously unfamiliar condition, the “European Princess Syndrome”.  EPS is a woe of mild to magnificent proportions, magnified to sanity-threatening levels if the offender is not very pleasant.  But mostly I have experienced rapport and solidarity with like-minded souls who have become solid, lifetime friends with many great shared memories.

When I was interviewed at the MSF Office in Sydney sixteen months ago my interviewer told me that the dynamic within the expatriate team either makes or breaks the experience of any mission, as these are the people whose pockets we are forced to live in, the upshot being a “warts and all” relationship, often with little breathing space.  At the time it went through my mind that this would not be the case for me because it would matter far more to me, to enjoy the work and have a “cultural experience”, and that any “expat effect” would be insignificant to me.  How wrong I was!  Thankfully the living situation here has been far easier than many MSF missions.  But at times during the past year my sanity has definitely been threatened – due to unpleasant EPS.  But thankfully, in the main, the expatriates living and working with me have been more compatible than I could have ever hoped for.  Which is definitely the main reason that I am returning home with cherished, positive, happy memories of a most amazing year.

Some time ago Bea lost a bunch of clothes which went missing after she put them into the laundry load for our cleaner.  I assured her that occasionally things go missing but they ultimately reappear.  Some months later her four or five clothing items remained missing and so we approached the responsible English speaking representative, who contacted the cleaner to enquire about the missing clothes.  That night her clothes were hanging on the communal clothes rack, looking like they’d returned from a long holiday all refreshed and crisp!  Without language skills to say more than a passing hello to the cleaner, we have never found out where they went and so it may remain a permanent mystery.

Marty, our much-loved boss and housemate who is departing tomorrow for pastures new, had told us about a beautiful riverside village that he knows well.  So this morning we went out on our bicycles to explore this area and I decided to wear my pink thongs.  But when I looked for them on the communal shoe rack they were nowhere to be found.  I mentioned this to Bea while we were out and she laughingly told me that at one of the other houses, our Cambodian colleagues wear her shoes around the house.  Oneday recently she looked down at her assistant’s feet and he was standing there in her Birkenstocks!  We were chuckling at this as we bounced along a pothole-ridden mud-soaked country road when Marty appeared cycling towards us, returning from an overnight stay with friends in the village.  We stopped for a chat and he confirmed our route before we continued in our opposite directions.

It was a beautiful bike ride to a very attractive village with an interesting pagoda complex, neat and pretty gardens and plenty of charming rural scenes.  With mud and puddles everywhere the polite but lawless traffic was even more disorderly than usual as vehicles veered to the wrong side of the road to avoid being bogged.  We cycled in a swerving pattern depending on what others were doing and despite cycling past cars, trucks, mini vans, motos and all manner of other larger vehicles passing us on very sloshy ground, not once were we spattered with mud as everyone slowed to a snail’s pace, often smiling or calling out “hello” as our paths crossed.

We made it home safely and when I walked through the door I flipped my shoes onto the shoe rack, to the vision of my missing pink thongs.  With everyone else away for the weekend, it was apparent that Marty had taken them for an overnight excursion to the village and he must have been wearing them when we chanced upon him during our conversation about the alien habit of wearing other people’s shoes!

With the rainy season comes the risk of accidents, which are minimised despite the lawlessness on the road, thanks to the collective courtesy I’ve mentioned.  On Tuesday I pulled into the office on my bicycle as our affable cleaner was standing near the parking area.  She shouted happily to me “Helen!  Soksabay te?!”.  I braked in my parking spot, put my right foot onto the ground and before I could reply to her, my foot slid across a patch of mould on the concrete, my body followed, and I toppled to the ground with my bicycle landing on top of me.  Unhurt I replied immediately with “Ot soksabay te!” (No!  I’m not well!).  I was laughingly hauled off the ground amidst lots of chatter and hilarity, feeling slightly humiliated by my oafishness as the watchman appeared with a shovel to scrape the mould off the concrete.

That evening the household were meeting out for dinner and I arrived at the restaurant first.  I sat down before realising that the standing fan was not blowing in the right direction.  I stood up and walked around the back of my chair to move it, unaware that the pot plant beside me had just been sprayed with water which had settled on the floor tiles.  My foot slid out from under me on the slippery floor and I landed on my right knee on the tile.  The waitress rushed to my aid and as she asked “are you okay?” my knee slid out from under my hip, and the floor tile rose to smack me in the face.  Lying face down on the floor I replied “yes” before clumsily lumbering myself up and moving my humiliated body back to my chair, as the waitress moved the fan into place before mopping the floor dry.

The next day I was cycling to work when, as often happens, another bicycle came around the corner towards me, on the wrong side of the road.  Looking at the teenage boy pedaling towards me, some lyrics from “A Slice of Saturday Night”, an old West End musical, entered my head: “I’m looking at you…. looking at me …. looking at youuuu…. who’s looking at meeee!”.  As we stared at each other I assumed in my lyric-preoccupied thoughts, that he would veer out of the way, given that he was the one on the wrong side of the road.  Apparently he made the exact same assumption about me and by the time we both realised that the other was not moving out of the way, it was too late.  I screamed in fright as our front wheels collided head-on without either of us even reaching for our brakes!  Once more the ground rose to meet me!  I lay on my back for a moment, my bicycle handlebars pressing into my abdomen, the back wheel pressing against my ankle.  Realising that I wasn’t hurt I pushed the bike off myself and stood up.  My fellow casualty, equally unhurt, stood up at the same time.  Standing beside each other with no common language, we looked at each other in stunned silence.  I started to laugh and he said what sounded like “bitch” but was probably something polite/apologetic, before mounting his bike and cycling away.  A Slice of Saturday Night is a very funny musical.  Almost as hilarious as this latest meeting between my skull and the ground!  I laughingly hummed those lyrics all the way to the office, approaching the intersections much more hesitantly than usual.

This evening I sat in my favourite restaurant writing when a text arrived from Chom “Hi, how are you?”.  I replied “I’m okay, I’m just sitting at <the restaurant> relaxing”.  Five minutes later a very wet Chom walked in the door and plonked himself down.  A boring day with no customers and now it’s raining!  We sat and talked for two hours, about the children we teach together and the funny things they say and do; about Chom’s family and childhood which is typically marred by premature death and suffering.  He reminded me of the day we were at a rural village together when some national colleagues appeared from nowhere as we were running from a rainstorm and called us in under their house.  They were having a bit of a party and we joined them for a beer while waiting for the rain to stop.  Chom asked me did I remember seeing the meat that the men were eating that day?  I don’t remember seeing any meat.  “Oh.  Because it was dog.  But they told me, don’t tell the Barang that we are eating dog, because they will not be happy with us”.  Quite honestly, as long as the animal dies quickly without unnecessary suffering, I don’t consider eating dog to be any different to eating pig, cow or any other animal (except I don’t intend to ever eat dog myself).  It was a fun couple of hours and I love having such a mixture of friends – local and expat, all mixed in together with such interesting and often-comical differences between us all.

Injustice Anywhere Threatens Justice Everywhere

These are a shortened alteration of words written by Martin Luther King Jr, the famous American Civil Rights leader.  They are words that have always struck a chord with me.  In quoting them here, I researched where they came from and it’s an interesting story.  In Birmingham Alabama in April 1963, during demonstrations against racial segregation, Luther-King was arrested and imprisoned for eight days.  During his imprisonment someone smuggled a newspaper to his cell where he read an opinion piece by a group of white clergymen criticising the illegality of the civil rights protests.  Luther King replied to them via the same newspaper.  In his reply he talked of the legalities of genocide in Hitler’s Germany compared with the illegalities of various historical civil disobediences which have changed the course of history for the better.  He outlined the difference between just and unjust laws.  He also addressed the accusation of the clergymen that “outsiders” were traveling to Alabama to cause trouble, by explaining his unity with fellow humans wherever they may be.  It’s an excellent although wordy letter, the full text of which you can find here

Ohio State University are currently running a (free) online 4-week-long Human Trafficking course via which puts this philosophy at the fore of my thoughts as I learn about some of the horrific existences many people we share our world with live, day-in-day-out.  It is estimated that almost 30 million people around the world today are held in slavery, which includes child trafficking, debt bondage, forced labor, sexual and criminal exploitation and domestic servitude.  Organ trafficking is also a big issue, with people from rich countries traveling to poorer, less- and un-regulated countries to purchase organs from live donors, many of whom are either not fully-informed, or not donating of their own free will.

In East Timor two years ago I worked alongside an English woman who had spent some years recently in Bangladesh, entering brothels to provide condoms and health education to prostitutes.  Most if not all of these women were held against their will by individuals or syndicates who had often procured the women by dishonest or violent means, usually tempting them out of desperate and impoverished circumstances with fraudulent promises of a better life.  This colleague told me a little about the stresses of her work in Bangladesh, where she and those she worked alongside had to suppress the urge to help individuals escape in order to protect both the safety of the women collectively, and also their own access to the brothels, in order to continue their work of protecting the women’s health.  Coming from a safe and comfortable existence where front page news usually highlights the latest celebrity marriage, pregnancy or divorce, outrages from the latest reality television shows and how to make the most out of your next overseas holiday, at the time I was horrified to learn that such things are occurring in our world, today.

More than any of the poverty and suffering I have observed in those around me here, which shakes me up and spits me out almost daily, the biggest impact of my experiences in East Timor and Cambodia is the awareness I’ve developed of my own incredible privilege.  Given that truly understanding others is ultimately a fairly futile pursuit as we can only ever view the rest of humanity through our own filters and perceptions, then all life experience really only ever allows us, is to develop insight into our own character and purpose.  During an interview fifteen years ago for a position working with indigenous people in Central Australia, my indigenous interviewer asked me to explain my understanding of cultural awareness.  My answer was very brief – that being culturally aware has nothing to do with understanding other cultures and everything to do with having insight into our own culture and how we might be perceived by others.  (He liked my answer and employed me!).  My opinion on this has never really changed after years of living and working alongside people with very different worldviews.  What has changed, is that I no longer only know in theory that I belong to the richest and most advantaged 5% of people in the world.  This fact has become blatant and tangible, pervading my everyday experience like a seventh sense.

With that privilege comes an evolving sense of my purpose in life.  I feel even more privileged that I can live this purpose, which is again, thanks to the entitlements I was born into through sheer luck.  Most of the people I encounter in the third world also have a purpose, but are so busy surviving that such ostentatious ambitions can only be fantasised about.  Not to mention the fact that the burden of poverty is almost entirely carried by the poor.  By this I mean that those of us coming to the third world to work and contribute are not the main contributors to alleviating third world suffering – that accolade belongs fairly and squarely with the neighbours, grandparents, older siblings and various other community members and local or national organisations who feed, clothe, house and care for the needy in their own society.  This further disadvantages already-struggling populations as the strongest citizens carry burdens instead of focussing on their own personal aspirations.

Even my colleagues whose families have dedicated time and money to expensive educations in order to increase their prospects, can only dare to dream about the opportunities that I take as a given.  When they ask me about my plans after leaving MSF I find the answer awkward as I am aware of the picture of affluence that it paints, to talk about traveling overseas for a year without working.  I’ve also started questioning these plans – to have lived the past year amongst hunger and adversity, do I really want to put myself in New York City and be hedonistic and self-centred?  Doesn’t it go against my supposed new sense of purpose?  Most people cannot imagine having such First World Problems and here I am, listening to Simon and Garfunkel croon about New York at me while I ponder whether my heart really is in New York, or if my goalpost has well and truly shifted?

The orphans are currently on an annual and much-anticipated holiday with their carers, visiting Angkor Wat, so our usual classroom has been unavailable this week and our class of 18 diminished to six, which then diminished further as two and then three of the remaining students were also absent.  We took these children on their own treat, to a riverside restaurant usually only affordable to Barang, where we ordered food and drinks from the menu.  One of the girls ordered a serve of ice cream which was very tiny but when I offered her to order something else she declined.  In response to this, Chom informed me that 13yo Vorn was instructing her “you have to eat everything you can because you will never come to a restaurant like this again, it’s too expensive for Khmer people”.  Three meals, four desserts and eight drinks grand totalled $24, which shows how “expensive” this restaurant is!

Today Win and I visited the little amputee guy at Shackville.  His baby sister had chicken pox last week and she spent the week coloured purple as Mum kept her smothered in Gentian Violet.  Today her big brother is sporting some lovely little poxes on his face.  Yesterday I picked him up and brought him with us to the restaurant where he sat with the English students, wondering what we were all doing, but happily sipping on a coconut milkshake and enjoying the “very nice house” that he told his Mum I took him to.  As he would have been in the infectious stage of his chicken pox yesterday I am now on tenterhooks, hoping I haven’t exposed the other children to the virus, or that if I have, they are already immune, which is quite likely.

When I told Win we had taken him with us to a restaurant yesterday, Win replied without judgement “you can see how easy it is for Khmer children to disappear or end up adopted.  Just because you are Barang, you can take him with you because they trust you and they are hoping for something better for him and for themselves.  You are a good person, but plenty of Barang with bad intentions could do the same thing, and they do.  He is very vulnerable”.  My admiration for Win only increased when we took a takeaway container of fried rice to the little guy oneday, when he had proclaimed hunger as his mother worked at her labouring job off in the distance while he sat alone on the undercover platform shelf outside their shack.  When we returned with the rice, Win noticed a young mother with her small child standing nearby and recognised that the little girl was hungry.  He took the takeaway container, ripped it in half and dished about a third of the rice into the second container, passing it to the young mother for her child.  As he did so he said to me “It’s important for all children to learn about sharing”.  His values, understanding and compassion are inspiring.

This ties in with the theme of human trafficking and why people from third world countries are so much more vulnerable.  According to the United Nations Interagency Project on Human Trafficking (UNIAP), there are a range of trafficking networks in Cambodia, from small and ad-hoc to large and well-organised.  Reasons for Cambodia’s vulnerability to these activities include the recent turbulent history which has seen an undermining of traditional structures such as family, community, the central role of elders and Buddhism; the lack of local educational opportunities and employment which encourages people across borders; natural disasters; corruption; debt pressures; increased tourism; untenable labour supply compared with the job creation rate; and many others (refer to UNIAP at  It is also a huge strain on the country that half of the population are under 20  years of age.

Meanwhile I have been roped into a fundraising bicycle ride in Sydney not long after I return and I recently registered online for the race before sending out a fundraising email to my all-too generous friends and family.  I’m amazed at the sponsorship I’ve accrued with next to no effort for a very worthy cause, but I can’t help but think about how much suffering this money could alleviate had I the means to raise the same amount for a Cambodian cause instead of a perfectly deserving health-related western cause.  But comparisons are not something I will allow myself to make as Australia has the means to sustain itself and that can never be considered a bad thing regardless of what is happening elsewhere.

This week I also heard from the husband of an amazing friend who I first met earlier this year in Cambodia.  She wrote to me about six weeks ago asking for my opinion on the idea of going to work with the Ebola outbreak in West Africa.  We exchanged thoughts and soon enough, as I predicted the moment she mentioned it, she signed up to go.  I have not heard much from her since, but she’s in Liberia and today I heard her voice crack as I listened to her interviewed about her experiences in the few short weeks that she has been there, describing it as “the zenith of her career; an honour to be part of the work; the sense of what you’re doing is just palpable; Doctors Without Borders needs much more help on the frontlines of this fight”.  You can hear the short interview at this link:

An excellent opinion piece appeared last week in the Washington Post by Dr Paul Farmer and his colleague and good friend Jim Yong Kim, which I will post below in full (it’s not very long).  The main point of their discourse is that “The Ebola crisis today is a reflection of long-standing and growing inequalities of access to basic health care”.  These inequalities do not have to exist and with any luck, given the work of people such as Farmer and Kim, they will follow the path of other outdated views, such as that which was once popular about the AIDS epidemic being “hopeless”.  It’s revolutionaries like these men who make the seemingly impossible, possible.  In a world filled with apparent hopelessness, champions such as Paul Farmer, Jim Yong Kim, Ophelia Dahl, Dan Murphy, Scott Neeson and so many others who work to make a difference rather than settling for the status quo, give our world hope and a future that doesn’t have to settle for the cynicism of despondency.  To quote Neeson who I am sure is quoting someone else, “while we can’t save everyone, if you save just one then you have made a huge accomplishment”.

As I listened to the interview with my American friend another friend in Australia messaged me asking how I can ever return home after the experiences I’ve reported from afar in the past year?  I guess that’s a question to be answered in 14 months’ time when I am due back at my much-loved, but well-worn job.  This past year has certainly challenged my perceptions of where I belong and what I should be doing with my life.

Abject Poverty

What’s Missing in the Ebola fight in West Africa

August 31

Jim Yong Kim is president of the World Bank. Paul Farmer is the Kolokotrones University professor at Harvard University. Farmer and Kim, who are infectious disease physicians, co-founded the nonprofit organization Partners in Health.

If the Ebola epidemic devastating the countries of Guinea, Liberia and Sierra Leone had instead struck Washington, New York or Boston, there is no doubt that the health systems in place could contain and then eliminate the disease.

Hospitals would isolate suspected cases. Health workers would be outfitted with proper protective clothing and equipment. Doctors and nurses would administer effective supportive care, including comprehensive management of dehydration, impaired kidney and liver function, bleeding disorders and electrolyte disturbance. Labs would dispose of hazardous materials properly. And a public health command center would both direct the response and communicate clearly to the public about the outbreak.

Ebola is spread by direct physical contact with infected bodily fluids, making it less transmissible than an airborne disease such as tuberculosis. A functioning health system can stop Ebola transmission and, we believe, save the lives of a majority of those who are afflicted.

So why isn’t this happening in West Africa, where more than 1,500 people have already died?

As international groups pull staff from the three countries, airlines suspend commercial flights and neighboring countries close their borders, some have argued that it will be next to impossible to contain the outbreak — that public health systems are too weak, the cost of providing effective care too high and health workers too scarce.

But Ebola has been stopped in every other outbreak to date, and it can be stopped in West Africa, too. The crisis we are watching unfold derives less from the virus itself and more from deadly and misinformed biases that have led to a disastrously inadequate response to the outbreak.

These biases, tragically, live on, despite evidence that disproves them again and again.

Just 15 years ago, Western experts said confidently that there was little that rich countries could do to stop the global AIDS crisis, which was killing millions of people in Africa and elsewhere.

Today, thanks to leadership and advocacy from President George W. Bush, a bipartisan coalition of members in Congress, courageous faith-based organizations and U.S. government researchers such as Tony Fauci and Mark Dybul, more than 10 million Africans are getting life-saving treatment.

The take-no-action argument has been used over the years as an excuse not to mount an effort to control drug-resistant tuberculosis, malaria and many other diseases that afflict primarily the poor.

But the reality is this: The Ebola crisis today is a reflection of long-standing and growing inequalities of access to basic health care. Guinea, Liberia and Sierra Leone do not have the staff, stuff and systems required to halt the outbreak on their own. According to its ministry of health, before the outbreak Liberia had just 50 doctors working in public health facilities serving a population of 4.3 million.

To halt this epidemic, we need an emergency response that is equal to the challenge. We need international organizations and wealthy countries that possess the required resources and knowledge to step forward and partner with West African governments to mount a serious, coordinated response as laid out in the World Health Organization’s Ebola response roadmap.