Two Plus Two Does Not Equal Four

These are wise words from a good friend and ex-colleague from MSF who works with me on the Board at Phter Koma.  About ten years older than me, he was a young boy when the Khmer Rouge took control of Cambodia in 1975.  When Lisa visited me in July last year she purchased a book “When The War Was Over: Cambodia and the Khmer Rouge Revolution” by Elizabeth Becker.  Not long later, she pronounced it as too heavy-going and I inherited it.  With everything else going on I haven’t read it regularly but I have continued to slowly plough through and am learning a lot from it.  I’ve just reached Chapter 7 on page 205, with over 300 pages to go yet.

The background to the Khmer Rouge is one of surreptitious paranoia on a background of communist and xenophobic doctrines.  After proving to be a less-than-average student, Pol Pot obtained a low-level qualification in Paris, where he became involved with Communist movements in Europe and then South East Asia before branching out to form the Cambodian Communist Party which became known as the Khmer Rouge (French for the Red Army).  For years his position as head of the organisation was known only by a very few close leaders in the party.  In the years prior to 1975, Cambodia was already politically volatile.  Lon Nol, the Prime Minister overthrown by Pol Pot in 1975, had himself led a coup against the ruling King Sihanouk in 1970.  Both of these predecessors behaved as megalomaniacs, lurching the country between disasters and predisposing their people to the legacy of the Khmer Rouge.  When the Khmer Rouge overtook Phnom Penh in April 1975, the city of 3 million people were immediately marched into the countryside to join agricultural collectives.  Millions lost their lives to violence, murder, starvation and disease as traitors were identified and “disappeared” and village populations inflated to beyond capacity upon their forced arrival.  In my opinion, Cambodia provides a prime example of the way that destructive power taking root at a given point in time in a given place, can impact upon many generations of time and place.

The repercussions of events from decades ago continue to impact significantly upon Cambodians today.  Anyone my age and older, is affected by memories of trauma related to American, Vietnamese and Cambodian terror including relentless air raids and land-based assaults.  Arguably the worst assault of all, being the defeat of Phnom Penh in April 1975 by soldiers who were initially believed by many to be liberating them towards peace.  This could not have been further from the truth.  As a young girl in New Zealand I have a clear memory of my mother claiming that “Pol Pot is a bad man” and that he was doing bad things to his own people in Cambodia.  It did not make sense to me at the time and I certainly had no comprehension that oneday I would go to live in this far-away land.  At the same time, as I was going to school everyday, attending Brownies and Swimming Club, sleeping over with friends, playing with siblings and cousins, jumping on our trampoline and eating three meals a day, my insightful Cambodian friend was living an altogether different existence.

He openly talks of his experiences and last night in conversation about things he gave me permission to tell my version of his story here.  I am afraid that I won’t do it any justice because his experiences are so far removed from my own that it’s difficult to comprehend what he is even talking about sometimes.  His mother was born in the year of the Tiger.  He says that “She was a rich lady.  Once she lost everything of her own, she pitied me and oneday she told me “You are really unlucky.  I am a tiger and I was very strong.  But now I am too weak, like the tiger without teeth.  So you have to learn how to live by yourself, because I have nothing to give you, I have no ability to feed you””.  When my own mother visited me last year he was very surprised to learn that I still had a mother and that she could travel.  My perception of this was “gee, I really must be looking old these days”.  But he went on to say “My mother died when I was still growing up.  I miss her even now.  She was the one person who I trusted entirely and who always listened to me and understood me no matter what”.  I feel the same way about my own mother.  The difference being that when I lose her, I will have had a solid lifetime of good health and prosperity with her, not a fleeting childhood of trauma and starvation.

My friend is a doctor who did his medical training in Vietnam after joining the South Vietnamese military in the 1980s.  In his 50s now, he has nothing.  The “good” salary of around $1,000 per month which he has earned via MSF for about seven years now will come to an end later this year and he expects to find a standard job as a doctor earning in the vicinity of about $400 to $500 per month.  He does not have a home or any savings.  His earnings have been used to put a number of nephews through university, who now sport some very impressive qualifications including a recently qualified architect.  When he has not been helping family he has been involved with the children of Phter Koma, most of whom he has known since they were infants, watching their parents die as he tried unsuccessfully to save them from their AIDS disease.  We were at Phter Koma together last night and the children, happy to see this paternal figure, put on a musical performance in the front yard for us, using a plank of wood as a microphone and a broom as a guitar.  Many laughs and hugs were shared.  When his contract ends with MSF he is planning a change in lifestyle.  There will be no money for personal internet connection or domestic travel, nor for continuing to assist others, including the children at Phter Koma.  Attempts to convince him of alternative solutions such as financial assistance are met with dignified refusal, which I understand but find difficult to accept.  The continuing legacy of Cambodia’s history is one of such intense destitution that the men and women best placed to execute positive change remain so focussed on survival that it is not possible to think beyond their own needs.

During the Khmer Rouge my friend grew up as an orphan, occasionally seeing his mother when their mobile collectives would merge together perhaps once a year.  He was placed in a collective with other boys and learned to be quiet and compliant as the soldiers monitored friendships and moved people around to avoid anyone becoming too close or friendly with each other.  He was also regularly quizzed about what he knew of the people in his group so he said nothing and he heard nothing in order to remain safe.  Anyone seen to be behaving in a traiterous manner could be taken away and never seen again.  Today he is outspoken and confident but he understands why so many of his generation remain quiet and without opinion.  He was the youngest of thirteen children in a wealthy family in 1975.  By 1979 his father and nine of his siblings, their spouses and children were all dead.  His mother died in the early 1980s.  He lived on the streets as an orphan before joining the military where his academic ability led him to medical school.

As we spoke last night he said a few profound things, which I have come to expect from this wise-hearted mentor.  I had offered to try and help in some way because to me, a homeless, fully functional doctor is not a normal or acceptable reality.  In my world respected doctors earn too much, not too little, and this situation feels intolerable to my western perspective.  His reply was that he was happy for me to tell his story but that I should not ask for help and that if help were to be offered, he would have to gratefully decline.  “Since I was born my heart has been broken so this is the normal life for me.  The suffering in Cambodia is so much and the children at Phter Koma are only 12.  For me, in Cambodia when you are old, no matter if you are Buddhist, Christian, Muslim or anything, you can go to the Pagoda and they will look after you”.  The future as he sees it has a Cambodian solution, not an imposed foreign solution and I appreciate this.  At the same time I lament the consequences Cambodia continues to live with, of an era impacting upon generations who did not create and do not deserve the world they happen to have been born into.

When he stated last night that “with human beings, two plus two does not equal four” he was not talking about anything to do with what I’ve written about here.  But his comment is the perfect title of this blog post because it exactly describes the disproportions of this arbitrary and somewhat pre-destined world we all share.

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Toilet Village to Tuk Tuk City

The more global citizens there are, and the more active and effective they are, the more progress the world will make. We hope you will show your support by signing up, because we believe that people can and must work together more to make the world a more equitable place. In fact, we’re betting on it.  ~ Bill & Melinda Gates

I love being around Khmer people, they are fun loving, gentle and full of good humour.  The other night I was at a riverside restaurant eating offal and fermented seafood like a local, with the locals.  When I say “like a local”, that’s if you ignore the concentrated straight-face trying to disguise my nausea at the smells, tastes and textures I was being exposed to! The restaurant was very close to Chom’s village.  Many laughs were had and I had a great time, but being near his home I did miss Chom, although the crowd I was with don’t know him.  The day before he had sent me this text as he left town for a brief trip to Phnom Penh without his wife, his son or his older adoptive sister (me)!  His message reflects my feelings exactly: “I leaving now.  My fell I very miss you.  I will be back tomorrow in the evening.   See you”.  I have my mother to thank for the friendship.  She came to visit a year ago and oneday arrived home full of stories about the wonderful driver she had spent the morning with.  Little did I know she was about to introduce me to one of the all-time best gems in my life.  Kind of appropriate I guess, that one gem introduced me to another.  Thanks Mum!

Before heading to Phnom Penh for a few days from this afternoon, Chom picked me up on his moto and we headed out to “Toilet Village” hoping to find a finished construction.  Alas they’re still working, probably held up by the huge boulders which had to be removed from the pit by hand.  They were tiling the room today and the pit is yet to be covered by a concrete lid and cemented over.  It is otherwise all but finished.  We’ll head back on Sunday with the intention of seeing the finished product and maybe, as suggested by Mum, I can do a ceremonial “first pee” down the squat pan!

The country lanes taking us about 15km out of town are full of interesting sights which I try to memorise whenever I am on them.  Roosters strut along the roadside, hens and their flock of chicks run at high speed to get out of our way, bicycles are overloaded with produce in their baskets and on their carriers, children ride bicycles, zebu cattle plough fields, laze in front yards or are led along dusty lanes.  Children shout out “HELLO” excitedly when they see the Barang.  An old lady carrying a pile of firewood on her head.  A man bathing in his underpants at a water tank, throwing water over himself with a plastic pot and waving at me, smiling white teeth through his shining wet skin.  Cows bathing in a small lake amidst water lillies and someone waist-deep in the same lake collecting lotus pods.  So many sights that it is almost impossible to remember them all.  We stopped to talk to the young crippled man again, at his tiny wooden hut and admired the vegetable garden that provides his family with a small income.  Amazingly, when we stopped to see them the other day, he was out in the fields collecting firewood with his young son.  Disability does not stop you from physical labour in this country.

As we arrived at Toilet House, Dara came running, along with dozens of other children all playing around the building site.  He scored the (fake) gold medal which I received as a participant of Sydney’s Spring Cycle Challenge in November.  As I gave it to him, the words on his t-shirt in the middle of a remote Cambodian village really tickled my fancy, particularly because they pretty much express the attitude this little 6yo amputee exudes.  I doubt whoever bought it has any idea what it says, so it’s just an uncanny coincidence!

I'll be famous oneday but for now I'm stuck in middle school with a bunch of morons!

I’ll be famous oneday but for now I’m stuck in middle school with a bunch of morons!

Yesterday I visited a local organisation who provide services to a village community known to be very poor after they were relocated from the riverside area in favour of turning it into a tourist haven.  Tiny children from 3yo to 5yo in little blue and white school uniforms sang a song to the visiting Australian donors.  They attend kindergarten here by day, while their parents work in the nearby factory which chugs a constant thick cloud of black smoke into the air between Phnom Srey (Woman’s Mountain) and Phnom Pros (Man’s Mountain) a few kilometres south of town.  A microcosm of the world as it is, with factory mogul no doubt getting rich at the expense of a poor and exploited labour force, while well meaning philanthropic community members try to inject some fairness into the situation.

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Arriving in Phnom Penh this afternoon, here to sort out my visa, the usual flurry of Tuk Tuk Madames harrassed me off the bus.  I bought my return bus ticket and then walked away from the central area to find a less ruthless driver to negotiate with.  A few corners away I negotiated a $3 ride.  A Khmer conversation with his tuk tuk mates on the same corner seemed to elicit a bit of excitement and I had no idea why until moments later, when he pulled over to check the address with me.  I’d accidentally said Street 192 and my ride was already up!  I explained that I needed Street 292 and he smilingly took me the extra kilometers without argument.  It seemed that a $3 profit was all he wanted, no matter what distance I needed to go!

The city doesn’t thrill me the way that the rural countryside does, yet there are plenty of amazing things to see here.  Tomorrow lunch and visa arrangements with Bernie, who knows what to do and where to go on the visa issue, are my only commitment.  On Saturday I hope to visit the riverside Cham community with the NGO she volunteers with.

Today Bill & Melinda Gates published their annual letter, which you can read here: http://www.gatesnotes.com/2015-annual-letter?page=0&lang=en&WT.mc_id=01_21_2015_AL2015-GF_FB_PromoTile_Top_20  Their “Big Bet”, 15 years after the inception of the Bill & Melinda Gates Foundation in 2000, is “The lives of people in poor countries will improve faster in the next 15 years than at any other time in history.  And their lives will improve more than anyone else’s”.  They are challenging all of us to get involved and be a part of the new global citizenship revolution.  As they say in Cambodia, “Da-dow” (let’s go!).

Generosity and Skilful Infants

Today Bea and KT from MSF came with Chom and I to Dara’s grandparents’ village for a toilet inspection.  Chom was on his moto with 3yo Microphone (because he’s so loud!) at the handlebars.  The three expats were on our bicycles.  Thirty kilometers and a sore rear end later, we made it home with new tales to tell, as expected!

The toilet remains under construction with focus now on the pit being dug, in ground which is full of huge boulders.  With no equipment to speak of these huge balls of rock have to be pushed out of the five-foot deep trench using sheer brute force.  Utterly amazing!

Human forklift, Cambodia-style

Human forklift, Cambodia-style

About 10am we turned up on our bicycles covered in sweat and dust and, unlike other low-key arrivals on the back of Chom’s moto, we appeared to attract the whole village.  We stood above the pit, awestruck at the boulder removal process while groups of children stared awestruck at us!  About half an hour later as we headed back up the dirt track on our bikes, at least twenty kids waved us off excitedly.  Latest advice is that the family should have a working toilet by around Thursday.  The builders only work in the morning because in the afternoon they have to tend to their rice field.  Which explains why they are a couple of balls of muscle – their days are filled with hard physical labour.  Chom would not let me part-pay them today “because I don’t want them to buy the rice wine and then they will get drunk”!  His cultural consultancy is hilarious!

Yesterday Phter Koma had our Board of Directors meeting, where a number of good decisions were made.  The most interesting being that we plan to recruit three more children to the house.  There are currently 12 HIV+ children residing with us, all with dire histories and backgrounds and all now, thanks to a stable home environment, thriving and receiving the medical attention and treatment that they need.  The needs of many children in Cambodia are equally dire and even more so when an HIV diagnosis is thrown into the mix.  We are licenced for 15 resident children and so yesterday we decided to “bite the bullet” and take on another three needy children, which is going to take some time to prepare for, including visits to the childrens’ homes, approval from the relevant government ministry, etc.

90% of the >2 million HIV+ children worldwide do not receive the necessary treatment to suppress the virus and avert progression to AIDS.  Treatment is complicated and cannot be well discussed in a short post like this.  Very briefly, treatment halts the disease’s progression but does not offer a cure.  Without treatment most HIV-infected individuals will develop AIDS within ten years of initial infection.  Once AIDS establishes itself, death typically occurs within three years.  Treatment requires specific medications to be taken routinely on a daily basis, sometimes different medications at different times of the day depending on the individual treatment regime.  Poor treatment adherence can lead to viral resistance to the drugs.  “Second-line” medications may then be used, but without good adherence resistance to these drugs will also occur and there are limited options after this.  So without good treatment adherence, the outcome is AIDS and death.  In Cambodia alone, 7,000 people die each year of AIDS-related sickness.  That is about 20 people per day.  Poor treatment adherence is due to many individual and complex factors, but it is inevitably the result of abject poverty.

What exactly is “abject poverty”?  The children of Phter Koma probably could not define it in words if asked, but they have all lived it.  Stories include a very young child brought to hospital with his unconscious father who subsequently died of TB meningitis, caused by AIDS.  With no other living relatives this child’s sole option was Phter Koma.  One of the children now being considered for recruitment is a ten year old girl whose background was written by a Khmer colleague who assessed her situation and reported it to the Board.  I won’t re-write his brief report except to change identifying details, because I think that his choice of words demonstrates his empathy.  “Ten year old  girl is living with her old grandma, 70 years old, in the very hard condition because grandma has to harvest in the field, hired by villagers and do whatever she can do in the village. But she has some relatives who sometimes have given her some support. Girl’s parents were passed away of HIV (father died last year). She is now in grade 2, her study is not good because no one helps or supports her, only the grandma. Clinic staff let me know that daily drugs of child is not good, no one reminds her and her grandma is very old and she sometimes has to work for others. The appointment with doctors was too late, sometimes missed because grandma does not have money. Obviously the day I met her at the clinic she was late about two weeks and her grandma could not come, she was sent with a motor taxi driver who living in the same village“.

This is one of so many stories that are the reality of life in Cambodia.  When I cycle through rural villages I feel acutely aware that I am surrounded by many such existences.  The other day Chom and I stopped on a rural lane and while I was taking photographs of the village scene before me a child’s voice shouted out “Hello!”, goaded by a male in the background to then shout “How are you?”.  I shouted replies back, not quite sure where their voices were coming from.  A young crippled man slowly made his way out of the gate and across the track to meet me and say hello.  Yet another to have been given an injection in his buttock and crippled as a result.  One of the first practical things I learned as a student nurse, is that when administering injections into the buttock you have to inject into a very specific area in order to avoid the sciatic nerve.  Until I came to Cambodia I’d never met anyone who had been incapacitated by an incorrectly administered injection.  In my very first days here I met Paint, who mobilises on his hands because of paralysis caused by this.  Since then I have met two other such casualties.  My guess is that the reasons this seems to be such a common occurrence here, could be due to three factors.  Wasted buttock muscle caused by chronic malnutrition probably makes the sciatic nerve much more difficult to avoid.  Poor practices resulting from a deficit of qualified teachers are very probable.  Thirdly, the capacity for unqualified practitioners to open clinics and administer treatment.

The last point has been highlighted in Cambodian news recently as an unlicenced practitioner in Battambang Province admitted reusing disposable equipment in his clinic.  This has been identified as the most likely cause of an outbreak of HIV in the village where he was practising.  He has been charged with murder by a government who in my opinion are complicit in allowing conditions to thrive which allow this type of practice to occur in the first place.
http://www.abc.net.au/news/2015-01-10/hiv-outbreak-in-cambodia-blamed-on-reused-needles/6010550

Phter Koma now have our own Facebook page which we decided was a good idea to try and raise our profile in the hope of attracting more support.

As we cycled home today we followed this ox-drawn cart along the track for a time before the young couple stopped to collect firewood.  As I stopped alongside them the wife jumped off the cart carrying a long stick of sugar cane which she presented to me for no apparent reason other than, in Chom’s translation “she want you to have it as a gift”!  Thankfully, in typical Cambodian fashion, a moto was all we required to get it home.  It traveled with us to a bamboo platformed hut restaurant where 3yo Microphone skilfully carved the bark from the cane with a butcher’s knife!  Six year old Dara joined us for lunch, limping around on his prosthesis and when we dropped him home, the blind lady whose husband drowned while I was away, was there!  Her 2yo daughter ran excitedly up to me and hugs were shared all-around.  She returns home tomorrow after a brief visit to town and without translation I have a very limited understanding of anything to do with her, so Win is lending me his translator skills in the morning.

Peasants giving me a huge stick of sugar cane!

Peasants giving me a huge stick of sugar cane!

Khmer style food delivery

Khmer style food delivery

Knife skills of a 3yo!

Knife skills of a 3yo!

I sat at a riverside restaurant this evening, typing this blog and watching the usual evening drive-by procession of motos and bicycles.  I’m becoming familiar with the elderly man who shuffles past in his black pyjamas each evening gripping his cane, the blind man with an amputated leg holding the shoulders of his young daughter for guidance, the neighbourhood children playing happily, some of them stark-naked, on the sidewalk above the river, the odd short-tailed grubby cat strolling by, the occasional “large mouse” (“we call them rats”) sneaking between gaps in the walls, and the random children shouting out “HELLO” as soon as they spot a Barang.  For such an impoverished nation, it is also an incredibly rich and generous place in so many ways.

My Nurses Are Already Dead

While I base myself in Cambodia on leave-at-half-pay, unsure what exactly 2015 will bring as I “stress” about how to spend my year off work, three of my colleagues from Australia’s Northern Territory are in Sierra Leone, working in an Ebola Treatment Centre.  The standard duration of Ebola missions is six weeks.  Considered to be high-risk and very tiring work, six weeks is the optimal time you can spend in this environment effectively before the chances increase, due to exhaustion, of breaching protocols and risking transmission of the virus.  In other words, you are at risk of becoming so tired that you are more likely to make a mistake while donning or doffing your Personal Protective Equipment (PPE), or even while wearing your PPE (eg removing goggles to scratch an itch on your face).

After six weeks of working in an Ebola Treatment Centre, it is then recommended to spend 21 days in low level “quarantine”, ie staying away from public venues and having minimal contact with others outside your immediate family.  Twenty one days is the maximum incubation period, being the time from virus exposure, to symptom presentation.  Once you’ve been home for 21 days, the risk of becoming symptomatic expires.  Without symptoms it is not possible to transmit Ebola to others, so keeping asymptomatic people isolated might seem like overkill but as I understand it, the concern is that from one moment to the next, symptoms may present.  As such it is best, and least likely to result in public panic, to remain isolated from the general public throughout the incubation period, regardless of whether you have symptoms.  The case of Kaci Hickox is an excellent example of the way media and the general public tend to panic when they don’t understand a disease or it’s transmission.  She dared to go for a bicycle ride during her quarantine period – placing noone at risk by doing so – creating a furore in the process.  Always sitting beside infectious disease outbreaks, waiting to rear it’s ugly head, is the epidemic of reactionist hysteria.

Working on an Ebola project results in being “away” for a total of nine weeks.  None of which, of course, compares to being an African afflicted with Ebola, either physically or through the loss of loved ones.  African health workers do not have the luxuries described above, of expatriate health professionals.  We fly in for a finite time, fly home to a life of comfort and follow all recommendations to keep ourselves and our communities safe from harm, without any of the intense strain that locals have to live with until the epidemic dies out.  These countries are already ravaged by poverty and Ebola has brought panic, crashed economies, demolished health systems and killed off hundreds of health professionals in an already-depleted workforce.  It has exacerbated the suffering already experienced in these places on a massive scale.  One of my options during this time off work is to volunteer at an MSF Ebola Treatment Centre and I have told MSF of my availability for this.  For those of you who know my workplace requirements, if I do this, it will be without pay as my current employer is paying me a salary and I am not entitled to undertake paid work during this time.  As such, I won’t be breaking any rules.

Some of the information being shared from West Africa is fascinating, albeit utterly tragic.  Trying to read everything I can, particularly from those in the field experiencing it first hand, I’m becoming a little obsessed with it!  “I Don’t Know If I’m Already Infected”, The Controversial Death of Ebola’s Unsung Hero is an illustrated article by Joshua Hammer which I read this morning, about Dr Sheik Hummar Khan.  He was a tropical diseases expert from Sierra Leone who was not only known for his research of viral haemorrhagic fevers, particularly Lassa Fever, but also ran the Ebola Ward at Kenema General Hospital.  Kenema’s first Ebola patient arrived at the hospital on May 23 and without adequate PPE or training many hospital staff almost immediately contracted the virus.  Already-inadequate facilities crumbled under the weight of the epidemic, which killed many of Dr Khan’s nurses and colleagues before he succumbed to the virus himself, in July after working 14 hour days without a day off, for two months.  He probably died due to a breach in protocol, thought to have occurred after doffing his PPE with a colleague who complained of feeling unwell.  Tired and not concentrating, Dr Khan immediately touched his colleague to perform a clinical assessment.  The colleague was diagnosed with Ebola and within days, so was Dr Khan.  He died on July 29.  A tragic and avoidable death which leaves the world bereft of a most brilliant and experienced infectious disease expert.  The full article for those interested in reading it, is here https://medium.com/matter/did-sierra-leones-hero-doctor-have-to-die-1c1de004941e.

Sheik Hummar Khan

This is just one of the many stories emerging from West Africa at a cataclysmic time in the region’s history.  Many other equally worthy articles can be found all over the internet but some of those that my colleagues have shared because they are particularly poignant, include:

A parody of The Kinks, Lola, singing about Ebola – very funny!  Even at times like this it’s worth having a laugh.
https://www.youtube.com/watch?v=RVv8VdHReh0

An excellent article from People’s Health Movement worth reading but I’ll quote a brief paragraph under the heading “Why the Epidemic?”:

Why then are we confronted with an Ebola epidemic in West Africa? The answer lies not in the pathology of the disease but in the pathology of our society and the global political and economic architecture. It is not an accident that the present Ebola epidemic has affected three of the poorest countries in the world. Liberia, Guinea and Sierra Leone number 175, 179 and 183, respectively, out of 187 countries on the United Nation’s Human Development Index13. Their health systems are ineffective and almost non-existent in many regions. The present epidemic is one brought upon by poverty and, as summarised below, by ruthless exploitation of the region’s natural resources.

http://www.phmovement.org/sites/www.phmovement.org/files/phm_ebola_23_09_2014final_0.pdf

When I attended the Ebola Infection Control Training with ARM Network in Sydney in November, one of the guest lecturers was MSF Nurse Brett Adamson who spent an hour with us before leaving to catch a plane to his next mission somewhere in Africa.  He was concise and eloquent in his criticisms of western governments and their inadequate response to the outbreak.  In this article from January 6, in which he is quoted as saying “nothing prepares you for the sheer brutality of Ebola”, he talks of his experience as a Project Coordinator on an MSF Mission in Liberia, finishing with this worrying quote.  “As a nurse I can only hope to never face such barriers to care again. Seeing the continued failure of the world to respond fast enough to the current situation I can only assume I will see worse. And this I truly dread.
http://www.theguardian.com/world/2015/jan/07/ebola-nothing-prepares-you-for-the-sheer-brutality-says-australian-nurse?CMP=share_btn_fb

Probably more than any other epidemic in living history, I think West Africa’s Ebola outbreak has shone a very bright torch on the inequalities between rich and poor nations.  A case of Ebola in a western country will certainly lead to public hysteria.  Previous outbreaks such as Swine Flu in 2009 attest to this.  But a single case of Ebola in a western country will not lead to uncontrolled spread of the disease.  Simply because our health systems are more than adequate.  Had this been the case for West Africa, then the world would not have lost Dr Khan or 840 other health professionals trying to contain the outbreak under impossible conditions.  It’s time for us to care about our brothers and sisters in the developing world, to demand that corporations and governments change their exploitative behaviours towards poor nations and to seek political change.  Ebola might be our warning call but the next disease outbreak may not be so kind on the Western world.

Early Days as a Volunteer

Today the normally-clear, blue skies above us in Kampong Cham seemed to reflect the murky brown waters of the Mekong. As the sun slowly set, I cycled back from my afternoon teaching session surrounded by motos purring around me in disorganised politeness. A tourist riverboat slowly made it’s way out from the shore and cruised upstream, towering over small wooden fishing boats as I cycled past the resident crazy guy whose dirt-caked trousers are ripped from crutch to knee. He holds them up with one hand, laughing uproariously into thin air as he strides purposefully around town. He sleeps on a table at a street corner nearby and I often wonder where the old lady has gone, who was sleeping on the concrete near him when I left three months ago. Alongside the pink and white ribbon-adorned wedding tent erected in the middle of the road outside my home, my heart pounded in time with the vibrating music. The wedding party, dressed in matching diamante-studded charteuse gowns and suits, waited at the tent entrance to greet their guests. So you are the people who woke me at 6am with the reverberations of rock music interspersed with monks chanting you into a long and happy marriage? The street is in for a long, thundering night followed by another loud awakening, based on previous experience with Cambodian street weddings!

The happiest times of my days now are spent at Phter Koma where the twelve resident children spend their days in a steady and organised routine. The manager shares his time between administrative tasks such as calculating the budget and writing the annual report, both due at our Board of Directors meeting this weekend, and spending time communicating with the children affectionately. When I arrived this morning, the counselor/educator had already taken two kids to their monthly hospital appointments on the back of her moto. The “Mum” was perched on a wooden bench preparing the next meal to be cooked on an outside fire burning inside stone urns. Some of the children were at morning public school lessons. One of the older boys was outside burning off garden rubbish in preparation for the next vegetable garden to be planted. Two of the older girls were sweeping the front yard with brooms made from straw on the end of wooden sticks. The group of 4 whose English lesson was due grabbed a folding table and set it up in front of the whiteboard before sitting down on plastic stools, pens in hand waiting for me to log into my laptop.

As the lesson was coming to an end, the other children gradually trickled in from school on their bicycles and gathered around the desk to hear and talk in English about shapes, colours and national flags. Games time in the front yard inevitably collapses into shouting, yelling and boisterous laughter as a jumping race, hopping race, backwards race and blindfold tag all caused wild excitement to the detriment of the unfortunate but uncomplaining neighbours. Across the road, an outdoor classroom with rows of wooden desks and benches facing a whiteboard are frequently crowded with mainly orange-robed monks listening to an English lesson in apparent oblivion of the commotion a few metres away. These kids all come from homes overshadowed by extreme adversity, yet they smile and laugh readily, concentrate on their studies despite nearly all having lost months if not years of schooling due to their ill health, and take care of each other in a home which flourishes with warmth and good cheer.

This morning I met with the manager after English class to discuss the budget. I was astounded to learn that at the BoD meeting this weekend, we need to discuss the need to increase certain budget lines by amounts from as small as $10 per month, which is money we need to try and redirect from other lines in the same budget. He led me around the house to show me the dishwashing detergent, washing powder, soaps, shampoos and toothbrushes and explain why the amounts for these items need to be increased. He then showed me the market schedule as I arranged to meet the “Mum” at market early tomorrow morning, to do an assessment on grocery amounts and costs, in preparation for talking at the BoD meeting. It’s all another steep learning curve for me, and the “basket evaluation” as it’s called, in a busy market place without access to any translation, is guaranteed to be an interesting experience!

The last time I visited the toilet construction was on Monday morning with Chom. He picked me up in his tuk tuk and we stopped off at his brother’s home out of town to swap tuk tuk for moto. His three year old son stood at the handlebars inside Dad’s arms and I climbed on the back, alternating between holding the sides of Chom’s shirt, and grabbing the underside of the seat behind me. We bumped along the uneven, dusty, rocky roads for 15km, past many rural sights. On arrival Dara was protesting unsuccessfully as his 12yo sister dressed him in his little white shirt and blue shorts school uniform. He limped across to the bicycle and climbed aboard the carrier, they stopped for a couple of photos, then she cycled them up the dusty track towards school for afternoon class. Chom and I motored past as they pulled in to the school gate and Dara beamed widely as we waved and shouted farewells at each other. We’ll repeat the experience tomorrow, when Chom plans to make some cash payments to the workers (‘first I will see how much work they have done and then maybe we will pay them half, or maybe we will pay them less, but bring enough in case we pay half”).

Apart from all of that, between Board of Directors stuff and lesson planning, I also have about ten “hospital kids” waiting to hear that they can learn English with me – we may have to conduct their lessons under a tree as I’ve been unable to find a venue. The Global Development Group application remains outstanding and we are also applying to UNAIDS for funding, so there is not a lot of spare time at the moment.  Which is a shame because there’s loads of stories deserving to be told and I am likely to forget them before I have time to sit and write about them.

Perceptions of the Poor

It’s really difficult to know how it would feel to be a person living in poverty, or how people in poverty perceive the “rich” people they occasionally encounter.  These thoughts regularly occur to me as I cycle or drive my way through remote villages being smiled, stared and even laughed at like the alien that I am to such parts.  I am not rich by any means of the imagination in a western sense.  I have three mortgages, many bills and commitments to keep on top of, a single salary, etc.  Yet, as someone who can travel and is currently on a 12 month break of paid leave, then by global standards I am “rolling in it”.  Which appears to be the perception that some around me have.  Not helped of course, when I arrived back in town with jewelery, bling pens and toys to hand out, all of which were cheap but compared to products available at local markets, they look high quality.  Not helped either, by the fact that I am staying in a riverfront hotel for the grand total of $7 a night – money that most around me could only imagine having.  Nor helped by the common knowledge that in my three months away I traveled to Australia, New Zealand and America.  It all goes to paint a picture of extreme wealth for people who earn anything between “enough rice to eat” and the top-dollar jobs of around $400 per month, with the average person making about $2 per day / $750 per year.

So it’s not surprising that I am encountering some interesting situations with people!  The first example is the cleaner at my hotel.  She works with children underfoot, including a thin and naked toddler and older children who attend school but often help her making beds etc outside school hours (children here only attend public school for half a day – alternating between morning classes one week and afternoon classes the next).  As a long term guest I decided it would be fair to tip her and began leaving 2,000 Riel (50c) on the bed.  My room has one large suitcase and two smaller suitcases, a few smaller bags all holding gear in them, plus a wardrobe storing clothes and make up etc, a toiletry bag hanging from the bathroom rail, shampoos and gels on the bathroom shelf, etc etc and I have not been particularly tidy or organised as yet so things have been strewn about somewhat.

Yesterday the cleaner’s daughter, about 12yo at a guess, was helping her mother.  When I returned to my room at around 10pm the first thing I noticed was that the brush from my compact blush, which I’d left on top of the dresser, was sitting outside it’s case.  Today I have left my room as bare as possible with everything that might be tempting zipped up, in a cupboard or hidden away on shelves or in drawers.  I’ve also left no tip.  I don’t want to report it because at the age of 12 I would also have been tempted to snoop and put a bit of make up on my face, and Mum’s job should not be jeopardised because of this fairly typical adolescent behaviour.  She works hard cleaning 15 rooms and probably doesn’t earn more than a few dollars for her efforts.  I had adolescents in my house in Australia fairly regularly and learned quickly to store things away that I didn’t want curious eyes and hands noticing.  I am also fairly sure that my mother wore make up to work during my teens even though I don’t remember ever seeing it on show in the bathroom!  No doubt the change in my room arrangement and the lack of tip will be enough to show that I’m aware, which should be message-enough.  If not, then I will try to talk to her but we have no common language so that’s a more tricky response.

The second and more entertaining scenario is the toilet construction in Dara’s village home 15km out of town.  My first visit to Shackville was with Win last week, who explained to his mother that while I was in NZ I received some money from people who wanted to help Dara’s grandparents have a toilet at their house.  Later that day I returned with Chom, my “advocate” with the family and I asked him to explain to her again that I had some money for the purpose of building a toilet.  “Helen I don’t want to say that because if I say you have money then they will think that you can give them the money.  I want to say to them that you can help them to build the toilet, but I don’t want to say anything about money to them”.  Okay, that’s fine.  He then said “they want to build it today but we should wait because I think they want the money but we need to buy all of the materials and not give them the money or they will use it for something else”.  We negotiated a time and Chom and I picked up Stepdad from Shackville on Friday morning.  We went straight to the bathroom shop where a white squat toilet (porcelain basin with foot-sized panels on either side) sold for $19.  With Stepdad and I using the toilet as a footstool to keep it from bouncing around on the floor of the tuk tuk, we then continued out to the village where a family member who works in construction was waiting with Dara’s grandparents behind the house on the site of the planned new toilet.

Rainwater cauldrons sitting on the site of the new bathroom, between two houses

Rainwater cauldrons sitting on the site of the new bathroom, between two houses

Conversation in Khmer began with Chom speaking for me.  I stood in the circle unaware of what was being said but fascinated at the heat of the discussion and wondering if the construction worker was angry or excited.  Eventually Chom turned to me and said that they have plans to make the bathroom 3.5m x 2.5m.  I worked this out in my head and said “Oh, that’s about the size of my bedroom in Australia!  Why so big?”.  That’s what Chom wanted to know and had led to the excited discussion.  Okay, so how much is it going to cost?  Chom listed the materials I needed to buy – sand, concrete, bricks, etc, and as I wrote it down the guy told us the quantity he needed of each.  Chom then said to me “Helen I think you will spend about $1,000 for this”.  My expression soured as I explained that I most definitely did not have $1,000 and that we would have to cancel our plans. More excited Khmer discussion ensued and I almost felt nervous about what on earth was happening.  Chom then explained that “I told them this is not possible and so maybe we can make it a smaller size?”.  Okay, how much if we make it smaller?  “How small do you think?”.  Well, I think that my bathroom at home is only about 2m x 1.5m, so that should be big enough for here too?  “Okay I’ll tell them 1.5 x 1.5?”.  Okay.  After further discussion and calculations, we came to an agreement that a small bathroom was do-able.  Chom then turned to me and said “I told them, do not think that she is the bank, because she is not the bank.  She is very friendly and she want to help, but if you treat her like the bank then she cannot help”.  Stern words, Grasshopper!  We then bounced our way back to town on the horrendously dusty, ungraded roads where we went from one supplier to the  next ordering sand, cement and bricks which were transported out that afternoon.

Work began on Saturday and by the time we arrived to check in and make sure everything was happening as planned, the patch had been roped off and bricklaying was about to begin.  Children ran around the edge, grandad was squatted nearby observing silently as he sucked incessantly on a cigarette, teenagers peered out through holes in the banana-leafed walls of the house above and men mixed sand, carted piles of bricks, made a water level out of tubing which they sucked on to pull the water through and various other fascinating activities.  All construction workers flopped around in slip-on sandals and thongs!  Chom explained that I needed to take photographs “to send to the people in New Zealand who are paying for this toilet” and they all nodded in agreement, even posing for me a couple of times!  We are now heading out there on a daily to second-daily basis to monitor progress and Chom has kindly obtained a moto to transport me on to avoid being thrown around like a rag doll in his tuk tuk again!  He is earning his keep as my driver, translator and mentor in how to negotiate with Khmer people who “think that you are the bank”!!

This morning English classes begin at the Children’s Home.  The children have been divided into four groups based on when they attend public school.  I will teach the same lesson to small groups of 4, three times during the day and then a different evening lesson with all of the children together (16-17 including the homeless hospital children), three days per week.  This totals four hours of teaching on Mondays, Tuesdays and Wednesdays, followed by four days off for lesson planning, socialising, trips away, etc.  The Childrens’ Home children will receive six hours of English per week and the homeless children three hours per week.  The homeless children have gathered various others who are all asking to learn English with me and today Chom is coming to the hospital to explain to them that it’s not possible to teach more than the group I already teach.  Meanwhile, if I can find a venue near the hospital then I might spend an hour in the middle of the day teaching these “extras”, but at this stage we have no venue for this idea.  The experience of many pairs of little eyes looking at me hoping for free English lessons with the native English speaker was not one I’d like to experience again.  Stories about why and how their parents can’t afford to pay for English lessons but they want to learn English came at me in chorus with translation adding to the hum of voices and I thought I might have a nervous breakdown before I could escape the monster crowd of small people!

After this morning’s English class Chom and I are heading out to the village on his friend’s moto to see the latest progress.  When I asked him how I should pay the workers, he replied “Let me work it out because I don’t want to give them the money altogether and then they will get drunk”.  Dealing with young men seems to carry the same theme with it, no matter where in the world you are!

Grandad watching on as the first bricks of the new toilet are laid.  This is going to be the flashest room in the village!

Grandad watching on as the first bricks of the new toilet are laid. This is going to be the flashest room in the village! (Which isn’t saying much).

Loving to Hate

Strangely enough I started this blog days ago, before the Charlie Hebdo massacre.  Of the many dozens of cartoons I’ve seen in the past couple of days, perhaps my favourite is this, which translates as “Mahomet overwhelmed by fundamentalists” and the prophet saying “It’s hard to be loved by idiots”.  I think it’s perfectly fitting for anyone capable of committing the atrocities we saw in Paris in the name of a religion which appears to have been hijacked by demented extremists hell bent on their homicidal agenda of oppression.

Mahomet loved by idiots

In about the year 2000 I joined an internet discussion group where I was utterly astounded at the level of hatred spewed forth on my screen against various minority groups from homosexuals to various ethnicities.  My fellow Australians were not the tolerant people I’d always assumed them to be.  I guess my life had been spent surrounded by like-minds, while the internet suddenly exposed me to attitudes I otherwise had only rarely encountered.  I ended up becoming quite opinionated in this group, led by the dismay I felt.

In one discussion I vividly remember someone telling me that, given my defence of Muslims who were being pigeon holed as a homogenous group of offenders, had I been in 1930s Germany I would also have defended the Nazis.  Actually, I would have been against the Nazis, but not against all Germans.  In fact, Nazi philosophy was very similar to a lot of anti-Muslim rhetoric, which in turn is not so different from Islamic fundamentalist rhetoric.

On another occasion someone braggingly stated that they had a friend who attended a park where Muslims were known to use the public barbecues, where he placed pork on every barbecue in the park to “fend off” the Muslims.  I suggested this was utterly grotesque behaviour and was met with “I guess you would also have thought it grotesque that he defended our nation in his time with the armed services”, as though this somehow defended anything the guy chose to do!   Pretty  irrational given that our armed forces have included Muslims, indigenous people, homoxexuals, etc, who were all being maligned so viciously on a daily basis.

Xenophobic attitudes threaten all of us and I feel very strongly that we should never accept, nor stay silent, in the face of bigotry.  In a glimpse at world news headlines in the days before the Charlie Hebdo massacre, a French mayor refused to allow a Romani baby to be buried at the cemetery in his town and Russia disqualified all transexual and transgender people from the right to hold a driving licence.  Such stupidity and yet those holding the views which lead to these decisions are always able to justify their attitude.

Meanwhile the irrational fear and hatred of Muslim extremists towards anyone threatening their contorted view on the world continues to menace the free world.  Most recently and horrifically, the violent murders in France by deranged idiots involved with terror organisations in the Middle East.  In the aftermath of this violence, now they are saying that “terrorist sleeper cells have been activated” and that France needs to remain on high alert.  Mosques are being defaced, Muslims and Jews talking about their fears of continued retaliations.  Yet Muslims and Jews were victims of this terror attack and some of the details emerging of what went on as events unfolded, outline heroic behaviour carried out by many individuals including Muslim and Jewish people.

In Germany the right wing anti-Islamist group Pegida have been demonstrating in Dresden, rallying the masses.  An anti-Pegida demonstration yesterday was double the size of the largest Pegida demonstration, calling for tolerance and freedom.  On Monday an anti-terror rally in Paris is expected to draw a million people including both the Israeli and Palestinian leaders.  Perhaps these are all signs of the world’s move towards tolerance, dialogue and openness?  But humans seem to love to hate, so I won’t hold my breath just yet…