Project Update

A regular Cambodian sensation is that of being a ball of molten lava on legs.  Thankfully this is the time of year when on most days, at somewhere between 4pm and 6pm, the rolling cumulo-nimbus clouds burst open and a cataclysm of water plummets from the sky, cooling everything down almost immediately.  Construction workers have been busy for weeks now, building a barrier wall on the embankment to protect the esplanade from rising waters.  Simultaneously over the past week or so, water levels have steadily subsided.  I wonder if the building endeavours were unnecessary, for this season at least, and if so, I also wonder what this means for the crops and consequent food security of the population.  The workers have a variety of responses to the rainfall, depending on it’s strength, which range from running for cover (especially when crackling thunder and lightning accompany downpours), to stripping down and continuing on half-naked in the slush.

Visibility becomes similar to that you’d expect standing under a raging waterfall and my usual view becomes a thick white wall metres from the door.  The deluge initially drowns out the hum of motorbikes, but traffic quickly disappears altogether and the streets become deserted.  Only the occasional moto drives by, usually with three or four per moto.  Twelve year olds drive their passengers confidently, ignored by everyone else as a normal sight.  Floral pyjamas are camouflaged by the patched and dyed plastic bags sewn onto each other into hooded “coats”, purchased for 4,000 riel (US$1) at local markets.  These last as long as any supermarket plastic bag is intended to survive with a human body moving around inside it.  Young men are predisposed to speed at the best of times, but on an empty road with rain pelting onto them, their momentum is doubled.  A few nights ago one such driver bombed along the dark unlit esplanade and drove head-on into a parked car.  We heard it happen but our only sighting was a moment later when the apparition of a mud-soaked pair of jeans sped past, escaping the scene!  Unlike their male counterparts, on the same wet and muddy roads young women slow down to a near-halt.  Variations of these ever-fascinating commuters include each passenger hugging the guy in front of them; bare-chested guys leaning back to let the rain soak them; driver in a cape, the back of which can stretch across as many as three adult passengers huddled behind; toddlers standing at the handlebars with the driver’s hands covering their eyes from the rain.

Bicycles also carry two to four bodies, some standing, sometimes one seat fits two bottoms (in fact a couple of days ago there were three seated bums on a single bike seat).  Sometimes the driver sits on the carrier over the back wheel, arms stretched around his passenger(s) perched on the seat in front of him, to reach the handlebars.  Sometimes passengers on carriers sit backwards to see the world from another angle.  There are never enough pedals or footholds, so legs hang loosely just above the road or feet sit atop each other, so that two pairs of legs rotate bicycle pedals.  Basically anything goes and as a Portuguese friend suggested, the number of bodies is only relevant to us foreigners in our state of constant amusement, because to the locals, making it fit is all that matters.

The journey out to little Dara’s village is full of fascinating sights.  Overloaded wooden carts pulled by Brahman cows, chickens rushing across the road, radiant green rice fields being ploughed, cows bathing in ponds of floating water lillies, all kinds of temporary and less-temporary houses, babies being washed at rainwater tubs in front yards.  Chom and I travel out there regularly and when Toilet One was being built back in January, even more so.  On one particular occasion Chom stopped to take a wee in a field in a random location.  Waiting for him, I spotted a chook hiding untold tiny chickens under her wings in the hope I wouldn’t notice them.  Hunched down on the roadside photographing the sight, I heard someone call “hello” in English.  As I turned to reply, a man with a severe limp was walking towards me from across the dirt track.  Shy but welcoming, he waited for Chom to reappear and invited us into his ramshackle wooden hut where we met a pregnant wife, son and daughter.  The next time we visited we met a brand new baby girl who had been born in the dirt floored shack days prior.  Sometime later it transpired that they knew we were building a toilet for someone in the nearby village and let me know that they also have no toilet.

Many visits later, this week Toilet Number Two is underway.  On Friday we contacted Dara’s uncle who built Toilet One and Chom announced he was “free!  Free!” to build another.  We met him on a shady rural lane just behind the village pagoda where monks were chanting incessantly at the funeral of their abbott.  I watched a front yard operation of hundreds of cucumbers being dried on bamboo trellises in preparation for pickling while negotiations took place.  Moments later we’d agreed on a price ($200 for five days’ labour of three men).  From there we headed to the supply store and a short time later a truckload of provisions was making it’s way up the rural lanes and offloaded in the front yard.  The next day work began.

On our way to check on Toilet Two, this morning we visited the sisters at hospital just as they were being discharged home.  That deserves it’s own blog post but we took them to the Ophthalmology Department who almost immediately referred us to a service in Phnom Penh.  Paula is coming to town tomorrow, but we still don’t have her mother’s passport.  She may stay for a night or three to avoid another trip to town, while we (hopefully) have the passport sent once it is ready.  As soon as all passports are available we can immediately make the online visa applications to the US Embassy.  Meanwhile the Phter Koma kids are waiting for their English lessons to recommence with me at the helm for as long as I can commit (currently an unknown duration).

More on each project as they progress.  Time is beginning to feel very precious and these will have to be my final Cambodian projects for now.


Economies of Scale

This morning’s blazing sun is glistening on the muddy waters of the Mekong, evoking impressions of being in a tropical paradise.  It’s tropical but it could never be accurately described as a paradise.  I remind myself daily that the rewards of being here for me, really exist at least in part because I have a choice to be here and can walk away at anytime.  The experience as an outside observer is profoundly different from the experience of being born into a quagmire of hunger and hardship that is the reality for those I share this space and time with.  This by no means suggests that Cambodians have no fulfilment.  In many ways, far more than many of us from the rich world, people here have very genuine enjoyment, from very simple pleasures.  The exuberance of children here carries over into adulthood, manifesting in dispositions of good humour, honesty and openness in a spirit which is quite foreign to my stiff-upper-lip, individualistic culture.

Lunchtime yesterday, I was sitting in a shady spot reading when a crowd of small friends spotted me from a distance and suddenly I was inundated by commotion.  Seven year old ordered me “Helen!  Slip!”.  As I pretended to sleep, five super cute midgets ran to find hiding spots before calling my name.  In all the obvious places – underneath various outdoor restaurant furniture, the cab of a parked tuk tuk etc, I feigned surprise as each of them accosted me excitedly.  Screams and excitement were hushed for the sake of the work meeting taking place inside a nearby doorway, although babbling children merge with humming motos, crowing roosters, hammering and buzzing from nearby construction, all of which can be disregarded when you’re used to a level of constant background commotion.

Joe’s two daughters, “Simona” (blind) and “Selena” (her older sister) are currently in hospital with Simona’s 4yo daughter who has a fever.  I’ve been wracking my brains to come up with a solution to the noose that is around this family’s neck.  Joe and his wife are too elderly to work (plus Joe is disabled) and Simona is blind, leaving Selena the only one in a family of four adults and two children, able to earn an income.  From one of the poorest villages I have visited, she works in a tobacco field, which is seasonal work due to cease sometime soon.  Her twelve hour days start with a 3-30am pick-up and she earns $3 per day.  For months I have been focussed on trying to conceive a way for Simona to generate some income and have hit a brick wall at every turn.  Their village is so poor that there are literally no customers, even if there was something that a blind woman in this environment could offer.  I have made a few suggestions now and each time the responses have been “not possible because she blind”, or “no customer”.  This is the reality of what “subsistence economy” means.  Small incomes allow people to access seeds and other necessities in order to grow their own rice and vegetables.  Some can keep a cow or two.  To be disabled in this already challenging environment is truly debilitating.

Yesterday Chom and I visited the sisters in hospital.  They are effusive with me, which I’m uncomfortable about and recognise is due to their desperation to have someone who may be able to help their desperate circumstances.  Chom makes a great bodyguard though, and I realise that sometimes his refusal to translate for me has to do with avoiding situations I may not anticipate, being unfamiliar with the risks associated with offering assistance to desperate people.  Walking onto the verandah of the dirt-ridden hospital, Chom screwed his nose up and commented  “Cambodian hospitals are so dirty”.  Not to mention resource-less.  In a room with bare wooden slat beds and bamboo poles for intravenous fluid bags to hang from, we sat with a small group of mothers and their unwell children.  As usual Chom created a lot of boisterous laughter in the room with these strangers and I was slightly suspicious he may have been making fun of the three family members, who are all afflicted with strabismus, or lazy eye (“she looks at the chilli but she sees the cucumber – she cannot find a husband with this problem”).  They were laughing along with everyone so whatever was so funny, seemed to be inoffensive.  But even when it appears inoffensive, sometimes what is considered funny has shocked me!

Aware that Selena has taken time off work to escort her blind sister and niece, Chom knew I wanted to help them with a small amount of cash.  “Don’t give it here, I told her we want to talk to her in private”.  We said our farewells and walked outside with Selena, stopping to talk under the shade of a tree.  When I reached into my bag he repeated “Don’t give it here because the other people are still watching you”.  We moved out onto the street, out of view, where we had quite a talk with her.  Chom said “You want to help Simona but because she is blind I think it is impossible.  To help her, this is the one you need to help because she is the only one who can help her family”.  Okay, so maybe we can find her a job in a restaurant?  “No it is not possible because she does not know Khmer”.  What do you mean?  “She cannot read or write Khmer.  But also she cannot speak English and many restaurant want people who know English.  They will not give her a job”.  Oh, so what could she do?  Maybe I can buy her a sugar cane juicer?  After a short conflab with her “She said no because no customer in her village”.  What can she do?  “She say she want to clean the rich person’s house.  But I think she is no good at cleaning, she does not know how”.  But she can learn?  We put a plan in place to ask a local NGO who work with youth, if they could make an exception for an older person in especially dire circumstances – perhaps she could learn to cook.  “Will you tell her that we are planning this?”.  No because if I tell her then they will think you can help them and they will call you everyday.  Wait until we can find out something first before we say anything.

Around this discussion she talked about her strabismus and how she wants to know if it can be fixed.  I believe that it can be and as they are staying on the hospital grounds, now is a good time to help connect her with the Ophthalmology department, which is on tomorrow’s itinerary.  I know the department because we took Simona there a few months ago to have some ocular pain assessed.  The staff appeared competent and the department is supported by a number of NGOs including Fred Hollows Foundation.  During this conversation the topic of finding a husband came up again.  “These women, they can never find a husband because noone will marry them.  She said that sometime she want to kill herself”.  I touched her arm and in Khmer said she was beautiful, to which he replied in English “You are the only one to say she is beautiful, nobody else will say this to her”.  That’s why you should not laugh about it with her.  “No!  I did not laugh about that, I was laughing because her blind sister can use the telephone but she doesn’t know how to use it.  I don’t laugh about her eye because it is very sad for her and I only want to laugh to help raise her feeling and make her happy”.  I was relieved to know the earlier hilarity was harmless.  He’s a good guy.  He then said “You should take a photograph of her and show it to your friends in Australia to find her a foreign husband?”.  Suppressing amused horror I said no, in Australia we don’t do things like that.  We never do that.  “Oh.  What about just to put it on Facebook then?”.  Ummm… no!  One of our more amusing culture clashes!  We’re meeting them tomorrow and hope to sort out her strabismus.  But “she is already 34 years old, I think it’s too late for a baby and husband”.

Meanwhile “Project Paula” continues to move slowly and surely.  Toilet Project Number 2 is underway and a few other smaller projects are also playing out.  Updates to follow once there’s something substantive to report.

The Birth Lottery

One of these people will travel far to sing to small children in a forgotten community.
One of these people will recruit a team of grandmothers to bring love to the poorest orphans.
One of these people will fight for a safe haven for children in a dangerous town.
One of these people will plant a garden to bring nutrition to pre-schoolers in need.
One of these people will bury two of their children on the same day.
One of these mothers will leave her children alone to fend for themselves while she works in a factory.
One of these people will give their children the love, care and attention they never received themselves.
One of these mothers will be forced to send her child to a school with no books, no toys and no sanitation.
One of these mothers will raise two children on her own, while she is still in high school.
One of these mothers will overcome maternal depression to look into her child’s eyes for the very first time.
Some of these children will receive proper nutrition, care and stimulation to develop in their early years, giving them the opportunity to thrive at school, have a chance for employment, and to break the cycle of poverty.
Many will not.
Early childhood development is both a moral and financial issue of our times.  Can we afford to ignore it?  What can be done?  These are the faces at the heart of the issue.

Birth Lottery 01

Writers’ Block has cursed me in recent weeks.  This morning, waiting around for friends to arrive from Australia, I’ve unsuccessfully drafted a number of posts while watching a mouse scurry about the place, seemingly watching me back as it reversed direction every time I looked in it’s general vicinity.  My first sighting elicited a scream as it’s tail, looking initially like the cord of my computer, wiggled around far too close to my toes for comfort.  Chom announced “don’t worry we’ll kill it”.  This came as quite a surprise after the rat infestation we had at the hospital last year, when during a meeting with the cleaners, the translator described a mousetrap with a door that closed the trapped mouse into a small wooden space.  I asked how this would kill the mouse and he looked at me in surprise, replying “we won’t kill it, we will take it somewhere and let it go”!  Perhaps Chom is less Buddhist than my hospital colleagues.  Moments ago the resident ginger cats scurried past me almost on top of each other and I screamed again when I realised that one of them had the mouse in his mouth.  So the non-Buddhist cat has saved non-Buddhist Chom from doing the deed!

The above quote comes from the opening video of a short four week course called Birth Lottery, beginning this week via Future Learn at  During my time fostering children in Alice Springs and watching many disadvantaged children move towards adulthood with predictably undesirable outcomes, this became a topic both close to my heart and also of academic interest.  Early childhood experience has become increasingly recognised as the most significant factor influencing outcomes in adulthood for all of us.  The most lay-friendly book I have read on the subject is The Boy Who Was Raised as a Dog by Dr Bruce Perry, a series of stories about children exposed to various types of trauma during crucial times of their childhoods and how this affected their brain development and consequently their adult behaviours.

About ten years ago at a weekend market in Alice Springs a very young, pre-orphaned Mathew joined friends and I as we sat on the grass watching the world go by.  He drank a seemingly infinite number of fresh juice smoothies and then came to a pizza restaurant with us for lunch.  My friend predicted then that this lovable and funny kid would end up in trouble based purely on the circumstances of his dysfunctional childhood.  Within a few short years, Mathew was orphaned by violence which led to further problems when services responsible for his care neglected him and exposed him to abusive situations, which in turn led to my fostering him for a significant period of time.  It came as no surprise to anyone when he began getting into trouble for various juvenile offences. I’ve since fostered other troubled children and could just as accurately predict their troubled futures.  Equally, I think it becomes predictable that in an over-privileged environment some of us are at risk of becoming contemptuous of those we believe to be inferior, based purely on being born or graduating into the other end of the same lottery.  Any number of global politicians, media moguls, televangelists and other similarly-leaning individuals could fit this classification of arrogant and self serving antagonists.

The disciplines used to cover this topic include demography, development studies, health studies, family studies, sociology, comparative social policy, history, political science and economics.

Yesterday Phter Koma plus “Vincent”, who I taught last year and sponsor to English school now, went on a day trip to a resort about an hour from town where an underground reservoir fills a flowing lagoon with clear water.  A 9th century temple and a small functioning zoo are both within a short distance of this resort.  I was the final pick-up.  The 12-seater mini van pulled up with 21 bodies hanging out of the windows waving and shouting excitedly.  The front seat was reserved for me, Number 22 (the sixth adult), and our resident seven year old joined me, agreeing to a seatbelt going around us both which was the only seatbelt in place.  Within moments his little head flopped into the crook of my elbow and he remained unconscious for the duration of the journey.  His tiny eleven year old mate stood upright in the centre floorspace between the driver and passenger seats, eagerly watching the busy road with his wide eyes.  Children swapped seats, jumping in and around each other and I was taken back to the days of sitting on the floor of Mum’s Morris Minor or lying down to snooze in the back of Aunty Mary’s child-filled station wagon.  On our way home at the end of a long day, bodies sprawled out atop each other asleep, we pulled over for some hitchhiking Italians who squeezed in somehow and brought us up to 24 bodies in a van built for 12!  Pinned under a seatbelt in the front seat with seven year old conked against me once more, I have no idea where our guests sat, but they chatted happily with our French volunteers, seemingly unperturbed by the congestion!

Our day consisted of visiting the zoo which was a lot nicer than I anticipated a Cambodian zoo to be, although I never enjoy seeing animals caged, some of whom looked very sad.  The children took pedal boats out onto a small lake while I waited ashore with the deaf attendant who managed to explain the cost of each boat using his fingers and a clap of his hands.  We fed fish and saw crocodiles, bears, ostriches, monkeys and rabbits.  We then visited the nearby pre-Angkorian temple ruins, sheltered and obscured by a beautiful overgrown jungle, where the children posed for photos before heading to the lagoon.  Under a thatch-roofed, bamboo platform-floored shelter we ate lunch and spent the afternoon alternating between hammock-lounging and swimming in the clear waters with a crowd of about 50 other children who informed me they were from an orphanage center based in Phnom Penh with an outpost home nearby.  Mingling with this other group who approached our Khmer staff asking for food, we floated on tyres, played ballgames, splashed, swam, soaked, socialised, climbed or were climbed over, during a fun but utterly exhausting afternoon of craziness.  The day ended with a “house meeting” encouraging the children to reflect on their day’s experiences.  Chaz suggested that they had shared happily all day and this should become a habit at home, where fights over who owns what etc, are not uncommon – as you’d expect in a house of fifteen!

Ultimately children – and adults – are the same wherever you go.  The Phter Koma kids are no different to myself and my siblings growing up in another place at another time.  In a country where children often have to work at least some of their days to keep the family fed, the Phter Koma kids, despite coming from extreme adversity and facing futures filled with challenges that I will never have to know, are actually some of the lucky ones.  Hopefully the memory of our very happy yesterday will help to strengthen their capacity to face what lies ahead.  It will be interesting to observe how their outcomes compare to the children I know in Australia whose social challenges are an incomparable set of circumstances in an incomparable environment, but not any better.

This quote is relevant on a globlal scale, where we are at risk of living in rich-world castles, surrounded by a poor-world wasteland.

This quote is relevant on a globlal scale, where we are at risk of living in rich-world castles, surrounded by a poor-world wasteland.

Hair Raising Inspirations

“Another guy on the construction site, yesterday he fall down and die”.

This was the translated reply when I asked after Dara’s parents yesterday.

Googling to find out more about construction worker safety, the top search results are:
Construction Workers’ Lives Hang in the Balance (November 2014, Cambodia Daily)
Construction Worker Falls to Death at Phnom Penh Job Site (April 2015, Cambodia Daily)
Elevator Crash Kills Three At Building Site (May 2015, Cambodia Daily)
Three Crushed To Death While Moving Marble in Phnom Penh (June 2015, Cambodia Daily)
Construction Tragedy (July 2015, Phnom Penh Post)
Concrete Collapse Kills Construction Worker (July 2015, Khmer Times)

The International Labour Organisation estimated that four occupational deaths per day occurred in Cambodia in 2009, with construction and brick kiln work listed as the most dangerous occupations.  Injuries outnumber deaths and accidents are neither tracked nor reported, except by newspapers if they learn about it, which it seems they usually do not.  Dara’s mother now knows of four deaths on her construction site alone in a matter of less than eight weeks.  None of these seem to have been reported in the media, testifying to the fact that most casualties occur without any publicity whatsoever.  Not only are there few physical safety nets on-site, but there are no insurance or workers’ compensation safety nets either, so injuries must lead to severe financial hardship as I have talked about a lot recently.  These peoples’ lives hold no value whatsoever.

Workers with no hard hats, no harnesses, most in flip-flops, above rooftops in Kampong Cham

Workers with no hard hats, no harnesses, most in flip-flops, above rooftops in Kampong Cham

The highest contributors to Cambodia’s GDP are the garment industry, followed by construction/real estate, and in third place, tourism.  The fact that construction is booming, especially in Phnom Penh where high rises are springing up all over the city, illustrates an improvement in living standards causing a high demand for housing.  Wages for construction workers are reportedly rising in line with this strong economic growth.  There are estimated to be between 175,000 to 200,000 construction workers in Cambodia, most of them unskilled workers who are paid cash by the day (between $5 and $8 per day).

Although the Ministry of Labor is officially responsible for worker safety, there is no safety code and private firms are left to police themselves.  There are no repercussions to companies for workplace accidents and it is difficult to inspect sites as authorities hold little power and are simply turned away.  Dara’s parents travelled home yesterday, and when we called to ask after them a few hours after our visit, Rita said that they are thinking about whether to return to work or not.  I am unsure about Nathan but I know that Rita does not read or write.  Her options for employment are therefore very limited and I expect that once the shock of the latest accident fades, she will be back on the ladder, climbing towards the sky.  The thought makes me feel ill.

Meanwhile I am trying to soak in as many memories of ordinary daily life as I can.  The organised chaos of  marketplaces and streets are filled with often-amusing, sometimes-horrifying, ever-interesting sights, usually courtesy of the capacity-defying abilities of bicycles, motorbikes, mini vans, human anatomy and agility, and other realms which my first world brain has spent four decades believing had much less aptitude than they actually have.  On a daily basis I can’t reach for my camera in time and miss capturing sights I want to tattoo into my memory bank.  On the odd occasion I gasp with surprise and get the camera into my hand and switched on in time.  Not a day goes by without a stirring in my heart at the hilarious abilities of people with so little, making so much out of what they have.

Cultural Chasms

They are late and still building momentum but the Monsoons have arrived in South East Asia.  With a bit of fluctuation, the Mekong River is rising steadily.  Slowly surging out into the delta, rising waters are transforming the lowest level green fields into massive brown lakes.  Soon many villages will become submerged in a combination of rain and swollen river waters for up to three months.  For now the rains turn everything to slush which, in the hot dry intervals between showers, quickly evaporates to dust.  Muddy puddles make great paddling pools for raucous children who haven’t developed my obsessive-compulsive-disorder about tropical diseases.  The other day I watched some children I know well, splashing around in roadside puddles before one of them ran over to me and leaned in for a hug.  Before my brain switched on in time to prevent it, I was theoretically smothered in a textbook of parasite species.  Consciously dissuading myself from OCD-induced panic, I took an unscheduled shower and determined to remember that course of Albendazole when I get home to Australia!

His krama wrapped turban-like around his head and otherwise clothed in just a pair of undies, Joe was sitting in his boat repairing the floor as we pulled up outside their bamboo gate last week.  The shoreline is currently about 1km away but soon enough this heavy wooden canoe will be their only transport from the top steps at the front door.  On our way out of town Chom and I packed the tuk tuk with eggs and stocks of long life food such as soy sauce, fish sauce, sugar and garlic: hopefully enough to last the family until they can reach town again in a few months’ time.  At home on smooth bitumen roads I inevitably break eggs between the supermarket and my front door.  In Cambodia they bounce around on unsealed tracks in a ricketty tuk tuk without so much as a hint of a crack.  Even eggs seem to have an other-worldly tenacity for survival against the odds!  After about an hour with the family I said my first farewells for the year as the roads will become impassable soon and I won’t be able to visit them again until my return sometime next year.

Helped by a push start, Joe demonstrates his new wheels

Helped by a push start, Joe demonstrates his new wheels

Joe and family at home before the monsoonal immersion

Joe and family at home before the monsoonal immersion

Speaking of tenacity, Paula has metamorphosed from a smiling and persevering bag of bones, to a laughing and animated bag of bones!  We also visited her last week to get some paperwork signed for the upcoming journey to USA.  Between us, including Chom’s invaluable and comical consultation, we decided that due to the language barrier, it was best to send “Samantha”, who coordinated Paula’s nursing care under my management and beyond, as their escort.  She knows the family well and has good English skills, meaning she can translate for Paula and her mother on the journey, which I could not do if I travelled alone with them.  Samantha has also never travelled before and so while it will be challenging for her to navigate airports and border control etc, she is perfectly capable and will be well prepped.  She is equally excited about the opportunity to visit another country.  The two young women speak daily now, for up to two hours at a time, about their upcoming, life-changing (especially for Paula) adventure.  I love being a bystander to their excitement.

Meanwhile in the US there is talk of a television network covering Paula’s story!  This would be deserved recognition, albeit only available to one of so many families in similarly miserable predicaments.  Paula and her family are a prime example of the human realities behind various analyses of global poverty and near-poverty.  In 2014 Cambodia ranked 136 of 187 in the United Nations Human Development Program’s (UNHDP) Human Development Index (HDI).  This puts Cambodia 51 countries ahead of the world’s most impoverished nation, Niger.  In comparison, Australia ranked second after Norway with USA at 5 and UK at 14.   The indicators used to calculate the HDI include, but are not limited to, life expectancy at birth, mean years of schooling and gross national income.  This is not a perfect tool because, for example, years of schooling does not measure the quality of education, which in Cambodia seems to be variable and lacking.  This is hardly surprising given that a mere generation ago all of the nation’s teachers and other educated professionals were exterminated.  The HDI is complicated and can be read in full at this link:

Despite the serious effects of the Global Financial Crisis of 2008, the news is not all doom and gloom.  For example the World Bank reported that Cambodia’s poverty rate had decreased from 53.2% in 2004, to 20.5% in 2011.  However, we should never look at this with blinkered “first world eyes”.  The same report states that the impact of losing US30 cents ($0.30) income per person per day would double the poverty rate to 40%.  The “near poor” status which many have transitioned to is not a safe nor comfortable circumstance.  Many Cambodians are food-insecure, with almost 40% of all children under the age of 5 having chronic malnutrition.

In such a vulnerable population, one would hope for a basic level of health care to be available.  No such thing exists although attempts are being made to implement a health insurance program to provide poor families with free access to health care.  The situation is complex.  World Health Organisation, in their 2014 “Country Cooperation Strategy – At A Glance” brief (, identify poor regulation of services, high levels of out of pocket payments and poor quality of care, as significant challenges to the national health system.  70% of health care expenditure in Cambodia is paid “out of pocket” by the individual patient.  In a population stricken by poverty and near-poverty, this manifests in high levels of debt and asset sales which can become a catastrophic cycle of financial obligation and destitution.  Families sell property and borrow money, often at high interest rates, to cover the costs of health care intervention.  Friends have told me that even basic interventions such as replacing an intravenous fluid bag or administering analgesia, can require a cash payment made to the provider before the work will be carried out and so officially reported costs could be severely underestimated.

I have known all of this for the best part of my two years in Cambodia.  I have also encountered many patients in stress due to debt caused by health care costs.  So why was I shocked when Samantha told me yesterday, about Paula’s family’s economic plight?  The only explanation is because I was looking at them with my blinkered first world eyes.  I knew that Paula has had multiple hospital admissions, surgeries and investigations for her unexplained and undiagnosed abdominal pain.  I also knew that she has not contributed to the family’s income generation since her illness incapacitated her.  The cumulative financial cost of her ordeal did not occur to me, despite evidence staring me in the face.  Samantha had to spell it out to me.

Paula developed abdominal pain during her pregnancy almost five years ago.  Over time she attended her local clinic, graduating to the regional referral hospital, and then a big city hospital in Phnom Penh.  With little in the way of diagnostic resources, she was operated on a number of times.  Prior to her diagnosis of Drug Resistant Pulmonary TB (DRTB of the lungs) in May last year, she had been told that she had incurable intestinal cancer.  She was tearful, believing that her illness was terminal.  This is not unlike a case of mesenteric TB I encountered in Australia, of a young man with abdominal symptoms which doctors mistakenly diagnosed as abdominal cancer.  Obviously misdiagnosis is not the exclusive domain of under-resourced third world health services.  We don’t know what her abdominal illness was, but upon commencing TB treatment the symptoms subsided.  By then she had already undergone various surgeries resulting in a number of post-operative complications including gaping, non-healing abdominal wounds which ooze faeces and burn her skin, and malabsorption leading to severe malnutrition.

The economic cost of her five year ordeal has been sale of the family home plus a comparatively large and crippling debt, which sent her father and young brother, who should be in school, to Malaysia where they can earn more in a labouring job than is possible in Cambodia.  As her main carer, her mother works early mornings selling vegetables from the back of an old moto around the nearby villages, before returning home to cook for Paula and tend to her wound dressings.

As is becoming a pattern with me, the main reason for my astonishment at the revelation of the family’s financial crisis, was my own ignorance of their plight.  This is partly due to the lack of shared language, but also the yawning cultural chasm between my first world perspective, and the perspective of people for whom struggles like this are a commonplace reality.  The mismatched underlying assumptions between those telling me something and me “getting” what this means continually throws my world view out of alignment.  For example “we don’t live in our own home anymore” (I haven’t lived in my own home for two years either) and “Dad and bro have left to work in Malaysia” (I have also been working overseas) have very different connotations in their reality, than they have in mine.  Coming from such divergent world views, it takes the likes of Samantha to translate for my first world brain.

As I talk to Samantha, Paula and her mother about what they can expect to see, hear and experience when they travel to big-city-America, where she will receive state-of-the-art first world treatment at no cost, I keep this chasm between us in mind.  It will be interesting to learn how well I did in my pre-journey cultural preparations once they return.  I fully expect there to be some assumption mis-matches which despite all attempts, I will not have been able to anticipate on their behalf.

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Paula as photographed by El Pais newspaper earlier this year

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Paula’s home as it begins to be immersed into the Mekong

It’s Calling Me Home

If I wasn’t so familiar with Cambodia, I might have been afraid.  Samantha, convinced that “being in the forest” would be frightening to me, asked over the phone “are you afraid?” and I assured her honestly, not at all.   For starters, I wasn’t exactly “in the forest”!  Listening to music on the bus I’d missed my stop thanks to my inability to read Khmer.  Krong Preah Vihear is the town in the Province of Preah Vihear.  Relying on Samantha who was meeting me for the weekend and traveling on the bus from Phnom Penh, which was about an hour behind mine, I had not bothered to think too much about exactly where we were going.  Realising the town was now behind me, I texted her to ask where I should get off.  We were confused by each other’s messages so I called her and she suggested I give the phone to someone so she could speak to them.  The assistant bus driver had already been dismissive of me, and he refused to take the phone from me until I insisted.  He handed it straight to the driver who continued driving as he held Samantha to his right ear.  Crouched in the aisle behind him, the passengers near me who were within earshot of the conversation chortled and snorted good naturedly, pointing backwards in the general direction of my error.  I shrugged my shoulders and laughed along – I am on holiday so what’s a bit of “lost in Cambodia” other than an adventure!  My previous “losts” have always worked out okay so why should this one be any different.  The phone was passed back to me and Samantha said “He will find a car to take you back”.  Such a plan would be disastrous in my world.  In Cambodia it was perfect.

Soon enough the bus stopped and the driver opened his side window, calling out to a car which appeared to have broken down in the middle of the opposite lane.  Peering out, I started planning how to decline an instruction if it came my way, to get off and travel in this overloaded car of excessively happy men.  The only thing going for them was the direction their vehicle was facing.  Everything else was wrong.  Thankfully the driver abandoned his bad idea and drove on.  A short distance along he pulled over again, this time on a corner where two men approached the edge of the road, peering around the front of the bus at me, as I peered back from near the door in case I needed to jump back on against the driver’s intention.  They were clearly sober and their smiles broadened as they heard the driver’s explanation of what had happened.  The dismissive assistant took my bag over the road and it was passed into the hands of one of the men.  Following, I waved goodbye to the amused driver, sitting down as instructed by one of the men, on a wooden bed base in the dust.

Staring at each other in affable silence, I rang Samantha who had a talk with him, then me, then him again, establishing that my only choice was to travel back to town, 27km away, by motorbike.  “He will find someone to take you”.  We hung up and the guy pointed to his own moto.  I nodded.   He took my case and perched it between his splayed-out knees on the front of the bike.  I climbed on behind him, placed my laptop at his back and with my handbag slung over my shoulder, off we cruised.  Preah Vihear is a province of tropical rainforests and hills, so the journey was picturesque.  Unable to converse with each other, my driver did say “tik-tik”, letting me know he was driving slowly (just as well with no helmet available).  I pulled my krama out of my bag and wrapped it around my head to block the sun, but even wrapped in local disguise I commanded many stares from the farmers and villagers sharing the road with us on their various vehicle contraptions.  About half an hour later we pulled into Preah Vihear and I was united with Samantha.

Bus travel in Cambodia is an indelible experience which I will miss immensely.  Leaving from home, Chom drops me at the station with a hug goodbye, usually with a little melancholy comment as though to ensure everything has been said in case we never see each other again.  Seats are usually allocated, at least from the original station, less often from the pick-up spots en route.  All kinds of people travel with children, often fathers and grandparents as well as mothers and couples.  The other day as I sat down the man diagonally in front of me smiled and stared so I smiled back in reciprocal curiosity.  A little while later with his seat reclined I noticed a small boy of about four years old sound asleep on his chest.  A short way into the journey we stopped and a tiny boy of about three walked up the aisle, followed soon after by an elderly couple, who began calling out as the bus started to drive.  Obviously panicked that their charge had been left behind, the whole bus erupted as the little guy appeared, standing on the back seat, only his head visible across the tops of the seats, clueless that he was the cause of the laughter surrounding him.

At the rural meal stops it is common for beggars with various deformities or not, to sit on the ground beside the bus door, hats held out to receive donations from travellers.  The other day a young man sat down at the bus door just before the lunching passengers were due to board and I wondered why he was begging as he looked perfectly okay.  One bus left and he reappeared on the ground at the door of the next.  When that bus departed I noticed him limping off into the distance and thought about the health care debt I’ve been so oblivious to, despite knowing about it, and determined not to judge a beggar by it’s cover next time.

When it’s time for the bus to leave, the driver honks his horn and starts to move slowly out of the dusty parking area.  Passengers saunter out, doors opening and closing for each of them, as a stream of people continually and casually embark the moving bus until everyone is back on board and the driver can finally accelerate.  Waiting for my own bus, I observed a man on crutches with a very high amputated left leg, a mother with her shining wet naked baby in arms obviously appearing from the bathroom, children and adults, all board the ambling bus as it graduated slowly towards the road before taking off.  Small boys dressed in khaki fatigues, girls in floral pyjamas, an Islamic guy in kulfi with a long thin beard and ankle length wrap-around skirt, are just some of the ordinary sights at one bus stop in Kompong Thom a few days ago.

Arriving home yesterday the tuk tuk drivers, desperate to find a customer during the low season, were queued at the station alongside the motodups.  One of my friends was first to “tag” me through the window in the sharpest eyes competition.  Disembarking, I shook hands with a couple of the runners up, uttering “sorry” as they reassured me “it’s okay” and headed off to search elsewhere for today’s sustenance.  One of them is very thin, Chom says because he has children to feed so he avoids eating as much as possible.  I wished he’d had the sharpest eyes so I could have helped out.  It’s not easy knowing their stories, really.

After almost two years in Cambodia, it was only during my weekend in Preah Vihear that I discovered bowng dea dre brawmar (egg and fish omelette) which Samantha ordered at dinner on Satrday night.  Utterly delicious, she assured me I could find it at the local market so today I ventured out in search of my newfound favourite meal for breakfast.  As I left home one of the girls called out “bowng dea drey brawmar!  Say it clearly!“.  Entering the restaurant Samantha told me would have it, the waiter shouted out indecipherable words with “Anglais” thrown in the middle somewhere.  Soon enough an English menu was presented to me, inducing slight offence because “I can speak Khmer”!  Having practised bowng dea dre brawmar for 48+ hours, I asked if they served it (“Mean bowng dea drey brawmar?”).  Ot mean (no!)!  In disappointment, I ordered breakfast of pork and rice instead (served with the traidtional small bowl of stock and a dish of pickled cucumber).

During breakfast various passers-by kept me distracted.  A woman with a large flat plate balanced on her head calling out the name of the food hovering over her like a halo.  A tiny child inside a homemade wheelbarrow pushed by Mum out collecting recyclables in the busy streets.  An elderly woman with a crooked leg and a sack on her back competing for the same recyclables.  A family of five on a moto, dropping three children to school in their crisp white and blue uniforms.  Three monks appeared at the doorway avoiding eye contact with everyone and waited while the waitress returned with cash for each of their orange bags before bowing to their blessing chant.  Ready for the bill, I waved to the waiter who wasn’t prepared to even risk that much communication and travelled via a table to collect pen and paper, where he wrote 6000 for me.  Breakfast for US$1.50.  That’s another thing I’m going to miss terribly!

Walking to Central Market on my continued bowng dea drey brawmar search, a woman with goroet (massive grapefruits) sitting in a basket on the seat of her bicycle shouted “sister” at me in the hope of making a sale.  Heading to my “usual” market guy, I tried to explain that I’d already eaten breakfast which turned into a bit of a farce until we both agreed to abandon the conversation and start again.  I then asked, “mean bowng dea drey brawmar?”  Mean!  Okay!  See you tomorrow for breakfast!  Okay!  That’s breakfast for the duration of my remaining couple of months, sorted.

These are just some of the many sights, sounds and interactions I need to try and record as my departure becomes imminent.  Adele sings this amazing song, some of the lyrics of which describe the feeling of my pending farewell.

Adele – Hiding My Heart Away

This is how the story went
I met someone by accident
Who blew me away.  Blew me away
It was in the darkest of my days
When you took my sorrow and you took my pain
And buried them away.  You buried them away
Dropped you off at the train station, put a kiss on top of your head
And watched you away.  And watched you away
Then I went on home to my skyscrapers and neon lights and waiting papers
That I call home.  I call that home…..
I woke up feeling heavy hearted, I’m going back to where I started
The morning rain, the morning rain
And though I wish that you were here
On that same old road that brought me here
It’s calling me home, it’s calling me home……..

We Can Survive Another Day

When you get as old as me everyone starts to look young.  Over 50% of the Cambodian population are under the age of 24 years old.  Coming from a country where 40% of the population are over 50 years old, it is no wonder that I spend my life wondering why I’m surrounded by twelve year olds.  These are typical demographic differences between the rich and the poor world.

The American hospital have agreed to cover the costs of Paula’s charity care!  Now we are at the nitty gritty stage – where will she stay during her convalescence, is there a Cham community who we might connect them with, how can we provide a guarantee to the hospital that they won’t be held responsible for any non-treatment expenses.  Once these details are nutted out we will move to the passport/visa stage.  It continues to seem as though she could be looking at an unexpectedly hopeful future.  Although life is dicey in her frail and vulnerable state – yesterday she attended an appointment in town but was dizzy and unwell and had to leave quickly to get home and lie down.  Anything could happen before she reaches the treatment which could save her.

Yesterday morning Chaz and I ate breakfast together.  As we finished off our eggs he said “we can survive another day now”.  I assumed he was referring to our attending another work meeting and muttered something about how we’ll be done by lunchtime.  He realised my confusion and said “In Cambodia this is what we always say to each other.  We ate a meal so now we can survive another day.  Tomorrow we will look for more food”.  Not a phrase my food-overloaded perspective could have understood without his translation!  We attended our final meeting at a city based organisation before he headed home on the midday bus in time for work today.  The tuk tuk dropped him off at the bus before delivering me to my hairdresser.  Only the salon was locked up.  So I popped into the cafe over the road and asked the waiter if said hairdresser (who I haven’t been to in almost a year) was still there.  The answer, “Yes!  But he open at 10 o’clock.  But now is 11 o’clock.  Because last night he was too much party”.  Hmmm…. perhaps not the best day to have my hair done?  I sat in the cafe for a couple of hours hoping he might show, before deciding to try again today.

Last night I arranged to meet up with Dara’s parents who I’ll call Rita and Nathan.  They are now working on a large building site in Phnom Penh.  Dara was recently in town for a hospital appointment about his leg, but has since returned home to his grandparents’ village.  As I walked out of the hotel, at the corner 100 metres away a young guy in a red t-shirt appeared, raised both arms into the sky as though he was surrendering to an army, and shouted “Tuk tuk Madame?”.  While I focussed on ignoring him, he disappeared around the corner.  A few seconds later he reappeared, chugging towards me in his tuk tuk, beaming a bright smile.  We negotiated a deal including to wait for me at my destination and bring me home.  I rang Rita’s number and he spoke to her for directions, before putting out into the harmoniously unharmonised traffic of this city of extreme contradictions.  Wealth mingles with poverty, designer motorbikes burn past hand pulled trash carts, guards walk into the middle of busy roads and blow whistles at oncoming traffic to give right of way to massive SUVs, beggars bow their heads humbly at patrons in expensive restaurants hoping to scrounge enough to buy a morsel with.  This city is a microcosm of everything that is wrong in today’s world.  As many battle to survive, others battle to make a dent in the injustices, while a few powerful individuals appear to have lost their hearts in favour of their egos.

Last week an Italian tourist sat with me at wine o’clock and bored me to tears about the destruction he believes immigrants are wreaking on Europe.  I listened in silence, wondering at the mentality of such thinking as he droned on about having been in the military and where he’s travelled etc.  Chai, the blind amputee, arrived on his nightly rounds and Chom joined us to have a quick talk with him about 2 metres from where Mister Italy was sitting.  I returned to my seat and without so much as drawing a breath, he returned to his monologue about himself.  There is no point arguing with an ego I will never see again, so I sat silently and thought about just how much he had in common with Chai, who sustained his injuries as a soldier at a time when they would have both been in their respective military jobs.  But being poor, foreign and visibly disabled, Chai was immediately beneath Mister Italy to even warrant a mention of interest.  His loss in my view!

As we approached the general vicinity of Rita and Nathan’s abode, a tall construction site came into view and Tuk Tuk Madame (TTM) spoke to them again.  For a surprisingly long period of time.  When he finally handed my phone back he explained that Rita was not able to tell him her location and had taken the phone to Nathan, who had a better idea.  Neither of them were able to give clear directions, which I explained was because they moved to Phnom Penh for work about a month ago, they are not from the city and do not read or write.  Nevertheless, we found ourselves on the right road and a young man who I recognised as Rita’s young brother, waved us down.  I’ll call him Phil.  He was standing beside the pitted bitumen track over the road from a multi-storey construction site with an older man who also seemed to recognise me, I guess because I only ever saw him from underneath his krama as he worked along the riverside in Kampong Cham.

The construction site over the road from us was alive with workers milling in and out under dim lights.  Thankfully, noone appeared to be working on the upper levels of the building framework.  On our side of the road a tall, makeshift fence of corrugated sheets obstructed the view of the corner block.  An opening between two of the iron sheets provided an entranceway through which workers were coming and going, obviously in and out from some sort of living quarters.  Via TTM the men said Rita was “at the bathroom”, so we waited for a while before TTM said “You can go in there if you want, but they said it is very dirty”.  No problem.  I followed them in through the opening, Phil lighting our way with his mobile phone.  A long muddy path was laid with wooden planks acting as bridges over the soggiest patches.  About halfway along Rita appeared, her hair wet, hugging me as she motioned that she had rushed home from work and washed as quickly as she could.

At the end of the path I entered another Shackville, only this temporary city of squalor, obviously housing hundreds, made Kampong Cham’s Shackville look positively swank.  Men and women wrapped in kramars were bathing at an open air communal “bathroom”, consisting of wooden platforms over the mud, large rainwater tubs and hand held plastic pots.  Below is the closest photograph I can find on the internet to show how people bathe at these open air public water supplies.

Cambodian bath

Past the “bathroom”, the “housing” began.  A busy estate of makeshift shacks made from various combinations of tin, plywood, wood and anything else that can provide shelter and privacy, all raised one high step above the muddy ground.  I was guided into an area underneath a large tin-roofed structure similar to, although much longer than, the open-air shed-like frame in the photograph below (sourced from the internet).  Instead of housing park benches, the shelter has been converted into many dozens of cubicles divided by thin walls of plywood, plastic sheeting and tin.  A muddy path runs through the length of the structure, like a tiny street dividing it down the centre.  On either side we passed many doorways opening into cubicles of about 2 metres squared with walls ending about halfway to the tin roof.  About halfway along we climbed into the little cubicle where Rita and Nathan now live.  A television blared in one corner, a rice cooker sat beside it and above us a square plank of wood balanced on the edges of the walls, taking up half of the overhead space just above head-height, used as a storage shelf.  They sleep on the plywood platform floor a step above the dirt.  In the dark I could not see beyond the dimly lit cubicle we sat in, to tell where the electricity was sourced from but I doubt it’s permanent or safe.

tin roof shelter

Nathan joined us for a while before returning to a group of men perched on a wooden log near the door just outside from us.  He reached up to the overhead shelf and pulled out Dara’s hospital appointment card and leg x-rays, pre-and-post his operation, to show me.  Phil and another young man sat in the doorway with their eyes glued to the television, listening in on our conversation occasionally.  A young woman joined us from one of the nearby cubicles, beaming at me and saying something I didn’t understand.  Eventually I rang Chom to get some translations of the conversation and it turned out the young woman was saying “I came to meet you because I never met a foreigner who can speak Khmer”.  Funny that, given that I had no idea what she was saying because I DON’T speak Khmer!

At one point they were talking about their work, climbing a ladder onto the multi-storey building frame and I was horrified at the image of them all those storeys up with no safety equipment to protect them.  I made a stupid joke with my hands, showing someone falling from a height and landing on the ground below.  They laughed but with a certain awkwardness.  Rita showed me her calloused hands and nodded when I asked if she wears her thongs up the ladder.  Later in the night I learned that so far, three people have plummeted to their deaths from this one construction site alone.  Part of my shock included the bad taste of joking about such a thing when I should have known better.  They earn $5 per day for their efforts – 7am until 6pm, seven days a week.  A friend in Kampong Cham tells me that “some offical people” use very bad words “against poor people”, calling them names which are “not even fit for humans”.  It’s difficult to grasp where such mentality comes from but seems to be a common human phenomenon to value human beings based on their status in society.

While he was on the phone I asked Chom to check if Rita wanted to come and eat something with me and her reply “Dov!  Dov!  Dov!” translated as “she really really REALLY want”.  Nathan stayed behind to watch over their cubicle of possessions which are safe during the day when most people are working, but more vulnerable at night to theft.  Phil came with us.  Walking out through the mud tracks, I was surprised to see young children and babies living in this workers’ slum and wondered many things, from how they manage to look so clean in such dire living conditions, to if and how they get their vaccinations.  A public health nurse would have a field day providing basic services to these people!

We reached the street and TTM jumped to attention.  I climbed aboard but Rita and Phil waited in the distance until I waved them over.  Giggling and whispering to each other, it became apparent that going to a restaurant in a tuk tuk was some sort of treat.  I assumed they would lead us to a nearby restaurant but when TTM asked where we were going they said they did not know any restaurants.  They eat rice out of the rice cooker in their cubicle for every meal and do not go out to restaurants.  I wonder if they have anything with their rice?  We did a u-turn and a couple of blocks away found a local corner restaurant to eat at.  TTM asked “It’s okay for you to eat this food?”.  Yes, no problem!  TTM sat on his tuk tuk waiting and we went in.  None of us able to read Khmer, I pointed to the only photographs on the menu and ordered – frog, pork, quail and rice.  Followed by an inward sigh of relief when they said they were out of frog!  We shared a happy, broken-Khmer meal together before dropping them back at Slumville.

The trip home was filled with contemplations and a very enjoyable chat with TTM, about many things including his baby son (“I VERY love him!”), the state of inequality in Cambodia between the super rich minority and super poor majority, his aspirations for a decent future, etc.  I returned to my boutique garden hotel with it’s private pool, ordered a red wine and spent the rest of my evening trying to come to terms with this world of haves and have-nots.  My sleep was disturbed by nightmares of Rita plummeting to her death after I made that stupid-stupid joke.