A good friend of mine here in Cambodia regularly says “If I had a gun, I would kill many people”. It’s ironic and funny because he’s a comedian who would never hurt a flea. The more serious underlying message is his reference to the terrible things he knows go on in our general vicinity. A brief example of the horrors in human trafficking can be read in Good Pimp, Bad Pimp. This article was written perhaps fifteen years ago now, and features on the website of yet another decent organisation working here, United Cambodian Charity.
A friend working with UCC recently described his relationship with Cambodia as “compelling and overwhelming”. A practising Christian, he includes religious meaning to his experience. Minus the religion, Cambodia gave me a very similar epiphany about life and the world. This probably would have manifested no matter which location in the poor world I became immersed in because my entitled and indulged existence is not most peoples’ reality or perspective. The moral compunctions described in Good Pimp, Bad Pimp stem from an exposure to things which we in the privileged world may theoretically be aware of, but most of us do not have to think about or face. Sadly, as the article communicates so well, this is not the case for those enduring life on the lowest rungs of the global justice ladder.
Paula is almost set for her journey to America. On Sunday she returned to town in preparation for a planned trip to hospital yesterday. Persistent morning rain threatened our plans somewhat but eventually we decided to stop waiting. We assisted her onto the tuk tuk and chugged through town in the ebbing downpour, to the hospital. A super kind and helpful nurse friend met us at the al fresco registration desk inside the gate where Mum helped them document her presence while the rest of us waited under cover of the tuk tuk. We drove around to the main building entrance, up the wide driveway to the undercover lobby area.
A series of high-roofed, open-walled corridors interconnects verandahs belonging to different departments and wards. Tropical plants rise up from central garden courtyards, where rain pounding against the broad green leaves dulled the drone of human voices. Almost all of the floorspace brims with bodies strewn out on bamboo mats on the concrete tiles. We stepped around newborn babies sleeping under cake mesh covers next to their mothers, merging indistinguishably with surgical patients belonging to the adjacent ward. Intravenous fluid flowed from hooks suspended on bamboo poles and white uniformed nurses tended to their patients by kneeling on the concrete tiles.
Arriving at the Surgical ward reception, Paula crumpled gracefully to the floor in a near-faint. While she recovered we spoke to the charge nurse who found a bed for her in a Nightingale-style room with six beds along each wall. Once she was settled there I was led to the staff room to wait for the doctor. My Khmer ex-colleague spoke on my behalf and after some explanation, it was agreed she could have an elective blood transfusion to see her through the imminent long haul flight. But it was best that she go to Emergency for this, in case something went wrong. We somehow got her back up the swarming corridor, but near the first verandah she crumpled again. A stretcher was sourced which Mum and cousin helped steer through the crowds to the Emergency ward.
The main feature distinguishing the Emergency room from elsewhere seemed to be a wide window between the nurses’ station and the open plan patient area. Staff overlook their patients, who in turn can attract staff attention without being in the same room constantly. Apart from the mattress-free steel bed frames, the only equipment in this room was a mobile curtained folding partition. The female patient next to us was assisted off her bed onto a bedpan on the ground next to her bed. I resisted the temptation to move the partition so she could have some privacy, figuring the family member assisting her knew her limits better than I. In a country where two thirds of the population do not have access to a toilet, privacy standards are not mine to judge and noone else seemed to be taking any notice so I followed suit. In the bed opposite Paula, an elderly man seemed to spend the whole day nearing his last breath. A daughter or wife wiped his brow and placed a cool cloth on his chest while a grandson fanned him with a cheap plastic leaf-shape on the end of a handle. Clearly in need of oxygen his only medical treatment was a bottle of intravenous fluid hooked to the bamboo pole above his head. My interest in the people and events around me was equally reciprocated leading to a day of smiling and exchanging sympathetic looks. The occasional brave person would attempt a conversation with me and we’d get briefly through a few phrases before I could understand no more.
In order to avoid a fee for the unit of blood Paula received, I attended the blood bank and donated a unit to replenish their stocks. The hospital user fees including two laboratory tests (pre-and-post transfusion) and a bed for six hours came to US$20. The debt people incur when they need hospitalisation is explained by these fees which can only be avoided if you pass a poverty test with an NGO who cover the fees for those in most need. This requires a daily interview which must be conducted with a family member of the patient, meaning the patient is not the only one removed from work during hospitalisation, as a caretaker is expected to accompany them throughout admission.
The lack of basic hospital equipment will never cease to astound me. Injecting equipment and needles are carried to the bedside on metal trays, which they are placed back onto after use, to be carried away and hopefully placed in a sharps container in an unknown location. Throughout the six or more hours we were there I did not see a cleaner once. Dust and grime lines walls, fan blades and ledges; electrical wires hang from ceilings waiting indefinitely to be attached to light fittings. One large blood pressure cuff attached to a manual monitor is used for everyone, including on Paula’s infant-sized upper arm, making her very low recording unreliable although believable given her clinical condition. Despite the dearth of basic resources, staff have a good knowledge level and in fact, because of lacking resources they are often far more enterprising and creative in their approach to patient care than those of us from wealthy health systems would imagine or dare.
Post-transfusion Paula had her haemoglobin level re-checked and was well enough for discharge. I called a tuk tuk and watched them putter off into the late afternoon shadows. If her haemoglobin remains at a reasonable level for travel she won’t need to return to town and we will next meet at Phnom Penh Airport for our journey to the USA.
On a less anxious topic, Chom and I visited Toilet Two a few days ago by motorbike, a charming little outhouse perched against a backdrop of lush green sugar cane and rice crops. The quiet owners, I’ll call them Sally and Jack, are so pleased with their new lifestyle that I have been dubbed “godmother” (which beats “grandmother”!) to the children. Chom, who played no small part as translator, driver and negotiator, was gifted two chickens. Getting the chickens home required a quick lesson in holding poultry the right way, before boarding the back of the moto and holding them captive for the 20+ minute drive home. It’s not unusual to see chickens traveling in various styles by moto, but the sight of a middle aged western female grasping one in each hand, was the cause of many double takes, surprised stares and laughs from fellow motorists. One male and one female, who will hopefully provide a family of future chickens, we planned their names on the way home and came up with Sally and Jack (chicken Mini-Mes of their original owners).
Safely home, Chom tied a ribbon to one leg each, and hooked them up to separate ends of the hammock under the house. With some impressive chicken impersonating, he taught me that upon waking the following morning their instinct to run will have been replaced by recognition of their new home. As such they are now happily free range in the yard underneath the stilted house. There are so many things that a standard western education just doesn’t teach you.