Chickens For A Toilet

Everyones Home

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.

Parasite Paranoia

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That’s my thong buried deep in Mekong Delta mud.  My foot was down there too, a moment before I took this photograph, at which time I was doubled over laughing.  It was a strange combination of hilarity and panic.  The idea of parasites burrowing through my skin into my capillaries and worming their way to whichever organ they are most suited to destroying, contributed to my uncontrollable cackles.  Chom’s comedic commentary played no small part either.

The experience of being on the receiving end of the health care system in Cambodia has been predictably interesting.  First with the birth of Chom’s son two weeks ago at a private, fee-for-service maternity clinic and secondly this week with The Eyes.  I am always reminded, when I attend health services with patients, how vulnerable we are to the behaviour of those employed to serve us.  Nowhere is this vulnerabililty more profound than in places where people are already incapacitated by poverty, illiteracy, ill health and the crushing consequences of corrupt systems.

In the 1970s an international scandal erupted, exposing certain formula milk companies who were aggressively marketing their products in the Third World.  It was estimated by US Agency for International Development, that a million babies were dying each year from malnutrition and diarrhoea, directly due to marketing strategies employed by companies to encourage mothers to abandon breastfeeding in favour of formula.  Free samples were supplied to new mothers amid zealous and dishonest promotion of the benefits of these products.  This assisted in reducing mothers’ breastmilk supplies, which are generated by suckling, quickly causing mothers to become reliant on formula to feed their babies.  Once free samples ran out, many were then unable to afford the formula they needed.  Lack of access to safe water, temptation to dilute milk in order to make it last, and inability to read product instructions, all contributed to the carnage.

This all happened over forty years ago now.  Since then Australia’s “Baby Friendly Initiative”, ensuring that babies and parents are protected against company marketing strategies, has been in place for years.  This prohibits companies from promoting baby products, particularly formula milk powders, anywhere near maternity services.  While the baby formula scandal is infamous to this day, in my rich world perception, it is historical.  As such it was, but should not have been, surprising to learn that in Cambodia no such protections exist against formula and baby product marketing.

Visiting Chom’s new baby at a maternity clinic two weeks ago, I observed in quick succession: a mountain of motorbikes at the front entrance, followed by a mountain of shoes outside the door.  I kicked my own shoes off into the jumble, but upstairs Chom said he’d already lost two pairs of shoes from there, so he ran downstairs and rescued them for me.  Inside the bustling foyer I was curious at a mountain of tiny eggs piled on a plate at the seated knees of a sole seller.  Two shops on either side of this foyer inside the clinic, are stacked high with baby products including floor-to-ceiling baby formula next to equally mountainous supplies of bottled water!  Abandoning my usual self control, I grabbed the camera and snapped a couple of photographs to share with the midwives back home, before heading upstairs to meet Microphone’s baby brother.  I ducked and weaved my way through crowds of mothers, neonates and visiting family members in and around beds on the open plan mezzanine floor, towards the expensively furnished double room where Chom and his cute little family were relaxing in privacy.

The story of his birth reinforced my assumptions after seeing the marketing of products at the clinic entrance.  Dad, not allowed in the delivery room, sat at the doorway in the corridor.  Upon delivery, as research recommends, baby was immediately placed on Mum’s chest to start feeding.  A short while later however, Mum needed “to be checked”.  Baby was removed from her and given to Dad.  Soon enough hunger set in and his persistent cries while Mum remained “unavailable” in the delivery room, eventually became distressing enough that grandma made an executive decision to purchase formula milk at the shop downstairs, plus the required bottle and teat.  It was a natural birth and there was no apparent medical or other reason for the baby to be kept away from his mother at all, let alone for so long.

My visit became a mission to educate the family on the benefits of breastfeeding and the tricks employed by formula milk companies to make money.  Yesterday, almost two weeks later, I was relieved to hear Chom say “we already threw away the milk”.  The same can no doubt not be said for the many dozens of babies born at this one clinic of many likely practising in similar ways.  Talking to Win at breakfast the next day about this, he said “this is why they generally don’t like white skinned people like you to come to their clinics”.  Which is not a reference to my white skin so much as my level of awareness about issues such as formula milk!

This week’s trip to Phnom Penh dragged out for four days, full of health practitioner and health system revelations and frustrations.  Advertised as “free of charge to the patients” on an Australian NGO sign above the registration window, I soon parted with around US$200 before the experience ended, without including transport, food and accommodation.  Cataract operations are free, courtesy of this NGO, but all other procedures and all medications are charged for.  For patients who have no idea why their vision is impaired, many of whom have to go into debt to afford the medications even if their surgical procedure is free, this surely seems like false advertising.

Thanks to a few family members who recently donated money to “Cause Cambodia”, when the doctor explained that there were no donors for strabismus correction, I replied “okay so I can be the donor”.  Selena was horrified to see me hand over $100, until I explained that my family had heard how sad she was about her eyes and had contributed the money, prompting a low bow of gratitude.  I also became the donor for Mary-Lu’s thick-lensed glasses which allow her to see properly for the first time in her short life.  Simona’s cataract removal surgery was free, apart from the post-op medications, but unfortunately she remains severely vision-impaired.

After an afternoon review by a very personable Khmer doctor on Monday, we returned at 0830am Tuesday morning as instructed.  A disorganised crowd were congregated around the registration window.  I soon learned that if I didn’t stand my ground I would spend the entire morning being shoved aside by some monumental “pushing in”.  With size on my side, after the first few pushers got in front of me, I simply stood my ground, keeping some sort of informal place in the mayhem until I finally reached the reception window.

The registration nurse, who I later observed assisting with minor procedures, had the worst attitude of any Khmer person I have ever met, apparently unable to mask her distaste for the lowly humans on the receiving end of her rude and dismissive conduct.  Refusing to speak to me in either Khmer or English, I called upon Tuk Tuk to communicate on my behalf and we were told to “wait”, with zero explanation.  With no other choice, we waited.  For two hours.  The following day I was instructed that both Selena and Simona needed protective sunglasses.  Walking up the driveway connecting the main road with the hospital grounds, I found a pharmacy selling sunglasses but Arrogant Nurse was the shopkeeper!  Clearly making an income selling sunglasses and medications to the patients she victimises at Reception, I refused to hand my money to her.  Tuk Tuk very patiently drove me out onto the highway to locate a sunglass shop nearby, where I parted with $2 for two pairs of Ray-Bans!  That, and putting her photograph on the internet, makes me feel avenged of her contemptuous treatment of us and others unfortunate enough to end up on the receiving end of her substandard “care”.

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The post-op medications alone came to US$35, which would be prohibitive to most Cambodians, including Selena and Simona.  With no explanation as to what the eyedrops and pills being bagged up without proper labeling were actually for, I was shocked at the price and spent an evening at the hotel researching the medications and expected prices.  All were sold to us at first world prices, but dispensed in third world fashion, unlabelled and with no explanation except when to take what, written in marker pen on the packets, eg 1 x 3 (1 tablet three times a day).  My research showed that some were recommended post-surgery and some were less necessary and more precautionary.  In my shock at being charged yet more money as I stood underneath the “at no charge to patients” sign, I took a risk and only agreed to purchase the eyedrops for Selena, forcing the nurse to remove multiple packets of tablets from the equation.  I then explained to the sisters that they could share Simona’s Paracetamol and Zinc tablets, amid protestations from a nearby patient who (quite rightly) knew not to tablet share.  Reinforcing that vitamins and Paracetamol are over the counter drugs which can be shared, Tuk Tuk translated this to my growing audience with apparent success.  Slightly anxious that Selena will now get an infection or other complication because of my frugality, we rang today and learned that both are feeling well.  So far so good!

After two nights in hospital, the family were discharged yesterday and we made our way with Tuk Tuk to the nearby market which minivans use as their pick-up station.  Hawkers at these locations often run out into the road, shouting and competing for custom when they see potential passengers approaching.  Tuk Tuk nodded at the first hawker and we were immediately surrounded – jumping onto the steps of the tuk tuk, running behind or alongside us, the wheeling and dealing shouted around me was completely beyond my grasp but a moment later bags were whipped off the tuk tuk and into a yellow van.  I stood at the door watching the women and two girls climb in and over the seats to the back of the van, wondering how their travel sick selves were going to cope back there.  The seat directly behind the front passenger seat was saved for me, so I sat three rows in front of The Eyes, and spent the journey reasonably unaware of how they were getting on.  Occasionally I would look behind to see Selena’s head leaning out of the back window.

From my comfortable front seat, only slightly squeezed in for only some of the way, it was a surprisingly uneventful journey.  As well as stopping at routine points along the way, the driver honked at people standing on the roadside, stopping for those waving him down.  We dropped off and picked up the whole way home.  At routine stops, beggars and sellers leaned in every window trying to sell their wares or hoping for a donation into their begging bowls.  In Skun fried bugs and spiders were the predictable order of the day but the wide eyed baby on her beggar mother’s hip was the biggest mutual attraction.  When she realised her baby was staring in fascination at me, the mother stopped begging to appreciate the hilarious experience of what may have been the first time her daughter had ever seen such pale skin or blue eyes.

Disembarking in Kampong Cham, I learned a very unwell Selena had vomited the whole way.  “Oh my god!  You should have given her a bag” came Chom’s belated advice.  “I did!”.  But she vomited too much, and the bag was too small!  Clambering over the seats to retrieve my bag from under their seat, vomit rubbed against my arm from the side of the case.  I passed it out through the back window to Chom who, sickened by the smell of his own newborn baby’s pooh, immediately began dry retching!  Tipping the driver apologetically as he wiped the floor with someone’s t-shirt, we squeezed onto Chom’s tuk tuk with all our gear and “they want to go straight home”, headed straight to their village 30km upstream.

After a brief interlude with Joe and his wife, very happy and thankful to see their little family safely home again, we headed back to town on the muddy roads.  Making a shortcut turn just outside their village, Chom hesitated at a muddy patch across the track and asked what I thought.  “It’ll be fine, go!” was my reply.  A moment later we were bogged.  “Oh my god, why did you say to go!”.  Jumping out to help push, the rest is explained in the opening photograph.  In mud up to my ankles, I helped us out with some serious pushing and on we went as the mud dried itself into a layer of cake tightening it’s hold on my skin.

Coping with some serious parasite OCD the rest of the way home, we encountered another puddle on another shortcut turn, and risked it again, unbelievably becoming bogged again!  This time the tuk tuk was immersed in a big brown puddle, angled sharply ro it’s right over the muddy water.  Remembering the last time this tuk tuk turned onto it’s side, I stood on the skyward-facing step and Chom shouted at me to jump off and push.  Hesitating as I looked down into the water, which was up to Chom’s knees, I remained on board as he stood beside his moto and revved, sending the tuk tuk onto an even sharper angle.  “Oh my god!  Why are you still there! I thought you already got off!”, he shouted when he realised I hadn’t moved and wasn’t helping.  Just as I was hysterically about to force myself into the puddle, with my foot hovering over the water like a child afraid to get into a cold swimming pool, a man and two young boys appeared out of thin air and Chom translated “they will push, they said you can stay there!”.  Feeling like a queen in her chariot, the four males powered us out of the bog, sending the tuk tuk back into an upright position.  We chugged off with shouts of thank you and good luck at the rescuers shrinking out of sight behind us.  Chom’s final words on the matter were “see how the poor people, they have nothing but they still give everything that they can?”.

On the way home I fantasised about the long body scrub I was about to have and pondered on how my stressful hospital experience in Phnom Penh was completely washed away (admittedly with muddy parasite-ridden water), as soon as Chom re-entered my life.  Life’s about to get a whole lot more boring.

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The Eyes Have It

Walking through Boeung Keng Kang Market in Phnom Penh this evening, the broken concrete floors were wet with vegetable juice mixed with animal blood from hanging meat, and sticky water splashed out of bowls housing flapping fish.  Stalls were closing up and some had hosed down, adding to the puddles filling the cracks and potholes.  Looking up for a moment, my thonged right foot promptly stepped in a fluid-filled, foot-sized crater.  “Don’t think about it”, I told my OCD-alarmed brain, managing to keep the parasite panic at bay.

With her arm hooked through mine as we strolled through the narrow market aisles choosing takeaway dinner for the family back a the hotel, Sophia was on the telephone to someone.  I didn’t know exactly what she was saying, but it was an excited conversation to do with being at Boeung Keng Kang Market in Phnom Penh, buying food, staying in a hotel.  At check-in an hour earlier, I led them to their room and showed Selena how to flush the toilet, how to turn on the shower water and make it hotter, colder or change it from the shower hose to the tap.  We then had a lesson on the television remote control which took up a solid five minutes.  The Khmer staff member translated for me that they should not take anything from the mini bar in the fridge because it is expensive (by Khmer standards, so $1 per can of soft drink which costs 40c at the local supermarket).  Selena was beaming from one ear to the other throughout this conversation and I didn’t know whether to be pleased for her, or sad that a flushing toilet and a television remote control could cause such euphoria.  Simona, her blind sister, was in the room with us and sitting on the bed looking just as delighted about life.  The only reason I knew to give them a lesson in flushing toilets and running water, was that last week Paula’s mother had found herself stuck in a dry shower cubicle, unable to turn the water on!  It hadn’t occurred to my first world brain that running tap water would be an unfamiliar luxury requiring a training session.  This week I knew better.

In the tuk tuk returning to the city from the outskirts where we’d spent all afternoon at a hospital Ophthalmology department, four year old Maia began pointing towards the river and shouting excitedly.  Initially I assumed she was pointing at the boats on the water upstream, but in fact she had spotted an aeroplane in the sky, descending into Pochentong International Airport.  I realised this was the first time she’d ever seen a plane and she was clearly astonished!  Her 5yo sister Mary-Lu also spent our cross-city journey pointing excitedly at revolving billboards, massive television screens and flashing lights.  Tuk Tuk shouted “what are they doing up there?”, pointing to a rooftop where plain and uniformed police were stealthily leading a handcuffed prisoner towards a doorway, their guns poised and ready to shoot.  Sadly the lights turned green so I’ll never know what happened on that balcony somewhere above Preah Monivong.

On the bus to Phnom Penh this morning, Sophia animatedly told me something I did not understand as I sat down beside her.  Realising the bus was half empty I soon moved to a seat across the aisle from her.  When I noticed her wearing a wet tissue on her face it still didn’t dawn on me and over half an hour into the journey she finally managed to indicate with sign language across the aisle to me, that she was ready to vomit!  Horrified, I looked around for something she could hurl into and there was nothing.  I fished in my bag for tissues and located a couple but they were of no use.  She lay back and closed her eyes.  Simona was in the seat behind her, similarly postured.  Arriving at Skun they wanted to eat which I thought may stave off the nausea.  We sat together with plates of rice, meat and vegetables before boarding the bus for the next half of our journey.  Phnom Penh’s sole skyscraper had come into sight when 5yo Mary-Lu shouted my name and I turned to witness 4yo Maia vomiting an impressive quantity of mushy rice onto the floor at Selena’s feet.

Tuk Tuk was waiting for us at the bus station and we made our way to the Ophthalmology Department.  “Next time we should not try to go anywhere when it is 11 o’clock” he shouted at me as we sat in congested lunchtime traffic for about an hour.  Finally we reached the trench being dug across the riverside quay that had caused the bottleneck trapping us for so long.  “Oh no, we will have to push”, Tuk Tuk shouted as we approached a raised pile of mud covering the already-completed excavations on one side of the road.   Upon instruction I made eye contact with the motos purring at our rear before jumping onto the busy road and grabbing a pole in the cab, pushing it with all my strength as Tuk Tuk jumped off his bike and ran.  He shouted at me to get in quick so I jumped aboard again and on we carried, towards the hospital.

During a long wait at the hospital Maia managed to locate even more volumes of rice buried deep in her digestive tract which she hurled out into the gutter at the hospital entrance.  We revitalised her as well as ourselves at a dim little cafe serving meat and vegetables out of huge metal pots onto plastic plates alongside the typical spoonful of rice.  Then we sat outside the outpatient room waiting to be seen.  Finally someone registered the two women and 5yo Mary-Lu.  We sat in the queue with our paperwork and a Khmer doctor proceeded to assess their eyes, one by one.

Perhaps an hour later all assessments were complete.  Mary-Lu will be properly assessed tomorrow morning before any decision on possible treatment is made.  Simona is blinded by cataract in one eye and traumatic injury in the other.  She could have surgery to remove the cataract which will allow the doctor to then view any additional problems which are currently obscured by the cataract.  It should also increase her vision somewhat.  She is reticent but with no central vision at all, she has nothing to lose.  Sophia, hoping to have her strabismus corrected so that both eyes are aligned properly, will have corrective surgery tomorrow.  The family will be hospitalised together.  I will be in blissful poolside solitude for an afternoon/evening.

Part of Sophia’s elation this evening relates to the fact that soon she will no longer attract attention with her eye deformity.  It will also make her much more marriageable.  I hope that the same will be the case for Mary Lu and that Simona may find herself able to see at least a little if she agrees to the surgery on offer.

It was a big day.  Tomorrow should be even bigger, but thankfully it won’t be as reliant on me as today was.  Which means Chom’s phone won’t ring as often as it did today, with requests for translations!  The women have instructed me via Chom that the air conditioning on the bus made them nauseous.  So we will travel back to Kampong Cham by mini van.  Overlaoded, air-con-free, hot, stuffy, people-and-produce-packed minivan.  That’ll be my next Cambodian experience.  Another I had hoped to avoid!

Perceptions of Peril

My right eyeball became acutely aware that it was aligned with, and traveling at a speed of knots towards, a steel rod hanging perilously from the back of a truck on Cambodia’s National Highway 7.  As my face came within arm’s length of the pole pointing menacingly at it, our taxi veered left into a narrow space between the truck to our right and the median strip to our left.  If only I could speak Khmer, I’d have compared the danger of our road trip with the safety of flying in an aeroplane, to Paula’s mother.  She has made and continues to make, untold sacrifices for this one of her eight children who has been rubbing shoulders with the afterlife for 4+ years now.  One of the biggest perceived risks she is now prepared to take, is embarking on an international flight.  Aeroplane travel is not something she ever imagined she would experience and she would prefer if it were possible to drive from Cambodia to America!

Yesterday morning my final visa preparation chore was a dash to Handicap International who have been such a great and helpful organisation, to plea for the loan of a wheelchair.  An elderly stroke victim and a number of amputees were mobilising on the physio bars as babies were held by waiting parents to be seen in the busy rehabilitation area.  Relieved to be recognised by the right people, a finger pointed to the nearest appropriate looking chair, then a dismissive wave when I tried to offer identification or guarantee with a call to “bring it back tomorrow!”.  Once again Paula refused to eat pre-travel.  On arrival at the hotel, she insisted on walking the 10 metres from car to hotel reception, causing another faint.  She spent the afternoon resting and eating but again this morning, due to the early Embassy appointment, she refused breakfast.

The US Embassy in Phnom Penh is an attractive cream-and-black modern building garrisoned by high steel sharp-tipped picket-style fencing.  Massive satellite dishes furnish the roof and lawn inside the fence where Stars and Stripes fly in obscurity behind the high security structures.  Uniformed guards monitor the perimeter path on foot and by moto.  The block-sized fortress sits in the shadow of Wat Phnom, an ancient Buddhist temple atop a small hill north of the city centre.  The city’s only two skyscrapers tower over it from the other side.  The grand century-old Raffles Hotel le Royal is located a short stroll across a lush strip of parkland.  This small area of the city could fool you into thinking you’re in a wealthy country.  Until you see the hand-pulled scavenging trolleys piled with recyclables making their measly living, or the cyclos pushed by men with faces so wizened that they could be 100 years old.  Only a privileged few in this place, get to enjoy their dotage.  At both ends of the spectrum, age does not preclude you from having to earn your daily rice.  In the countryside the peers of these labourers are in rice fields or husking mountains of corn.

In a rush of confusion upon registering at the security window, I was, as suspected, denied entry and suddenly found myself waving reassuringly as my three anxious companions disappeared through the heavy iron door.  I crossed the road to say hello to Samantha’s family who had accompanied her en-masse to her very exciting visa interview.  Her young son, almost two years old, was limp in his grandmother’s arms as she sat on the pavement.  His cerebral palsy has led to severe malnutrition caused by frequent vomiting.  His hands are clenched permanently and his little arms and legs are wasted away.  Despite her own heartache, Samantha is excited at the prospect of a trip to America and told me last night with tears in her eyes that “first I will worry about Paula, then I will focus on my son”.

It was three hours before we laid eyes on each other again.  My tuk tuk friend drove me to a pharmacy where I located some Vaseline for Paula to use on the acid-scorched skin around her abdominal wounds.  We then drove to an Islamic restaurant to get some Halal food so that she would have something to eat as soon as she exited the Embassy.  As I noticed the massive mosque complex in this neighbourhood for the first time, two Buddhist monks in bright orange robes under yellow umbrellas strolled underneath the crescent-moon-and-star-topped minarets towering towards the clouds.  After posting a picture of this symbolic scene on Facebook I learned that the temple, funded by a Dubai-based businessman, opened earlier this year and is the biggest mosque in Cambodia.  Stopping at the gate so I could photograph it, an Islamic man approached my driver to tell me I was welcome to go inside.  With nothing to cover my head, I declined the invitation until another time.

I later read that Al-Serkal Mosque was inaugurated by Prime Minister Hun Sen, during which he spoke of Cambodia’s religious tolerance.  From my observations living in a Cham populated area, I would have to agree with him.  Which by no means makes me a supporter of his other political views.  Paula lives directly opposite her village mosque, a large and beautiful temple.  It is common when visiting her, to see men and women arriving for or leaving from prayer, dressed in full Islamic regalia, including women in niqab with only their eyes visible.  This doesn’t stop them from offering waves as they shout “hello” in English, or from slowing or stopping to watch the unusual visitors with curiosity.

Returning to the Embassy with takeaway containers of rice and beef, we parked over the road to wait.  We sat diagonally across from each other in the tuk tuk, our legs resting on the seat opposite as a footstool.   The topics of wealth and poverty monopolise conversations in this country of extreme contrasts.  Even more so this morning in this prime location where the power of a wealthy minority imposes visibly over the toiling and disempowered majority.

At almost three hours to the minute since they disappeared out of sight, Tuk Tuk suggested I might want to climb Wat Phnom?  Just as he spoke the words, Samantha, Paula and her mother exited the main building and made their way towards the roadside security exit.  Tuk Tuk drove around the block to park up beside them while I crossed the road to greet them.  Upon sighting me Samantha broke into a wide grin and threw her thumbs into the air.  Visas approved!  The excitement of the moment was overshadowed by Paula’s visible exhaustion.  Mum helped her into the tuk tuk while I showed Tuk Tuk how to fold the wheelchair which he hoisted onto the floorboards between the seats.  Samantha and I climbed in behind the wheelchair and we high tailed it to the hotel to get Paula horizontal asap.

Inside the Embassy everything had gone smoothly until Paula  had to stand up to be fingerprinted.  She immediately fainted and a doctor was called.  He wanted to postpone her interview until another day but meeting with serious resolve from three determined women, he agreed to allow her to persevere.  There was no doubt of the authenticity of the visa request and everything was approved promptly.  This afternoon she has been resting in bed and eating French Fries, which she has ordered as a takeaway breakfast for the morning taxi ride home!  We are all in a permanent state of exhausted elation.  All that is needed now, is to get a blood transfusion sorted out for Paula pre-flight, and put our travel arrangements in place, which is being done from New York.  My October departure from Cambodia has been known for years.  What wasn’t known until today, was that I’d be returning home to Australia via a mercy dash to the US West Coast.

Various other updates to follow, but I needed to post this amazing news.

Magnifying the Magic

The world is full of magic things, patiently waiting for our senses to grow sharper ~ WB Yeats

The day I met Paula and her family 16 months ago, they were resigned to a diagnosis of terminal cancer.  Tears were common at that time and I remember not believing our initial reassurances to her, that there was still hope she could be cured despite what she had been told.  You might wonder why doctors and nurses would give a patient false hope.  Without any first world resources of even the most basic capacity, her diagnosis was made purely on the basis of medical guesswork.  She had since been diagnosed with a second illness (Tuberculosis), which potentially explained her “terminal cancer” of the lining around the intestine, called the mesentery.  I have seen mesenteric TB before, in a young man in Australia, who was also diagnosed initially and incorrectly as having terminal, intestinal cancer.  In Australia’s robust health system, diagnostic tests eventually gave an accurate diagnosis without any unnecessary interventions and he was treated successfully with anti-TB drugs.  Not before he too, had grieved his imminent death for a few weeks until the conclusive test results brought good news.  There has been no confirmed good news for Paula, just an evolution of realisation that she appears, despite her chronic state of ill health, not to have terminal cancer.  It was memory of the Australian man’s experience which urged me, despite not knowing, to give her as much hope as I could muster from my ambiguous thoughts.

There are tears now too, but today’s tears come from a different place altogether and now they flow as far away as America, where a dozen or more people who have never met Paula are already involved in getting her into the hands of those with the skill to cure her.  Until today I’d managed to remain stoic in the face of all Paula-related tears, be it last year’s mourning or this year’s rejoicing.  Today however, Paula’s grandfather ambushed me with some dignified and humbling words.  A group of her siblings and other extended family were with me in a semi-circle facing Paula on her camp bed.  Another translator friend (not Chom, whose long-overdue son finally entered the world late last night) was sitting with us.  Tall, quiet and elegant, her grandfather entered the room of their elevated wooden home and sat beside me on a mat on the bamboo slat floor.  He lives over the road from Paula, beside the big colourful community mosque, and obviously saw us arrive.  After sitting for a few moments he spoke to me serenely as he allowed an occasional tear to swell before blinking it away.  He waited for translation at the end of each sentence before continuing on and his words included the following.  We have nothing to give you to say thank you.  But we give you our hearts.  You are not from our country and we do not have the same religion but you help us anyway.  We don’t know why you do this for us and we never met anyone like this before.  My reply to this was that I have a lucky life and I want to share it with others who don’t have my luck.  Nodding recognition of this, he continued.  Everyday I go to the mosque five times and five times everyday I talk about you and I ask Allah to give you a long life, good health and good luck.  You should have everything you wish for because you are taking my grandaughter to America.  The only dry eyes in the room belonged to raucous children.  So I finally capitulated to the infectious Paula tears!

After time with The Eye Sisters on Monday, I made a mad overnight dash to Phnom Penh on Tuesday to farewell friends holidaying from Australia.  Wednesday was a return mad dash home, on a bus that broke down about halfway up the highway.  Hanging around on the roadside, passengers chatted and formed friendships.  A young guy who I’d noticed in his seat diagonally across from mine, hoisted himself off the bus with a walking crutch.  His left foot hangs loosely at around knee level on a shortened, deformed leg.  He works for a company, traveling the country to repair machinery.  Keen to speak English with me, we had a friendly chat and swapped numbers so that “when I have spare time I can call you”.  Looking for shade, I then joined a mother with her three small daughters under a tree and we had a conversation of sorts, in Khmer.  In desperate need of the toilet, I then walked to a nearby restaurant where a lot of fellow passengers were hanging out.  Asking in Khmer for the toilet, the server instructed her small daughter to escort me.  She led me across a large dust bowl behind the restaurant and into the yard of an elevated wooden house.  Near the stairs leading up to the front door, a crowd of men appeared to be playing cards together.  They turned in unison to look at me, we chum-reap-suored each other and I was led behind them to the toilet.  A typical brick outhouse with squat platform and makeshift bathtub filled with mud-brown river water for “flushing” things away with a plastic pot floating in the water.  On my way out, the owner stopped playing cards and escorted me back to his restaurant, speaking in English to ask where I was from, where I was going, apologise for the mud-brown flushwater, etc.

About two hours later I finally arrived home and Paula was already here, lying on her hotel bed, with Mum, 5yo son and 15yo brother.  Too embarrassed to be seen in public and too incapacitated to walk far unassisted, she did not leave her room for 48 hours.  But she was thrilled to be here.  The family had already eaten lunch and announced that the western hotel food was delicious, much to my surprise!  Mum did ask if there was any dried fish, which there is not, so the next morning I headed early to Central Market and got the Islamic restaurant to make up five takeaway breakfasts of rice and dried fish which I shared with the family in their room.  But they were keen to revert to the hotel food thereafter, much to my amusement, including a hamburger order!  We managed to apply online to the US Embassy – a massive rigmarole which took up about ten hours of my time including time with a translator going through a myriad questions relating to intent of travel, then paying the fees and organising all relevant documents, making the appointment, then requesting an expedited appointment for medical emergency, all via required and exacting processes.  We took 5yo son for a couple of tuk tuk rides, to organise the fee payments at the bank and get his grandmother’s visa photograph taken, which helped keep a bored child semi-happy, assisted by the acquisition of a new truck at Central Market.

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Forty eight hours later it was time to drop them at the morning minivan for the journey home.  Paula never eats prior to travel, in order to avoid digestion problems during the journey.  This causes her blood sugar to plummet and she becomes very faint.  We went by tuk tuk via the photograph shop to have her visa photograph taken.  On an empty stomach and weighing 30kg, her mother half-carried her into the shop, a distance of around 15 metres.  She sat down, suddenly looked very pale and then glided gracefully to the floor with Mum’s very calm assistance, unconscious.  About 20 seconds later she woke in Mum’s arms beaming a smile, eliciting guffaws from everyone looking down anxiously at her!  She soon sat up for her photograph and we dropped them at the minivan under assurances she would be fine.  My heart sank later in the day when a new website page instructed me that the passport sized visa photograph had to show the ears of the person – both women had their hijabs in place and ears out of sight.  This week we have to go through the process again, although this time I’ll arrange it at a time when she has been able to eat.

Two of Paula’s brothers are reportedly very clever and through my time with the family I’ve learned that English school costs $4 per month which the family cannot afford.  This week I agreed to sponsor the two to attend private English classes and today’s trip to the community was in order to put this in place for them.  Chom was insistent I pay the fees directly so that I can see the school and know the fees have not been redirected.  We arrived at their home this morning and the boys changed out of their Islamic long dresses and headgear, into shorts and shirts.  We then drove the 8km to the nearest town and found the private English school.  Five months of fees for two set me back US$40.  What a worthwhile expense, especially for 16yo who keenly speaks to me in single words to show me his enthusiasm to learn my language.  Each afternoon 11yo brother will go on the carrier of his older brother’s bike and they will travel the 8km to school for an hour, then make the return trip home.  It might require a second bicycle but I will wait til Chom is free to advise me on this.  Such small amounts of western money can make such big differences in the lives of people in the poor world.  My experience here over the past two years has taught me that sharing the magic magnifies the magic, for myself as much as anyone else.  All of us from the wealthy world can enrich our own lives by sharing some of our magic with those less fortunate than ourselves.

A 16km round-trip each day will bring Paula's two brothers to this private English class, under the teacher's elevated home.

A 16km round-trip by bicycle, six days per week, will bring Paula’s two brothers to this private English class, under the teacher’s elevated home.

Paula's mother's market vegetable stall. While in America, Paula's sister will keep the stall going in order to keep an income in the family.

Paula’s mother’s market vegetable stall. While in America, Paula’s sister will keep the stall going in order to keep the family income flowing. They earn between $0 to $3 per day at this stall and her father is in Malaysia, earning $70 per month.

So Much Serendipity

There is nothing serendipitous about the pair of old fools who turned up here yesterday on their big macho motorbikes, drank beer, became progressively louder, harrassed the waitress who is probably a third their age, and asked for directions to the nearest chicken farm.  An old American guy who almost immediately stripped his shirt off, strutting around like a peacock confronting us with his hairy back and chest.  His even louder, obese Australian mate remained clothed but is just as offensive.  Their motos pulled in at the doorway of the hotel yesterday, and my heart sank before they’d even removed their helmets, so there’s something very visible about their Sex Tourist status.  The night before a lovely young English guy was here, traveling Cambodia on a very similar motorbike and had none of the peackock strutting of these two creepy fools.  I am off to Phnom Penh today and hope they’ll have moved on to another base for their chicken farm activities by the time I return.  I especially don’t want them to be here when Paula joins me for a few nights to organise her visa.  Sadly I have no say in the matter or they’d have never gotten through the door yesterday afternoon!

Time with the Eye Family yesterday was interesting.  Two days earlier I’d given Sophia, the family’s only breadwinner, the equivalent of US$20 to cover her loss of salary while in hospital with Simona (her blind sister) and Mary-Lu (Simona’s oldest daughter, 5yo, who was hospitalised with a fever).  Yesterday we took Mary-Lu and Sophia to the Ophthalmology Department and along the way she told Chom that Simona had taken all the money from her.  “Why she did that to her sister?!  Her sister look after all the family!  She should not do that!  I will talk to her!”.  Okay, but don’t be mean!  Our standard joke is that he’s mean to people – he’s not at all but he does “get” things that go over my head due to the language barrier.  I often hear in his tone that he’s being strong with someone and will accuse him of being mean which makes us both laugh because I have no idea what is actually being said.

Upon discharge we went with them to the roadside where Chom spoke to Simona about “not making trouble or I will tell Helen she shouldn’t help you anymore”.  Without knowing what she was saying I could see that Simona was giving him a very powerful response, defending herself.  On what was a day of revelations about this family, I realised that Sophia being the only income earner, automatically has the most power and that Simona, a strong young woman, works to keep some of the power in other ways.  Chom said “she really strong!”.  A blind widow with two children to raise in this environment has no choice.  He walked away to get his motorbike and call a tuk tuk, and in his absence I could sense via the tone and the few words I did understand, that the siblings were having words with each other.

There’s a square in Kampong Cham where mini vans that have travelled to town from villages, park and wait for their villagers to return from nearby Central Market.  Makeshift restaurant stalls with plastic chairs and tables line the edge of the square and every morning literally dozens of mini vans park up and slowly fill with people and produce, often piled high on roofs and tied in ingenious ways as it hangs comically out of open back doors.  The family followed Chom’s moto with me pillion behind him, to this square, and we saw them onto their village’s mini van and paid the $2.50 for three of them to travel home together, before heading off to see Toilet Two.

Another revelation yesterday, which I’d had a few casual thoughts about previously, related to Mary-Lu’s behaviour.  Her younger sister has “normal” (looking, at least) eyes, and normal behaviour.  Mary-Lu on the other hand, is a strange child (Chom says “she is crazy”).  I’ve vaguely thought it’s probably to do with her wonky eyes.  Yesterday as we sat on the verandah of the Ophthalmology Department I showed her a picture on my hand-held fan.  To view it she tilted her head and moved her “good eye” up close to the picture.  It slapped me in the face that she actually has very poor eyesight!  Getting them all seen by a specialist is a high priority and I feel slightly panicked that I’m organising this for them so close to my departure from Cambodia.

An Ophthalmology nurse took one look at Mary-Lu, said that she needs to go to a service in Phnom Penh, and wrote the name and telephone number of the service for us.  Next week I will travel with the two adult sisters and the two child sisters, to Phnom Penh.  Later in the afternoon I was Googling the service to ensure we’d been given correct advice.  During my online search I clicked on a link to the Childrens’ Surgical Center in Phnom Penh, where I’ve been a few times now (with Dara for his leg and one of the Phter Koma kids who needed ear surgery).  I then happened to click on a link to one of the NGOs they partner with, SEE International.  This is an American non-profit who coordinate international expeditions with first-world eye specialists to third world countries.  Amazingly, having already arranged to take the family to Phnom Penh next week, SEE International’s expedition calendar shows that from this Friday, for two weeks, they will be in Phnom Penh, for the first and only time this year!  This seems almost as miraculous as having lunch in Provence with the wife of a colo-rectal surgeon and managing to save Paula from her misery!

The family likely have some sort of genetic vision problem and so I’ve told the women I want them all (minus Joe and his wife – who are parents of the adult sisters) to come with me to Phnom Penh next week.  Traveling to the city is a big and scarey thing to these poor and illiterate villagers who may never have been to Phnom Penh before (I must ask).  They (with Joe’s permission) have agreed to go with me.

After taking Simona to the local Ophthalmology Department some months ago, I was happy with the service she received.  The doctor who assessed her seemed competent.  But we received no information on exactly what her condition is, just that he could see that she had no sutures in her eye (which she had claimed) and that he could see what caused her blindness.  The lack of information was probably partly due to the language barrier (he did speak English) but also it is normal practice here, that doctors don’t make too many explanations to their patients.  I assume this practice has evolved from a circumstance of educated doctors dealing with a population with very limited literacy and numeracy.  It is commonly and rightly assumed that patients won’t understand detailed explanations, and lack of information sharing has become “the norm”.

Next week with western doctors, I hope to receive some explanations as to why she is blind with a vision impaired daughter, in a family where three out of six people have strabismus.  I don’t dare hope for anything beyond that, but have a feeling that things could improve for this family thanks to the latest miraculous coincidence of timing.