The Magic is Always There

Somewhere over the rainbow
Way up high
There’s a land that I dreamed of
Once in a lullaby

A few weeks ago I saw the recent NZ film Hunt for the Wilderpeople at the cinema with Karen.  An indigenous teenager from one of Australia’s most remote communities, she laughed loudly and often, sometimes at inappropriate times.  I was amused but slightly uneasy that the audience around us might be irritated.  At the same time I pondered on the concept of sophistication.  I’m sure that if I spent significant time in Karen’s community I would also behave in ways that locals would consider unsophisticated.  If sophistication is a heightened insight of the culture you are interacting with then noone has universal sophistication.

In it’s first weekend following release, Hunt for the Wilderpeople grossed over $1.2 million at the Box Office in New Zealand.  In a country of 4.5 million people, at $20 per ticket, 225,000 people attended a screening.  That’s one person in every 20 who saw one film in one weekend.  In the majority of the world economies of survival mean that such frivolous entertainment is not even in the mindset of most people.  Events such as this one film release showcase just how prosperous we, who live in wealthy countries, are.  There is a reason beyond targeting an English speaking audience, that these films are not released, or that world famous entertainers do not perform, in poor countries.

Today I see the prosperity in my world with the eyes of someone who grew up immersed in it as “the norm”, but whose view of the world was chewed up and spat out by the revelation that I belong to an over-privileged minority.  My life and the lives of those around me in Australia and other Western countries, have an overriding theme of freedom, comfort and opportunity.  In Cambodia – as with most of the world – the lives of my friends and colleagues have an overriding theme of crushing adversity.

On Facebook this morning my goddaughter messaged me from London with her latest plans for her Australian holiday next month.  I then opened my email to news from another friend who had just returned to London from a business trip to Rome, Budapest and Amsterdam.  At the same time an ex-colleague in Cambodia wrote that he has two critically ill patients with only one oxygen cylinder, days after his last message about a TB patient who had died due to inadequate medical attention.  Earlier this month I met with a group of doctors all earning high Australian salaries in a work environment considered “normal” for the rich world minority yet unimaginable to most, including resources, training, paid holidays and superannuation.  They admitted to knowing little about Tuberculosis thanks to the fact that it is such a rare disease here.  As I sat observing them, I thought of my good friend and Cambodian doctor earning $700 per month, who sees dozens of sick and dying Tuberculosis patients everyday.  He once said to me “I try not to think about my future because it is very dark”.  This comment from a medical doctor took my breath away.  In my world, the future of any medical doctor is one of opportunity, reward and status.  To suddenly have to comprehend that this is in fact, the exception rather than the rule, for medical doctors on a global scale, was a massive shock to my first world brain.

These disparities exist purely due to circumstance.  Ultimately all health professionals have the same goals – to do the best for their patients.  The abilities of my Cambodian colleagues are suffocated by lack of resources to do for their patients, what we are able to do for ours here in the wealthy world.  The opportunities that I and my western world friends are offered, exist purely because we were born into a prosperous system.  Not everyone in the wealthy world takes the opportunities on offer and in fact, not everyone in the wealthy world appreciates or envisions that these opportunities are available to them.  Conversely, opportunities in the poor world exist in a highly competitive environment, often cloaked in corruption and nepotism, and incomes are rarely more than enough to survive on.  Yet many know that beyond their world are prospects that they would strive for if they could.  These people work hard towards improving their situation, working long hours, finding creative ways to improve their knowledge and education, sacrificing meals and other basic needs, all in the hope that the world might be better for their children than it has been for them.

Speaking of one of the many children enrolled in the Cambodian Children’s Fund’s educational programs, Scott Neeson said “She arrived in May, 2013 in a terrible state, out of school, sick, without a light in her eyes and an overwhelming sense of sadness. That was then…. Yesterday she won “The Best Student of 2014” at her facility. Note the confidence, joy, poise – and the light in her eyes….As I have said many times before, it is not about us putting all this magic into the children: it is already there“.  The same can be said for the indigenous children I know here in Central Australia, and for disadvantaged children anywhere, as Harris Rosen can also attest after his Tangelo Park Project turned a troubled American community around in only 20 years.  All that children anywhere really need, is the right input, to retain and realise their boundless potential.

We all have the capacity and the right, to have that light in our eyes.  The loss of human potential resulting from deprivation of basic freedoms and opportunities, whether due to poverty in a distant and impoverished country, or disadvantage in sub-populations of wealthy countries, is a loss to us all.  Children all over the world are born with that light in their eyes.  What could be more important than working towards ensuring justice and equity for everyone – not just an entitled few?

Over the Rainbow was one of my all-time favourite childhood songs.  Especially when Kermit the Frog sang it from his log on a pond during The Muppet Show on a Saturday night.  How amazing it is, to discover that the land beyond that rainbow, is where I always was!  How wrong and unforgivable that so many of our equally deserving fellow humans do not know this liberty.

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The Price of Fish in Mexico

Chickens

As kids we wondered about the price of fish in Mexico as a way of suggesting something was highly irrelevant.  I thought of this as I wrote to a friend to ask about the price of chickens in Cambodia?  Who’d have ever thought such a thing would ever be relevant to my life?  Turns out it kind of is!  Take a glimpse at how the world works beyond our first world box of safety and comfort!

Why Bill Gates Would Raise Chickens

If you were living on $2 a day, what would you do to improve your life?

That’s a real question for the nearly 1 billion people living in extreme poverty today. There’s no single right answer, of course, and poverty looks different in different places. But through my work with the foundation, I’ve met many people in poor countries who raise chickens, and I have learned a lot about the ins and outs of owning these birds. (As a city boy from Seattle, I had a lot to learn!) It’s pretty clear to me that just about anyone who’s living in extreme poverty is better off if they have chickens.

Find out why by reading the rest of his blog and enter the competition to “give a flock of chickens to a family in need”.

Why I Would Raise Chickens : Bill Gates’ Blog 7 June 2016

Melinda also wrote on the subject:

Melinda Gates Blog on Chickens Solving Problems, 7 June 2016

Oh and the going price for a live chicken in Cambodia?  US$10.  In a country where the average income is $852 per year, or $2.40 per day, that makes chickens financially valuable before you even consider their social impact.

Disease and Discrimination

The average number of individuals directly infected by one infectious case during the entire infectious period of a specific disease is defined as the basic reproductive rate.  Infectious diseases have individual characteristics, such as the route of transmission and the number of organisms needed to cause infection, which make this calculation different for each disease.  Variables such as population immunity will also affect the reproductive rate.

One of the most contagious human diseases is Measles, an airborne virus which spreads rapidly in non-immune populations.  A person with Measles is infectious from four days prior to the rash appearing, until four days after the rash appears.  Assuming contact in a non-immune population, the index case will infect between 12 to 18 people during this short period.  Today we are seeing outbreaks of Measles in certain first world populations who have become opposed to vaccination.  It also causes outbreaks in conditions of overcrowding such as refugee camps where people have migrated from places with disorganised health care systems where vaccination programs are either absent or unreliable.  A high rate of vaccination in populations is needed to prevent this rapid transmission in such a potentially deadly disease.  In brief, this is why organisations such as Medecins Sans Frontieres run mass vaccination programs in refugee camps.

A single case of Influenza will infect between 2 and 3 non-immune people during the infectious period which lasts approximately eight days.  In Australia we see 10,000 people hospitalised with Influenza each year and up to 4,000 deaths.  This often comes as a surprise to people who have come to consider Influenza an unimportant disease, perhaps because of the over-use of it’s name in people suffering from a common cold or other mild winter-associated viral infections.  Epidemiologists keep a very close eye on Influenza patterns in populations as it is highly likely to cause the next global disease pandemic due to it’s ability to spread rapidly whilst constantly mutating into potentially more virulent strains.  In 1918 the world saw an Influenza pandemic known as Spanish Flu, which killed an estimated 20 to 40 million people.  The next time this happens is a matter of when, rather than if.    I am a strong proponent of Influenza vaccine and one of my biggest work frustrations is when I am unsuccessful at convincing Influenza Doubters that there is good reason to have the annual Influenza vaccination.  Those of us who are young, strong and healthy can assume we don’t need the vaccination but part of the purpose of vaccination is the protection of vulnerable people by reducing disease transmission.  Personally I would hate to be responsible for spreading a disease which may not threaten my own health, but which kills thousands of susceptible people.

Ebola is considered infectious for the duration that a person is unwell with symptoms.  Symptoms of Ebola in the West African outbreak last year, lasted an average of ten days before patients either recovered or died.  During this ten day average, each index case infected between 1 and 3 secondary cases.  The outbreak was only contained when appropriate preventive measures were able to be implemented, such as early diagnosis and isolation of cases.

Tuberculosis is vastly different from the above three examples of viral infections which spread quickly and have very short incubation periods.  Not only is Tuberculosis a bacterial disease, requiring much closer and more prolonged contact to spread between people, it also has a unique and complicated incubation period which depends on multiple host factors such as age, presence or absence of other sicknesses and risk factors such as smoking, certain immune-suppressing medications etc.  The bacteria is slow-growing and usually causes a slow onset disease in people unable to contain it.  TB disease can present in many ways, with 70% of all TB disease occurring in the lungs, but 30% occurring in other parts of the body.  Only a proportion of TB disease is infectious, but when an index case does have infectious TB, World Health Organisation estimate that on average they will infect between 12 to 18 people per year (assuming a person remains infectious with untreated disease).

Despite it’s much slower reproductive rate than many other diseases, and despite the human immune system’s ability to contain the bacteria in up to 90% of people infected, TB is nevertheless the world’s leading killer over any other single infectious organism.  Because of this, it causes fear and anxiety across the globe.  In countries of high prevalence, people have often watched loved ones or neighbours die from TB, which leads to fears about transmission resulting in stigma and discrimination.  In wealthy countries similar concerns happen thanks to the disease’s reputation, combined with low incidence rates which have made it a mysterious disease that few people understand well.  This is exacerbated by the fact that the disease is complicated in the way it interacts with human hosts, sometimes causing disease whilst other times not; and causing a very wide range of disease presentations.

Recently a friend working as a photographer in Cambodia sent me this message:

Hi , visiting a man living alone with TB this morning, some of the saddest photos I’ve taken so far. He is taking medication but has to walk from the community to the bridge and then take a remorque for 5 km to the TB clinic, every day, because they don’t want to give medication for more than a day at a time. He leaves at 5am in the morning, returning around 11am. We are trying to help, with food and shelter and maybe finding a clinic that is closer. He is sharing his platform with another family, a grandmother who had a stroke but is looking after three grandchildren while the parents are working. I’m not quite sure how easily TB is transmitted, so we just asked him to wear a mask all the time. He spends his nights sitting up because it is too painful to lie down. And apart from a really lovely young couple, the rest of the neighbours don’t want him out of his platform. I thought that maybe if we could have like a simple information meeting about TB, people would not be so afraid of him… Do you have anything, or MSF, for that purpose? Like with drawings for example.

TB Case

In the poor world, where 95% of all TB cases occur, stigma, social exclusion and discrimination such as this are a common experience of TB patients.  In the rich world, where TB is far less common, the same fears exist but often steeped in incorrect assumptions about the disease.  A quick Google News search of Tuberculosis this morning comes up with the following items:

  1. More than one-third of refugees in Vermont test positive for tuberculosis
    http://watchdog.org/266740/vermont-refugees-test-positive-for-tuberculosis/
    The article then goes on to describe Latent TB Infection, which is not TB disease but simply shows that a person has been exposed to TB.  One third of the global population has Latent TB Infection, most of them untested and unaware and 90% of them will never get sick or be infectious.  That includes me.  The article is potentially misleading and could easily cause fear and discrimination in a community of low TB prevalence.
  2. Is Tuberculosis Making a Comeback?
    http://www.ktoo.org/2016/06/01/tuberculosis-making-comeback/
    This article tells the story of a woman in Vermont who became unwell with TB and spent 3 months returning to the doctor looking for a diagnosis before it was finally pin pointed as active TB disease.  It also mentions briefly the extreme measures that are taken in the rich world, with low prevalence rates, to identify contacts of an active TB case in order to reduce their chances of developing active TB.

Nowhere in the first page of Google news feeds on Tuberculosis is there a headline about the 95% of TB patients living in poverty with challenges such as the elderly Cambodian man my friend is trying to help.  Contact tracing in places such as Cambodia and East Timor is a very limited activity as services buckle under the pressure of active disease.  By comparison, the rich world offer the opposite extreme, spending almost all of our resources on trying to identify contacts and reduce their risk of developing disease.

TB is a curable disease, with the exception of MDRTB and XDRTB which present challenges for treatment and cure.  Yet, almost exclusively because of poverty in far away countries, it remains one of the world’s biggest public health challenges.  In the 1700s in England, 1 to 2% of the population died of TB.  The reduction of poverty and improvement in living conditions across the country, all but defeated this and many other diseases.  History has demonstrated repeatedly, that when social conditions improve, so does population health.  Instead of talk about closing borders and stopping travel, as some politicians did during the Ebola outbreak last year, we should be promoting information and involving ourselves in trying to make the world a more equitable place for everyone.

The Definition of Success

In 2013 Angelina Jolie won a humanitarian award at the Governor’s Awards, which celebrate lifetime achievement in film, and form a part of the Academy Awards in Hollywood.  Her heartfelt, at times tearful, utterly inspiring speech, started out acknowledging various people including friends and family.  She then went on to honour her mother, who had been her biggest support, encouraging her artistic ambition and spurring her to live a life of meaning and use to others.  A video of the full speech is here .

<My mother> gave me love and confidence, and above all, she was very clear that nothing would mean anything if I didn’t live a life of use to others.  I didn’t know what that meant for a long time.  I came into this business young and worried about my own experiences and my own pain.  It was only when I began to travel and look and live beyond my home, that I understand my responsibilities to others.

When I met survivors of war and famine and rape, I learned what life is like for most people in this world, and how fortunate I was, to have food to eat, a roof over my head, a safe place to live, and the joy of having my family safe and healthy.  And I realised how sheltered I had been. And I was determined never to be that way again.

We are all, everyone in this room, so fortunate.

I have never understood why some people are lucky enough to be born with the chance that I had, to have this path in life, and why across the world, there is a woman just like me, with the same abilities and the same desires, same work ethic and love for her family, who would most likely make better films and better speeches.  Only she sits in a refugee camp.  And she has no voice.  She worries about what her children will eat, how to keep them safe, and if they’ll ever be allowed to return home.

I don’t know why this is my life?  And that’s hers?  I don’t understand that.  But I will do as my mother asked, and I will do the best I can with this life, to be of use.  To stand here today means that I did as she asked, and if she were alive, she’d be very proud.  Thank you.

My own mother would have been foolhardy to encourage me into a life of art, although I do remember the occasional ludicrous suggestion such as joining a marching team and getting involved in local theatre!  Otherwise, Angelina’s words about her mother’s love and encouragement reflect my own experience, for which I am eternally grateful.

More than that, Angelina’s words echo my own daily thoughts around how and why I – over so many others equally and more deserving – was born to such incredible good fortune.  Not a day goes by now, when I don’t have at least one jolt of astonishment at my pure luck of birth.  It also amazes me daily, that despite my education, world travels and easy access to information through all forms of modern media, I had led such a sheltered existence as to remain steadfastly unaware of my windfall in life.

Since 1979 when the Khmer Rouge were overthrown, a total of over 64,000 landmine victims have been recorded in Cambodia.  There continue to be approximately one casualty every couple of days in the country, reflecting the inordinate number of mines planted in the country and the great difficulties of landmine identification and clearance in a resource-stricken, systemically chaotic nation.  Surviving victims live almost exclusively in extreme poverty, with even more limited means of income than their able-bodied peers.

I knowingly met my first landmine victim during a holiday with my own mother, visiting from New Zealand, and the mother of a good friend, visiting from France, in January 2014.  We were sitting at a bar enjoying an alcoholic beverage one afternoon when he appeared before us, a small basket hanging at his chest via a rope around his neck, filled with books for sale.  One arm amputated below the elbow, the other missing part of his hand and one leg amputated below the knee, standing upright on an old fashioned flesh-coloured, leg-shaped, rubber prosthetic.  Not used to such sights, his appearance came as a shock to us.  We did not want to purchase any books and he departed, placing an A4 page on our table with his story typed out in English.  We read it and I put it in my bag.  Injured by a landmine as a teenager in the Cambodian army, his only income is from selling books to tourists, he tries to feed and send his children to school but it depends on sales.

For hours I thought about how life would be if there was no way to earn an income, if my limbs and hands were deformed or missing, if I were impoverished and every day I had to bravely approach wealthy people who look shocked at my physical appearance and who have no perception of my reliance on their generosity.  The inequality and indignity seemed inexcusable and so from our hotel room that night I sent him an email offering to help in some way.  He replied with gratitude and about a month later we met.  I bought his wife a sewing machine and I send them US$50 each month – a perfectly affordable contribution from my first world income and yet significantly valuable to the life of a disabled man and his extremely grateful family.

When I visited them again last year, the sewing machine was in a corner of their tiny room, smaller than my own bedroom but which serves as bedroom, living room and kitchen to four people.  On the wall above it was a poster in English reading “donated by Madame Helen from Australi”, next to a framed photograph of Mum and I sitting together in a cafe in New Zealand!  Across from our framed photograph, on the opposite wall is a photograph of Cambodia’s much revered King Norodom Sihanouk (now deceased) and his wife Queen Monineath!!

Since leaving Cambodia I have sensed a fear in my friend, that he may lose me to the unknown world where I come from.  He maintains irregular contact with me on Facebook, apparently when he can afford to visit an internet cafe and find someone to help him with an English message.  I regularly assure him of my ongoing assistance.  Our communication this week is a good example:
Hello Madam how are you and your family ? I’m good thank you, Today, I a,m, never without tourists broken today any where to pay more rent, I do not deWhen tourists visit Cambodia, Thank madam Good luc to you and you family and good health from my family !!
Hello Kosal. I am sorry to hear about the tourists not coming to Cambodia. I always remember that you need my help and I will send some money soon. Probably next week $50. Every month I send you $50 but I have to wait until my pay day. I promise I will never forget. Stay strong!  I hope the tourists will return to Cambodia soon!

I feel acutely aware of the power I wield over someone who simply lucked out around the same time that I lucked in.  Not only is it my responsibility to maintain the help I have offered, but helping offers me a sense of reward that my good fortune in and of itself, does not.  The fact that we cannot help everyone in need does not mean that we should not help anyone when it is within our means to do so.

Success in Life