Time Has Flewn

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Theodor Seuss Geisel aka Dr. Seuss, died 25 years ago today.  Of all the great memories I have of his books, the best by far is from the days when “Miss Twelve” lived with me.  She was thirteen but obsessed about being twelve, hence the nickname.  From her first night here, Green Eggs and Ham became her favourite bed time story.  Fairly quickly I began to dread the Green Eggs and Ham hole that drilled itself into my brain every evening.  Miss Twelve could not read but she became so familiar so quickly, with Green Eggs and Ham, that she learned exactly when to turn the page.  The first night this happened there was wild excitement that she “know how to read”!  A child who had hardly been to school in her first twelve years of life, became dedicated to learning – at least in part thanks to Dr Seuss but also in part thanks to the behavioural management of her very skilled teachers.  She is all grown up now and embarking on motherhood.

Many of the local children I’ve known and loved here in Alice Springs have families of their own now.  That’s a strange feeling.  So is the feeling, after owning a permanent position for eighteen years, of making the decision to resign.  But time really has flewn and new adventures await.  I said I would wait a year before making any decisions about this and ten months in, I came close to keeping my word.

If you want to get things you can’t buy in a store
You have to do things never thought of before
~  Dr Seuss

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Blackened Swans

Painted Black

In 2003, days before the Allied invasion of Iraq, Natalie Maine was performing on a London stage as lead singer of the Dixie Chicks.  She is quoted as saying to the audience, “Just so you know, we’re on the good side with y’all. We do not want this war, this violence, and we’re ashamed that the President of the United States is from Texas“.  The fallout was swift and severe.  Country music radio stations across the US boycotted their music.  Two disc jockeys were suspended from one station for playing Dixie Chicks against station policy.  Public demonstrations crushed and burned piles of their CDs.  Hate mail and death threats were posted.  Concerts were cancelled.  Within a single week one of their songs fell from No. 10 in the charts, to No. 43, before falling off the charts altogether.

Three years later, in response to the furore, the Dixie Chicks released their single Not Ready to Make Nice, which went on to win Record of the Year, Song of the Year and Best Country Performance at the 2007 Grammy Awards.  Above is a still image from the single’s elaborate music video.  In dark scenes of puritanical retribution, three women dressed in white are tarred black under the watch of a group of cold eyed, imperious figureheads who stare and whisper in judgement.  The symbolism is genius, articulating the ugliness of unjust condemnation.

Recently Natalie Maine has compared her very mild comment in 2003 with the vitriol spewing from the mouth of Presidential candidate Donald Trump in 2016.   Rightly so, particularly as many of the same mindset who denounced the Dixie Chicks, now make up Trump’s cheer squad.

We’ve all been that blackened swan, unfairly condemned by others.  We’ve also all been that unforgiving puritan, sitting in unfair or excessive judgement of others.

That said, I feel justified to talk about Kim, the amputee landmine victim detailed in previous posts such as:
Monks on Motorbikes, March 2014
Imperfect Equals, July 2016
Mum, Ruth and I were sitting at a cafe in Siem Reap one afternoon, sipping wine and watching the world go by.  Perhaps more than anywhere else I’ve been, Siem Reap is a city of bustling contrasts where wealth, tourism and relaxation are juxtaposed with poverty and all manner of visible hardship and struggle.  One of many disabled peddlers targeting tourists in the lanes around Pub Street, Kim was suddenly standing before us, a basket of books suspended at his chest via a scarf tied around his neck.  We declined to look at or buy a book and he hobbled away, placing a typewritten note on our table as he departed.  The note described his life, family, hopes and the anxiety of trying to survive.

It affronted me that I was returning to a luxurious hotel for a swim in the shaded rock pool while this man I’d denied help to was left worrying about how to feed his family.  So I emailed him and offered to help.  He was the first person in Cambodia I offered support to and for over two years I sent a small sum to him each month.  I visited a number of times and met his family, purchased his wife a sewing machine and spent time with his young daughters.

A few months ago, as described in Imperfect Equals, Kim contacted me to say that the lack of tourists was affecting their lives badly and he had no way of paying his rent.  He had only contacted me once prior, when one of his daughters was sick and he needed money to take her to a clinic.  I trusted his words so I dedicated time and thought to the matter, ultimately deciding that I wasn’t able to send more money.  A very short while later he sent me a photograph of the family via Facebook.  Clicking on the photograph took me to a Facebook page dedicated to raising money for Kim’s family.  At first I was perplexed by the posts on this page, talking about funds raised and the assistance being provided at a village outside Siem Reap, such as water tanks and toilets.  It is all in Kim’s name and he features in many of the photographs.

Reading through the posts it became apparent that an Australian man called Bob was very involved with fundraising for Kim, his family, and their village.  I called Bob to find out more, trying to process what it meant – if it meant anything at all – that Kim had never mentioned this guy to me before?  When I visit his house, there is always a photograph of Mum and I on the wall, but no photograph of any other donor.  Last time I visited I saw his wife in town on a motorbike, which surprised me as they couldn’t afford such a thing.  They did not know I’d seen her and when I asked if either of them rode a motorbike, I was told that she knew how to but that Kim, due to his amputations, was not able.  I guessed she had loaned it from a neighbour.  I also noted that the sewing machine I’d bought his wife appeared to be missing, although it was difficult to see for sure as the table where it once sat was covered over.  I’d told them to feel free to sell the machine after learning it was difficult to earn much through the agent, who provided materials and paid her 12c per dress.  Yet they had not admitted that the machine was sold and I wondered why it appeared to be a secret?

Bob and I spoke at length and I discovered that the family’s rent had been paid up for a full year, until October.  His fundraising efforts had also purchased Kim’s wife a motorbike, meaning she could transport him to town and back for his book peddling, when in the past he’d had to walk.  So while they had not expressly lied about the motorbike, they had kept it a secret from me.  In June when Kim expressed concern about paying his rent in hope of receiving extra help from me, he was lying.  I immediately contacted him to say I had spoken to Bob and I knew his rent was paid, and that he had lied to me.  He denied the lie.  I withdrew further financial support for the time being.  He has since apologised, clearly in hope of my changing my mind.

With our language and world view differences, we need some proper clarity and so I will visit him with an interpreter during my upcoming visit.  He knows this is the plan and appears to think that it means I will support him again.  I might.  I also might not, depending on what eventuates.  He continues to contact me semi-regularly with messages such as, his daughters can no longer attend English school, or there are no tourists and life is hard.  A few days ago he expressly requested money, repeating his apology for lying.  Determined to follow through with my plan to do nothing until we speak in person, I replied “Sorry.  No”.

There are very many people in Cambodia who could benefit from the small help I was providing Kim, yet who do not dedicate their lives to begging from tourists and who maintain a sense of dignity that I feel Kim may be missing.  The help Bob provides is partially spent on others in Kim’s village and this has apparently caused friction between them as Kim feels his family’s needs should be paramount.  I get the impression though, that the help which is due directly to Kim’s activities in Siem Reap, gives Kim some standing in his community that he otherwise would not have.  Neither Bob’s nor my help has in any way made Kim wealthy or secure, merely relieved some discomfort and stress for him and his family.

Kim’s disability has become his asset in some ways.  It would be easy to blacken him for his behaviour.  But who am I, in my comfortable life, to sit in judgement of him?  Our childhoods played out simultaneously.  As I was cycling to school on paved roads, returning home to watch television, jump on our trampoline and eat three meals a day before going to sleep in a soft bed, Kim was recruited as a child soldier to the forests of Cambodia where he stepped on a landmine and lost the use of three limbs.

I don’t want to feel exploited.  Equally I don’t want to play judge, jury and executioner of someone whose chances in life will never match the chances I have always taken for granted.  In ethical terms, Kim’s dishonesty could easily be matched by a privileged and puritanical austerity.  My intention when we meet is to resolve the conflict rather than to blacken his dignity.  It will be interesting to see if we succeed.

judge-others-define-yourself

Rocks and Hard Places

If I had to pick a pivotal milestone during my daily experiences in Cambodia, I would probably pinpoint the boat trip with Mum and Ruth in January 2014.  It was my first holiday, three months into my assignment with Medecins sans Frontieres.  Since landing in Phnom Penh I’d been bombarded by sights which did not immediately make sense to my rich world brain.  Adorable tiny babies who could walk and talk initially captivated me.  The genesis of their adorability however, is acute-on-chronic malnutrition caused by severe deprivation.  Astonishing sights on the roads, of vehicles loaded beyond imagination, were highly amusing.  Until my thoughts processed that these dangers are the result of people doing everything within their power to earn enough to feed their families.  At the hospital many people literally died of starvation before my eyes.  Children out of school, the elderly, blind, amputees and those with deformities and disabilities seemed very visible and behaved in ways which were unfamiliar to me.  Walking the streets with a sense of determined purpose, foraging for something to eat, or for something to sell in order to eat.  Many sleep rough in the city’s streets.

Perhaps it was the fact that everything was happening on water rather than land, that the sights along the Sangker River and across the huge Tonle Sap lake between the cities of Battambang and Siem Reap, seemed so striking to us?  We spent eight hours traveling on an open air boat through riverside and floating villages, dismayed by the scenes of poverty and simultaneously fascinated by the bustling activities all happening on this endless body of water.

Shopping on the waterways of Sangker River, January 2014

Shopping on the waterways of Sangker River, January 2014

Our journey set sail on the outskirts of Battambang city.  Less than a year later Roka village, a short distance west of the city, with a population of around 800 people, made international headlines.  In November 2014 a 74yo TB patient from Roka tested positive to HIV, a routine test in any TB diagnosis.  With no risk factors for HIV he became concerned and his family also sought testing.  His son-in-law and grandaughter also tested HIV positive.  The family alleged that injections from a local unlicensed practitioner were to blame and encouraged others who had visited this medic to get tested.  30 new HIV notifications from within or close to Roka were reported in December 2014, compared with four new notifications for the whole year preceding this.

Experts from a Phnom Penh university and the National Centre for HIV/AIDS, Dermatology and STIs (NCHADS) immediately formed the Roka Cluster Investigation Team and traveled to the village.  Over 8,000 residents living in the area around Roka were tested and by February 2015, 242 new cases of HIV had been diagnosed.  Analysis of the blood samples confirmed that most infections were recent and that a single HIV strain was responsible for the outbreak, meaning they all originated from the same source.  Many had no risk factors at all, including young children born to HIV negative mothers and 4yo twins, only one of whom was HIV+ on testing.  There was a significant association with the administration of intravenous fluids or injections in those who tested positive.

A significant number of victims also tested positive for Hepatitis C virus, which is also associated with unsafe injecting practices.  Until very recently Hepatitis C, which ultimately leads to cirrhosis and liver cancer, has been extremely difficult to treat.  This year the Australian government approved the use of brand new treatments which can cure the virus with few if any side effects.  Australians infected with Hepatitis C can now access these drugs free of charge on the Pharmaceutical Benefits Scheme.  Each short course of treatment costs in the vicinity of $80,000, meaning the drugs are inaccessible to most people in the world.  Obviously villagers in Roka have no way of receiving such treatment although Medecins sans Frontieres are working at implementing a program to make the drugs freely available to a cohort of Hepatitis C patients in Cambodia.

The self-proclaimed “doctor” at the heart of the Roka outbreak was 55yo Yem Chroeum who has since been sentenced to 25 years imprisonment on charges including murder and knowingly infecting people with HIV.  He is accused of reusing needles and syringes on multiple patients.  Chroeum received informal training by a foreign doctor in a Thai refugee camp during the 1970s/1980s.  He returned to a distressed country decimated by genocide and civil war with 25 surviving qualified doctors, most of whom could or would no longer practice medicine.

Immediately after World War II ended the USA shipped billions of tonnes of food to Western Europe and Japan before implementing more long term economic supports to rebuild both regions which were considered paramount in preventing the spread of communism from Russia and China.  Both regions became powerful economic forces despite their war time devastation.  Cambodia on the other hand, “liberated” by the communist Vietnamese in 1979, has suffered an entirely different fate.  The entire Western world enforced economic sanctions and blocked almost all foreign aid to the country, effectively debilitating the nation until the Paris Peace agreement was signed in 1991.  Their opportunities to rebuild and prosper have been severely hampered.

Chroeum settled in Roka in 1995 and was allegedly a popular medic among villagers, reputedly skilled at treating fevers.  He maintains his innocence but has admitted to reusing equipment.  However, according to Centers for Disease Control, 99.7% of needlestick injuries involving HIV-infected blood do not result in transmission, so reuse of infected equipment alone does not seem to account for the outbreak?  Since his arrest Chroeum’s family have suffered social isolation and financial hardship.  Without their father’s income and as many villagers now refuse to buy from the family shop they struggle to pay for his prison meals which are not provided by the state.

Intravenous infusions are a highly popular treatment for all ailments in Cambodia.  Bags of fluid suspended from bamboo poles traveling through the streets are a regular sight as patients cruise on the backs of motorbikes while they wait for their infusion, delivered by the many local private clinics, to finish.  Some Cambodians have told me that if a clinician does not offer intravenous infusion as part of the treatment for any ailment, they are not considered authentic.  In a country so poverty-stricken, under-resourced and under-trained it is amazing, with so many intravenous lines being inserted, that more service-acquired bloodborne virus transmission does not occur.  In fact, Cambodia have been highly successful at reducing their HIV prevalence rate which peaked at 2% in the mid-1990s and is now down to around 0.4% of the population.

Almost 300 people linked to the Roka outbreak have been diagnosed as HIV+ and at least 16 have died, mostly infants or the elderly, who are less able to contain the infection and/or unable to tolerate the side effects of anti-retroviral treatment (ART).  ART medications are provided free of charge via the Global Fund but all other health interventions cost money and many have had to sell land, livestock and other assets in order to pay for medical expenses.  Many have fallen victim to theft as illness has made their homes and livestock vulnerable to opportunistic crime; many are also too sick or too weak from medication side effects to work, intensifying their financial hardship.  Stigma and discrimination, travel companions of HIV and other bloodborne viruses in the most privileged and educated of societies, have stamped their mark, with many first hand reports of ostracism within and beyond Roka which also severely affects peoples’ livelihoods.

In response to the outbreak, the government cracked down on unlicensed health care providers.  Cambodia has a total of 3,000 qualified doctors for a population of 15 million.  This is comparable to the proportion of doctors in Afghanistan and contrasts with Australia where we have 70,000 qualified doctors for 20 million people.  With such inadequate services, 70% of Cambodians seek health care from unlicensed providers and many have never seen a qualified doctor in their life.  The official health system is so fraught with problems that it cannot guarantee a better quality of care anyway.

These are the realities of what it means to be impoverished.  Lack of individual money is only one aspect to a widespread societal issue relating to options and opportunities which are tangled up in historical considerations, education, economics and politics.

As the experience in Roka demonstrates so acutely, poverty is an expense that society cannot afford.

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