Resolutely Carnivorous

Friends in Alice Springs live on a rural property where they breed their own poultry and the occasional larger animal.  Oneday last year I was standing in their chicken coop, a glass of wine in hand and about 50 chooks at my ankles, when my friend approached me holding a bedraggled cockerel.  “Do you think he’s normal?”, she asked, pointing out some bald spots, mis-shapen claws and a gloomy countenance.  Hardly the expert, I replied with an uncertain tone but it was enough to reinforce her opinion and she instructed her husband to “put him out of his misery”.

The bird was secreted around the corner of the shed.  At the sound of an axe making contact with a hard surface, I peered around the corner just as Dad told his 15yo assistant to reposition their still-intact target and another – successful – blow was administered.   To this day the memory torments me.  Yet I’m just as likely to have eaten chicken for dinner that very night.  Here in Cambodia it’s a daily sight to see motos encircled with live chickens hanging upside down from a frame or pigs laying upside down behind the moto driver transiting them to their demise.  I’m always sticken by their plight, yet they feature frequently in my diet.

This morning my phone rang at 7am.  Paula’s 17yo brother, I will call him Mark, is a star student and the family have hopes he may further his education and acquire a career with a good salary.  This is very dependent on a number of factors, including the family’s financial ability to offer him continued education.  Five evenings a week, he and his 12yo brother attend a $4/month/student English school at the town nearest their village.  The family are unable to sustain this cost, so I sponsor them with six monthly payments of $48.  Mark cycles the 5km journey on a busy rural highway with his younger brother on the carrier, where they attend a two hour evening class before the return cycle home in the dark.  Native Cham speakers, English is their third language, after Khmer.  Mark was on the end of the line this morning.
Helen?
Yes?  Mark?
Yes.  Today Paula come to Phnom Penh.
Oh!  Can I see her?
Sorry?
Can… I… see… her?
Kunaiseeha….?
Where in Phnom Penh?
Sorry?
Ummmm…. How… can… I… see… her?
Sorry?
I switched to my shameful level of introductory Khmer and said a Khmer person would call him.  Thanks to Win, my old translator, I learned she was coming to Phnom Penh, staying near the big mosque behind Calmette Hospital for one night, and going home tomorrow.

They wouldn’t call to tell me if there was no plan to meet me, so I waited.  A few hours later Win texted to say that Paula had arrived in town and he had told her that when I am ready I will meet her.  After lunch I called her and with more introductory Khmer, explained I was coming soon.  I rang my tuk tuk, who meets my introductory Khmer with introductory English and we somehow manage.  Leaving the house I informed my American colleague/housemate that I wasn’t sure if I might be going to “the big mosque”.  She agreed my baggy clothes and the scarf packed in my bag should be respectful enough for such an occasion and I met my tuk tuk guy outside.  We rang Paula and upon hanging up he quizzically informed me she was at Olympic Market.  Okay, so that is nowhere near Calmette!  Laughingly we made our way to the market.

After a short wait surrounded by bustling market scenes and sounds, Paula and a friend exited the crowded bazaar carrying large plastic bags bulging with clothes, purchased for onward selling at their local market.  They jumped onto my tuk tuk and he asked where we were going.  I didn’t know and I asked the girls.  They didn’t know!  So I suggested my apartment but I wasn’t particularly comfortable with this idea.  They live in an impoverished environment and my apartment is a large, fifth-storey, two bedroom condominium looking over the rooftops of Phnom Penh.  I asked if they drink coffee?  Yes.  So we started at a cafe near to my place, but it was crowded and when Paula’s friend uttered the word “pizza”, before Paula followed her with the word “hamburger”, I knew where to go.  We returned to the tuk tuk, who was looking after their bags of shopping, and he drove us around the corner to a western style restaurant where the main meals average at around $4 to $5 (beyond the reach of most locals).

As I called out to tuk tuk that we had arrived, the girls looked at the menu board photographs at the door, excitedly clasping their hands together and saying “thank you” in English at me.  Eternally astonished at the difference between my life of “having” and that which I have come to know as an intimate bystander, of “having not”, I am also eternally grateful for the opportunity to share in such small ways, the comforts that I take for granted, with those for whom these comforts cause such delight.  After a conversation with the waiter, to confirm that there was no pork “because we are Islamic” (explained from underneath their hijabs as though we might not realise!), Spaghetti Marinara eaten with chopsticks was the girls’ choice.  I was highly entertained by the amount of selfies, giggling and posing the girls engaged in during the meal.  We chatted and laughed in broken language, and I will see Paula again next month when I visit during a long weekend.

Yesterday I visited Wat Opot.  A couple of different friends were also there, one of them with his drone which he flew over the kilometre-squared residence, taking aerial video and mapping 3D images of the property while eliciting much excitement.  I was last at Wat Opot two months ago, when we met a new HIV orphan of about twelve years old who was severely malnourished and barely able to walk.  With only a few short weeks of anti-HIV medication, adequate nutrition and some TLC, she is unrecognisable, full-faced, active and happy.  Wat Opot’s slogan is “The things we’ve gone through together” and while in the past, much of this refers to tragedy, today they mostly share positive transformations of children whose lives have been spared.

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Notes I made along the route to Wat Opot include the constant purr of traffic as we wound through narrow residential lanes to avoid using the main, crowded boulevards.  Life in these streets displays the impressive productivity that springs forth from impoverished communities who must find a way to survive.  Many thousands scavenge for recyclable cardboard, plastic and cans, pulling barrows piled high with refuse and stopping to forage through garbage bags left on the street.  They often have a small rubber air-filled horn in one hand which causes an almost comical squeak, alerting their presence to anyone with recyclables to throw away.  I regularly wonder what sort of earnings these people, who walk the streets at all hours of the day and night, might make?  Often small children travel in these carts behind working parents and siblings, some of whom are themselves, disturbingly young and likely not in school.  Very elderly men and women, often hunched over by spines deformed by illness or over-work, are not exempt from needing to earn a living.   The carts are often made of welded steel but it’s also common to see very rudimentary wooden barrows in use.  They travel in the thick of teeming traffic, meandering between vehicles in often dangerous conditions. I could write about so many other equally intriguing street scenes but I feel these trash collectors deserve recognition.

Trash cart cropped

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Heroines and a Kape

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Getting to Kampong Cham after work on a Friday night is not very easy.  The last bus from Phnom Penh leaves mid-afternoon.  Everyone with a car is a taxi in Cambodia, so I assumed that I could get a ride but it was more hassle than I predicted.  Turning up at the market place and hoping for the best may work, but it may not.  Drivers sell you a seat in their car but will only travel once they have a full car (the more bodies, the cheaper the fare and locals are not averse to squeezing in on top of each other to make it more affordable with reports of 10+ people in one ordinary sedan!).  So you buy your ticket and unless you’re the final passenger, then you wait.  If enough seats don’t sell the driver may decide not to travel that day, in which case you’ll be reimbursed.  This was not an experience I needed to have, nor a chance I was prepared to take.  One of MSF’s rules for expats, is that we travel in a car with one seatbelt per passenger so I would have to purchase a number of “spare” spots in any car planning to travel this way.  I now understand what is going on at the various transport junctions through the country, where men chase tuk tuks and motos calling out, hanging on to the sides, and even jumping aboard for a hard sell.  They are chasing the next seat in their car or mini van!

Colleagues asked around for me, with quotes from Phnom Penh drivers between US$50 and US$100 per car, all above what I was prepared to pay.  So I called Dan in Kampong Cham who said “my friend is a driver, I will call him”.  Moments later I had a reasonable quote from a Kampong Cham based driver happy to travel to Phnom Penh and pick me up at the door of our clinic.  I was acutely aware that a single passenger boarding a car to drive all the way to Kampong Cham must have seemed so extravagant to my colleagues, yet I was paying similar to what public transport for that distance in Australia, would cost.  As happens every day here, I was acutely aware of just how free I am, compared to most in this world.

One of my reasons for visiting Kampong Cham was an invitation to attend a celebration at an NGO yesterday. I knew little about this NGO until yesterday’s event, except that one of the staff at my usual Kampong Cham haunt was able to go to university because of a scholarship she received from them. It was this staff member who proffered the invite.  I have met the occasional western volunteer based with the organisation, as well.

Yesterday I learned more about them and their work is worth sharing.  Kampuchean Action for Primary Education (KAPE) is the largest local NGO working in Cambodia’s education sector.  They run a number of different programs, connected with thousands of the country’s poorest students across 11 provinces.  Yesterday’s celebration in Kampong Cham was hosted by this year’s new students entering university through KAPE’s Cambodian Tertiary Scholarship Program (CTSP) in Kampong Cham.  These 30 students are the third cohort for CTSP which began in 2010 and has so far seen 116 graduates, all of whom have found employment with companies, government departments or NGOs.

I spent some time talking with a dynamic young Cham woman working as program manager with CTSP, who explained a little about the scholarship and students.  “The living conditions are so poor, you cannot even believe it”, was her description of where the students come from.  Criteria for scholarship selection include impoverished home life, single parent families and minority ethnicity or religion such as Cham but also female gender due to the inequality of education between genders.  KAPE’s selection process includes media announcement via radio and through high schools, applications from potential students, shortlisting to the poorest applicants, an entrance exam and finally a home visit to each applicant, to ensure those with the highest need are selected.

Successful applicants to CTSP receive a scholarship to attend university in Kampong Cham.  This includes accommodation at the house where all 30 students live together and a $30 per month allowance.  They put $22 of this towards food which leaves them with $8 per month for extras.  They pool their spare $8 together, in order to make it a more spendable amount.  I would love to know more about this, as it is another example of the Khmer teamwork I have observed in so many different situations.

Yesterday’s event was held at the dormitory where these 30 students are boarding while they attend university.  A pink and white nylon awning, as used for weddings and other ceremonies, was draped in the front yard of the elevated wooden house, with pink chairs covered in tight plastic set in rows facing a stage area.  The excitement as I arrived was palpable as this year’s 30 students, dressed in their navy and white uniforms, were joined by the previous two cohorts plus a number of guests such as various organisational directors.  I was one of a few expatriates and the hosts insisted that we sit in the front row.

Showcasing the CTSP, two of this year’s students were emcees to the event, standing confidently and speaking to an audience of 100+ people, many their peers.  The Cham Program Manager more than once told me about individual students taking their turn on stage and the home life they had come from – always shocking poverty.  It was hard to imagine as each stood with their heads held high and presented themselves eloquently.  By the end of the afternoon I had the distinct impression that the CTSP scholarship was doing more than educating these young people.  They were also benefiting from a camaraderie with their fellow alumni and a sense of self assurance and purpose.

Some of the girls have just started to learn traditional dance and performed a beautiful show in borrowed costumes before we heard people such as organisational executives and previous graduates speak of their experiences with and thanks to KAPE.  The students acted out a highly entertaining stage show illustrating the difficulties of education for girls in poor families, where boys tend to be given first preference and where poverty incorporates so many other problems, from domestic violence to ill health.  Two of the girls belted out a rendition of Kelly Clarkson’s “Because of You”.  When the official schedule ended, chairs were rearranged with round dining tables moved into the yard.  A meal of noodles and Khmer curry cooked by the students was served.  At the same time, the boom box came out and the students took turns at serenading us with various English songs before the crowd merged onto the dance floor for a whole lot of frivolity.

Yet another organisation doing valuable work in this country where there is so much need.  It was so uplifting to learn about KAPE and to personally observe such powerful results when an education and a sense of value is offered to young people who did not grow up believing that their future could be something other than destitute.

KAPE rely on donor money and with more donations, they could offer educational opportunities to more impoverished youth than the 30 per year who have so far been given the chance to attend university in Kampong Cham.  CTSP is only one of KAPE’s programs and when attending home visits, the CTSP team have observed children not eligible for sponsorship but for whom something else could make a big difference.  Small interventions, such as a bicycle, or the small daily fees required at public schools, can ensure that children otherwise missing out, will continue to attend school.  Being in the community means KAPE staff can identify other children most at need.

Click here for more on KAPE and CTSP

The point of yesterday was to celebrate International Women’s Day with a group of (mainly girls) receiving an unexpected education.  They in turn, delivered a surprising insight to their audience, of just how inspiring young people can be, when given the opportunity to shine.

Traveling as a Team

Traffic accidents are the leading single cause of death in Cambodia.  In 2015 there were 2,265 deaths by traffic accident and 15,000 injuries, 40% of which were serious.  Knowing the health care that is available here, I dread to think how much cumulative serious suffering these thousands of injuries cause each year.  I think of these dangers everyday as I cycle, walk and tuk tuk on the pothole-ridden, tumultuous streets of Phnom Penh.

This week alone I witnessed two minor accidents in the space of 30 minutes, ricketty-tuk-tukking from one side of the city to another.  In both, a motorbike collided with a larger load.  The first happened in the lane traveling alongside us on a busy boulevard.  A moto piled wide with a bulging sack of unknown produce clipped the wheel of the moto beside him.  The hit moto driver skidded sideways onto the asphalt right in front of a truck.  Thankfully we were all traveling at about 20km/h so the truck was able to stop in time and the driver bounced onto his feet without injury.  The second accident had already played out as we passed, a moto lying on it’s side underneath the front wheel of a Land Cruiser, both drivers apparently standing on the roadside, counselling or arguing with each other.

There are tricks to traveling on wheels in Phnom Penh.  My initial perspective was that chaos reigns.  The more I cycle, the more I realise it is an organised chaos with it’s own set of rules.  I am just a foreign player in this purring labyrinth of weaving, winding traffic.  Becoming familiar with the streets between home and office, I have changed my route to avoid as many potholes as possible as they interfere with my game plan.  You can predict anything if you are vigilant enough, except what someone will do when a pothole appears in front of them.  Yourself included.  Avoiding potholes is paramount to staying safe.  Everything else is a piece of cake.

Some of the unspoken rules include:
When turning a corner, pass around the outside of those going straight, which cuts them off but ensures they see you.
When someone passes you to turn in front of you, move with them.  Turn into the corner with them and once they’ve passed you, veer back out onto the road you intended to be on.
When crossing intersections on a two-wheeled vehicle, your best option is to move beside a four-wheeled vehicle going in your direction.  No one is driving any faster than you are cycling and the four-wheeled guys make a perfect shield.  Four wheeled vehicles can include motos pulling wooden trailers of produce, walking sellers pulling carts of fruit, and any other number of carts and pulleys being pulled in any number of ways.
If there is no four-wheeled shield nearby, move into the intersection slowly and weave your way around everyone else, who will weave around you.  This is where the potholes get in the way as you can think you’ll weave one way, then you or someone else swerves unexpectedly to avoid a sharp edged rut.
When turning corners, cross diagonally towards the corner you are aiming for, from as far away as you see fit.  You will find yourself cycling along the wrong side of the road for as far as you think it helps, the main purpose being to get across the road during a gap in traffic.  Everyone else is doing the same, so always expect and accept to see vehicles traveling towards you on the wrong side of the road.
Weave and swerve, look in all directions constantly, keep your heart in your mouth but remember everyone is going slowly so it’s hopefully going to be okay!
Finally?  Never visit Cambodia without travel insurance!

In keeping with the topic of accidents, last week in a remote province nine children piled into a single person canoe and paddled out to pick lotus flowers.  The boat capsized and seven of the children drowned.  A few weeks earlier, Caz traveled with me by tuk tuk to visit Chom’s wife via a few other stops including Paula’s village.  We bought a bag of rice to deliver to a poor family I met through Chom, along the way.  Just beyond some ponds of lotus flowers in bloom, we pulled over at their riverside hut and the mother of four appeared at her little doorway with very swollen eyes.  Her three year old son, whose malnourished state I wrote about eighteen months ago when I last visited them, had drowned the day prior, at the lotus flowers.

According to WorldLifeExpectancy.com Cambodia ranks 28th by list of nations with highest drownings, at 8.41 drownings per 100,000 per year, which according to SwimSafe.org  equates to 6 children drowning everyday in this one small nation.  In Asia as a whole, a child drowns every 45 seconds!  It is hardly surprising given the poverty set amidst so much water.  Swimming with Khmer colleagues at a conference three years ago, one of my staff asked me how I had learned to swim.  When I said that I had attended swimming clubs from a very young age he replied “we don’t have those in Cambodia, in Cambodia your swimming lesson is don’t-swim-drown”.  He was laughing but the message was a sad one and yet another example of the difference in opportunity and security that our economies provide to us.

Today I am in Kampong Cham for a number of reasons, one of them being a visit to the house in progress.  The builders (the girls’ cousin and his elderly father) were up there in their bare feet and bare chests, hammering and sawing away in the sun.  When I asked how they got up there, Dan informed me they climb the foundations!

Crossroads and Crackdowns

In 2001 I visited a remote central Australian community about 800km from Alice Springs in my role as a public health nurse.  I don’t remember the exact reason for my visit, but I spent some time wandering the community with a list of names and a cool box holding a small supply of vaccines, looking for people who had not been fully vaccinated.  In fact, vaccination rates in indigenous communities are very high but there are pockets of high risk individuals not captured in certain areas at certain times.

Sitting in the dust with a group of young people, a very handsome teenager approached us with his nose poked inside a tin can suspended around his neck with a string of rope.  After all the horrific stories I’d been told about petrol sniffers and the violence they perpetrate, I was initially afraid of him.  I was also aware that he was at high risk of all kinds of illness and a premature death.  He needed vaccination more than any of his non-sniffing peers. His name was on my list and he was eligible for three vaccines.  I explained this to him with some trepidation and he told me to go for it.  At no time during these three injections did he remove his nose from the can of petrol.  The introduction of unleaded petrol throughout Central Australia has since seen petrol sniffing rates plummet to nothing.

Since then I have had all manner of interesting encounters with people doing all kinds of interesting things, both positive and negative.  These experiences have played on my mind for years, as I try to understand from my perspective of comfort and privilege, how it must be to grow up and exist in poverty, surrounded by chaos. Perhaps my most significant observation is that the most attention is given to disordered behaviour.  A teenager sniffing petrol is far more engrossing to observing eyes, than the mother locking herself in a room to sleep in one bed with many children in order to keep them safe, as must happen every single night in millions of locations around the world.  I contend, despite all of the attention paid and praise crooned to those of us living as expatriates in “the poor world”, trying to have an impact, that in fact we are not the ones deserving accolades.  It is the mothers, fathers, aunts, uncles, grandparents, neighbours and villagers, soldiering on with no spotlight or admiration and in fact, often denigrated in the blanket condemnation of the poor and marginalised, who in fact deserve any accolades on offer.

It is estimated that about 13,000 people in Cambodia use illicit drugs, with about 10% or 1,300 of these using injectable drugs.  This week my new assignment took me to some drug “hot zones” in Phnom Penh.  These field visits were reminiscent somewhat, of my time in Central Australian communities.  We accompanied outreach workers visiting street-dwelling drug users who they clearly have trusting relationships with.  The workers knew where to go and when we appeared at the top of stairwells in slums or on mounds of dirt in cesspits of refuse on otherwise-disused land, noone ran and noone tried to hide what they were doing.  Exiting one building, someone on a corner called out to a woman all-in-white, who launched herself as if to flee.  She looked behind me at the outreach workers, realised we weren’t the police and squatted back down. Tiny and visibly malnourished children played in rubble around sleeping parents.

Clean needles and syringes were retrieved from the workers’ backpacks, sometimes just in the nick of time.  Workers squatted beside injecting or spaced out drug users to talk to them.  Access to services such as HIV testing or information about who had most recently been arrested in the government’s drug crackdown, were topics of the day.  One of the workers had a pair of long silver tongs which she used to flip rubbish searching for used needles.  As she placed dozens of these in her plastic bottle for safe disposal, I understood why they had insisted I replace my thongs with a pair of black work boots, which I was clomping around in.  As my French colleague described with sarcasm, it was “very sexy”!

All the while I was aware that surrounding us were human stories.  For every drug user, who of course has their own story, there were any number of non-users trying to hold things together in this ferociously demeaning environment where human endurance prevails.  The little boy carrying his bicycle up the grimey stairs on his way home from school, stopping for a quick rest on our landing before taking the next flight of stairs upwards; the old woman lugging her bag of vegetables home from market; the scavengers pulling their wooden barrows past us and the sugar cane juice seller with his bamboo bar perched across his shoulders, a wooden bucket of juice hanging from each end.  They barely even looked in our direction as they made their way past us at various locations.

The Cambodian government declared a “war on drugs” late last  year and to date in 2017 there have been over 4,000 drug-related arrests, mostly of drug users.  Following a visit from the Phillippines’ President Rodrigo Duterte, Cambodia’s Prime Minister Hun Sen announced that there would be no bloodshed in Cambodia as there has been in the Phillippines.  There have, however, been various other undesirable consequences.  An almost 50% drop in access to needle exchange programs places users and the wider public at higher risk of transmission of diseases such as HIV and Hepatitis C.  Users disengaging with medical services such as HIV treatment and Methadone Maintenance Programs due to fears of arrest, or actual arrest removing them from access to services, all have consequences to public health.  Jails and courts have swelled to breaking point.  Outreach workers are no longer able to locate their clients, or clients have become so transient in their evasion of authorities, that services are overlapping and therefore less efficient than they were previously able to be.

It is an interesting time to be working with Hepatitis C in Cambodia.  New Direct-Acting-Antivirals (DAAs) mean that people infected with this virus, which leads to often-fatal liver damage, can be cured of their infection quickly and easily – a breakthrough in modern medicine which only occurred within the last two years.  Curing enough people will see a reduction in transmission of the virus amongst the highest risk groups, of which IV drug users are the most at risk.  This in turn will protect the general public.  Yet there are very many obstacles in the way of ensuring appropriate treatment reaches those who need it most.

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Sniffing glue on the streets of Phnom Penh (Ref Radio Free Asia article 2010)

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Sniffing petrol in Australia (Ref Sydney Morning Herald, 2012)

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Outreach workers on the job in Phnom Penh (Ref Google Images)