This Thing We Could Do

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Study after study by psychologists has shown that there is no correlation between wealth and happiness. The only exception is in cases of real poverty, when extra income does relieve suffering and brings security. But once our basic material needs are satisfied, our level of income makes little difference to our level of happiness. Research has shown, for example, that extremely rich people such as billionaires are not significantly happier than people with an average income, and suffer from higher levels of depression.

Madness of Materialism

This is just one short paragraph from one single link, in the plethora of knowledge about the causes and ills of materialism.  I like it because it implies the difference that those of us with disposable income can make if we were to replace the all-too-common act of “retail therapy” with “philanthropic therapy”.  So many of us are suspicious of others’ need for help, believe that we can’t make a difference or think that by offering help we could make ourselves vulnerable to charlatans.  Our suspicions are – in the main – completely wrong.  Katharine Hepburn, in the quote below, speaks for me in this regard.

Atheist Katharine Hepburn

This week alone I have been involved with five different families suffering from an inability due purely to lack of finance, to access the health care that their children, elderly or vulnerable need.  This is not a small problem that people recover from, but a profound and overwhelming problem which leaves families indebted and reveals itself in the premature life expectancy rates of an entire nation’s population.  Functioning health systems rely on good governance, reliable information, adequate financing and other elements which are either absent or inadequate in countries fraught with poverty, political instability, lawlessness and systemic disarray.  Sadly these descriptions reflect the current day Cambodian experience despite so many good people doing what they can to improve matters, which continue to progress in small steps.

I know a vibrant young Cambodian woman who is waiting to die from the manifestations of Rheumatic Heart Disease.  One of the obvious “diseases of poverty”, Rheumatic Fever was a leading cause of death in America, Australia and Europe until less than 100 years ago.  Improved living conditions reduced our risk of exposure to the bacteria Streptococcus pyogenes which can cause an autoimmune response leading to various symptoms, the most serious being scarring of heart valves which results in heart failure and ultimately death. At the same time, Penicillin was discovered and we learned that it could treat Rheumatic Fever to effectively prevent the heart damage before it manifests.  As such, rates of Rheumatic Fever and Rheumatic Heart Disease plummeted in the wealthy world.  Our health systems also improved dramatically with significant advances in surgery and medicine meaning that cardiac surgeons can now cure Rheumatic Heart Disease when it occurs by repairing or replacing damaged heart valves.

Today the highest recorded rates of Rheumatic Heart Disease in the world occur in Central Australia’s indigenous population.  Just one of the many diseases of poverty our indigenous people live with and die from, this is a travesty.  Yet we have a health system which can count and record the diseases prevalent in our population, who do have access to Penicillin and cardiology services.  Places like Cambodia on the other hand, likely have even higher rates of these diseases, but without the resources or systems in place, people suffer and die silently and invisibly, often without any explanation of the cause of death.

With no cardiac surgery services available in Cambodia’s public health sector, the only option available to this young woman is to find the funds needed for surgery at a private hospital.  Her desperate husband and family have started a GoFundMe page (link below).  As poor rural villagers, they don’t know people who can contribute in any significant way, as you’ll see by the contributions made.  My hope is that some reading this will think about our ability to engage in retail therapy at whim and take a chance at substituting a trip to the shops with offering something towards helping to save a young life.  Even if we don’t make it to our goal, small contributions will show her that she is cared about.  If only 600 people donate $10 each, our goal will be reached.  Be one of those 600!

Sophors’ Family Surgery Fund

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People From The Sky

Good enough

It’s okay to be imperfect.  On the other hand, we should not allow perceived success or praise for perceived success affect our ego.  Someone cycling Road X is no better or worse than someone walking Road Z.

In the field of humanitarian work it’s easy to find people willing to shower you with praise.  This sits uneasily with me as I’m well aware that I am living the life I want to live, because it suits me.  I don’t believe there is a humanitarian anywhere with entirely selfless motivations.  Living as a nurse in a place like Cambodia is really not so different to living as a nurse in Australia.  The challenges are different and there are difficulties that don’t exist in the wealthy world, but ultimately I’m using the same skill set to do similar work, only for a different population and with different resources.

Yet it could be easy to believe the praise.  Which I guess is why it is not so difficult to find people working in the so-called humanitarian world, who are driven by ego and power.  Thankfully my current assignment has no such characters among the expatriate team.  My first assignment was a mixed bag, as I made firm friends but I also struggled enormously with one or two conceited narcissists.  Some of my Khmer friends with a long history working in international NGOs such as MSF confirm that it can be extremely difficult to work with “the people from the sky” (they fly in, dominate with an air of aggrandized importance then fly out again).

It’s very true, that you find all sorts in all places.  It’s also true that there are different motivations towards pursuits which are seen generally as altruistic.  The best example I have is a French doctor some years ago who, in criticising MSF for not approving an extra day off, declared “They should be grateful to have me!  I don’t have to be here!  I am not a local staff who has no choice!  I am a Ewe-Manit-Eerian!  So are you!  We are both ewe-manit-eerians, ‘Elen!”.  Never had I wanted the ground to swallow me up so badly!  Being ewe-manit-eerian is a running joke within my current team who appreciate the farce of over-inflated ego.

The definition of what makes a humanitarian is also an interesting question.  MSF focuses on emergency relief so that many of our expatriates have experienced war zones, famines, disease outbreaks and natural disasters.  Some of these field workers, after multiple assignments, move into the ranks of management based in first world cities such as Paris, Tokyo and New York.  One recent such visitor from London suggested that “you should not stay too long in one place, because it becomes something other than a humanitarian action if you end up staying for your own reasons”.

With a deep love of Cambodia, I’ve ruminated on this statement greatly.  It is dangerous to be poor in this world – you will be forced to live in varying degrees of peril.  If you are incapacitated there will be almost no assistance outside of your own unqualified and un-resourced family or village.  If you die prematurely, it will likely be as an invisible non-statistic who was never counted anyway.  The billions of dollars going towards medical research in first world institutions across the globe generally don’t benefit anyone but those living in the wealthy world, so that preventable illness, injury and death is a common theme in the poor world.  I have loved realising the experience of making small differences to lives which ultimately, to the powers that be in their own higher society and levels of government but also to most of us in the world, hold little to no value.  Stay or go, like all of us with a choice, I’ll choose what suits me most.  Whether here or elsewhere, my main hope is to avoid becoming one of the “People from the Sky”.

Meanwhile, The Excruciating Fundraiser has surpassed it’s goal and our friend can have surgery with a safe and more comfortable recovery than would otherwise have been possible.  We took the family swimming today at a local resort with a small water park.  It was their first time at a swimming pool and a very happy day was had.  On the way home we crossed a bridge over the mud brown river, where a bunch of children were playing on a black tyre in the muddy water lapping at the doors and floors of their little wood and tin shacks. The contrast with where we were coming from was stark.

This 4 minute video, which I think I’ve shared before, explains why this stark contrast exists.

The Richest 300 People

Delta Deliveries

At some point in school I learned about the Mekong Delta, where waters from the river rise and seep out onto low lying flood plains, transforming dry land into shallow marshland for months every year.  Receding waters dump alluvial deposits, rich in nutrients to form a perfect fertiliser for growing rice and vegetables.  It was beyond my imagination that decades later I would find myself inhabiting this floodplain, cycling and tuk-tuking through colourful rice and vegetable fields, interacting with locals and learning about a culture as rich as the alluvial plains that feed it.

Months since I’d been to Kampong Cham I determined to spend a weekend visiting.  It had to fall the same week that our medical referent was visiting from Tokyo.  I was obliged at a 4pm Friday debriefing with her and my polyglot colleagues who are not averse to holding long, humourous, productive, interesting, but ultimately long, meetings.  I asked my translator to call the driver and book the car.  He put the phone on hold to ask “will you book the whole car?”.  The options are many – half or even a third of a seat, a whole seat to yourself, or the whole car.  The 125km, two hour journey costs US$35.  I took the whole car.  The other options involve waiting at known “hot spots” connected to your province, until enough passengers appear.  This can take hours.

On Friday morning my translator took a call, then informed me my driver had arrived!  He had brought a car load of passengers to Phnom Penh and so now all he had to do was drive me back in the evening.  His car sat outside the office all day while he waited at a local coffee shop and lunched with my translator!  Informing the team that I had a driver waiting and so I would be departing at 5pm regardless of anything, it was great to be able to spend the whole meeting with them and learn about the plans for our project which are many, varied and interesting.

At 5 o’clock I was out of the door and in the car.  A reasonably quick journey across the width of Phnom Penh and onto the highway north, I pondered as usual on the many sights sharing the road with me.  My cousin messaged me from New Zealand, lying awake with a young baby late at night.  The road grew dark without street lights.  Tuk Tuks and motorbikes become difficult to see and horse driven carts are invisible until you are upon them. As she talked about how well her baby sleeps we passed a young man sitting forward on his moto to make room for the 50kg bag of rice hanging over the edge obscuring his tail light, a tiny baby sound asleep over his shoulder and one hand on the handlebars to steer his precious load.  How different those two babies’ futures are.

This morning I knew we were in for an adventure and I kept wondering at the idea of drowning in the Mekong.  With the villages I usually visit by road underwater, we had to take a wooden boat.  When I asked Dan “are you afraid” he replied “a little bit because I don’t know how to swim”.  Instead of death though, our adventure was all about birth.   We started at the market, where we piled Dan’s tuk tuk with 100kg rice, four bags of charcoal, a box of miscellaneous groceries and 20 eggs in a plastic bag on my knee.  Not a single egg cracked, traveling by tuk tuk then wooden boat – this fact constantly amazes me.  Eggs in solid containers traveling in my car on smooth Australian roads inevitably crack, but Cambodian eggs seem impenetrable!

The elderly woman who scavenges for recyclables in the city streets on her poorly healed broken leg to feed her 3 orphaned grandchildren told Dan she had moved to the pagoda because her house was flooded.  With the tuk tuk heaving we started over the river at this pagoda where locals have constructed a makeshift village inside the temple grounds, of canvas, tin, bamboo and wood huts.  We located her and amidst much laughter and excitement delivered a 50kg bag of rice, half the eggs and a bag of charcoal onto her wooden platform under strips of tin next to a young family squatting under their similar structure about 1 metre away.  A small gas cooker was boiling something on the bamboo platform as two chickens clucked around hoping for a morsel, apparently unperturbed by the fire.  None of these sights seemed terribly interesting to the locals, who were all far more mesmerised by the foreigner in their midst.

After many platitudes, most of which I didn’t understand, we departed for the riverside.  Dan rang the boat driver whose directions were unclear and as the floodwaters crept closer to the floor of the tuk tuk I shouted out “are you sure about this?”, just as Dan decided to u-turn out of waters which felt like they wanted to carry us away.  Excited children soaked from playing in the brown lagoon that has submerged their yards, ran alongside the tuk tuk shouting and laughing, holding the sides and jumping onto the steps until Dan told them to jump off.  We finally found the docking station and our groceries were offloaded from the tuk tuk and carted down the muddy bank onto the rickety wooden boat by a bunch of men including the skipper.  Climbing down into the boat, Dan instructed me to sit on a plank of wood, where I stayed the rest of the journey, surrounded by about ten Cambodians clearly unexcited about going on a boat on the Mekong Delta.

At our first drop-off point I asked Dan, would we also be walking in knee-high water?  “Probably” was not the answer I had hoped for as I talked to myself calmly that “Albendazole can kill hookworm, it’ll be okay”.  Steering us through a gap in the bushland we pulled up at the house next door to “the eyes” family, who were waiting in knee-high water to greet us.  More self-assurances before stepping down into muddy water, I embraced the feeling of all that fertile alluvium squishing between my toes somewhere underneath my knees and trusted that every step was going to be okay.  A short visit to their elevated house to deliver charcoal, rice, eggs, oil, canned fish, ant killer and some fruit, we arranged for “the eyes” to come by tuk tuk to Phnom Penh on Monday.  Seven year old’s strabismus has not been corrected by two years of wearing glasses so she needs to see the eye specialist again.  They will travel in Dan’s tuk tuk because they all have serious travel sickness.  Dan thinks he can get them to Phnom Penh in two hours, so I can meet them at the hospital in my lunch hour and work out the logistics of their stay thereafter.

Within half an hour the boat was pulling in next door to pick us up so we squished our way through knee-high mud and climbed back onto the boat, promising to see them on Monday.  Crossing a large expanse of water that I’ve only ever known as a corn field, we arrived at the next village where I spotted a pregnant woman walking along the dirt track, aided by a young man and accompanied by an older woman and a girl of about 7yo.  Dan informed me “she is having an emergency and needs to go to hospital”.  They boarded the boat and she sat facing away from me as Dan told me “this is her first baby and she is having problems”.  I immediately called my housemate, an obstetrics trained physician who didn’t answer, so I texted her “I’m on a wooden boat in the middle of nowhere with a primip in labour.  Help me”.  She called back and talked me through it saying the woman was highly unlikely to deliver anytime soon, just keep her comfortable.

Writhing and calling out in pain her husband and mother looked distraught.  I offered them a bottle of water and my umbrella and moved down the boat near Dan to give them as much privacy as possible.  The journey was long and painful for all of us but I had assured Dan she wasn’t going to give birth on the boat.  As we approached the muddy bank Dan stood up and said to me “oh the head is coming!”.  The bottle of alcohol hand rub in my bag came out like a shot, and I rubbed my hands vigorously, pouring some into grandma’s hands, who thought I wanted her to rub it on the baby’s crowning head!  She soon followed my lead, but was apparently confused as to what this was all about.

The boat pulled into the muddy bank.  My telephone against my left ear, taking housemate’s instructions; my right hand pressing a clean-ish looking krama scarf that I pulled out from underneath grandma against the woman’s perineum, I listened as housemate said the head would pop out and rotate, just as it did.  A head!  She then said the baby would come out of it’s own accord, just as he did!  A boy!  Screaming to the heavens!  Delivered on the wooden floor of a rickety boat on the Mekong Delta!!  Not my first delivery, but my first “such” delivery!  Unwrapped the cord from little one’s neck, lifted him onto Mum’s chest, reassured everyone, and tried to relax as housemate said as long as he remained attached to the placenta it would be okay.  Dan followed my orders, finding a plastic bag from dry land to keep the placenta inside so that it could remain as clean as possible until we could find a way to cut and tie the cord.  While looking for the plastic bag he also found a doctor at a nearby clinic and soon enough we were joined by a woman in a white coat with latex gloves.  I took my blood-stained hands and creeped away silently up the muddy bank.  Dan and I will visit the family at hospital tomorrow.

Just another day on the Mekong Delta.  They didn’t warn me about this in school!!