Perspectives

When I lived in Kampong Cham during the two years between 2013 to 2015 there was one swimming pool in this town, about 5 metres long and knee-deep, belonging to a local hotel.  In the past two years two swimming pools have appeared here.  “The Chinese” built a large town pool complex with four different swimming pools including a large diving pool, a large lap pool and two smaller pools.  The $1 entrance fee makes it inaccessible to most locals meaning that it is often empty of customers.  Which is great for the likes of me who wants to swim away from the crowds.

The crystal blue waters always remind me of my childhood, swimming at pool complexes in New Zealand.  On days when there are other customers, almost all of them wear an orange life jacket hired from the entrance desk.  The sight of so many orange life jackets on bodies in a town pool strips me of my NZ memories entirely as it’s so foreign to my experience.  Locals who can afford the entrance fee are also likely to be educated and therefore informed of the high rates of drowning in Cambodia, which I guess feeds the assumed need of a life jacket in a place where swimming lessons are extremely rare due to a lack of trainers in such a micro economy.  On busy days I have seen young men sitting poolside watching swimmers and occasionally directing people away from rule breaking behaviour, who appear to be hired as lifeguards.  On quiet days such as today and yesterday the guards are missing, I guess it’s not financially feasible to employ them for only a few customers?

Swimming Pool

Around the same time as this western style swimming pool appeared, someone built an undercover pontoon structure in the river.  It seems like a rectangular wooden terrace enclosing a strip of river water, covered with a tin roof and accessed from shore via a wooden platform bridge.   With many decades of only ever swimming in blue pool, ocean or river waters and the parasite phobia I have developed since coming to Cambodia, this is not a pool I ever plan on swimming at so I don’t know the entrance fee but imagine it to be cheaper than the Chinese town pool.

Kampong Cham - Piscine !! Cambodia - October 2017 (213).JPG

Yesterday I brought the Phter Koma children, who have moved to another organisation, swimming and then for lunch.  Last time I saw them we also swam together.  I arranged with their carer to meet up at “the new town pool”.  Arriving a few minutes late, I was nevertheless earlier than the children.  Some time later they still hadn’t arrived and I called the carer, who said they were due to arrive any moment.  Some time later he called me to say the children were at the pool but they couldn’t see me?  We soon worked out that while I was waiting at the Chinese pool, they had interpreted “town pool” as the riverside pontoon!  They soon joined me, donning their life jackets before a raucous time ensued in the crystal blue deep waters.

This mismatch of assumptions reflected our different perspectives.  A town pool to me, is a crystal blue chlorinated complex with lifeguards.  That concept is very foreign to Cambodians who only ever swim in the river which feeds their homes and soaks their rice fields.  Of course the undercover pontoon would be the place they interpret me as meaning when I said “town pool”.  Equally, of course this was never going to be the place I meant!

At work last week I told a staff member that we only needed her to work for two hours on Friday, from 10am to 12pm so she could use her annual leave for the rest of the day.  Without the translator present, she mistrusted her interpretation of what I was saying, double and triple checking with me.  I repeated slowly, using signs to depict my meaning, that she should arrive at work at 10am and then at 12pm, she could go home.  Many laughs were had during the conversation as we knew we weren’t entirely on the same page.  Sure enough, at 10am the following day she arrived at work and I felt confident that we’d managed to understand each other.  About an hour into the afternoon I approached the nursing staff and there she was, still at work!

Mix-ups like this are a part of everyday life here as I, with my western privilege and monolingual interpretations of the world, try to navigate a foreign world which makes limited sense a lot of the time, with people forced to communicate with me in what is a foreign language to them.  Miscommunications are common, often time consuming and also often amusing.  This includes my experience of frequent miscommunications with the French as well as Khmer people I work with.  Through our Khmer translator, I often hear the words “there is not a direct translation for that”.  The way language informs cultural perspectives means that bilingual and multilingual people are far more adept at cultural awareness, as understanding another language also gives an insight into the world view of people speaking the language.

Communicating in writing can be even more challenging.  This week I had this conversation with Sokum’s husband on WhatsApp about her return to hospital with complications following her heart surgery.
Her surgery body need to clean.
Yes, the wound, is it ok?
<Photographs of an infected wound with opening areas along the suture line>
It looks infected, did they give medicine?  Very important not to touch it with your hands, did they put something over it to protect it?
They give medicine to my wife before clean wound everyday.
For pain?  But maybe she needs antibiotics to take everyday for maybe 2 weeks?
Yes.
Did a doctor look?
The doctor go to Korean now.  After they were clean it ready send to doctor.
Do they put something on it like this <photograph from internet of gauze dressing>
Yes, they use like this after cleaning.  <Photograph of her chest with a thick dressing>
An infected wound in this setting is a very worrisome situation with such low standards of infection control.  This will all be adding to their expenses as she rents a room in Phnom Penh to be near the clinic and they travel daily to have the wound dressed.

After living for almost three of the past four years in Cambodia and still speaking only very broken Khmer, unable to string more than a couple of full sentences together, I have a deep respect for Sokum’s husband’s ability to get his message across, even though I am not as fully informed of the situation as I had hoped.  He may sound simple in his use of written English to mono-linguists who have never had to communicate in another language or culture but he is in fact, highly skilled.  Noone understands this better than the European contingent, who jump between their native tongue and their second, sometimes third and fourth languages, as a mainstream behaviour.  Many Khmer people do the same and of course, Australia’s indigenous people are highly adept multi-linguists.

Dara’s parents are working in Phnom Penh again, on another construction site and this week I visited them after work.  My regular Phnom Penh tuk tuk driver probably knows more English than he admits to, forcing all of our communications except when totally desperate, in Khmer.  I like being forced to use my limited Khmer with him and we always seem to make sense of each other.  Unlike my other regular tuk tuk drivers, this means he doesn’t double as a translator.  When we traveled to Dara’s parents’ work location Tuk Tuk called them to get a pin point on exactly where we should go and they instructed him to wait at a particular corner beside a massive construction site.  The workers traveling home in all manner of styles were fascinating to me.  Tuk Tuk was far more interested in watching my reactions as I photographed vehicles heaving with workmen and women being transported home after a hard day of physical work at various heights above the city.

Communicating with Mum and Dad is almost easier than with people who speak English, because we know 100% that we are guessing each other’s meaning.  They are living in a communal building with other construction workers along a narrow, muddy, bumpy dirt track about 2km from their work site.  They earn $5 per day (Mum) and $5.50 per day (Dad, who has a team supervisory role).  Their tiny room in a corridor of other tiny rooms is furnished with a mosquito net hanging over a bed-sized bamboo mat on the floor, a tiny toilet with a shower hose on the wall and a small bench holding a rice cooker.  Most of their meals are plain rice with a little fermented fish for taste.  We sat on the floor of their room together as neighbours lined up at the door, staring in at the foreigner and speaking English words at me as I spoke Khmer words  back.  When I asked Mum and Dad about their salary they seemed to be saying that they earned $5 and $5.50 per month.  Only when Dad wrote it down and added x 30, did I realise they were saying that they get paid their daily wage, monthly.

Yesterday afternoon Dan traveled to Dara’s village without me to collect grandma with Dara and his tiny sister, bringing them to town so that we could share dinner together at the Night Market.  It never ceases to amaze me how much fun you can have with people, especially children who are so communicative, despite having no shared language.  I am also always aware that the way I experience something, such as eating fried rice at the Night Market, or swimming in crystal clear swimming pools, or interpreting health care, is completely different to the way my companions are experiencing it.  The same goes for my experience on board a river cruise boat earlier this week.  Friends were on an expensive cruise from Ho Chi Minh to Kampong Cham and when they anchored in Phnom Penh I was invited on board to join them for drinks and a meal.  It was a fabulous experience in plush surroundings.  Yet all I could think of, was the Cham people on their little wooden boats less than 500 metres on the opposite shore from us, hungry, on leaking boats with no roofs, surviving from one meal to the next.  At times these contrasts are confronting but I am constantly grateful for my good fortune which in fact, can only be genuinely enjoyed and appreciated when it is shared with those less fortunate.

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Boat Baby Update

He lives in a home with walls constructed of bamboo, elevated on wooden stumps ten ladder steps from the ground.  I have cycled or tuk tuked along this track which runs parallel with the Mekong countless times over the past four years.  The track passes through many impoverished communities, an interweave of Buddhist and Islamic villages living side by side for at least 50km.  About twenty metres from the road, a large expanse of open flat delta leads to the front steps of his shack.  With Wet Season in full swing, this land is currently a muddy swamp.

Yesterday was nine weeks to the day since Boat Baby arrived on the floor of that wooden boat.  Dan pulled the tuk tuk in at the roadside and pointed the house out to me.  Looking across the quagmire between us, BB’s mother waved from the front door as his grandmother bounded down the ladder and immersed herself in the mud, striding deftly through the swamp towards us.  I registered the depth by the mud marking  her legs.  Dan asked me, is it okay for you to go there?  I replied I don’t like it but I’ll do it, should I take my shoes off?  No, keep them on.  He informed grandmother of my reply.  She took a firm hold of my elbow and guided me to the bottom of the ladder.  With my thongs jamming in the mud I removed them and now there was mud to the top of my ankles and on my left hand, holding the rubber strips as daintily as I could.  Parasite OCD kicked in and I concentrated on shaking it because BB was waiting to meet me.

Grandmother bounded back up the ladder and returned a moment later with a plastic pot of water.  I swished my feet around in the brown water at the edge of the ladder to soften the mud, then she poured clean water over them and I stepped onto the dry first rung.  Up ten ladder steps, a red hammock was swinging between two wooden foundation poles, tiny Boat Baby snoozing as he rocked.  Mum picked him up and handed him to me.  Tiny, but fat and perfect.

Only about ten minutes ride from The Eyes family, I was shocked to hear that Mum, who is about 20yo, does not work because she also has vision problems!  She has had three operations on her eyes so far, all at the nearest District Referral Hospital, who operate at no cost and offer transportation fees.  My limited knowledge of the way the health system works here confirmed that this family fit the criteria of poor enough to  warrant financial assistance when they engage with hospitals.  This is not a guarantee however and when they registered at the maternity ward the day Boat Baby was born, they were not deemed poor enough and charged $40 for an overnight stay – money that they did not have.

Boat Baby’s father, who was on the boat with us the day  of his birth, moved to Phnom Penh a month ago to wait tables at a restaurant, to earn money for the family.  He has been unable to return home at all – a bus ride costs $7 one way.

This area was heavily bombed during the Vietnam War.  Agent Orange was sprayed across the region by US forces to kill the foliage, making the bombing campaign more efficient.  Could it be that the common vision problems apparent through my own small anecdotal experience of this one small village, are connected to the use of Agent Orange less than 50 years ago?  Local doctors apparently claim that babies in this area are 50 times more likely to be born with disabilities than in other parts of the country.  Little or no research has been undertaken.  Research is another example of privilege preserved for wealthy nations.

We said our farewells, Grandma holding my hand tightly as if to let me know of her hope for a connection between her family and this mysteriously lucky foreign woman who can travel far and wide and wants for nothing.

The Only Thing is Kindness

Kindness is a free currency from a well that will never dry up,”
“The most efficient way for you to act with young people is to be a calming force
.
”                                                       ~ Lady Gaga

The United States Conference of Mayors (USCM) is the official non-partisan organisation of cities with populations of  30,000 or more.  There are 1,408 such cities in America today.  Each city is represented in the Conference by its chief elected official, the mayor.

Last year, at the US Conference of Mayors, Lady Gaga spoke with the Dalai Lama to an audience.  Her words were full of kindness as the only thing.

We need to shift the perspective.  The solution is that we need to build a kinder and braver world.  Get rid of those labels.  These different factions; Gay – Straight – Rich – Poor – Mentally Ill – Not Mentally Ill – Gun Owner – Not Gun Owner.  None of this can matter anymore.  We are unified in our humanity and the only thing that we all know, we all appreciate in one another, is kindness.  So this has to come before all things.  And you must operate relentlessly this way.  With everything you have.

Lady Gaga on Kindness as our Solution

Join the movement and commit a random act of kindness everyday.

 

Heart Strings 02

Heart Strings 02

The congested, hot, overstocked and fascinating Phsar (Market) Tuol Tom Poung, or Russian Market as it’s known in English, takes up a full block of the Phnom Penh neighbourhood I live in.  From the top floor of my apartment building we can see the rooftops of the Russian Market – a patchwork of multi-coloured, rusty tin roofs pressed up against each other to form one massive block-sized square of roofs.  One street along the northern edge of the market turns into a fresh food bazaar every evening.  Vendors set up on their paid plots of verge or stroll around with produce in trays balanced on their heads, a stool crooked in their elbow for a quick seat if they happen across a customer.  The crush of stalls narrows the bitumen thoroughfare to maybe 2 metres wide along which crowds of motos, pedestrians, cyclists, beggars, tourists and locals wend past each other.

Boxes of fresh green vegetables are positioned in a tight square around their seller, beside which a canvas is laid to present many dozens of pairs of shoes, beside which another canvas acts as a death bed for fresh fish laid out to die in the open air, occasionally making a last ditch jump off the edge of the canvas, onto the bitumen.  Large tin bowls filled with water hold live crabs crawling around on each other, beside mobile restaurants frying pancakes, dumplings and various other fast foods.

It’s not unusual to see a moto with one child perched up against the handlebars and two perched behind the adult driver.  Mum will pull in at an open air vegetable stall, lean across to choose her vegetables, pay for them, hang them from the handlebars and slowly drive off while all three kids stare blandly as though it’s all very ordinary and boring.  The disabilities on show here can be distressing and I always wonder about one young girl in a wheelchair who is sometimes pushed through the streets and at other times, left alone on a corner to beg.  She is not the only one apparently being managed by external parties for the purposes of organised begging.

Interspersed with these very local experiences are many western style cafes, bars and restaurants catering to the foreign and wealthy Khmer populations residing in or passing through the area.  Fashionable, understated boutique eateries are a theme of Tuol Tom Poung and after six months living here I still haven’t tried every establishment.  Good food, charming ambience and specialty menus all come at extremely reasonable prices if you are earning a decent salary, which makes them inaccessible to a large proportion of the people passing them by everyday.

Tonight I walked down the street to find dinner and stock up on a few groceries.  The side streets intersecting with main roads around Tuol Tom Poung have a village feel in the middle of this busy city.  Neighbours perch on chairs at front gates nattering, people play cards on the floor of a wide front room opening out onto the street, children kick a ball in the middle of the street, the barbecue meat patty guy fries up on his open fire at his front gate.  Moto dups approach pedestrians from behind to offer “moto, Madame?”.  Tuk tuks on every corner chat on their phones, listen to music or convene in one cab to have a drink together, all ignoring me as if I’ve become a regular who they know not to hawk business from.  Popular franchise Brown Cafe opened down the road within the past month and suddenly that corner is crammed with parked cars jutting out onto the busy road, adding even further to the traffic congestion of the main street.

Our own street is a charming little village in it’s own right, especially on cool evenings like tonight.  Our corner tuk tuk guys always stop us to have a chat in broken Khmer about where we’ve been or where we’re going.  The local shop keeper sits in his wooden recliner at the doorway of his little wooden hut watching the world go by.  Families appear from behind tall steel gates to socialise in the street together.  Mobile restaurants pull their carts through the street and stop as neighbours come out to order dinner, cooked and packed on the roadside before the vendor moves on to find their next customer.  Our apartment security guy, his shirt tucked up around his chest to cool off, wanders away from the street party and back into the property as we approach, to make his presence known.

Observing all of these sights tonight was an especially happy time because while I was at the grocery store Sokum’s husband called me.  “Helen?  I have happy news.  Now she already surgery and the doctors said it is success”.  It’s early days and even with the most successful operation she will be on medication for the rest of her life, among other considerations.  But surgery was a success and the road to recovery has begun.

Heart Strings 01

Heart Strings

When I first heard about Sokum’s condition, her husband called it “corollary heart disease”.  Obviously he meant “coronary artery”, but why would a 20 year old already have coronary artery disease?  It had to be Rheumatic Heart Disease.  When I visited last week I wrote “Rheumatic Heart Disease” on a scrap of paper for her husband and told him how to pronounce “Roo-matik”.  He would ask the doctors.

Surgery was supposed to happen sometime last week but for some reason it was delayed.  She has transferred to the surgical hospital and yesterday I went to visit.  A rumbling thunderstorm had rolled into town and the storm drains were pouring out into the roads.  The heavenly deluge soaked motorists from above as their tyres drove whitewater at them from below.  I was perfectly dry behind the waterproof tarpaulins that my tuk tuk driver had tied down, turning the open air carriage into a car-like cabin, minus ventilation.

Husband came out to meet me with a large umbrella.  My tuk tuk parked outside a large open walled building with shining white tiled floors, brilliantly clean whitewashed walls and evenly spaced, equally clean white fans dotted across the unmarked white ceiling.  Was this a Cambodian hospital?  Entering the main building my astonishment continued.  The walls and floors were clean!  The staircase was light and spacious.  We walked past patient rooms with uniformly black mattresses on the beds.  Staff in scrubs were seated at a desk with computers.  Only two things distinguished this place from any western hospital – the beds, albeit clean and furnished with mattresses, had no linen; and large oxygen tanks were lined along one wall, indicating that there is no piped oxygen available.

In a five-bed room I met Sokum, her mother, her aunt and a young friend.  Family and friends have attended the National Blood Bank en-masse, donating blood so that all blood transfusions Sokum needs during and after surgery are replenished.  The blood bank relies on this system of a donation from the patient’s network in exchange for each transfusion.  Husband informed me “surgery will be tomorrow at 1pm because they said it is urgent”.  A team of doctors including at least one from Korea will be operating today.

When I asked Sokum how she was feeling, husband translated “after the doctors explained about the surgery, now she feels better”.  The doctors were happy to answer their questions and had confirmed that her diagnosis is Rheumatic Heart Disease “that she got when she was a child” (RHD results from Rheumatic Fever which occurs primarily in childhood and primarily in impoverished environments where the Streptococcus bacteria is able to thrive).  The air was sharp with smiling anxiety from everyone, including her very bright-eyed father who came out to the tuk tuk to meet me as I was leaving.  Patients in the beds around her stared and smiled at me and as I left some of them expressed “oor kun chiran” (thank you very much) at me.  I wondered at their stories, aware that you don’t end up in a Cambodian hospital without a story of struggle and debt to tell.  This shifted my thoughts to an American patient I know of who has been billed $63,000 as the “gap” between his insurance cover and the missing costs of surgery.  This is no way to treat our sick and most vulnerable, regardless of which borders they live within.

At 12:20pm today husband called me to talk.  Except he didn’t really talk.  I did elicit from him that there are a lot of people with them now at the hospital – family and friends have come to lend support.  Sokum is scared, her mother is crying and husband obviously escaped to make a phone call in hope of reassurance.  All I could say was that it is normal to be scared, normal to cry, normal to feel worried, and that I would not say “don’t worry” because it is okay for them to worry.  He said “the doctors say don’t worry”.  I said that’s because they are not worried, they know this operation and they know that they can do this, but the family do not know it, so it’s okay to be worried.

He will call me again when she returns from surgery later this afternoon.  In honour of Sokum I am posting this blog at 1pm just as I imagine she is being wheeled into the Operating Theatre.  As to my earlier blog post, This Thing We Could Do.  It seems we did it!

What is Rheumatic Heart Disease?

A short, touching article from Professor Chris Semsarian, an Australian cardiologist who spent a week on a research project in Cambodia:
While rare in affluent countries, RHD is a major public health problem in the developing world in populations living in poverty with low socioeconomic status and limited access to adequate healthcare.

RHD Australia’s Website:
RHD is a chronic, disabling and sometimes fatal disease. It is 100% preventable.