Boules, Badminton and a Broken Bamboo Bridge

It’s probably ignorant of me but I don’t think I had ever heard of boules, also known as pétanque before last week when a French colleague gave a set to the office as a Christmas gift.  Since then I see it everywhere.  It seems to be a sport du jour across Kampong Cham, probably across Cambodia at a guess.  Each evening at 5pm the front courtyard of our office comes alive with joviality as people congregate on the allocated patch of lawn where the game has been set up and start competing loudly with each other while there’s also always a couple of people in the driveway volleying a shuttlecock between each other with the badminton rackets.  Then I get on my bike and with my eyes on the traffic as much as possible, cycle past parks and sport grounds where badminton and boules are being played by many dozens of other locals in a similarly relaxed and cheerful manner.  The hours between 5pm and about 7pm are a time for socialising and fun, when it feels as though all of town appear on the streets to see and be seen.  The Night Market lights up with stalls of food averaging at $1 per meal, clothing stalls, a skating rink with loud music next to a games arcade and nearby some trampolines, dodgem cars and other child-alluring attractions.

Kampong Cham is the most populated of Cambodia’s 23 provinces and despite the poverty I see all around me, it is also apparently a wealthy province thanks to the fertile land which allows productive rice, tobacco, rubber and other plantations.  One of the things the province’s capital city, of the same name, is most famous for, is the Bamboo Bridge which is erected at the end of the Wet Season every year, once the Mekong River level recedes enough.  This year I was here during the building of the Bamboo Bridge and about ten days ago I took some photographs of it in the last stages of construction.  Surprisingly, despite it’s fragile look, it is strong enough to hold vehicles, connecting people between the mainland and the island of Koh Paen, a few hundred metres out in the middle of the Mekong.

Bamboo Bridge in final stages of construction, 21 December 2013

Bamboo Bridge in final stages of construmction, 21 December 2013

My housemates and I were looking forward to our first cycle across the Bamboo Bridge onto Koh Paen but last weekend when it opened, it was extremely windy and we decided to postpone our plans.  On Sunday a new housemate who had not yet seen the bridge, went down to the riverbank to have a look at it.  She came back saying that she was unable to find it.  I was bemused by this because it is certainly not difficult to locate, so she must not have cycled far enough perhaps?

However, news transpired that over the weekend Vietnam had released water from a dam upstream from us and the water had gushed downstream at high speed.  A car and four motorbikes were reportedly on the bamboo bridge as it started to give way to the water pressure and all made their way off the bridge post-haste, thankfully in time before the bridge gave way and fell into the water!  This is apparently the first time this has ever happened.  This must be devastating for the owner who pays many thousands of dollars to have it erected every year, before turning a profit by charging travellers 1,000 to 1,500 riel (about 25 to 40 cents) to cross.  Only days prior I spent time convincing family and friends that this matchstick-looking bridge across the Mekong was safe, so it has also been quite an amusing outcome from my perspective!

Slightly upstream from the Bamboo Bridge, is Kizuna Bridge.  This is the first permanent bridge in Cambodia to have been built across the Mekong and it was only constructed as recently as 2001.  We regularly cycle across the Mekong to visit villages and temples on the opposite banks of the river.  It rises steadily to the centre, before sloping back down to the other side, with views for miles both upstream and downstream, beyond floating villages and fishing boats.  Horse drawn carts, overloaded trucks, motorbikes crammed with people or produce and other cyclists constantly stream across the bridge.  From the balcony of our house we look downstream to the bridge which lights up at dusk, with reflections on the water reminiscent of the city lights of Manhattan shining on the Hudson River at night.

Traveling on Kizuna 002

Traveling across Kizuna Bridge (stolen from the internet)

Traveling on Kizuna

Traveling across Kizuna Bridge (stolen from the internet)

Horse drawn carriages mingle with traffic across Kizuna Bridge

Horse drawn carriages mingle with traffic across Kizuna Bridge

Cambodian Christmas

It is estimated that 95% of Cambodians are Buddhist.  Apart from the fact that people politely acknowledge Christmas as meaningful to westerners, there is a complete absence of Christmas here.  I may have seen two Christmas trees, which appeared about a week ago, outside some tourist hotels along the riverside.  Apart from that it’s been business as usual, making it easy to forget that elsewhere family and friends are celebrating lavishly with tinselled Christmas trees, gifts, excited children and excessive food and drink.

Yesterday as I was leaving work a few of my staff wished me a “Happy Merry Christmas”.  I asked would I see them tomorrow at work and one answered that he was having a day off “for Christmas”.  Oh, are you Christian?  He heard my “Christian” as “Christmas” and replied yes, to an uproar of laughter – apparently that’s an “of course not!”.

Last night a party of about fifteen people, mostly colleagues, met at my house, where two German friends had spent days preparing a Christmas feast.  Around half of us were of European persuasion and about half of us Cambodian.  Music blared from a sound system that had been set up specifically for the occasion, a dance floor was cleared which we made good use of, wine and beer were served,   After an hour or so of socialising upstairs, we were summonsed downstairs where a banquet table of delicious German fare awaited us.  Dinner was followed by a lot of frivolity on the dance floor upstairs and many laughs.

After this interlude, Christmas Day was business as usual.  This afternoon I had to meet with some colleagues at the laboratory over sputum specimen containers.  The usual stock is unavailable and an inferior quality container is being used instead, which does not seal properly, leading to potentially infectious sputum leaking and creating havoc in more ways than one.  Our meeting took around an hour as we tried to come up with a solution.  In the first world, the solution would be to obtain the better quality stock, which would not be a difficult chore.  Here it is not a difficult chore but an impossible one, as shipments only arrive a few times each year.

Something I discovered when I worked in East Timor last year, is that when something seems unsolvable to a “first world brain”, it is usually solvable with a little bit of time, imagination, teamwork and flexibility.  I for one, am used to considering those things that are necessary for the basic functioning of a health service to be available without any effort or thought involved.  So it’s quite an experience to suddenly have to turn off my first world brain and get into a different mode of thinking altogether.

After a group of us sat in a circle engaging in a lot of discussion and debate, some of it almost heated and interspersed with many sighs and frowns, my colleagues found a plastic box and some metal framework that fits into the box, determining that if the containers are placed into metal racks in this box, and the box is transported in an upright position, then the leakage should be avoided.  It’s not an ideal solution, but it’s the only one we could all agree on so we’re trialling it until the next stock arrives, in a month or more from now.

I then had to find a way of transporting this box from the hospital to the office, where our Logistics team need to make changes to the shape of the metal racks, so that the sputum containers can fit into them.  We do have drivers, but it seemed a menial thing to require a car for when the office is so close.  The next thing I knew, a nurse appeared with some oxygen tubing and two of them tied the box to the back of my bike in another display of teamwork!  I then cycled off, my bag bulging out of the basket at my handlebars, and a big red plastic box tied to the carrier behind me.  I have spent two months now, laughing at the way Cambodians can transport all manner of things, and vehicles are so overladen, with motorbikes transporting whole market stalls or ox drawn carts bursting at the seams, etc.  So cycling along with my bike slightly crammed seemed like a very Cambodian experience.

And that is how I’ll remember Christmas in Cambodia.

Monolingual Me

My brother is profoundly deaf and his primary communication is sign language.  Living in a hearing world he manages to get by with spoken and written English, but his grammar and style are very similar to that of someone with English as a Second Language (ESL).  His communication struggles can be extreme at times as he tries to decipher what people are telling him, or in return to get his message across.  In my teens I became fluent at sign language, but these days it’s a dim memory as I have lived overseas from him for more than half of our lives, using sign language when I see him, perhaps once a year.  So apart from this attempt at claiming fluency in another language, I am really a very boring monolinguist.

After trying (unsuccessfully) to learn Spanish on and off for most of my adult life, I also spent most of the past 15 years working in Central Australia where 18 indigenous languages are still alive and well.  So I have been exposed to other languages and have even spoken a little Western Arrernte.  But Central Australia is English speaking territory so my attempts were not forced upon me and I never really got past a few necessary phrases.

With Spanish and Western Arrernte in my head, I’ve experienced a phenomenon which I am sure is not unusual to multi-linguists, where I open my mouth to say something in one language, and the wrong language comes out of my mouth.  This happened just the other day when I opened my mouth to say “si’l vous plait” to my French colleague, but “por favor” came out!  It’s very amusing and almost shocking when it happens, but it’s also very interesting as it seems to show that a very specific part of the human brain is responsible for language.  This includes sign language – I spent time in Ecuador trying to learn Spanish about six years ago and on one occasion I replied impulsively to someone with my hands, instead of in Spanish!

Coming to Cambodia and working for a French organisation with Khmer people on an English speaking project, has been about the most fascinating experience I have ever had.  The very first impression is of how clever people are, speaking, understanding and actually being productive in a foreign language.  The second impression is of how boring it is, to only know and speak one language (albeit the most influential language on the planet – which I don’t necessarily see as something to be proud of).

In Cambodia I live with two French people, one German and a Ugandan, all of whom speak English with each other and with the two Australians in the house.  At work most people are Khmer speakers and some of them speak English.  Actually it turns out, two months later, that most of them speak and understand at least a little English, many of them being too shy or otherwise reluctant to let on to me that this was the case.  For the first six weeks or more I communicated with almost everyone via my translator, completely unaware that I was being understood despite the translation taking place.  It came as a huge surprise when one of my Khmer colleagues who appeared to have no understanding of anything coming out of my mouth, suddenly said to me one Friday afternoon, “next week I would like to speak English with you”!  To this day I continue to be surprised at who actually understands me, can speak back to me in English, and can even write in English, when I’ve spent weeks assuming otherwise!

The biggest impression on me has been working alongside translators.  I walked in on my first day, completely unaware that the translator introducing himself to me was going to be a necessary shadow, not to mention a loyal colleague, adviser and friend.  The first time I remember attending the morning nurse handover, for some reason there was no translator in the room.  I was oblivious to the fact that the nurse who began handing over in English was doing this solely for the benefit of the three westerners in the room and that this was a highly unusual event.  A few moments later a man entered the room and the nurse immediately switched to Khmer.  The newly appeared man then repeated what had just been said, in English.  At some point in what is now a very blurred but high-impact memory, the room broke out into applause for this nurse, congratulating him for his English handover.  I asked my predecessor, who was sitting with me at the time, what had just happened and he explained that they began handover in English because the translator was late to arrive.  It has taken me weeks to work out how significant this was as a symbol of the meaning that language holds in all of our lives.  Perhaps when you grow up around languages, this is neither surprising or even very interesting?  I’m sure that many indigenous Australians could answer that question for me.

Simultaneous translation is the most staggeringly clever thing I’ve ever experienced.  During handover each morning, the Khmer nurses report on the patients in Khmer in short bursts, while the translator listens and makes notes, eyes never breaking contact with the person they are observing.  Then the nurse stops and the translator repeats what was said in English for the sake of the non-Khmer people in the room, which is sometimes just me.  As a consequence, everything happens at a slow, calm and deliberate pace, with communication taking twice as long as it otherwise would.  At meetings it’s common for the meeting to continue uninterrupted, while the translator sits close to me and tells me what is being said.  Sometimes English and Khmer are both spoken and the translator has to switch languages, often mid-sentence, depending on what language is being spoken, to ensure that everyone in the room remains aware of what is being said.  One heated argument between two doctors occurred in English from one and Khmer from the other, with a single translator switching rapidly but calmly between English and Khmer.  To a monolinguist this is a staggering skill, and one I’d never seen before.

I have started to learn Khmer, and have an hour of language lessons courtesy of MSF each Saturday morning.  At first the words being taught to me were almost impossible to pronounce.  Khmer uses sounds that don’t exist in English or other Latin-based languages and I can hear myself saying things incorrectly but unable to work out how to pronounce them correctly.  When I repeat one of the phrases I’ve rote-learned to my staff, I completely understand why they are so amused!

There has been a little talk recently from some of my colleagues, about starting some mutual language classes, where I might teach English in exchange for them teaching me more Khmer, which I am very excited about.

The Europeans deserve a mention on this topic, as their language skills are so honed, a reward I guess for living on a continent broken into lots of little language pockets.  Quite the opposite to Australia, a huge continent dominated by a single language.  A few days ago I travelled home from Phnom Penh in a car with a Khmer driver, a Khmer doctor fluent in English and French, a French doctor fluent in English and Khmer and a Swiss doctor fluent in (at least) French and English.  The conversation bounced between French, Khmer and English, while I watched the Cambodian countryside float past my English brain and pondered on the brilliance of language.

One of the truly wonderful aspects of the work that MSF and so many other NGOs do seems to be a mastery of communication.  We might not always get it right, but for people from all corners of the globe to merge in a given location and collaborate on the mutual goal of achieving justice, is a pretty impressive thing in my view.

Driving Cambodia

A motorbike carrying four people is not unusual but I was slightly surprised to realise that Dad, driving,  had one arm on the  handlebars of a bicycle being driven home alongside the family.  Ten year old boys line up two or three behind their underage driver alongside young families and crowds of teenagers.  One father had his right hand on the handlebar and his left arm cradling his baby, with a toddler peering over Dad’s shoulder and Mum sitting behind with her watchful eye over the family.

A number of my colleagues have told me that the children don’t like to go anywhere in the car, demanding instead to cruise on the motorbike.  Evening cruises on the bike seem to be something that Cambodian children do from the time they are born, evolving into a social event for teens who cruise the streets three and four bikes abreast, socialising on the move.  Evenings in Kampong Cham are filled with families and crowds cruising in the open air.  One boy on a bicycle held the back of a motorbike which towed him for a number of blocks until he decided to let go and pedal.  Another did the same with the back corner of a truck as his towbar.  Girls in blue and white school uniform ride pillion behind their friends.  Road rules are just a guide, which makes someone from a country where road rules are strictly adhered to, more than a little nervous as I weave through the traffic and especially as I approach corners where drivers regularly cut in front of me over to the wrong side of the road.  But it seems to work because everyone looks out for each other and despite many kilometers traveled on everything from single lane dirt tracks to wide roads congested with stopped traffic, having witnessed three accidents, I am yet to see a single episode of road rage.

Driving is a significant aspect to the work of MSF here.  Many kilometers are traveled daily, taking nurses and social workers to remote parts of the province to reach people with Tuberculosis or at risk of developing Tuberculosis with otherwise limited access to health care.  This week I travelled with a driver, two nurses and a translator to a remote village along dirt tracks through villages, to conduct a health promotion activity at the village pagoda.  Sharing the track with ox-drawn carriages, passing through villages with front gardens featuring haystacks belonging to a Dr Zeuss storybook, we bounced our way slowly to the pagoda where we were due to provide health promotion to those villagers able to spare time away from the rice fields for us.

Ox-drawn cart, Kampong Cham

Ox-drawn cart, Kampong Cham

Dr Zeuss style haystacks decorate many front yards in villages around Kampong Cham

Dr Zeuss style haystacks decorate many front yards in villages around Kampong Cham

From what I can tell, “Pagoda” is a general term for the communal area where Buddhist monks live and serve the community.  They provide a meeting point for the community and often also a refuge for people in need. Historically they have been places of shelter during political unrest but at times this safety has been wrongly assumed.  For example during the genocidal Khmer Rouge regime, pagodas were used as prisons, but even as recently as last month, headlines have reported police brutality against people sheltering in pagodas during political protests.

Arriving in the village, we drove through the gates of the fenced pagoda and parked near a large shady tree.  The chief monk was sitting on a bamboo bed base close by but with his back to us and he remained that way for another half hour or more.  Another car drove in and people unloaded a mattress and some bedding from the car, delivering it to the monk before sitting on the ground before him, when a prayer session began with chanting.  My translator explained that they were praying for peace for their ancestors, and for themselves to pass into a better life after this one.  The monk received a decorative silver urn with a small wooden handled brush which he used to sprinkle water over the small congregation sitting on the ground before him.

We were near a concrete platform upon which a series of statues were placed, telling the story of Buddha’s birth, which my translator explained briefly to me.  On the other side of this stage were homes with people coming and going.  Behind us was a high-set, beautiful temple with golden roof.  To our left was an elevated house under which a class appeared to be conducted with a group of children.  Against the fence about 200m to our right, a lot of gardening activity was taking place.  Trucks loaded with soil were driving through the entrance gate over to this area and offloading the dirt.  As they left empty, they slowed down near a small boy of about 10yo who passed them a slip of paper.  This was apparently proof of delivery, ensuring they would be paid.  Some men appeared on motorbikes and joined us quietly as we watched the various activity happening around us, and were introduced to me as the c-DOTs (community volunteers involved with Direct Observed Treatment of TB).

After the gift and prayer ceremony ended, the congregation slowly dispersed towards us.  A bed base was lifted and moved to the front of a table before us and a group of very young robed monks appeared and sat here.  As the trucks continued to deliver their soil and pass by the young boy to collect their ticket, monks wandered through the courtyard, class continued under the house in the distance and a small crowd gathered under the tree  before us, to hear the nurse talk to them about Tuberculosis.

The education session, apart from being delivered in Khmer and translated to me, was exactly like any TB education I have delivered in Australia – the same information, use of similar resources (pictorial flipchart), etc.  Yet, sitting in front of a crowd of Cambodian people sitting on the ground with their knees under their chins, and brightly coloured Buddhist Monks in robes, in this very spiritual / Buddhist location, it felt like the world away that it is.

TB health promotion activity at a pagoda in Kampong Cham

TB health promotion activity at a pagoda in Kampong Cham

Banana fronds and Bamboo huts

When a patient is diagnosed with Drug Resistant Tuberculosis (DRTB), measures are put in place in an attempt to cure the patient as well as to hamper the bacteria’s transmission to other people, particularly close family and household contacts.  In a third world setting DRTB mainly travels amongst the poor, who already have impaired health and restricted opportunities.  The bacteria often wastes their bodies before they find themselves placed into enforced isolation in hospital while their families are left to deal with the repercussions of their absence, which is an enormous strain if the patient is a main breadwinner or carer.  Treatment side effects can often be extreme, exacerbating the patient’s fragility so that they are left to endure physical illness combined with social and financial stress.

Many people I encounter in Cambodia are earning in the vicinity of US$1.25 per day, often in exchange for heavy physical labour.  Today I traveled to a remote village in the north of our province with a nurse and two social workers to meet with family of a hospitalised DRTB patient and discuss plans for discharge.  This included identifying a villager who is able to provide the daily Direct Observed Treatment (DOT).  This volunteer will receive basic training within our program about storage and administration of the drugs, including injection techniques and how to monitor side effects, in return for less than US$1 per day – which could and often does double the family’s income.

Including our very entertaining driver, five of us drove north out of the city, over the Mekong River and towards Vietnam.  The main road was busy with agricultural workers transporting hay, fruit, vegetables and other produce, almost all overloading the vehicle so that every motorbike, wooden trailer, truck and tuk tuk appears to be straining under the weight it carries.  Hay hangs out doubling the width of motorbikes or rises to the sky from the base of trailers, sacks of carrots ooze out of the back and over the top of trucks, ox-drawn carts lug rice as the oxen clip-clop along the busy highway apparently oblivious to the traffic weaving around them.  My eyes bulge at the evolving scenes before me while my Cambodian colleagues disregard it all in favour of chatting and laughing with each other.


Kitchenwares for sale in Kampong Cham.
An example of what I mean when I say “overloaded”!

About an hour up the road we turned off the highway and drove through a busy marketplace before entering a rural village scene with elevated wooden houses and thatched roof huts, chickens pecking along the side of the road, dogs trotting amongst them, children playing in the dust and adults sitting at the top of the wooden ladders leading to their front doorways or lazing in hammocks slung between tree trunks.  We turned onto a dirt track shaded by banana fronds interspersed with towering coconut palms and after some directions offered by a villager dressed in a short checked sarong wrapped around his waist, found the family we were looking for.  The driver parked in the middle of the dirt track and occasionally children playing on a bicycle or villagers on mopeds drove around us while we stood in the middle of the track talking to the family group.  They were expecting us and about six adults with a few children were congregated in the dusty front yard.  A hen had dug a dirt nest and was trying to keep her tiny chickens in check under her feathers, while roosters and chooks pecked about under the house and through the yard.

The social workers sat on the laddered steps to the front door with some women while the father crossed the road with the nurse and I to his own yard opposite to speak separately with us.  His house was very basic but very charming, made from vertical strips of wood elevated about six feet high on wooden pylons held on small concrete blocks in the dust by the weight of the house.  The front door was made from flat vertical bamboo strips secured by about three horizontally placed bamboo strips.  Underneath the house a hammock was slung between two of the pylons, a bamboo bed base in one corner and many more pecking chooks and roosters roaming around in the dust.  He explained that his son had received a scholarship to attend a local high school.  This included a bicycle for his son to travel to and from school and some chickens for the family to raise in order to have enough food.  The social workers obtained an assessment of the family and house, to determine how many contacts the patient has, where the patient would live and sleep upon discharge home and what supports may need to be put in place to ensure the family can continue to earn and survive.  The family also identified a local villager who could be approached and asked to provide DOT.

We then drove up the shady dirt track, past neighbouring village houses and stopped near the next corner.  Myself and the nurse walked through the dusty yards of about five houses, exchanging chum reap suors with various neighbours, to the back section where the village DOT volunteer was waiting for us on a bamboo bed base under a thatched shelter in the yard with her husband and family.  The volunteer and two men sat on the bamboo base, offering us a plastic chair each, and the conversation about community DOT, or c-DOT, took place in this beautiful tropical jungle location.  Two dogs slept lazily in the dust nearby, chooks roamed and pecked, a massive pink pig oinked from a wooden pen on the other side of a thatched roof bough shelter and family members slowly climbed down the stairs from the house and came to sit nearby and listen in.  Under the bough beside us a young woman sat on a tree stump in front of a table made from another tree stump, chopping something green very finely with a machete.

The nurse and the c-DOT had a lengthy conversation about her experiences volunteering with TB patients, her availability to attend the next training, what her role will entail and the stipend she will receive in exchange for providing c-DOT to the patient.  A young couple sat smiling politely at us for a while before going over to a tall tree nearby with a very long piece of wood which they used to knock three large green coloured fruits down from the tree.  A plastic bag appeared and the fruits (oversized grapefruits called “goroetlong”) were placed into the bag which was tied and put on the bed with a smiling gesture towards me.  When we left, the bag of fruit was given to us as we all exchanged chum-reap-lears (the farewell version of chum reap suor).