International Human Rights Day

Every day of the year seems to be dedicated to the awareness of an issue, even an International Day of the Toilet!  Which is not as ridiculous as it sounds given that billions of people do not have a toilet and are forced to defecate in the open.  10 December (yesterday in my hemisphere) was International Human Rights Day, with this year’s slogan being “Human Rights 365”, signifying that every day should be Human Rights Day.  United Nations Secretary General, Ban-Ki Moon, is quoted as saying “I call on states to honour their obligation to protect human rights every day of the year.  I call on people to hold their governments to account”.  Which is easier said than done if you come from a country where any deviation, even peaceful protest, can lead to a threat on your life, such as the police brutality reported by Cambodian media on a daily basis.  Even worse, the brutality people face in other parts of the world which is not even reported, for example the story of any one of the world’s 30 million slaves who suffer without any real publicity to their existence.

In 1948, following the end of World War II, after the large scale and heinous crimes against humanity which occurred through Europe, the United Nations held a General Assembly in Paris on 10 December.  At this Assembly the Universal Declaration of Human Rights was adopted and the annual custom of International Human Rights Day began.

A step in the right direction, yet human rights continue to be violated across the globe on a continual basis as governments and groups are motivated by control, greed and violence.  In my opinion, we are all a part of this global picture, particularly the violation of human rights via economic oppression.  The widespread yet invalid belief in the wealthy world, that poor nations only have themselves to blame masks a reality which is far more complicated and convoluted, and no matter what people in places such as Cambodia do, they will remain poor.

As I write this blog I am chatting online with a colleague in Cambodia.  She has the same qualifications as me, only hers were obtained at great financial sacrifice to her family who put her through university in order to improve their quality of life.  Once she was qualified and working, she met a man and got married.  Their child was born as I began my year living in Cambodia and she appeared to be incredibly happy and stable.  Until the baby, at around 3 months, was identified as having Cerebral Palsy.  Around the same time her husband lost his job.  Their expenses for medical assessments and attention increased at the same time as their income almost halved.  With no reserve (no medical insurance exists in Cambodia, every clinic or hospital visit costs money, her younger siblings are all still studying but the family income has dwindled which threatens their continued studies), things basically fell apart.

Her father was then diagnosed with lung cancer and with no means to afford pain relief (let alone any other therapy), died a painful but thankfully reasonably quick death.  Living three hours from her parents, her baby had been in their care.  Upon her father’s diagnosis the baby had to be sent to her husband’s parents, who live an eight hour journey away.  Now the baby, who once saw his mother each weekend and who relies on expensive formula milk because he is not with her, has not seen either of his parents for a number of months.  Grandparents looking after babies and children is an extremely common, in fact normal, phenomenon.  His mother now supports her own widowed mother, siblings trying to maintain their studies, and a disabled child.  Her husband was unemployed for many months but finally found work and lives in another part of the country for his job.  Her own job with Medecins sans Frontieres is coming to an end as the project will close next year.  With very limited job opportunities throughout Cambodia it appears she will also now face the threat of unemployment.

These are all fairly standard stories for Cambodian people – once something goes wrong, there is no back-up system and things can very easily nosedive. People either sink or swim.  Many sink, succumbing to malnutrition and then disease and death.  We can all offer a little help, eg build a poor family a toilet, sponsor a child in Africa, send money to a charitable cause.  But no help from the “donor fatigued” most privileged 5% of the world’s population, can ever make the difference that is needed.  This ignores the constant stress that villagers and family members live with as they struggle to assist others while dealing with their own destitution.  The only real difference has to come from an overhaul of global economic systems, giving poor nations opportunities to improve their own living standards.  But while rich governments and corporations continue to take far more out of these nations, than their individual citizens can possibly give back, this will never happen.

My colleague’s situation is just one example of many I know of, which supports my absolute agreement with a quote by Pope Francis from an article in The Guardian last year.  Despite growing up in the Catholic Church, I no longer consider myself Catholic and I don’t support all of Pope Francis’ views, but on this I am happy to quote him: “Human rights are not only violated by terrorism, repression or assassination, but also by unfair economic structures that create huge inequalities”.  (http://www.theguardian.com/world/2013/mar/13/jorge-mario-bergoglio-pope-poverty).

We are all a part of these global economic structures and as such we are all partly responsible for changing them.  Those of us from countries where challenging the status quo is a safe activity, should follow Ban-Ki Moon’s advice and challenge our governments on those policies which adversely affect poor nations while protecting wealthy corporations.  Only when these economic structures are reversed to bring some favour to our brothers and sisters in the poor world, will oppressive regimes, terrorist organisations and corrupt systems stop thriving.  And only when these organisations and systems stop thriving, will we all have the security that we want.  In other words, we should do it for ourselves and the future of our own children.

If this blog post depressed you, take a look at some positive news at this 13 minute presentation by Bono from U2.
http://www.ted.com/talks/bono_the_good_news_on_poverty_yes_there_s_good_news?language=en

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So Many Worthwhile Causes

There are so many worthwhile causes in this world.  I find myself saying “no” to requests for donations to all kinds of charitable organisations who approach via door knocking, mailouts, emails and telephone calls.  It seems overwhelming sometimes.  Only recently have I realised that the reason “we” in the western world are so inundated by requests for philanthropy, is because of the global imbalance between rich and poor.  While poverty in Australia is defined as any single adult living on less than $358 per week, elsewhere in the world 1.2 billion people continue to survive on less than $1.25 per day.  From what I saw in Cambodia, many of these people actually earn nothing at all.

There is a calculator at https://www.givingwhatwecan.org/get-involved/how-rich-am-i where you can work out how rich you are in comparison to the rest of the world.  According to my calculation I belong to the richest 0.3% of the world’s population and if I give 10% of my income away, I remain in the top 0.5%.  Amazing stuff!

Another excellent reference is this four minute video infographic displaying global inequality and outlining the causes.  https://www.youtube.com/watch?v=uWSxzjyMNpU .  The richest 2% of people in the world have more than 50% of all global wealth.  The richest 20% have 94% of global wealth while 80% of the world have only 6% of the world’s material wealth.  Is it any wonder that we, at the upper end of this scale, find ourselves being highly sought after?!

Only 200 years ago the richest nations in the world were about 3 times richer than the poorest.  Today we are 80 times richer.  This has happened mainly by material wealth being removed from poor countries, by corporations and wealthy countries, which occurs at a rate many hundred times higher than the rate of aid injected into these countries.

I’m currently visiting family and traveling in New Zealand, where the wealth of our small nation has never seemed so visible to me as it does on this holiday.  Looking at the infrastructure alone we are clearly well resourced – even the most rural country roads are almost all bitumenised, potholes are almost non-existent, roads are well marked, road signs are clear and standardised, roadworks are staffed, signposted and extremely safety-conscious, hospitals and schools are clean and organised with modern conveniences unseen in most of the world.  It’s so far removed from the world I became used to for a year, where waste disposal was erratic, sewerage leaking on the grounds of a public hospital was considered unfixable, patients often sleep on floors in walkways of hospitals, roads were mainly pothole-ridden dust tracks, schools were bare concrete buildings with ancient wooden furniture and no reading resources, etcetera.

This leads me to the reason for this blog post!  As someone who says “no” to donation requests almost daily, I recognise that this is just “yet another cause” which most will not feel able to assist with.  I also know that in order to want to contribute to a cause, we need to feel connected in some way to the cause in question.  When we are detached from the concern at hand, we are less inclined, or not at all inclined, to feel a need to involve ourselves.  Being involved as I am, is why this is a cause I want to mention.

When I first arrived home a very good friend of my mother announced that she was coordinating a fundraiser for me and that I would need to present to a public audience!  She and Mum worked together at a nursing home in the town where I spent my teenage years and the event was held at this home / hospital last Wednesday afternoon.  The audience was quite a mish-mash!

An artist of considerable talent, she donated a beautiful acrylic painting of red poppies which was raffled alongside a book written by a local nursing friend and a brass door knocker which were both also donated to the cause by separate donors.  She recruited an audience from far and wide, produced and distributed a written invitation to the event, baked cakes, enlisted others to assist with catering, networked at various social gatherings, promoted raffle tickets all over town and I probably don’t even know what else, towards hosting the event.  It was a real “kiwi” experience, reminding me of the community spirit that exists here in spades.

Mum and a couple of other family members, many of Mum’s old work colleagues, an old high school friend of mine, a boss from my first out-of-school job and various others joined interested nursing home residents and staff in the large ocean-facing lounge room of this beautiful nursing home.  I put together a powerpoint presentation titled “A Year in Cambodia” and picked some of the stories which had touched me the most to share from a large projector screen on the wall of the residents lounge.  Standing not 20 metres from the Tasman Sea which rolled and broke into white fringes out of the panoramic window beside me, I spoke for 45 minutes about my experience and my hopes to assist the Children’s Home with much-needed funds.  The assumption that I would be nervous, stemming from jitters which surfaced days prior when I gave the same presentation to a group of  aunties and other extended family in Mum’s lounge room, turned out to be incorrect.  Despite a number of the audience nodding off to sleep before me!

I also gave a similar presentation to a Year 6 class upon request of my good friend’s 11yo daughter which was a highly entertaining exercise.  After speaking semi-regularly at schools and universities in Cambodia, the small classroom with comfortable desks and chairs, a computerised presentation system, children all speaking confidently of their overseas experiences and extra-curricular activities could not have been more different to the classes I spoke to in Cambodia.  Since I’ve been home others have also generously donated, either to Phter Koma or to individuals they know of through this blog.  I am so grateful to many for their eagerness to contribute, which is not just about the money but also the big hearts of many of my family and friends.

Until now I have not named the Children’s Home I regularly mention.  But they have a public profile and the Board of Directors have farewelled me on a holiday to Australia, New Zealand and America in the hope that during my travels I might manage to raise money for the home, so I guess it’s time to name them here and outline what we do.

Phter Koma Children’s Home in Kampong Cham Cambodia currently cares for 12 children between 6yo and 16yo who are HIV+ and have lost one or both parents to AIDS.  The home is licenced under Cambodian law for 15 resident children but currently does not have the budget for more than the existing 12.  I am the only Australian member of the Board of Directors at this home which was established by a group of doctors and social workers who came to the realisation whilst working together on an HIV program, that many of their clients were dying and leaving behind HIV+ children with no one to care for them.  This placed the children at high risk of health problems related to poor HIV treatment as well as many social risks including homelessness, neglect, abuse, child trafficking and prostitution.  The children all come from families who are unable, for various and often shocking reasons, to provide them with proper care, in a nation crippled by poverty.  They are beautiful children, keen students who attend school daily and extra classes whenever possible in order to try and catch up after losing out on schooling due to circumstances including ill health, poverty and chaotic home lives.

The home is 100% Cambodian managed, with a Manager, an Educator and two carers who rotate in shifts to provide general care to the children including cooking, housework, coordinating the children’s activities and health appointments and ensuring care and routine in their lives.  In order to function at a basic level, Phter Koma needs a minimum of US$2,500 per month which covers accommodation (they rent a house near the children’s school), staff salaries, food and clothing for the children, transport, school fees and other general costs.  The carers earn around $100 per month in salary and all staff earn less than $400 per month, so most costs relate directly to the care of the children.

Cambodia is renowned for it’s “orphanage tourism” which corrupts children in care for the purposes of fundraising for personal gain/profit.  Phter Koma is a genuine, licenced and ethically managed not-for-profit association with processes in place to ensure the protection of their resident children, whose best interests are the association’s only concern.  The Children’s Home website is at www.phter-koma.org .

The role of the Board of Directors is to provide technical advice and oversee budget implementation, as well as to raise funds to keep the home functioning.  Most funds currently come from France where one of the home’s founders, a French social worker, spends exhorbitant amounts of time and energy sourcing private donations.  We have a provisional budget of US$30,000 for the following year, but currently only have US$26,000 available (almost all from French donors), so we are looking for an extra $4,000 to ensure the home remains operational into the following year.  If we are able to raise more funds we will be able to increase our resident children from 12 to 15.  There are many HIV+ children in the region who fit the criteria for admission to Phter Koma and have an immediate need for residential care to protect their health and improve their future chances at a decent quality of life.  We also have a currently-unaffordable idea that we would like to separate the children into two separate homes, by gender, as they move into their teens.

Both France and USA have tax exempt connections to Phter Koma allowing their citizens to make donations to us as an official charitable organisation.  I am currently working towards obtaining this status within Australia, which is a complicated and lengthy process.  All donations are warmly welcomed by anyone interested in contributing to a highly worthwhile cause but permanent donations which can ensure continued income for the home are most valuable as they mean we have a better chance at maintaining operations into the long term.  For more information or to make contact, refer to www.phter-koma.org or feel free to email me privately at hjtin@yahoo.com.

The Story of One Patient

Many stories came out of my year in Cambodia.  I feel particularly close to one of my patients and I am not sure I ever fully told (my part of) her story.  At 25yo this young woman who I will give the pseudonym of Phan, was admitted to our ward weighing 21kg.  Her father carried her into the ward and placed her on the bed.  I had never seen anyone look so malnourished and frail.  During the admission process we needed to weigh her and she said she would be able to stand on the scales for us.  She misjudged herself, her legs gave way under her and she fell to her knees.  Her father picked her up and we weighed her in his arms, with his weight then subtracted from the total.

A Cham (Muslim) family from an impoverished rural riverside village, she was hospitalised with us for over two months, during which time she constantly had family present and caring for her – a cousin, a sister, her mother and various others.

Two years prior she had been suffering with abdominal swelling and pain for years and after years of suffering her family somehow managed to obtain the funds to take her to Phnom Penh for expert opinion.  Unfortunately, in Phnom Penh it was initially decided that she had appendicitis, which is an acute condition that cannot last for years and should have clearly been a misdiagnosis.  Surgeons operated to remove her appendix and during the operation discovered swollen lymph nodes which they diagnosed as cancerous.  They excised some of the nodes by a bowel resection, forming a stoma where the newly created end of her bowel now opens out onto the skin of her abdomen and requires a plastic bag to cover and catch the faeces.  They also told her that they had not been able to remove all of the cancerous lesions and that they could not tell her how much time she had left to live but that the cancer would ultimately be terminal.  In a country where chemotherapy and radiotherapy do not exist – the wealthy travel to other countries for such luxuries – this was the best they could do.

One of the risks with abdominal surgery is the formation of adhesions, or scar tissue which sticks internal abdominal tissues and organs to each other, which are normally soft, slippery and not attached to each other.  Adhesions can be asymptomatic or they can cause pain and intestinal obstruction which requires further surgery, which in turn risks the formation of more adhesions.  Phan developed painful adhesions and was operated on twice more in the following months.  These operations resulted in the formation of a fistula between her intestine and the skin of her abdomen on the opposite side of the deliberately-formed stoma.  She now has two permanent openings on her abdomen which ooze faeces.  One, the stoma, has a plastic bag attached to catch the faeces; the other is treated like a wound and dressed multiple times per day depending on how much faecal ooze occurs.  The skin around both sites is raw and inflamed due to the constant faecal ooze.

Her treatment in Phnom Penh was very poorly documented and our medical team had to make a lot of educated guesses about her condition.  To cut a long story short, my personal conclusion is that she (obviously) did not have appendicitis and that the visible lymphomas which, in the face of no real diagnostic tests, were determined to be cancerous, were in fact tuberculous.  That is, all along she actually had abdominal Tuberculosis which would have been cured by a standard six months of anti-TB medications.  Unfortunately it is very difficult, without appropriate testing, to differentiate between abdominal lymphadenopathy which is caused by abdominal Tuberculosis and that which is caused by lymphoma (cancer).  In countries with high TB prevalence and poor resources for diagnostic testing, this is an easy mistake to make, although her age and the prevalence of TB in her population may have seen another medical team make the right educated guess about her diagnosis.

The abdominal surgeries which all could have been avoided, have resulted in a state of malabsorption where she is unable to absorb enough nutrients before the digestive process ends at the opening of either her fistula or her stoma.  This leaves her in a constant state of malnutrition, and her weight continues – years later – to hover in the region of 21kg to 22kg.  Had she been born in a wealthy country, she would receive parenteral nutrition into her veins which would allow her digestive tract a chance to rest and heal and her prognosis would be very positive.  Unfortunately her only option is to eat and she is receiving extra food and therapeutic food supplements to try and assist her nutritional status, but it is proving ineffective due to her clinical state.

The malabsorption has also meant that, finally commenced on TB treatment, she does not absorb the TB medications well.  After a time on TB treatment, tests returned that she had MDRTB (multi drug resistant TB), which the doctors  have theorised is likely caused by her inability to absorb all of the anti-TB molecules properly.  This poor absorption exposes the TB bacteria in her system to small doses of anti-TB molecules which allow it to produce enzymes which obstruct the anti-TB properties of these molecules.

It is unbelievable that despite her precarious physical condition, having been told that she has an incurable cancer and will die, she continues to survive.  But she does and it has been an honour and a privilege to know her.  Earlier this year her husband divorced her and remarried.  They share custody of a 3yo son who her parents care for when he is at their home.  The below photographs show some of the children at her home and her mother caring for her at home.

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I made a number of visits to her home before she was discharged (with the DRTB Nurse who identified a Home Based Care Nurse to administer her daily Direct Observed Therapy) and I have visited her a few times since she  returned home.  Their living conditions are less than basic.  Water supply is the muddy Mekong, the shores of which their elevated wooden home sits on.  During the Wet Season the Mekong rises and flows onto the land, at which time they can only leave home by stepping out of the door and into a wooden boat.

We had to work out the best dressing and stoma care materials for her and at one point an expatriate clinician based in Phnom Penh suggested we provide reusable materials which could be washed, until I explained their water supply to him.  Very basic things like this were eye opening to my first world brain, which has never had to imagine the dangers associated with dirty water supply.

I have maintained contact with her and am hoping to return to Cambodia in January with supplies that might help improve her situation.  She spends her days lying on the wooden floor of their home, surrounded by extended family including many children, receiving an impressive level of care given the circumstances that they live in.  I have contacted a stoma care nurse in Sydney who is trying to assist me in obtaining appropriate colostomy bag supplies, but this is not an easy task because Australian standard supplies, which are free to Australian citizens, are very expensive to purchase privately.  We are waiting on further contact with a company who have begun supplying more basic colostomy bags at a fraction of the cost, to poor nations.  However they have various conditions attached to supply, such as a contact person in the country, someone responsible for teaching the carers how to use the bags appropriately, etc.  With mail unreliable and expensive in the best of circumstances, her very remote location which makes receiving mail impossible, and my unknown duration of stay, these are not easy things to put in place.

Yesterday I gave a brief presentation to some family members about my year away and a photograph of this beautiful young woman elicited questions about her prognosis.  This prompted me to write about her this morning.  I believe that her prognosis is better than she has been told, in that she probably doesn’t have terminal cancer.  However, she is living precariously in a state of extreme malnutrition, in very poor living conditions which place her at risk of exposure to infections which, in her state of chronic ill health, make her very vulnerable to disease and death.  The MDRTB she is being treated for may in fact be her demise.  Her quality of life is also extremely low, relying as she does on family members for everything.

A bright, beautiful, friendly and intelligent girl who enjoys reading and practising her English, she is a perfect example of the potential that our world misses out on due to material deprivations in substantial expanses across the globe.  Our collective impotence at making the world an equitable place for all ultimately detriments us all.

Special Farewells

A quick message from Phnom Penh Airport.

Last night I received a message from one of the Alice Springs town camp kids I have known since she was five years old.  She is a real stand-out and now at 16, attending boarding school with a focus on her education which if you knew where she comes from, is no mean feat.  I was so chuffed to get this message from her:

Hey Helen how are you going ?  Um I was just wandering what’s the job that you are doing called?, because I’m thinking about doing something like what your doing when I leave school

If that wasn’t uplifting enough, as I checked my emails at the airport, twelve separate emails arrived in my inbox from the orphans who are learning to use email and obviously continuing with their English studies.  Each email is a little different but here are a couple to give you the general gist:

hello helen
how are you?
i love you
i like banana, i like apple, i like coconut,
i like orange,i like tomato,i like to swim,
i like skate,i am happy,thank you helen
i am fine thank you
i like to go to skate with you
i want to study English
i love you helen thank you

And another:

hello helen
how are you?
i love helen.
i like basketball
i will be a guide
i will skate
i like study english
i am happy.
i like study computer.
good bye

Win rang me at 4pm.  He knew that was check-in time and wanted to ensure I didn’t need anything.

I leave Cambodia feeling very loved and the feeling is returned!  Thanks and Goodbye, Cambodia!!

Here in Subcity

There’s something quite exotic about the streets of Phnom Penh, especially at night when I regularly get a sense of being inside a historical South East Asian novel, which I don’t ever recall reading.  The closest I can think of is the film The Best Exotic Marigold Hotel which is set in 21st century India.  The main streets are busy, crossed frequently with quiet laneways where people sit outside their houses in the dark alongside smelly canals lined with the city’s waste and various rubble, watching the world go by.  Motos and tuk tuks putter past, dogs bark, children play and sellers continue to offer their various produce from sidecars, traybacks and wheelbarrows moving slowly through the streets.  Just driving through the darkened streets on a rumbling old tuk tuk makes me wish I were a novelist.  Alas that is not what I am!

Yesterday my colleague arrived at the house and carried my oversized case down the stairs on his shoulders, wrapped it in a big tarpaulin on the trayback of the work ute and drove me out of town, south-west towards Phnom Penh.  My year-long mission is over and I have begun my journey home.  My manager was returning from Phnom Penh so we did the regular halfway meet, swapping cars and drivers.  Texts, emails, Facebook messages and phone calls have arrived steadily from people I am already missing, particularly little Dara who my housemate sent some previoulsy-unseen photographs of.

The driver from Kampong Cham is a guy I came to know well over the past year as we have driven hundreds of miles together, visiting patients, families, health centres and home based care nurses across the province.  A little younger than me, he was born during the Pol Pot regime.  His story has always touched me, probably because we were growing up simultaneously in parallel worlds.  While I was riding bicycles, jumping on trampolines, going to swimming club, Brownies, birthday parties and decent schools, he was surrounded by Khmer Rouge soldiers and then labouring in the fields to ensure the family’s food security which was always a temporary guarantee.  He is now married with a child and lives 4 hours drive from his young family.  His wife spends the busy season at home in the rice fields and during the quiet season she leaves their infant at home with her parents and moves to Phnom Penh to work in a garment factory, earning $70 per month for her sacrifice.  With MSF talking of closing their Cambodian program he is preparing to return to the family farm as the chances of re-employment are so low.  The advantage of this probability is that he will get to spend time with his daughter who he currently only sees one weekend per month.  His wife is talking about going to work in Malaysia as a factory worker, where she can earn more than is possible in Cambodia.  He is a quietly spoken, smiley, fun and gentle guy who tells his story matter-of-factly with the odd comment such as “yes it is very difficult”.  We said goodbye just outside of Skun on the red dusty highway, hugging in the shadow of a truck loaded sky-high with sacks tied metres above the cab, which threw dust at us as it chugged by at an arm’s length from us.

The Phnom Penh driver who took me the rest of the way to the city is a man I also know reasonably well.  In his 50s, dressed in smartly ironed suits and spectacles and speaking excellent English, he gives an impression of being middle class.  Spending most of my time in provincial Cambodia, only visiting Phnom Penh occasionally, it has also been easy to assume that Phnom Penh inhabitants are more urban and prosperous, which is certainly true of some individuals.  Last time I was in a car with this driver, he stopped along the road to visit his sister in law briefly, who was not well.  On that particular day we waited in the car during his five minute interlude.  Yesterday I asked after her and he said she was still not well, unable to walk on her leg and not able to move the arm on the same side.  Thinking it sounded like a stroke I asked what her doctor had said and he replied she had not seen the doctor because she had no money.  As we were driving near her home I offered to stop in and visit her in case there was something I might be able to do to advise.  He agreed.

We pulled into the side of the highway, along a parallel side road with a row of the usual elevated wooden houses where he told me his family all live as neighbours.  His sister in law was sitting alone on her raised verandah with two bowls of food on the floor beside her.  We kicked off our shoes and climbed the stairs to her.  Blind and clearly suffering with acute arthritis in a number of joints, he explained to me that she had been blind since birth and had never married.  Within a few moments a younger man climbed the stairs to join us, accompanied by a young boy of about 12yo.  My colleague introduced them as a nephew and his son.  This man and his older brother, also living in this row of houses, are also blind.  Noone knows why certain members of the family have hereditary blindness.  I asked how they obtain food and was told that the blind men are able to work in the rice fields!!  The woman, immobilised now by her arthritis, stays at home alone and the children of the family – I met five of them, the eldest being the 12yo boy – keep an eye on her from the neighbouring houses while the adults are working.  I wrote the names of some medicines that might help her if she can access them and gave a little money to assist her in affording them for a brief time.  Their gratitude was as strong as my horror at their circumstances.

Across Cambodia these are the ordinary and everyday stories of people.  Every time I see a trailer piled a storey high with cardboard or a motorbike framed in it’s entirety by bunches of bananas driving down the motorway, I realise that the amusement I am experiencing also has a story of persistent adversity behind it.  Not one of the hundred or more people I have worked with and come to know in the past year is separated from this ubiquitous poverty.  As a foreigner visiting the country, it is easy for the destitution and hunger surrounding us to be invisible to our first world eyes.  We are not only regularly entertained by the staggering creativity so commonplace on the streets of Third World countries, but we also expect poverty to have a certain “look” which it doesn’t have.  It has many faces and in my Cambodian experience it hides well behind handsome, well dressed young people in a country where half of the population are under 20 years old.

Writing my last blog from Cambodia for a couple of months (unless something extraordinary happens tomorrow), I sat on the mezzanine floor of a coffee shop sipping red wine, looking down a spiral staircase at the wealthy and mainly-Khmer customers on the marble floor below, their busy chatter echoing up to the chandeliers hanging parallel to my head over a decorative banister.  I wish this level of prosperity for all Cambodians, that they may all sit at plush tables with their iPhones and iPads, sipping iced coffee and wine with their friends and family.  Thanks to Tracy Chapman for entertaining me while I wrote – my current favourite croon from her is very appropriate to the topic, as Cambodia is the epitome of her Subcity.

Tracy Chapman – Subcity

Crying for Cambodia

As a young teenager in the mid 1980s Mum sent me off to boarding school and suffered severe consequences for her sins.  Noone is capable of shedding such sorrowful and persistent tears as the teenage me was.  Then in 1989 I traveled to London and spent the following six years living, working and studying in England.  Despite the amazing experience this turned out to be, I was still capable of regular tearful calls home to Mum.

On my first night in Kampong Cham almost exactly a year ago I went to my predecessor’s farewell party where a lot of dancing and frivolity went on around me.  I sat next to a quietly spoken Cambodian colleague only a few years older than me, who told me that he had lived through the Khmer Rouge and experienced some terrible things before his family decided to escape across the border to Thailand after the so-called “liberation” in 1979.  Thai authorities ordered them home through landmine-ridden jungle dotted with corpses, shot at them and they almost died from starvation.  When I got home that night, I remember thinking “wow… I just met someone who survived the Khmer Rouge”, as though it was symbolic of the year I was about to have.  I was right, it was symbolic and many of my colleagues have memories and scars from that era.

After working with and developing a very high regard for this particular colleague over the past year, last night at my final work function I found myself sitting next to him once more.  He was already speaking with one of the other expats when I joined in on the conversation and he was talking about the American bombs which fell on his province when he was a small boy.  The Khmer Rouge used villagers as human shields, forcing hundreds of people into their military headquarters while they inhabited the villages in order to survive the bombing of military targets.  He told us about the shrapnel damage his father suffered from the bombs and how incredibe it was that none of them were killed, and returning to their village where every house had been razed by the Khmer Rouge, including his pigs which had burned alive.  He had a young friend who attended a Khmer Rouge assassination in his village and returned telling a gruesome story about a man sliced open alive and having his liver ripped out.  This friend was “marched away” by Khmer Rouge soldiers some time later and my colleague regularly wakes in the night even now, worrying about what went through this friend’s mind as he was marched to his death, or the manner in which he might have died, knowing the atrocities they were capable of.

The same day that the Khmer Rouge captured Phnom Penh in April 1975, my colleague’s 2yo brother died of Measles.  “My brother was a very lovely little boy.  To lose him like that was terrible.  For one year I did not smile”.  His family tried to move north towards the most peaceful area of the country, piling seven into a car with all of their belongings and traveling through hundreds of road blocks, each of which was manned by guards demanding bribes to allow them through.  But the Khmer Rouge infiltrated the whole country and they spent the next four years separated into communes which were moved regularly, so he spent periods of time living near his mother, father or siblings, and periods apart from them, depending on where he was ordered to live at any time.

They lived on rice water.  Rice was boiled and fed to the Khmer Rouge soldiers who controlled everyone.  The citizens “ate” the water that this rice was boiled in.  On one occasion it was raining very heavily and the rain was falling into his rice soup,  In order to stop any further dilution of his only calories he tipped some of the rain water from his bowl and a Khmer Rouge soldier who saw him doing so accused him of being a capitalist who was used to eating well.  This was a very dangerous accusation and could have seen him marched to his death.  He remembers this soldier well and says “I last saw him riding a horse cart sometime after the war ended.  To this day I would recognise him and I feel that I would be entitled to do absolutely anything to him for what he put me through.  I would even follow him to Hell to ensure he got there”.  His life from 1975 until 1979 was spent focused on survival from starvation and threats of death by the soldiers controlling his every move.  “In the 1980s we saw pictures on television of Ethiopia and then Somalia during famine and I looked at these pictures of children and I recognised them because they looked like I had looked.  I knew what they were experiencing.  When you are so hungry that it is impossible to sleep and your belly swells and there is nothing between your skin and your bone”.

When Cambodia was liberated from the Khmer Rouge by the Vietnamese he was in a commune with his younger sister, but in the excitement and fear of events, she fled.  He waited for her for a day before deciding he had to return to his family.  “I walked back to my parents.  It took me many hours to reach them and when I arrived I said to them, my sister is gone.  We had to assume she had been killed and we were so sorrowful and then, after two days, my sister returned.  It was unbelievable”.  The family (parents and five remaining children) then decided that rather than remain in the Communist regime which had “liberated” them, they would escape to Thailand for a chance at freedom.  They spent many days walking along a track which had been de-mined, so they knew it was safe to walk to the border.  Along the way they had to look for food and water.  At the Thai border, they entered a village and were held at gunpoint and robbed of all belongings.

They were then allowed to continue but upon reaching the border authorities told them they could not stay in Thailand.  The border guards had also set up a search hut near the refugee camp in order to strip search people as they crossed the border but journalists arrived with cameras to report on the situation and this plan was abandoned (the power of scrutiny!).  Almost immediately they were made to board a bus which drove all day.  The driver and conductor were very kind men who looked sad the whole journey and like their passengers, did not eat all day.  He now realises that they knew where they were taking their passengers.  They were disembarked in an area, given food and water rations, and told to walk in a particular direction back into Cambodia.  The area was heavily mined and there were corpses and injured people “one woman was trying to walk but her leg had been blown off and there was noone to help her.  I don’t know how far she got but she fell and died”.  They ran out of food and water and his father told them to wait while he went to a known stream to collect more water.  While he was gone a mine detonated in the distance and they assumed their father had been blown up.  They were mourning for him when he reappeared with the water he had gone for.  It took them a day to walk not even 200 metres as they tried to make their way through the landmines.

Somehow they all survived but his sister died “from a disease, I think it was probably Tuberculosis” in 1986.  His father died in the 1990s and his mother in 2008.  His other siblings are still alive.  Through all of these harrowing stories which I have rehashed via my memory of only a few of the things he talked about last night, he did not show any emotion, although he talked of his emotions, sadness and fear.  But when he talked of his mother’s death the tears streamed out of his eyes as he continued speaking, explaining the tears as “I try not to talk too much about her and what she went through because when I do the tears just fall out of my eyes like this and I have no control of them”.  Our eyes were streaming too and the thought went through my mind that “this is one time I am crying for a worthy cause” as I thought about where I was and what I was doing, and not to mention what I was probably crying about in my privileged world, as he was surviving his living hell.

As late as 1989, when I was probably roaming the cobbled streets of Covent Garden or seeing a West End show, he was in the mountains with his brother searching for gems, when they heard soldiers nearby who demanded they show themselves.  They stayed still in the thick vegetation and a soldier commanded his team to shoot into the jungle at them.  “This is the most afraid I have ever been.  But then they did not shoot and they eventually left the area without finding us”.  On other occasions he has been accused of being Chinese and of being Vietnamese, both accusations which at certain times, in certain places, have been life threatening.  His family changed their name in order to escape the persecution of being Chinese, although they mistakenly changed from one Chinese surname to another!  The Cambodian war actually only ended in 2000.

Now in his mid-50s he has four children, the youngest eight years old, who live in his home province in the north of Cambodia while he lives and works away from them, like so many other Cambodian men and women who I work with.  Land ownership is a tenuous thing, so families are forced to stay with their land while the breadwinner goes to wherever they are able to find work.  Women have three months of maternity leave and return to work many hours away from their tiny babies who are inevitably cared for by grandparents.  This is a very common theme which I have seen many times in the past year, and the same goes for fathers who work away from young families who they see one weekend per month, finances permitting.  These are the privileged Cambodians who can speak English or have other skills which make them attractive to employers, almost all of whom are Non-Government Organisations.  Their c.$500 monthly salaries make this sacrifice worthwhile.  Their situations are far more tolerable than the 80% of the population who work as subsistence farmers.

I like to think that things will only improve for Cambodia but there is reason to have doubt.  The government, headed by an ex-Khmer Rouge who defected and returned in 1979 with the Vietnamese to “liberate” Cambodia, are all-powerful and very wealthy.  The population are kept on their knees by systems which ensure survival remains the main focus – a survival which not everyone manages to win.  Visiting the paediatric ward at the hospital is the most extreme example of the depravity around me.  Dara’s mother is there with his big sister at the moment and I stopped to say hello yesterday just as a baby was passed to her from another mother in the bare concrete surroundings.  This little floppy baby lay in her arms looking sadly into my eyes, his hand limp when I put my finger into it hoping to feel a grip.  He just stared, silently expressing far more wisdom than any infant should ever have.  I was told things about him which I could not understand but it was obvious that the other mothers in the room had a lot of concerns for him.  A stark example of the lack of justice in Cambodia.

True peace is not merely the absence of violence, but the presence of justice ~ Martin Luther King

Millions of Monks

Cambodia has an impressive total of 28 national holidays per year.  That’s another 5+ working weeks of days off added to the annual leave people can take.  Not that most people are entitled to annual leave given that less than 20% work in occupations which follow the labour laws.  Most people work seven days per week, 52 weeks per year, just to feed themselves, many managing this in a less than adequate way.

Yesterday was not a public holiday but provincial towns including Kampong Cham held a big annual event of dragon boat racing.  Between 40 and 50 rowers per massive canoe raced on the river outside of our house during the day.  This was a lead-up event to the famous Water Festival which has it’s main celebration in Phnom Penh in November.  Unfortunately I only saw a very brief glimpse of the racing en route to work.  Over my year here I have seen many of these beautifully decorated boats sitting under shelters as we’ve cycled through their owner villages.  The purpose of yesterday’s event was to put the boats and rowers from these villages onto the water in preparation for the bigger event in Phnom Penh, where they will all travel downstream in about a month’s time.  It was quite a sight, with dozens of oars on one boat moving in chorus, propelling the boat at some speed over the current of the Mekong.

In the evening small homemade boats decorated with food and candles were floated onto the river, apparently in order to send the ancestors back to their other-world after they visit as ghosts during the observance of the two week Pchum Benh festival.  It was a big and busy day for Kampong Cham, followed by a big and busy evening.

I went out in the evening to check things out, starting at a riverside restaurant where the young wait staff were busy decorating their paper and banana leaf boats and preparing to join the procession to the riverbank.  Variously adorned skiffs appeared from behind the bar amidst a lot of excited commotion.  At one point a young waiter appeared with a ceramic dinner plate bedecked with a bunch of bananas and a candle in the centre, which sent his workmates into spasms of laughter.

Processions began to make their way along the promenade, including one large ornamental boat carried on the shoulders of a crowd of men who chanted as they marched along.  Most others were small and humble, but there were swarms of people everywhere, both on foot and oozing out of vehicles which purred along the crowded esplanade at snail pace.  I found a place on the walled embankment to sit and watch the full moon rise as these symbols were released onto the water, enjoying the sight of two big boats cruising nearby, one of them a new riverboat with fairy lights and light music playing to a subdued crowd who I imagined probably had champagne flutes in their hands; the other a big old wooden barge with a crowd concentrated on the bow, clanging steel on steel in rhythm and shouting out boisterously.  As the symbolic boats were released some people were jumping into the muddy water to swim them out into the current; other groups were on small fishing boats, collecting the rafts wafting on the shores and transporting them into the middle of the river to release them again.

It was a busy, interesting event to be amongst and as I was sitting enjoying the spectacle, Chom called me and shouted into the phone “I am at the front of your house!”.  I shouted my location back to him and he said he’d join me.  Moments later he appeared with his wife and son and we sat for about an hour watching the small and large boats, swimmers etc in the river under the moon’s reflection.

This morning a million monks weaved their way in single file through the busy streets of town, collecting alms from shopkeepers in a slow procession which stretched for many blocks.  The sight of monks collecting alms is not unusual but I have never seen them in such numbers before.  Apparently during the Wet Season (which has been disappointingly dry this year), monks stay at the pagodas and do not seek their regular donations from the general public.  This gives farmers and others reprieve to grow crops or save their produce without having to make regular donations from crops which are not yet ready to be harvested.  Today was the beginning of the new season in Buddhism and so the monks appeared in full force to begin their alms collecting again.

Monks collecting alms in Kampong Cham today

Monks collecting alms in Kampong Cham today

Yesterday while cycling through town to get Dara his daily treat I noticed a woman I have seen before in the same spot, sitting quietly with two naked children.  Clearly hungry, I bought them a fruit shake and took it to her.  Ineptly I asked if she had clothes for the children and she indicated no.  She then lifted her sleeve and showed me a badly infected, cellulitic arm.  Horrified, I asked if she had been to the hospital and was told no.  Payment of user fees in the health care setting here is an issue which keeps many Cambodians indebted and I understood why she was wary of my suggestion.  I said I would return in the afternoon but by then it was raining heavily and she was no longer there.  Meanwhile I recruited Win who provided me with some hand-me-down clothes from his son and I had these in my bag ready to clothe the babies.  Today at lunchtime I managed to locate her and she immediately clothed the children who were rapidly transformed – it’s amazing how good a clean pair of shorts can look on a little grubby, raggedy street-dwelling body.  I rang Chom who agreed to join us and while waiting for him, I cycled to the market and got some fried rice and coconuts for them.

As I arrived back at their tree Chom pulled up alongside us at the same time as a man on a bicycle who parked up and joined her on her park bench.  The ensuing conversation revealed this was her husband and they had four older children who were in the streets with sacks on their backs, scavenging for recyclables.  Chom explained that we knew somewhere she could go to have her arm seen to and when she initially declined, we explained that there would be no cost attached which immediately changed her mind.  She left the 3yo boy with his father and boarded Chom’s tuk-tuk with the baby.  We traveled in tandem, bicycle and tuk tuk, and made our way to a clinic where she was able to see a doctor who dressed the wound and provided her with antibiotics as well as de-worming tablets for herself, her husband and their six children as a precautionary measure due to their living conditions and the childrens’ malnutrition.

We all returned to the same park bench about an hour later and the older children appeared, two stunningly beautiful girls and two stunningly handsome boys aged 13yo down to 6yo, all dressed in filthy rags.  Dad immediately dispensed the de-worming tablets to each of his children and they dished out the two serves of fried rice between them.  Chom talked to me about his perceptions, which were much like mine, that this was an impoverished and uneducated village family eking out a form of a living by scavenging in the city.  As I am leaving next week there is little I can do for them and I am learning that there are very few NGOs here who can help in any meaningful way.  I am also learning that this is not an unusual situation for people to find themselves in, as I realise that there are hundreds of sack-bearing scavenging children on our streets.

Children scavenging along the embankment during a tropical downpour, yesterday.

Children scavenging along the embankment during a tropical downpour, yesterday.

Around 4pm this afternoon I was in a meeting when a text arrived from Chom “How are you?”.  I replied “Fine thanks and you”, to his “Me too, no customer and lonely”.  I suggested a 5pm drink together and we met at a riverside restaurant to catch up.  We spoke at length about some of the things we’ve done together, helping Dara and his family, the lady who sold her hair, and the family we saw today.  He said “I feel like my life is really changed now.  Before I thought so much about money and how I want the car and I want the nice things, but I don’t think about that anymore, I just think about my family and my friends and I really like having you as my friend and to help people with you”.  Doch knea – same here!  He then told me that his mother-in–law’s neighbour was widowed recently and has no way of feeding herself and “I told her that maybe you can help”.  To which I agreed and with a grand total of $10 we were able to ensure she has a stock of one month’s worth of rice, soy sauce and other extras including some eggs and fish for protein.  He rang her to tell her and there were tears and many thank yous.

I think about the charity Cambodian Childrens’ Fund a lot, as they are doing such remarkable work in Phnom Penh with families and individuals such as those I encounter here.  Interventions such as ensuring children attend school while giving their parents alternative choices, caring for the elderly and widowed, providing much-needed health care, etc.  How amazing it would be to come up with a plan to implement something similar for the people of Kampong Cham and other provincial towns, who have so little with no alternative but to live on the streets, begging and scavenging.

Meanwhile, these are all little things I am going to miss being involved with over the next few months while I catch up with family and friends and take a holiday back in the parallel universe that I call home.