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.


Culture Clash

Anyone else with a tendency for writing would have blogged ceaselessly had they lived the month I just lived.  Midway through my one year assignment in Cambodia, I traveled home to Australia and New Zealand to visit family and friends, visiting two major Australian cities, the Australian outback and various locations around the south island of New Zealand.  From a desert in bloom to towering snow topped mountains, a hillside harbour view villa to a waterfront city condominium, any decent travel blogger would have spent a month writing fervently.  Two road trips, shopping, scenic walks, soaking in hot pools, sipping wine and dining out were all on the agenda.  Where once Australia and New Zealand were ordinary places that I called home, they are now strikingly special places that I call home with a sense of awe at my fortune.

Nevertheless that is as much as I am inclined to write about my holiday, which would rank as the “trip of a lifetime” for many, because I have now had about 15 hours back in Cambodia, catalyst to my writing impulses.  Friends and family at home express problems such as waiting for an expensive dress to go on sale before being able to afford to try it on; needing to work full time to pay the mortgage and whether to stay in the current job or look at other options.  There are always other options.  The main topics of conversation at home revolve around issues that sit at this comfortable level of lifestyle in a robust and functional economy.  I couldn’t see three friends whilst home because one family were road tripping interstate; another were holidaying in Singapore and a NZ friend was on a long weekend in Brisbane.

In contrast, when I ask my Cambodian contacts if they have traveled, most admit to never having ventured beyond their small hometown and almost noone has been to an airport let alone on an aeroplane.  Finding the next meal is the focus of millions.  This is an observable phenomenon everywhere in Phnom Penh if you understand what you are witnessing as you travel the bustling roads past street vendors, hawk-eyed tuk tuk and motodup drivers, trolley-pulling scavengers, disabled beggars and more.  Most wealthy world witnesses, speaking from my own experience, actually don’t comprehend this fact, rather seeing the sights as intriguing and exotic.

With the contribution of many, including two considerably large donations, it appears that enough funds are going to be raised for 20 year old Sokum to have the heart surgery that should save her life.  Had I not traveled home when I did, this would likely have never happened.  Asking for money (my most loathed pursuit), even in a case of the life or death of a young person, is an almost guaranteed flop when you do so from afar, eg via online communication.  Speaking to people in person has a slightly better strike rate although it is an excruciatingly awkward activity which I feel risks friendships.  Many are already giving generously to their own causes and “my” cause does not ever have to be anyone else’s cause.  Yet it is an interesting phenomenon because while it’s so difficult to engage people in something such as Sokum’s fundraiser, the challenge is trying to connect people to the cause as I know that if people met her, they would give generously.  Those who do engage get an extraordinary amount of joy from the experience.  An example is my friend’s teenage daughter who wrote to say that she had decided to forego her 16th birthday present in favour of sending the money to me “for Cambodia”.  My friend wrote last week to say “She has also inspired some of her netball team and they want to donate as well“!

Last week I informed Sokum’s husband (the only English speaker, who has been actively pursuing all limited avenues to raise the money) that we look to be able to meet their target amount.  It has not happened yet, but we have surpassed the halfway mark and have enough pledges on promise to bring us to the mark.  He thanked me immediately and asked when I was coming home to Cambodia.  A few hours later he informed me that they were bringing his wife to Phnom Penh on 25th September, to meet the doctors.  After a 14 hour day of travel yesterday, this morning I was woken by his call that “we are at the hospital now“.  I dragged myself out of bed and called my days-off tuk tuk guy before walking to three different ATM machines to withdraw the money already received (which can only be withdrawn in $400 amounts).  Passing one of our two workday tuk tuks, I stopped for a quick chat and gave him the Sydney Australia t-shirt I bought for him, before heading across town to the hospital.

At the hospital I fell in love.  Yet again.  The most gentle, humble, smiling, beautiful young couple, with her equally charming mother, were sitting in a stuffy waiting room, waiting to see a cardiologist who would be available sometime after 2pm.  The hospital is privately funded by a multitude of NGO partners, aiming to serve Cambodia’s poorest with quality care that is otherwise unavailable to the population due to the lack of resources and regulations within the government’s seriously under-funded Ministry of Health.  In a sea of deficit there are occasional islands of hope, and while not coming anywhere near the quality we take for granted in the wealthy world, this seems to be one of them.  Nevertheless, cardiac surgery does not come free and with no health insurance of any kind in Cambodia, the only way for this to happen is via a user-pays system.  Sokum’s husband explained that the surgery is offered to them here at half the cost it would otherwise be.  Still an inaccessible amount when you earn $100 per month.

After about an hour sitting together, talking about Sokum’s health, writing “Rheumatic Heart Disease” on a scrap of paper for them to ask the doctor if this is her diagnosis, photographing the medical information they had with them to send to a cardiologist in Australia who offered to assist if possible, answering questions about life in Australia and New Zealand and why I am in Cambodia, talking about her husband’s job and looking without success, for their tiny remote village on Google Maps, I left them with the funds received so far.  Our farewell included promises to stay in touch and it seemed she will likely have surgery sometime later this week, but so far I haven’t heard the outcome of today’s consultation.

During our time together they informed me at least three times that “you can be our grandmother”.  So now, at 48 years old, I find myself grandmother to adults in their 20s?  It was spoken with such a tone of respect that I knew we were having a culture clash and that I was being granted some sort of honour, rather than being labelled an old hag!  En route home we approached the corner of our street and there was my tuk tuk friend perched on his moto with no customers but looking very Australian in his new t-shirt.

After an outstanding holiday at home, the best day of my month off work was, of course, Day One back here in Cambodia.

The Excruciating Fundraiser

My heart sinks in Australia whenever I get a cold call at home, or accosted in the streets by charities looking for donations.  Ditto when friends write saying they have a cause and would I donate?  It is not possible to help everyone and the phenomenon of donor fatigue is something I experience on a regular basis, particularly from Australia, where I can quickly feel disconnected from the need that I see here in Cambodia.  From within Cambodia it is quite the opposite, you could almost say I’m plagued by donor impulse here!  But I identify well with donor fatigue and I understand what my friends are experiencing when they see yet another appeal coming from my general vicinity.  This is what makes me loathe what I call The Excruciating Fundraiser.

On that note, I hope anyone reading this understands that my sharing this story is not to make you feel obliged, pressured or judged in any way.  Read it as a story of interest.  And if you are inclined to donate, then do; if not, no problem.  If you are inclined to share it with others then do; if not, no problem.  It really is interesting to know this story though, and if you click on the link you can watch a very touching video that was filmed before the family received the help that has since seen some improvement in their situation.

This project involves a single mother of 4 who broke her ankle >2 years ago now.  I talked about her in Bongs and Tycoons.  She walked on the bone for over a year because she couldn’t afford to seek medical care. This obviously did further damage. She finally sought care at a South Korean charity hospital, but has to pay to get there and for any medicines and tests – it’s just the doctor’s consultation that is free.  The surgery is much cheaper than it otherwise would be, but has (and will) still cost her. These small things have put strain on her financially and at one point, for an extended period her 13yo son was out of school in order to walk the streets pushing a cart selling clams and banana fritters.  Since getting to know this family my perception of the many similar street vendors in Phnom Penh has changed.  Where once they were mysterious, appealing and sometimes funny, now they are all these things while I also contemplate on what led to them purchasing a steel cart to wander the streets through traffic as a way to earn money.  Even more so when the seller is elderly, very young or visibly disabled, which is often the case.  No doubt every one of them has a story worth sharing.

In May this year Mum was climbing the rickety ladder from the door of her elevated wooden shack to the ground (about 2 metres high) when she slipped through the gaps to the ground, breaking the steel fixer pin holding her bone together! So now she is walking around with a broken pin in her bone.  When I visit her, I physically tremble climbing up and down this ladder with it’s rotting rungs.

We got involved when a friend shared the video with me and asked if I could find her because a wealthy businesswoman wanted to offer her some money. I met her and took the family out for a meal (pizza – if you watch the video or read the earlier post you’ll know why). Then I met her again with the businesswoman’s daughter and nephew, who gave her an extremely generous donation which is going towards the expenses of her ongoing medical consultations. She has to have repeat surgery in September and meanwhile needs to travel to consultations weekly, pay for medicines, tests and transport etc.

The doctors have told her the only hope for a reasonable recovery is if she rests her leg.  With no back up welfare system here, she has no choice but to work – except for the fact that she has since had this help, meaning that at the moment she can rest (but she has a 2yo daughter, so can’t stay off her leg the whole time). So we are trying to help by raising enough money to get her into a ground level home that is not dangerous (her elevated shack is very dangerous, the ceiling leaks during rainfall, some of the ladder rungs are rotting, the floor slopes and feels soft underfoot in places), plus have a carer for the baby during school hours when her sons cannot help her, plus replace the income she cannot earn.

We will need a minimum of $4,000 to make this possible for her, for about six months post-surgery. So far we’re only a quarter of the way there.

See the link created by my MSF colleague / housemate and watch the video if you are interested in just one of the many stories that surround me, provoking my constant battle with Donor Impulse.

The Excruciating Fundraiser

Bongs and Tycoons

There are so many cultural quirks in Cambodia that you could write a book on them, if you were confident enough in your knowledge.  One of my favourites, perhaps because of the similarity with Central Australian indigenous custom, is the practice of referring to people according to an assumed kinship status.  Here I am often referred to as “Bong”, meaning “older sibling”.  These people to me, are “P’un”, or younger sibling.  It is a polite reference, favoured over using a person’s name; if you know their name then you can add it after the title, eg I can be Bong Helen.  If you’re in a restaurant and you want the attention of the wait staff, you call to them as Bong or P’un, depending on their age against yours.  If you’re unsure, then you default to Bong.  Other designations include Uncle and Teacher, depending on the relationship, eg a man old enough to be your father or someone deserving of respect due to their wisdom.  Something about this practice seems to give you an immediate affinity with the person you are interacting with.

In my last blog I mentioned the video clip a friend in Kampong Cham sent me, of a young boy being interviewed on camera about his struggles trying to earn an income for his family after his mother was injured in a moto accident.  My friend had contact with a local Khmer “tycoon” who had seen the video and offered to help the family if someone could locate them.  Fortuitously, unbeknownst to my friend when he asked me to help, the young boy’s usual trolley-hauling route seemed to be very close to my workplace in Phnom Penh.  On Monday my colleague/housemate came in a tuk tuk with me and within ten minutes we had located the boy’s mother.

Some transcript from the 12 minute video which is only available through Facebook so I can’t share it here:
Boy: I want to start up business to feed my mother.  I don’t want her home alone.  I want her take a break and not in difficult situation.  I also want to take care my siblings so my mother not in trouble.
Mother: Since I broke my leg I am very difficult.  I jobless and no money.  Sometimes I beg money for my children and pay electric, water.  I really suffer.  No matter my leg hurt, I have to try for my children.
Boy: Talks about selling shellfish, fried bananas and fried potatoes while the cameras show him preparing the food and pouring it into a shallow tray on a barrow which he then pulls through the streets amongst traffic, including at night.  My mother wake at 2am to cook until 6am.  When she feed my sister I go to sell.  At the day I push clams and call customers, anybody buy clams or not brother?  After sell and get money I give to Mum for buying food.  My Mum think about children more than herself.  Sometime she not eat in order to get enough food for us.  Father leaves us for a long time so we don’t have father.
Their story continues and Mum talks about lending money from her neighbour to get to hospital, her concerns for her malnourished baby, not wanting her son to become a beggar, her experiences with a violent husband and deciding to finally divorce.  I really suffer when my son asked me, “Mom, when we go to eat pizza?”  I responded “It is very expensive, I can’t afford it son”.  I pity my son so much.

On locating Mum last Monday, we told her via telephone translation with Win, that we’d like to take the family to eat pizza, and a date was set for Saturday.  Today we ate pizza together.  Samantha joined us for translation with her sister, her daughter and her niece, so with the family and my housemate and I, we made up a table of ten at The Pizza Company.  Mum came with her three youngest children, the oldest son who is 16yo and did not appear in the video, was in school today.  Upon arrival the children (sons 13yo and 7yo and 15mo baby sister) were initially shy.  When we told them we’d seen them on the television screen they relaxed and soon enough we were bombarded with smiling, playful, happy children who beamed thank yous at us from the motorbike of five people as they drove away, pizza digesting in stomachs and boxed leftover pizza hanging from the crook of a small boy’s elbow.

During lunch we learned a few things.  All three brothers are engaged in school at an NGO involved with vulnerable children.  They like school and they like their teachers.  They are not learning English but they wanted us to know they can say “what is your name” and “my name is”, which we practiced together.  As lunch drew to an end the two boys put their hands together in sampeah gesture and said clearly “thank you”!  Mum broke her ankle in a moto accident two years ago, whilst pregnant with her now-1yo daughter.  She walked on the broken bone for over 1.5 years before finally seeing a doctor.  To be poor in a country where the health care system is user-pays, keeping a significant portion of the already-impoverished population in debt, unregulated, under resourced and of variable quality, means that when you have a health problem, you avoid seeking health care until often it is too late.  She has since had an internal fixation of the bone, but it was probably performed far too late after a lot more damage had likely been done.  She walks with a limp and does not sleep well at night due to ongoing pain.  Doctors have told her she should not walk on it but her only income generation comes from pulling her cart of food for sale through the streets.  Her next appointment with the orthopaedic surgeon at a hospital for the poor, is later this week and we have arranged for Samantha to attend with her so that my MD housemate/colleague can get some more detail and find out if she’s receiving quality care.

We arrived home just before a tropical downpour, at the same time as my telephone rang.  The nephew of my Kampong Cham friend’s so-called “tycoon” introduced himself in perfect English and asked me if I knew how he could contact the family?  Yes I did!  I gave him the family’s telephone number and we spoke for a while about today’s pizza outing.  When he heard me speak a few words of Khmer he broke into Khmer, immediately referring to me as Bong!  We said farewell before he called me back to say that tomorrow he will visit the family with the money from his aunt.  This wont solve the problem of this mother’s badly injured ankle or her poverty.  But it will relieve some of her stress.  And for today at least, she and her children know that they matter in this world.


A first they thought would never happen: eating pizza


Hijinx in the restaurant car park with baby sister

Pearls of Maternal Wisdom

Balancing two boxes of mangoes on her head, a complete stranger greeted me gregariously as we came face-to-face around the same corner this morning.  The only word I understood was “American” but I recognised a sales pitch and turned her down as graciously as possible.  Lifting my parasol to dodge the roofs of tuk tuks and the heads of moto drivers, I passed a blind man playing a traditional string instrument alongside a small boy beating a drum as they strolled slowly along the roadside, busking.  Another small boy, pulling on a checked kramar scarfe wrapped around the man’s waist, was guiding him along the busy street.  I replied to his “hello” without stopping, simultaneously conscious that offering money to children who should be in school only adds to the problem of begging, and that I seemed indifferent to their wretched plight.  The footpaths are crowded with food stalls, parked motos and displayed goods so that throughout Phnom Penh pedestrians are forced to walk on the road, sharing space with the neverending purr of moving wheels and engines.  Ahead of me the yellow umbrella of a monk appeared to float behind his orange robe and sandaled feet.  Battered bananas sizzled in hot oil beside one vendor’s moto-sidecar shop; a barrow filled to overflowing with green coconuts was being pulled by a vendor across the street and another barrow filled with cardboard, plastic bottles and cans was being pulled towards me.  Above us white balls of cloud gathered, pushing a close blanket of stifling dank air around me so that by the time I reached the clinic my clothes were sodden with my own sweat.

Every day my mind wanders to an 18yo boy lying on a hard wooden bed base underneath his family’s bamboo elevated home on an island in the Mekong.  I met him when one of the nurses I worked with in 2014 asked Caz and I to visit him for a western opinion.  He has a tumour on his thigh so large and grotesque, that it seemed a medieval spectacle when the sheet was pulled back for us to examine it.  When we left his home we both hoped we had been able to disguise our shock.  A nurse visits him daily for $2.50 to dress the wound resulting from the diagnostic biopsy which his family went into debt to pay for and which is slowly turning his whole leg black.  He will die soon, with almost no medical intervention.  You need money to pay for oncology services, which his family are simply unable to consider.  We offered what we could, thanks to donations from a friend in England.  It is little but perhaps enough to reduce the family’s financial stress as they lose their son in the prime of his life.  He refuses to eat, believing that food is causing the tumour to grow.  Our attempts to suggest otherwise seemed futile and I can’t blame him for believing as he does.  With any luck the tumour will remain numb, as it has so far, so he can die without pain.  It is hard to imagine speaking of someone’s 18yo son in this way, but at the same time I have learned that such lack of health care is far more commonplace on a global scale, than the entitlements that we in the “other world” assume as our moral right.

Australia’s current affairs series The Project recently hosted Bill Shorten, our Leader of the Opposition in parliament.  He talked about housing (un)affordability in Australia as a video camera drove past a nice but ordinary home.  I envisaged the tree-lined street this house is on, inhabited by ordinary working people living their Australian lives which we all assume as unremarkable.  As I watched, I reflected on the streets of Phnom Penh and the way they constantly highlight to me, that so-called “ordinary” Australian (and NZ, American and European) life is actually a remarkable and privileged phenomenon.  An ordinary Australian home is a deluxe manor in comparison to where most people in the world live and an ordinary Australian life is sumptuous and stress-free compared to most lives.

It is difficult to describe the difference as a multitude of factors cause the vast disparity between those of us from high income countries, and the great majority of the world’s population.  Housing, access to health care, education, food, transportation, employment, income and perhaps most significant but least apparent, our levels of freedom.  No matter what I do as an individual, I belong to a nation with a robust economy.  During my modest, small town New Zealand upbringing, one of the expressions my mother used regularly was “the world is your oyster“.  Even from our little three bedroom suburban home, this was a fact.  For most of the world it is a whimsical fantasy which any fair and loving mother would not tease her child with.

Another favourite of Mum’s was “we don’t know how lucky we are“.  I was in my forties before I came to appreciate the truth of this expression.  At the same time I realised that so many of us go through life never appreciating our unique fortune in place and time.  As a consequence we miss out on many opportunities to help those in our world who are not born to inherent privilege.  My ultimate fortune came from learning that the value of life has little to do with accumulating self-centred and material achievements, and everything to do with making myself useful to those most in need.

Cambodia In America

Existence would be intolerable if we were never to dream
~ Anatole France

These words could have been written specifically for Paula.  After developing severe, chronic abdominal pain during pregnancy in 2011, her interim years have been a living hell.  We met on one of her most wretched days, approximately 16 months ago.  She had already undergone five surgeries and her gaping wounds, oozing faecal liquid onto her abdominal wall, have caused constant pain, immobility and severe malnutrition.  The family spent thousands of dollars seeking medical care for her mysterious abdominal symptoms.  They sold their home and later, their grandfather mortgaged his home so that it is currently owned by the bank.  With over $5,000 owed, her father moved to Malaysia and her brother to Thailand.  Both send their wages home to cover the repayments.  The family (Mum, seven children and Paula’s son plus various other extended family) live in the home of Paula’s aunt while she too, is in Malaysia where she can earn more than is possible in Cambodia.  When she returns, the family will be rendered homeless and do not know where they will live.  The debt will take them three years more to repay before they can begin to think about re-establishing a new home.

Not long after Cambodian surgeons informed Paula that there was no hope, and that she should go home to die, she was diagnosed with pulmonary tuberculosis.  She began standard TB treatment, which in a “dying” patient is more a public health protective measure, than a life saving intervention.  A few months later culture results from her sputum specimens confirmed that her TB was resistant to one of the standard drugs, and she came to us in order to begin a drug resistant (DRTB) treatment regime.

A beautiful young woman with a dedicated and loving family, her story seems to have evolved into a very rare instance of DRTB actually saving a person’s life.  Without the TB diagnosis she would have remained at home waiting to die.  Instead, she came to the attention of people with “outside connections”.  A rare and unlikely opportunity for an impoverished rural villager from Cambodia.  She has featured in two separate reports on TB in Cambodia by Spain’s largest newspaper, El Pais and also in a fundraising brochure for a European branch of Medecins sans Frontieres.  She’ll never know the existence of such paradises as the hillside home of Patricia Wells in Provence, near the medi-eval village of Vaison la Romaine, with it’s clifftop castle and ancient cobblestone laneways.  Yet it was in Patricia’s beautiful garden of lavender, herbs, vineyards and summer blossoms, where Paula’s fate changed dramatically, one sunny day in June this year.

Since that astonishing day when I heard the words “my husband could probably fix her”, followed sometime later in the same conversation with “if her husband treats her for free, I will cover the additional costs”, I have had many doubtful moments.  Awaiting confirmation of charity care from the treating hospital in America; sending Paula, her mother and our Khmer translator (my ex-colleague, “Samantha”) into the US Embassy in Phnom Penh to obtain visas; seeking medical clearance from the airline and many other stages in the process of getting her here.  Amazingly, almost a week ago we did get her here.  She is hospitalised and investigations all show that her condition is operable and she should return home in good health, to a normal life, reasonably soon!

The astonishing coincidence of happening to have lunch with the very people who could make this happen for Paula, and happening to mention her miserable existence to them without knowing of their connections and abilities in this regard, appears to have set a  pattern for Paula’s continuing good fortune.  The long haul flight from Cambodia to America was challenging to say the least.  She travelled the almost four hour journey to Phnom Penh airport in a minivan with at least 30 family and neighbours.  I have no idea how they crowded in together, with Paula lying on a stretcher bed in the same vehicle!  By the time we (Samantha and I) arrived at the airport, in our own minivan with Samantha’s hordes, the Paula hordes were already there, crowded around her stretcher bed which they’d positioned outside the main doors.  It was amazing to be a part of the excitement and I have never been the subject of so many photographs as I was that night before check-in.

We made it across the Pacific Ocean with her, a 25 hour journey in total including 14 hours of flying time broken by an 11 hour stopover.  The excitement of going on an aeroplane was slowly overshadowed by her progressive exhaustion.  By the time we boarded our second, much longer flight, she appeared more like a little old lady than the 25 year old beauty that she is.  Pushing her tired little bones through Customs and Immigration made for an expedited entry into the USA, with officials showing nothing but compassion and respect.  There is a large and tight-knit Cham community here and an Imam met us at the airport with his wife.  As they drove us into the city to the hospital we discovered via conversations in Cham and Khmer, that he comes from a village on the opposite shore of the Mekong from Paula.  In fact, I believe he comes from the village where Chom and I rolled in the tuk tuk!

This week the world has shrunk even further as a steady stream of Cham visitors have appeared daily, some of whom even come from Paula’s actual village!  Their stories seem to be a mix of escaping as refugees during and after the Khmer Rouge era, or more recently, being sponsored by wives or husbands already living here.  Their immediate connection with Paula, especially for those who know them as neighbours and extended family members, but even as strangers meeting for the first time, is surprisingly strong, based on a mutual language, religion and culture originating from a distinct area of the Mekong Delta.  It has been amazing as an outside observer, and also a little overpowering as someone from a very individualistic culture, to find myself embraced by this community spirit.  Karen, paying for the out-of-hospital expenses, has so far had a very tiny food bill because home cooked meals are arriving daily from the community.  The hotel we had booked for Paula and her mother post-discharge until she is deemed fit to fly home will probably be cancelled.  A choice of family homes are earnestly offered for them to move into for as long as they need.

On Thursday I was asked to spend the night at a family home with Paula’s mother and Samantha, who is also having a very awesome first-overseas experience.  We were picked up and transported about an hour from the city to a large family home where extended family and neighbours were either waiting, or joined us later.  A large meal was simmering on the stove, conversations flowed in Cham, Khmer and English, beds were organised, a neverending supply of food was served, children played at our feet and talk of Cambodia, America, food, religion, health care, poverty and wealth kept us awake until after midnight.

Yesterday morning we were taken on a tour of the area after breakfast.  We were due to attend the mosque and talk to the community about their Cham sister/daughter’s plight but information arrived that Barack Obama was coming to town for dinner and traffic delays were expected.  Paula’s mother stayed behind while Samantha and I were driven back to the city in time to avoid the traffic and ensure Paula was not left alone for another night.  As we approached the city a phone call arrived to say that the community had raised over $1,000 towards the family’s debt!  This morning a follow up phone call has placed this at $2,000!  Equally surprising is the information that Paula’s mother, 2 years my senior, has told the community that “my mother will decide what to do with the money”.  Naiively accepting this comment, as I vaguely wondered who she meant as her mother died during the Khmer Rouge, I was then informed “you are the mother, so it is your decision”.  Brain whirling in horror, I maintained some telephone composure and discussed how the money can best be utilised – by paying it towards the family’s debt, and how to best ensure this happens.

In the early days Paula regularly asked “do you think there is any hope for me?”.  My colleagues and I reassured her while in private discussing whether these reassurances were the right approach given her utterly hopeless condition in a country where a prolonged and miserable journey towards death is accepted so often as normal.  To have dreamed that an outcome such as this was remotely possible, would have been ridiculous.  Yet, the utterly ridiculous appears to be taking shape!  If only she were not just one of many thousands with equally harrowing existences.

Parasite Paranoia


That’s my thong buried deep in Mekong Delta mud.  My foot was down there too, a moment before I took this photograph, at which time I was doubled over laughing.  It was a strange combination of hilarity and panic.  The idea of parasites burrowing through my skin into my capillaries and worming their way to whichever organ they are most suited to destroying, contributed to my uncontrollable cackles.  Chom’s comedic commentary played no small part either.

The experience of being on the receiving end of the health care system in Cambodia has been predictably interesting.  First with the birth of Chom’s son two weeks ago at a private, fee-for-service maternity clinic and secondly this week with The Eyes.  I am always reminded, when I attend health services with patients, how vulnerable we are to the behaviour of those employed to serve us.  Nowhere is this vulnerabililty more profound than in places where people are already incapacitated by poverty, illiteracy, ill health and the crushing consequences of corrupt systems.

In the 1970s an international scandal erupted, exposing certain formula milk companies who were aggressively marketing their products in the Third World.  It was estimated by US Agency for International Development, that a million babies were dying each year from malnutrition and diarrhoea, directly due to marketing strategies employed by companies to encourage mothers to abandon breastfeeding in favour of formula.  Free samples were supplied to new mothers amid zealous and dishonest promotion of the benefits of these products.  This assisted in reducing mothers’ breastmilk supplies, which are generated by suckling, quickly causing mothers to become reliant on formula to feed their babies.  Once free samples ran out, many were then unable to afford the formula they needed.  Lack of access to safe water, temptation to dilute milk in order to make it last, and inability to read product instructions, all contributed to the carnage.

This all happened over forty years ago now.  Since then Australia’s “Baby Friendly Initiative”, ensuring that babies and parents are protected against company marketing strategies, has been in place for years.  This prohibits companies from promoting baby products, particularly formula milk powders, anywhere near maternity services.  While the baby formula scandal is infamous to this day, in my rich world perception, it is historical.  As such it was, but should not have been, surprising to learn that in Cambodia no such protections exist against formula and baby product marketing.

Visiting Chom’s new baby at a maternity clinic two weeks ago, I observed in quick succession: a mountain of motorbikes at the front entrance, followed by a mountain of shoes outside the door.  I kicked my own shoes off into the jumble, but upstairs Chom said he’d already lost two pairs of shoes from there, so he ran downstairs and rescued them for me.  Inside the bustling foyer I was curious at a mountain of tiny eggs piled on a plate at the seated knees of a sole seller.  Two shops on either side of this foyer inside the clinic, are stacked high with baby products including floor-to-ceiling baby formula next to equally mountainous supplies of bottled water!  Abandoning my usual self control, I grabbed the camera and snapped a couple of photographs to share with the midwives back home, before heading upstairs to meet Microphone’s baby brother.  I ducked and weaved my way through crowds of mothers, neonates and visiting family members in and around beds on the open plan mezzanine floor, towards the expensively furnished double room where Chom and his cute little family were relaxing in privacy.

The story of his birth reinforced my assumptions after seeing the marketing of products at the clinic entrance.  Dad, not allowed in the delivery room, sat at the doorway in the corridor.  Upon delivery, as research recommends, baby was immediately placed on Mum’s chest to start feeding.  A short while later however, Mum needed “to be checked”.  Baby was removed from her and given to Dad.  Soon enough hunger set in and his persistent cries while Mum remained “unavailable” in the delivery room, eventually became distressing enough that grandma made an executive decision to purchase formula milk at the shop downstairs, plus the required bottle and teat.  It was a natural birth and there was no apparent medical or other reason for the baby to be kept away from his mother at all, let alone for so long.

My visit became a mission to educate the family on the benefits of breastfeeding and the tricks employed by formula milk companies to make money.  Yesterday, almost two weeks later, I was relieved to hear Chom say “we already threw away the milk”.  The same can no doubt not be said for the many dozens of babies born at this one clinic of many likely practising in similar ways.  Talking to Win at breakfast the next day about this, he said “this is why they generally don’t like white skinned people like you to come to their clinics”.  Which is not a reference to my white skin so much as my level of awareness about issues such as formula milk!

This week’s trip to Phnom Penh dragged out for four days, full of health practitioner and health system revelations and frustrations.  Advertised as “free of charge to the patients” on an Australian NGO sign above the registration window, I soon parted with around US$200 before the experience ended, without including transport, food and accommodation.  Cataract operations are free, courtesy of this NGO, but all other procedures and all medications are charged for.  For patients who have no idea why their vision is impaired, many of whom have to go into debt to afford the medications even if their surgical procedure is free, this surely seems like false advertising.

Thanks to a few family members who recently donated money to “Cause Cambodia”, when the doctor explained that there were no donors for strabismus correction, I replied “okay so I can be the donor”.  Selena was horrified to see me hand over $100, until I explained that my family had heard how sad she was about her eyes and had contributed the money, prompting a low bow of gratitude.  I also became the donor for Mary-Lu’s thick-lensed glasses which allow her to see properly for the first time in her short life.  Simona’s cataract removal surgery was free, apart from the post-op medications, but unfortunately she remains severely vision-impaired.

After an afternoon review by a very personable Khmer doctor on Monday, we returned at 0830am Tuesday morning as instructed.  A disorganised crowd were congregated around the registration window.  I soon learned that if I didn’t stand my ground I would spend the entire morning being shoved aside by some monumental “pushing in”.  With size on my side, after the first few pushers got in front of me, I simply stood my ground, keeping some sort of informal place in the mayhem until I finally reached the reception window.

The registration nurse, who I later observed assisting with minor procedures, had the worst attitude of any Khmer person I have ever met, apparently unable to mask her distaste for the lowly humans on the receiving end of her rude and dismissive conduct.  Refusing to speak to me in either Khmer or English, I called upon Tuk Tuk to communicate on my behalf and we were told to “wait”, with zero explanation.  With no other choice, we waited.  For two hours.  The following day I was instructed that both Selena and Simona needed protective sunglasses.  Walking up the driveway connecting the main road with the hospital grounds, I found a pharmacy selling sunglasses but Arrogant Nurse was the shopkeeper!  Clearly making an income selling sunglasses and medications to the patients she victimises at Reception, I refused to hand my money to her.  Tuk Tuk very patiently drove me out onto the highway to locate a sunglass shop nearby, where I parted with $2 for two pairs of Ray-Bans!  That, and putting her photograph on the internet, makes me feel avenged of her contemptuous treatment of us and others unfortunate enough to end up on the receiving end of her substandard “care”.


The post-op medications alone came to US$35, which would be prohibitive to most Cambodians, including Selena and Simona.  With no explanation as to what the eyedrops and pills being bagged up without proper labeling were actually for, I was shocked at the price and spent an evening at the hotel researching the medications and expected prices.  All were sold to us at first world prices, but dispensed in third world fashion, unlabelled and with no explanation except when to take what, written in marker pen on the packets, eg 1 x 3 (1 tablet three times a day).  My research showed that some were recommended post-surgery and some were less necessary and more precautionary.  In my shock at being charged yet more money as I stood underneath the “at no charge to patients” sign, I took a risk and only agreed to purchase the eyedrops for Selena, forcing the nurse to remove multiple packets of tablets from the equation.  I then explained to the sisters that they could share Simona’s Paracetamol and Zinc tablets, amid protestations from a nearby patient who (quite rightly) knew not to tablet share.  Reinforcing that vitamins and Paracetamol are over the counter drugs which can be shared, Tuk Tuk translated this to my growing audience with apparent success.  Slightly anxious that Selena will now get an infection or other complication because of my frugality, we rang today and learned that both are feeling well.  So far so good!

After two nights in hospital, the family were discharged yesterday and we made our way with Tuk Tuk to the nearby market which minivans use as their pick-up station.  Hawkers at these locations often run out into the road, shouting and competing for custom when they see potential passengers approaching.  Tuk Tuk nodded at the first hawker and we were immediately surrounded – jumping onto the steps of the tuk tuk, running behind or alongside us, the wheeling and dealing shouted around me was completely beyond my grasp but a moment later bags were whipped off the tuk tuk and into a yellow van.  I stood at the door watching the women and two girls climb in and over the seats to the back of the van, wondering how their travel sick selves were going to cope back there.  The seat directly behind the front passenger seat was saved for me, so I sat three rows in front of The Eyes, and spent the journey reasonably unaware of how they were getting on.  Occasionally I would look behind to see Selena’s head leaning out of the back window.

From my comfortable front seat, only slightly squeezed in for only some of the way, it was a surprisingly uneventful journey.  As well as stopping at routine points along the way, the driver honked at people standing on the roadside, stopping for those waving him down.  We dropped off and picked up the whole way home.  At routine stops, beggars and sellers leaned in every window trying to sell their wares or hoping for a donation into their begging bowls.  In Skun fried bugs and spiders were the predictable order of the day but the wide eyed baby on her beggar mother’s hip was the biggest mutual attraction.  When she realised her baby was staring in fascination at me, the mother stopped begging to appreciate the hilarious experience of what may have been the first time her daughter had ever seen such pale skin or blue eyes.

Disembarking in Kampong Cham, I learned a very unwell Selena had vomited the whole way.  “Oh my god!  You should have given her a bag” came Chom’s belated advice.  “I did!”.  But she vomited too much, and the bag was too small!  Clambering over the seats to retrieve my bag from under their seat, vomit rubbed against my arm from the side of the case.  I passed it out through the back window to Chom who, sickened by the smell of his own newborn baby’s pooh, immediately began dry retching!  Tipping the driver apologetically as he wiped the floor with someone’s t-shirt, we squeezed onto Chom’s tuk tuk with all our gear and “they want to go straight home”, headed straight to their village 30km upstream.

After a brief interlude with Joe and his wife, very happy and thankful to see their little family safely home again, we headed back to town on the muddy roads.  Making a shortcut turn just outside their village, Chom hesitated at a muddy patch across the track and asked what I thought.  “It’ll be fine, go!” was my reply.  A moment later we were bogged.  “Oh my god, why did you say to go!”.  Jumping out to help push, the rest is explained in the opening photograph.  In mud up to my ankles, I helped us out with some serious pushing and on we went as the mud dried itself into a layer of cake tightening it’s hold on my skin.

Coping with some serious parasite OCD the rest of the way home, we encountered another puddle on another shortcut turn, and risked it again, unbelievably becoming bogged again!  This time the tuk tuk was immersed in a big brown puddle, angled sharply ro it’s right over the muddy water.  Remembering the last time this tuk tuk turned onto it’s side, I stood on the skyward-facing step and Chom shouted at me to jump off and push.  Hesitating as I looked down into the water, which was up to Chom’s knees, I remained on board as he stood beside his moto and revved, sending the tuk tuk onto an even sharper angle.  “Oh my god!  Why are you still there! I thought you already got off!”, he shouted when he realised I hadn’t moved and wasn’t helping.  Just as I was hysterically about to force myself into the puddle, with my foot hovering over the water like a child afraid to get into a cold swimming pool, a man and two young boys appeared out of thin air and Chom translated “they will push, they said you can stay there!”.  Feeling like a queen in her chariot, the four males powered us out of the bog, sending the tuk tuk back into an upright position.  We chugged off with shouts of thank you and good luck at the rescuers shrinking out of sight behind us.  Chom’s final words on the matter were “see how the poor people, they have nothing but they still give everything that they can?”.

On the way home I fantasised about the long body scrub I was about to have and pondered on how my stressful hospital experience in Phnom Penh was completely washed away (admittedly with muddy parasite-ridden water), as soon as Chom re-entered my life.  Life’s about to get a whole lot more boring.