Eye Is For Ice

This week I lost my housemate and friend to Bangladesh, where she will work with the Rohingya refugees escaping indescribable violence in Rakhine State across the border in Myanmar.  We spoke a lot about them and about Cambodia before she left.  It always looped back to ourselves, our appreciation for our extreme luck of birth and our drive to make the most of our good fortune.  I’ll miss the thought provoking conversations.

Rakhine State

For now I live alone.  Right now I am typing a blog overlooking the skyline of Phnom Penh from my balcony.  Five floors above the streets where people are doing whatever they can to simply survive, it is a “bubble” up here.  Outside people are searching for ways to have enough food for the day while I live in protected luxury, with the comforts that have always constituted my charmed life.

As a first year student nurse in England the first essay I ever wrote was 5,000 words on Inequalities of Health.  I still have that essay somewhere, with it’s featured photograph from The Independent newspaper in 1991, of a homeless man lying in a sleeping bag in the snow in a London park.  The wealth-poor divide is highly visible in Phnom Penh, as it is in any location where travelers from the Rich World live alongside locals who never have the opportunity to leave the small patch of territory where they toil day after groundhog day.

Last week The Eyes came to Phnom Penh so that 7yo could have her surgical appointment with visiting overseas ophthalmologists via SEE International .  Her behaviour suggests more than just eye problems.  So do some of her facial features.  She is odd looking and oddly behaved, does not learn well at school, has no friends in school, and generally a highly unfortunate little girl.  A child like this in Australia would be known to various specialist support services.  In Cambodia she lives in a little village in the dust with a blind widowed mother and widowed grandmother whose most recent distress came from the theft of their chickens.  I received a call from Dan about a month ago, the chickens have been stolen and they needed them to sell at market and now they have no food to eat.  As well as sorting out some food for the month we put our heads together with the village builder and organised a new chicken coop.  I’m always entertained by these unlikely agricultural interventions I find myself engaged in!

Chicken coop 02

Hoping to avoid further chicken thefts

The day that Boat Baby was born we were taking supplies to The Eyes, who live in the same village but across the vast corn field which was under water on that visit.  These peoples’ only experience of water is shown in this photograph of Little Sister greeting me as our wooden boat arrived in the brown slush of the Mekong Delta outside their house.  Last week those little girls had their first and only taste of water as I grew up knowing water.  Oneday at the hospital we were sharing lunch together with noone to translate so I was forced to practice my Khmer.  I picked up a chunk of ice and announced it’s Khmer name.  They smiled and agreed, before asking me it’s English name.  “Ice”.  “Eye”.  “Ice”.  “Eye”.  S never comes at the end of words here, so I agreed they had it right, laughing privately at The Eyes repeating the word Eye to me!

Three out of five members of The Eyes family have vision problems which were not addressed due to their inability to access health care, until I met them three years ago.  It has possibly cost me in the vicinity of US$500 to engage them with SEE International over the past three years.  We have lived through three operations, four sets of glasses, a number of trips to Phnom Penh for pre- and post-operative appointments, severe travel sickness on buses and mini vans leading to tuk tuk rides of >5 hours each way and all kinds of other issues.  The eye surgery is offered free of charge but villagers with no income have no way of affording the transport, accommodation and other associated costs such as post-operative medications.

This is only one family of the millions worldwide who cannot and therefore do not access necessary health care.  Their story includes grandad Joe, who I wrote about many times, a probable victim of Polio whose death a year ago this month was likely due to Post-Polio Syndrome.  All he could tell me when I asked, was “during Pol Pot I got a fever and then I couldn’t walk properly”.  For years he survived without the wheelchair he needed, which I was able to organise almost immediately thanks to my financial ability to bring him to town and engage him with the relevant organisation.  Their story also includes the girls’ father who drowned in the Mekong, with no clear story of what happened.  As a friend of mine said at the time “it could be murder, but she is a blind woman and very poor, so she has no power to talk to the police”.  It could also have been suicide.  We will never know although people seem to think it was not an accident.  He and his motorbike were dragged out of the Mekong three years ago.

I always assumed a genetic cause for The Eyes vision problems.  Last month when I visited Boat Baby I learned that his mother also has vision problems.  Could this be mere coincidence?  Reading up on Agent Orange, I have learned that 173,000 acres in Kampong Cham were sprayed with Agent Orange between April 18 and May 2, 1969.  The spraying took place at night with evidence that it was carried out by the CIA.  Villagers allege in fact, that similar spraying continued frequently into the 1970s.  There are no official records of most of these sprayings which defoliated vast areas, intending to expose enemy troops to the bombers flying above.  I am unable to find a map showing exactly where the spraying occurred.  The area was also heavily bombed and many of my friends and colleagues here have vivid memories of bombs exploding on their villages and homes, killing family members and leading to the digging of rudimentary underground bunkers covered with layers of bamboo.

Vietnam War veterans in New Zealand, Australia and America have long held strong opinions that exposure to Agent Orange has caused high rates of developmental, immunological and neurological problems in their children and now, their grandchildren.  Governments have been reluctant to accept the argument, but compensation is provided in various ways to children born to Vietnam War veterans with certain disabilities.

The issue can be summed up briefly with these two statements:

The US military denies any link between the defoliants and the illnesses and deformities found in Vietnamese children who have become the world’s most recognizable symbol of the effects of Agent Orange. Among scientists the debate over the (alleged) adverse effects of Agent Orange remain a contentious issue.
Cambodia Daily March 2004

Kampong Cham, Cambodia | The proportion of babies born with disabilities in eastern Cambodia is more than 50 times higher than in other parts of the country, according to local doctors….While the reason for the higher rate has not officially been confirmed, it is generally believed to result from the use of Agent Orange, a dioxin-containing defoliant, by U.S. forces during the Vietnam War….The scale of the damage wrought by use of the chemical in Cambodia is still unclear as there has been little research into the victims. Local doctors have called for an official survey on the effects.
Star News article 2008

 

agentorange

A child at the Ba Vi orphanage, part of the third generation of Vietnamese victims of Agent Orange and other chemicals used by the U.S. military a half-century ago.   Ahkoblitz Blog   Visiting The Eyes at hospital last week I saw a child with a similar affliction to this.

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Boat Baby Update

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

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

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

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

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

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

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

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.

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A first they thought would never happen: eating pizza

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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.