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.

Heart Strings 01

Heart Strings

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

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

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

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

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

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

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

What is Rheumatic Heart Disease?

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

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

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.

Unconnected Connections

Fundraising for the 20yo woman with (probable?) Rheumatic Heart Disease needing urgent heart surgery continues.  A friend asked me to prepare a Powerpoint presentation for a fundraiser she is organising and I thought I would share it here as it summarises some of the stories I’ve spoken about disjointedly.

Story One: An Inconceivable Connection

In May 2014 I met a 25 year old Islamic woman from a rural village in Cambodia who had been told she had terminal cancer.  Surgeons in Cambodia operated twice to remove the “cancer” from her abdomen, first forming a colostomy as they removed some bowel.  The diagnosis came purely from the doctors opening her abdomen to investigate the pain she had been experiencing since pregnancy with her now-8yo son.  They based their diagnosis on what they could see – inflamed lymph nodes in her abdomen.  There were no resources to take a biopsy or other investigations which would give a proper diagnosis.

Surgical practices are basic at best and often dangerous without good equipment.  When her pain persisted, they performed a second operation which damaged her bowel, causing a second opening on her abdominal wall to form (a fistula).  She now oozed faeces from two sites on her abdomen.  This caused acidic burning of her skin and she was unable to absorb food so she became severely malnourished.  Doctors finally told her she should go home to die.  A short time later she developed a chronic cough and was diagnosed with lung TB.

Although it was thought she was dying, her TB needed to be treated for public health reasons.  Constant abdominal pain, oozing faeces which burned her skin and severe malnutrition were her main physical problems when she was admitted to the MSF program I was working on, with drug resistant TB.  We were unable to find any muscle mass to inject the second-line TB drugs when she was admitted to us, and she was unable to stand up without assistance.  She weighed 20kg.

After a few weeks on the right TB medications her cough eased and her abdominal pains ceased and I was sure that she had abdominal TB rather than cancer but there was no way of confirming this.  She continued to ask us if we thought she was going to die and we had no way of knowing the medical answer to this question.  She stayed in hospital for two months before we discharged her home.

My nurse team visited her at least once a month and I visited her either with them or at weekends, multiple times but I was at a loss to help in any meaningful way.  She needed colostomy bags and protective dressings but they were unavailable in Cambodia.  When I came home to NZ and Australia  I tried to source them but they were expensive and I was not able to supply more than a few weeks’ worth, so I did not supply them.  She had to wipe the openings with tissue or gauze many times during the day and night.  All I could really offer was a little financial help to the family for food, school fees and gauze, and some emotional support.

El Pais 009

Waiting to die from surgical complications related to undiagnosed mesenteric tuberculosis (2015), photograph courtesy El Pais newspaper who visited the MSF TB project

Her other problem was the debt her family had accrued trying to find a diagnosis and treatment for her.  They sold their house.  Her father had moved to Malaysia where he could earn a slightly better income selling food at a street stall.  Her grandfather had taken a loan out with his house as collateral.  Her younger brother, a very eager student, had been told once he turned 15yo that he would have to leave school and was thinking of moving to Thailand to work on unregulated fishing boats.  They were financially desperate.  Her mother stayed at home to nurse her daughter’s wounds and care for her 4yo son.  They were living in an extended family home in crowded conditions.  Laundry is done in the nearby Mekong and I was constantly astounded that the open, oozing wounds, had not become infected.  This was testament to the family’s extreme care.

In June 2015, a year after I met “Paula”, I was on holiday with an American friend in Provence in the south of France.  She invited me to a lunch at a beautiful medieval homestead with some wealthy Americans at an exclusive cooking class.  During conversation some of the Americans were very interested in Cambodia and asked me to explain what I meant when I used the word “poverty”.  I tried to explain Paula’s situation and the health care system.  I described her sitting on her death bed in a wooden hut beside the Mekong as we sat at this lush table with so much more than we needed.

Three American women sitting opposite me were on holiday together.  They were especially interested and one of them cried as I told Paula’s story.  Another asked me so many questions that I thought she must be a doctor or a nurse.  But she eventually told me that her husband is one of America’s leading gastro-intestinal surgeons and he would be fascinated by Paula’s story and would want to treat her himself!  When I explained that this was a nice idea but completely impossible, she assured me that it was perfectly possible.  She and her husband sat on the hospital board and could influence them to agree to a charity case for free surgery.  Someone else at the table was so inspired that she offered to pay for all other costs if the medical costs could be covered.

IMG_5042

A very memorable lunch

I returned to Cambodia almost immediately, cutting my European holiday short to organise a million details including passports, American visas, air travel for a critically unwell passenger.  She fainted at the photograph store when we took her for her passport photographs; fainted between the tuk tuk and hotel a number of times; fainted twice inside the American Embassy in Phnom Penh during her visa interview.  My life from July 2015 until early October 2015 was filled with taking this dying woman to various appointments and helping her fall to the floor as we challenged her to travel and walk distances she was not in any position to tolerate.

In October 2015 I travelled with her, her mother and a Cambodian nurse who acted as our translator, from Phnom Penh to Seattle.  A local Imam met us at the airport and drove us directly to the hospital.  En route, with the skyline of Seattle ahead of us in the distance, I heard her speaking Arabic to him from the front passenger seat.  Some time later he informed me that she had said to him “I can die now, because look at the experience I have had”!  She was admitted to the surgical ward and immediately began receiving the type of health care that we in New Zealand take for granted.  Within days her nutrition had improved and within two weeks she was deemed nourished enough to undergo surgery.

During our first 24 hours I found myself responsible, as the only native English speaker, for finding Halal food for her and her mother, which was quite a feat in a wealthy inner city area of one of America’s most prosperous cities.  After some time searching the streets I found a Vietnamese restaurant and ordered takeaway.  When I arrived back at our hospital room, a group of Islamic people were visiting.  They approached me eagerly to ask “are you the Australian doctor who brought her here for surgery?”.  Errr… no?  “Yes you are, it’s you who did this for our sister!”.  From that moment for the following two week stay, I was overwhelmed with attention from dozens if not more than 100 Cham people, mostly refugees from Pol Pot’s Cambodia in the 1970s, who have a strong community.  I never went looking for food again, as we were inundated with home cooking multiple times per day.  I was invited to stay at a family’s home where dozens of Cham Cambodians came for dinner to meet us.  The next morning the teenage son of our host family found a shoe box, cut a hole in the lid, taped the lid to the box and said he was taking it to mosque to raise money for Paula’s family.  He returned a few hours later with US$3,000.  The money was given to me and I was told “you must tell them what to do with it”.  I carried it back to Cambodia and gave it to grandad, who took it on the back of Paula’s sister’s motorbike, straight to the debtor, at my request and with me following in Chom’s tuk tuk!

Within two weeks of our arrival in USA an eight hour operation rejoined Paula’s bowel and closed her wounds.  She remained in America for five months to recover and to cut a very long story short, this is a photograph of her at home in Cambodia taken last week <not shared online to protect her privacy>.  She remains impoverished but she can care for her son and she works, selling homemade rice cakes from outside her house.

Story Two: A Fishy Connection

In February 2017 after more than a year away I returned to Cambodia and am now working on a project with Medecins Sans Frontieres, based in Phnom Penh.  The rich-poor divide in the city is visible and extreme.  The poor have few options and I can probably count the list of their choices for income on ten fingers.  One of them is to run a mobile “restaurant” from a trolley on a bicycle, cycling the streets hoping to find someone who will buy your fried banana.

Inequality in a pic

Searching the streets for recyclable tin, plastic, paper and cardboard is another common income generator and you see very young children and very elderly people pulling trolleys through the streets, as well as parents with children in the trolley with their collection of rubbish.

Phnom Penh Scenes 01

Last year when I came home to visit I landed in Christchurch at midnight with no way of making my way home to Mum until my uncle insisted on driving the almost three hours one-way to collect me and taxi me home in the middle of the night.  This uncle fishes off the shores of New Zealand’s picturesque South Island almost daily.  He took me out in his boat to pull up some craypots, and we swam in the open ocean in wet suits.  He dons goggles and swims with a long spear, catching butterfish.  He has regular close encounters with fur seals and dolphins and has even been up close and personal with Orca.  He refused to accept anything from me in thanks and so I promised that I would fix a fishing boat in Cambodia on his behalf.

Across Cambodia and in a particular location near Phnom Penh there are many landless communities of Islamic Cham people who live on boats or, when the river water is low enough, build makeshift shacks with any material they can find, on the riverbank.  A friend of mine volunteers with an organisation who work with one such community of about 500 people, ensuring the children have birth certificates, pay the school fees for families who fit their criteria (agree to keep their children in school and not make them work on the boats), work with families in need of health care etc.

For at least part of the year the community live on their boats as the riverbank disappears underneath the rising waters during Wet Season.  In April this year a particularly strong storm swept through Phnom Penh.  Even from my fifth floor apartment with it’s double glazed windows I could hear the torrential rain and winds.  That night one family’s boat sank to the bottom of the Mekong leaving them without their only source of income – access to fish which both feeds their family and gives them something to sell.   When I told the organisation a few weeks after this storm, that I had a donation to use on repairing a boat, this was the family they identified.

The family bought a new boat and when I visited about eight weeks later, it was upside down on the riverbank being waterproofed.  They told me via a translator that “we do not know how to thank you, there is no way to tell you how much thanks we have for your help”.  I also learned on that visit that they could not live on their boat as they had no roof for it.  The parents and two youngest children were sleeping in a tiny shack, two other children with a neighbour on their boat, and two children in a land based shack with another neighbour.  The wrong (cheaper) roof could potentially pull the boat over in strong winds and they could not afford a better roof.  When I asked how much a decent roof would cost they showed me a roof that was for sale at a boat nearby, for $60.  We funded this roof for them immediately.

046 Cham Visit

035 Cham Visit Roofs 13

The $60 (unaffordable) roof for sale, in front of the neighbour’s boat.  The neighbour has a newer roof (on the boat behind), hence the older roof for sale.  This “quality” roof can last for about ten years.  The family are able to live together again on their little boat.

Story Three: The Rheumatic Connection

Or so I think.  It could be another disease, but it’s most likely Rheumatic Heart Disease, a condition of poverty which occurs at very high rates in impoverished populations, including Central Australia’s indigenous communities.

Last month a friend told me about Sokum, a 20 year old woman dying from heart failure.  She could live if she could access the cardiac surgery that would treat her condition, but cannot afford the $6,000 needed.

Her family have no way of raising the funds to pay for her surgery and an American student working with Sokum’s husband started a fundraiser to help them.  So far we have raised just over US$3,000 but donations are drying up.

The family went into debt to organise a cardiologist review some months ago, and were told that she will be too unwell for surgery if they wait too long but without the money for hospitalisation costs, they have no choice but to watch her fade away.  Without access to her cardiologist I can only guess that her most likely diagnosis is Rheumatic Heart Disease, which is common in populations living in poverty.

When I asked her husband to say something for fundraising purposes in New Zealand here’s what he wrote:

My wife’s name Sokum and 20 Years old.

Before her parents take her go to meet traditional doctor but she is not better and then my parents continue to take her go to public district health hospital a doctor said that lung failure. The doctor provided a lot of medicine but feel not well more serious ill so, my parents continue to take her go to referral provincial the doctor said that can not treatment here need to send Phnom Penh city. In the Calemet health hospital doctor asked her about situation and check with x’ray so the doctor tell her truth about heart problem.  need to make surgery very soon.

Before we don’t know but when we were to Calemet hospital and know about her heart problem 1 year.

Now she doesn’t work because too sick of her. She stay at home right now can’t do hard work and can’t eat with salt food.

Before she is works at factory worker 3 years and during work with factory she working hard to find money to support the family.

Thank you helen
If you have more question please feel free let me know.

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I should be in a position to provide an update on this fundraiser in a week or two.  Things are moving slowly but surely and Sokum had a cardiologist appointment in Phnom Penh today.  Some incredibly generous gestures have been made on her behalf which I look forward to speaking about once everything falls into place.  All donations continue to be warmly welcomed, either through Go Fund Me or by contacting me directly.

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.

Quick Cambodia Visit: Joe

Post-polio syndrome (PPS) is a condition that affects polio survivors years after recovery from an initial acute attack of the poliomyelitis virus.  Most often, polio survivors start to experience gradual new weakening in muscles that were previously affected by the polio infection.  The most common symptoms include slowly progressive muscle weakness, fatigue (both generalized and muscular), and a gradual decrease in the size of muscles (muscle atrophy).  Pain from joint degeneration and increasing skeletal deformities such as scoliosis (curvature of the spine) is common and may precede the weakness and muscle atrophy.

National Institute of Neurological Disorders and Stroke
http://www.ninds.nih.gov/disorders/post_polio/detail_post_polio.htm

Having lived with (probable) undiagnosed Polio since an infant, Joe is now very unwell, I guess with Post-Polio Syndrome.  He reports that for the past five months his already-incapacitated legs have become floppy and paralysed.  He can no longer leave his bamboo shack and the hand-propelled bicycle-wheelchair Chom and I sourced for him over a year ago now, sits unused.  He has constant pain in his joints particularly in his legs.  There is no clinic near his home and he cannot maneuver out of his home even if there was somewhere to go for help.  There is no money to consider purchasing pain relief.

I promised to send medications and once I reached Phnom Penh en route home I purchased some painkillers from a pharmacy.  Two months’ worth of Tramadol and Paracetamol was not cheap even for me (but I had money from my generous family and friends to use in just such a situation).  There must be many thousands who suffer and die in pain, unable to afford any relief.  I delivered the medications to Chom near his Japanese language school, who delivered them to Kampong Cham when he travelled home to see the family.  Dan collected them and transported them to Joe in his remote village for me just the other day, reporting back via Facebook:
Him: Hi Helen How are you? Today i bring the medicines and cream to give Mr and i tell him to use the drugs so his daugther is understand . Thanks bye!!!|
Me: Thank you SO much . He looks so unwell, I really feel bad for him. I hope to help him some more but I do not know how?  I hope your family are all happy too. See you very soon again.
Him: Yes. You welcone. I know his family unwell and i have a small money for him (10000 riel) because i not have money too. Thanks
This is just one example of the persistent evidence I have observed for years now, of support to the poor coming almost exclusively from other poor people.  Dan also sent this photograph of Joe receiving his medications.
nj-medicines

Joe has three daughters.  As is often the case in Khmer families, they all have ridiculously similar names.  I’ll call them Simona, Sophia and Selena, with their mother’s name of Sabrina!  Selena is married and lives with her husband somewhere else.  I have not met her.  Simona is a blind widow with two daughters, 5yo and 6yo.  They live with Joe and his wife in their banana frond/bamboo hut.  Sophia is a single woman, who had a strabismus which, when we took her blind sister to have eye surgery in Phnom Penh last year, also had surgery to correct the defect.   Chom translated for me oneday last year, that because of her eye “that looks at the capsicum but sees the cucumber”, she often wanted to kill herself.  When I told him “but she is beautiful”?, he replied in English as she watched silently unaware of what was being said, “Helen, you are the only one who thinks she is beautiful.  In Cambodia she will not find a husband, because when she looks at the capsicum she sees the cucumber!  You should put her photograph on Facebook so that one of your Australian friends can see her and maybe marry her?”.  Following our rather memorable journey to Phnom Penh last year, which I blogged about at the time, Sim now has two eyes which are perfectly aligned, such that when she looks at the capsicum, she sees the capsicum!

She has moved away from Joe and the family in order to support them with an income.  She happens to live a very short tuk tuk drive from Paula’s home, beside an ice making factory.  Housekeeping for two “rich” families, she works 5am until 9am at one home and 5pm until 9pm at the other, earning a total of $35/month.  This allows her to purchase a $25 bag of rice for Joe and the family at home, which lasts one month.  The remaining $10 covers her expenses away from home.  It is the tightest budget my rich-world-brain has heard of yet!

When we visited Paula two Mondays ago, we visited Sim first.  I had a silver compact mirror with a kiwi engraving on the lid for her to admire her new looks which she otherwise does not get to see.  She informed me that there was no way for her to purchase new clothes given her financial obligations to the family, and that she only had one outfit to wear.  We went to the local market, a series of tarpaulin-covered stalls sitting in the hot dust.  For $25 she came away with three shirts and two pairs of trousers.  I came away with the experience of buying from a market vendor who, instead of haggling about price with the wealthy foreigner, asked Dan what we were doing and brought his price down so that Sim, acting as though it was Christmas, could have an extra shirt at his expense!  The generosity of the poor never ceases to astonish me.

A wall of steaming cold water plummets from an unknown source, down the side of a building, to an unknown location, behind the wooden house under which we sat during our visit to Sophia.  When she saw me looking agape at the sight, she grabbed my hand and walked me up the hill, around puddles of tarred mud, to the factory door where machines and disused engines sat in the muddy tar, rumbling at decibels which would be illegal in a residential area where I come from.  I had no idea of what she was telling me but it was obvious that she felt pleased to be able to give something back, by way of teaching me about the factory where she lives!  It was a hot day and her “housemate”, swinging in a hammock next to the metal chair they sourced for me, turned his fan around so that it blew onto me.

When I’ve visited Joe in the past I have wondered at the car battery sitting in the doorway leading from the big open front room, to the smaller back room.  It all fell into place when Sophia, through Dan, asked if I would consider sponsoring the family to have electricity connected “because they use the battery but it only gives very weak power and they are the only family in their village with no power”.  Connecting electricity at their shack will cost US$250 plus 25c per kilowat of usage once connected, which they will also need assistance with.  Whilst I can support this, and keep imagining how much more comfortable Joe would be if he had a fan to keep him cool and to keep the swarming mosquitoes at bay, I am also wracking my brain trying to think of a way to help them develop an income of some kind so that my support is less necessary.  It is not an easy idea for people living in a village where there is no economy to generate income.  People grow their own food and rely on distant relatives, who live away from home in order to be able to provide financial support.  With two disabled people in one family, there is more pressure on Joe’s two unimpaired daughters than they have the capacity for.

I am returning to Cambodia in early February, when I will have time to travel and visit for three weeks prior to commencing my MSF assignment.  My good friend Caz will be traveling with me and she is nothing if not an Ideas Person.  Who knows what we may be able to come up with together for Joe and his family of girls.