How Not To Be Ignorant About The World

A garden with only one type of flower or flowers of only one colour is no good.  This is a reminder that our strength, growth, survival and very existence lies in diversity.  It is however, a message of courage as well.  For a flower does not ask for anyone’s permission to bloom, it was born to offer itself to the world.  Fearless love is it’s nature.

Attributed to Chheng Phon

Last year Professor Hans Rosling, a Professor of International Health at Karolinska University in Sweden, passed away from pancreatic cancer following a long fight with Hepatitis C infection.  He had dedicated his life to public health and was described in this Guardian article as “a kind and constantly curious genius. He was truly committed to the poorest people in this world, passionate about statistics and dedicated to communicating a fact-based worldview. His knowledge, virtuosity and humour infused his unique data visualisations with a life of their own, encouraging people around the world to engage with facts about population, global health and inequality that might otherwise have passed them by.”  His work took him from Sweden to India, Africa and Asia.  Had Professor Rosling been born in a war-torn or impoverished nation, his potential would never have been realised, to the detriment of all of us, whether we have heard of him or not.

A toddler at the time, I don’t remember the first time I traveled overseas (from Australia to New Zealand).  I also have no clue how many times I’ve traveled overseas since that time.  Whilst always aware that the ability to travel is a privilege, due to my own personal enjoyment of the experience, I have never considered what it means to hold a “powerful” passport.

Passport Index is an interactive website ranking individual country passports according to their power.  This is determined by how many countries will accept entry using a specific country’s passport.  The Passport Index includes a total of 199 countries, states or territories who issue independent passports.  The Australian passport has a high visa-free score with a power rank of 8th in the world, alongside Malta and Czech Republic.  Australians can travel to 157 countries either visa-free or by purchasing a visa upon entry to the country being visited.  Singapore are ranked 1st in the world with 164 nations accepting their passport easily.  In contrast, Cambodia ranks 79th with only 52 countries offering visa-free entry to Cambodian citizens.  Perhaps not surprisingly given the ravages of war in the region, but adding to the disempowerment of their people, the four bottom ranking countries are Syria, Pakistan, Iraq and Afghanistan.

This power of passports is a very human construct, based purely on perceptions and decisions of people in powerful positions.  It makes me wonder how much the world misses out on due to our deliberate limiting of human potential.  By “our” I mean all of us – including governments involved in oppression of their own citizens.  Despite two world wars and untold other conflicts including mass genocides, as well as natural disasters, last century saw colossal global progress in improved health outcomes, medical breakthroughs and scientific discoveries.  Noone has captured this information better than Professor Hans Rosling in his various presentations at conferences and TED talks.  I wonder at the loss of potential directly resulting from the need humans seemingly have to discriminate against each other?  How many potential scientists, researchers, artists, leaders and peacemakers have been unable to realise their potential because of the power others have held over them?  How many today are instead pushing trash carts through impoverished city streets or surviving by other menial and demeaning pursuits of mere subsistence?  What have we all lost because of this individual loss of realised potential?

Obviously laws are needed and countries need to have borders.  But I wonder if our attitudes and laws were based on the need to promote human potential, rather than on anxiety and fear of things that are considered foreign, how much we could all benefit?  In Australia we have some very fear mongering politics and I often wonder, for a country with so much unlimited opportunity to shine, where our visionaries are?

Today’s national news featured an item about one young visionary, Molly Steer from Cairns in North Queensland.  At just 10 years old, Molly was deeply affected by a documentary she saw highlighting the damage done to oceans and marine life by plastic straws.  She began a campaign, Straw No More and has managed to convince 90 schools in Australia and overseas to abandon plastic drinking straws.  Earlier this month she won Cairns’ Young Woman of the Year Award.  During her acceptance speech she called on Cairns City Mayor to join the campaign.  Almost immediately, Cairns Regional Council unanimously agreed to eliminate plastic straws from all town council operations (which includes office buildings, markets, events and venues that the council are responsible for).  Cairns is on the doorstep of Australia’s infamous and beautiful but threatened Great Barrier Reef.

As I watched Molly on this morning’s news, my 10yo amputee friend Dara entered my thoughts.  Out in his dusty remote village where the damage of single use plastic is likely not something anyone has an awareness of, let alone power to do anything about.  In places like this, sellers drive sugar cane juicers attached to archaic motorbikes, serving their iced fresh juice in plastic bags with plastic straws along the roadside.  There are no waste disposal services.  Ocean pollution begins on land and flows to the coast via river systems.  This is a tiny example of the fact that for global benefit, we must fight for global equality of opportunity across populations.  Not only does Dara deserve a safe and healthy childhood, a basic education and the opportunity to shine, but we all deserve for his life to hold such value.

This week I received a call for help from a friend in Phnom Penh.  The family of a 2yo who drowned in the Mekong in March (mentioned in my blog of 15 March), needed a boat repair.  The boy’s grieving father was unable to feed his family without the ability to fish.  They were asking for someone to make a micro-loan to them of US$150 so that they could repair the boat.  I put a message on Facebook and within two minutes a friend contacted me to say it was not a loan, the money was en route.  This morning my friend visited the family to inform them of the good news and organise the boat repair.  “What a difference” was her message attached to the photographs of a smiling couple with their surviving baby.

We all have our own inherent biases, related to our personal experiences, attitudes and beliefs, which limit our perception of reality.  This is discussed well by Hans Rosling and his son Ola, at their 20 minute TED Talk in 2014, How Not To Be Ignorant About The World, where they discuss perceptions of poverty and how wrong we can be based on our preconceptions.  It is so common to hear that there is no point helping the poor because nothing gets better.  If the smile on that father’s face is not enough, listen to Hans and Ola for twenty minutes and learn how wrong this idea is.

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Every Time I Go On A Plane

Kung Future is a tiny NGO working in Phnom Penh off the smell of an oily rag, with landless Cham people who live on their boats at the conflux of the Mekong and Tonle Sap rivers.  This week Kung Future reported the death of a two year old boy who fell off the boat he was living on and disappeared, despite the efforts of many who tried to find him by diving into the muddy waters.  His body was found some days later.  Kung Future do a lot of work in this community including organising birth certificates for children who would otherwise officially not exist; enrolling children whose parents cannot pay the fees, to school; some health care support when possible.  They also provide upkeep for boats in disrepair, which often leaves families with no choice but to try and fill holes with whatever they can find, even rolled up paper!  The community’s needs are high and the resources to meet their needs are extremely limited.

Cham fisherman painting his newly repaired boat, courtesy Kung Future

Meanwhile back in Australia, I feel a world away from all that.  The Project is a current affairs entertainment show airing here on weekday evenings.  One night recently, musing on a news item related to our national airline Qantas, one of the commentators said “every time I go on a plane…” as if it was the most ordinary statement, along the lines of “every time I eat breakfast…”.  As ordinary as they may have seemed to most Australians, these words revealed the extreme privilege that simply being born in Australia bestows upon us.  Our privilege is so normalised to us that we don’t see it.  Not every Australian can speak so casually about plane travel, but every Australian can hear it with a feeling of mundanity.  In contrast, I have lost count of how many seemingly worldly Cambodians have asked me with genuine fascination, about flying on an aeroplane, or how many countries I have visited.

Almost daily someone currently asks me if I find it difficult to settle back in at home.  The biggest impression I have on my return is our normalised privilege.  I don’t struggle with it at all; I am merely returning to my own normal life.  However I do have a very heightened awareness of it after moving rapidly (in the space of a 10+ hour flight), from a place where survival and limiting hunger are the focus for a large proportion of the population, to a place where liberty and comfort are central to our reality.  My friends and family here are securely employed, living in homes with solid roofs, paying off affordable and regulated mortgages, driving safely maintained cars, with opportunities to travel and the right to hold political opinions without fear.  My friends in Cambodia have between none and a few of those things, on a much smaller scale and in a suffocating economy where poverty is a highly visible feature of everyday life.

Something else many people ask me is why I would choose to follow my plans to return to Cambodia rather than stay in Australia.  A Cambodian friend suggested that maybe I don’t really love myself, that I would choose to live there rather than be among the comforts of my first world existence.  Friends in Australia frequently suggest I need to focus on settling down / building a nest egg for the future.  To the contrary, these quotes speak the most to me:

~ Jim Carrey

In The powerful way that normalisation shapes our world, Jessica Brown comments that “our grasp of normal is an entanglement of objective and subjective, moral and social judgements, prone to changing for the better and for the worse“.  She highlights the complex nature of normalisation, in that it can easily change (eg the normalisation of various previously unacceptable behaviours during the era of Trump) but can also be very fixed (eg ideas on female beauty).  It is an intricate phenomenon that most of us probably never really think about.  The reason I think about it is because what seems normal when I am living in Cambodia, is very different to what seems normal when I am living in Australia and these differences are particularly heightened for me now, as I settle back into a six month stay in Australia.

As one of many examples, I am staying with friends at the moment, who due to some veterinary visits, have spent more on their pet dogs in the last two weeks than most Cambodians can spend on themselves in a year.  These friends are living well, but they are not wealthy by Australian standards.  Yet to my adjusting brain, sharing their lifestyle for this short time highlights how extremely privileged we in Australia are, with very little recognition of the fact because it is merely normal to us.  It gives me some context to refer to, when trying to understand the complex nature of my relationship with impoverished villagers in Cambodia, who see me as infinitely wealthy.  My existence is beyond their normality, for the sole reason that I have enough money to appear in, and disappear from their lives, seemingly at whim.  Most of these are people who have never traveled away from their own village.

Before leaving Cambodia I wanted to visit Boat Baby, who I “caught” when he was born on the small wooden boat over the Mekong Delta in August.  About six weeks ago now, I spent a weekend in Kampong Cham, visiting various people with Dan (tuk tuk driver), to say farewell.  Boat Baby lives in the village next to the blind family who I have often talked about, so we added him to our itinerary in that direction and picked up an extra bag of rice for his family.  Five months old, he was swinging in a hammock inside the family’s elevated bamboo shack as we arrived.  He appeared to be asleep and I tried to stop grandma from waking him, as she bent to pick him up.  As she did so, I realised he was awake, but with semi-closed eyes.  A short conversation with Dan ensued, who then turned to me and with a tone of surprise said “Helen he is blind”.

Yet another vision impaired person in the same village?  Can this really be just coincidence?  My thoughts keep reverting to the knowledge that this area was heavily sprayed with Agent Orange in the 1960s.  We will never know because this is not a place where researchers will spend money or time investigating, and even the American veterans exposed to Agent Orange, still reporting high rates of disability in their offspring, have had limited recognition.  There is almost nothing written about it, but according to this article from 2008:,

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.

I was predictably horrified at the news and wanted to help.  His grandmother was forced into the jungle in this area during the Vietnam War and remembers living as a soldier alongside the country’s Prime Minister, who also comes from this region.  When I asked via Dan, does she know if they sprayed Agent Orange in the area, I understood her swift answer immediately – a very normalised “yes”.

The family had returned days prior from Phnom Penh, where doctors had already advised them to go to the paediatric hospital in Siem Reap where surgery may help.  Having just traveled to Phnom Penh, they did not have any money for this and would have to wait.  I gave them US$200 for the purpose of having him seen immediately but they could not leave now due to harvest commitments.  Last week they finally took him to the hospital, a day-long bus trip, and were given a planned appointment for the end of this month.

My communications with Dan following this trip to Siem Reap not only saddened me but also highlighted the complexities of relationships such as mine with this family.  A return bus trip and 1 or 2 days’ stay in Siem Reap would have cost a tiny portion of the $200 I had given them.  So I was confused by their request via Dan, for more money to attend the next appointment.  Dan never says anything bad about anyone, yet his reply to me when I asked why they needed more money already, implied that they had spent the money on other things assuming my money was free flowing, and that “everything not good” (ie he is unhappy with them).

Obviously I won’t continue to support the family in these circumstances.  Which means the baby will either not receive any treatment for his congenital blindness, or his family will have to go into debt for the purpose.  Health care debt is a normality in Cambodia where all health care works on a user-pays system.  Poor families may receive discounted or waivers if they can produce a “Poor ID” card, however these cards are notoriously provided by village leaders to their own family, leaving the poorest in communities with no evidence that they need support.

In my world, people do the wrong thing all the time but they don’t have to pay for it with their health, the health of their children, or as is so often the case in Cambodia and other poor places, their lives.  I feel very disheartened by this little boy’s circumstances and his family’s inability to understand the risk they took by making assumptions about my perceived wealth and perhaps my perceived obligation to him.  Finding a balance in this situation is going to take some time, patience and soul searching.

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Boat Baby at home with Mum and Grandma

World Wealth Distribution

From Pew Research Center http://www.pewresearch.org/fact-tank

Anyone interested in where they fit into this scale of global wealth can enter their basic information into the calculator at GivingWhatWeCan.org.  Despite my exposure to poverty which I think is probably more than most Australians, my hunch about my own wealth was completely wrong and I am far wealthier than I would have thought.  That’ll be normalisation playing games in my head!

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.

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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.

Mirroring Me

It’s essential that in life, you see yourself reflected in other peoples’ stories….”  (Oprah Winfrey)

Oprah is talking about her need, as a little black girl in America, to find people who “kinda looked like me”, at a time when there were no black people in high profile public roles to model for her, who she could be and what her potential was.  Her quote is important for those growing up and living without the privileges that others of us take for granted.  I’ve often had this thought for indigenous children in Central Australia who learn from birth in many subtle but intense ways, that they are less worthy than others in their community.  Yet Oprah’s quote is equally and conversely relevant for those of us living with often-unseen privilege.  To see ourselves in that little black girl, or in any number of others with a different identity, perpetuates our own humanity and potential.

The difference between my networks in New Zealand, Australia and other wealthy countries and my networks in Cambodia, is a disparity that is difficult to articulate.  When Cambodians talk about their aspirations, their focus is more likely to relate to more basic facets of life.  Physiological experiences such as hunger and shelter are not uncommon topics of conversation.  In contrast, my New Zealand friends are much more likely to aspire towards a winter trip to the ski slopes, an overseas holiday or wondering about their next career move.  At no time in more than twenty years of nursing in England and Australia, did a patient ever claim to have gone hungry to pay for a medical appointment.  Last week when I was informed via translation by a patient’s wife, that “we sold everything including our rice, and contacted all of our relatives to source the money so that we could pay for the transportation to attend our appointment”, it was a commonplace Cambodian anecdote.

It is so hard to raise money for people who have no money.  When you look at GoFundMe, there are funeral, memorial and animal medical funds which have raised many thousands of dollars for causes that are human and animal, dead and alive, in the wealthy world.  I wonder at the comparison with the $1,000 so far raised with great difficulty for Sokum, a 20yo young woman who will die without the heart surgery she needs but cannot access without private funds of US$6,000.  I remember being 20yo very well, living a productive and happy life in London on the other side of the world from my home.  I was safe and secure, had I needed health care it was available to me, my potential was unexceptional and being realised as I assumed it would and should be.  Yet I now appreciate that it was pure fluke of birth, that at the age of twenty this was my experience.  It is equally pure chance that this 20 year old, who could just as easily have been me, will die because the equivalent of the funds I spent getting myself to London at her age, are unavailable for her survival.

There is still hope that we will raise enough money for Sokum in time.  Some very kind people are involved in helping with fundraisers but it seems a long way to go with limited time due to her deteriorating health.  Some have expressed that they don’t want to donate through GoFundMe, and we are happy to receive the money privately as well (contact me directly for options).  Anything donated will go directly to Sokum and all donors will receive a personal acknowledgement and progress report(s).  The below photographs are shared with Sokum’s permission.  I think they show well, that you don’t have to give a big donation to make a big difference.

The family home

The family kitchen

Sokum and her husband at home earlier this week

This Thing We Could Do

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Study after study by psychologists has shown that there is no correlation between wealth and happiness. The only exception is in cases of real poverty, when extra income does relieve suffering and brings security. But once our basic material needs are satisfied, our level of income makes little difference to our level of happiness. Research has shown, for example, that extremely rich people such as billionaires are not significantly happier than people with an average income, and suffer from higher levels of depression.

Madness of Materialism

This is just one short paragraph from one single link, in the plethora of knowledge about the causes and ills of materialism.  I like it because it implies the difference that those of us with disposable income can make if we were to replace the all-too-common act of “retail therapy” with “philanthropic therapy”.  So many of us are suspicious of others’ need for help, believe that we can’t make a difference or think that by offering help we could make ourselves vulnerable to charlatans.  Our suspicions are – in the main – completely wrong.  Katharine Hepburn, in the quote below, speaks for me in this regard.

Atheist Katharine Hepburn

This week alone I have been involved with five different families suffering from an inability due purely to lack of finance, to access the health care that their children, elderly or vulnerable need.  This is not a small problem that people recover from, but a profound and overwhelming problem which leaves families indebted and reveals itself in the premature life expectancy rates of an entire nation’s population.  Functioning health systems rely on good governance, reliable information, adequate financing and other elements which are either absent or inadequate in countries fraught with poverty, political instability, lawlessness and systemic disarray.  Sadly these descriptions reflect the current day Cambodian experience despite so many good people doing what they can to improve matters, which continue to progress in small steps.

I know a vibrant young Cambodian woman who is waiting to die from the manifestations of Rheumatic Heart Disease.  One of the obvious “diseases of poverty”, Rheumatic Fever was a leading cause of death in America, Australia and Europe until less than 100 years ago.  Improved living conditions reduced our risk of exposure to the bacteria Streptococcus pyogenes which can cause an autoimmune response leading to various symptoms, the most serious being scarring of heart valves which results in heart failure and ultimately death. At the same time, Penicillin was discovered and we learned that it could treat Rheumatic Fever to effectively prevent the heart damage before it manifests.  As such, rates of Rheumatic Fever and Rheumatic Heart Disease plummeted in the wealthy world.  Our health systems also improved dramatically with significant advances in surgery and medicine meaning that cardiac surgeons can now cure Rheumatic Heart Disease when it occurs by repairing or replacing damaged heart valves.

Today the highest recorded rates of Rheumatic Heart Disease in the world occur in Central Australia’s indigenous population.  Just one of the many diseases of poverty our indigenous people live with and die from, this is a travesty.  Yet we have a health system which can count and record the diseases prevalent in our population, who do have access to Penicillin and cardiology services.  Places like Cambodia on the other hand, likely have even higher rates of these diseases, but without the resources or systems in place, people suffer and die silently and invisibly, often without any explanation of the cause of death.

With no cardiac surgery services available in Cambodia’s public health sector, the only option available to this young woman is to find the funds needed for surgery at a private hospital.  Her desperate husband and family have started a GoFundMe page (link below).  As poor rural villagers, they don’t know people who can contribute in any significant way, as you’ll see by the contributions made.  My hope is that some reading this will think about our ability to engage in retail therapy at whim and take a chance at substituting a trip to the shops with offering something towards helping to save a young life.  Even if we don’t make it to our goal, small contributions will show her that she is cared about.  If only 600 people donate $10 each, our goal will be reached.  Be one of those 600!

Sophors’ Family Surgery Fund

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People From The Sky

Good enough

It’s okay to be imperfect.  On the other hand, we should not allow perceived success or praise for perceived success affect our ego.  Someone cycling Road X is no better or worse than someone walking Road Z.

In the field of humanitarian work it’s easy to find people willing to shower you with praise.  This sits uneasily with me as I’m well aware that I am living the life I want to live, because it suits me.  I don’t believe there is a humanitarian anywhere with entirely selfless motivations.  Living as a nurse in a place like Cambodia is really not so different to living as a nurse in Australia.  The challenges are different and there are difficulties that don’t exist in the wealthy world, but ultimately I’m using the same skill set to do similar work, only for a different population and with different resources.

Yet it could be easy to believe the praise.  Which I guess is why it is not so difficult to find people working in the so-called humanitarian world, who are driven by ego and power.  Thankfully my current assignment has no such characters among the expatriate team.  My first assignment was a mixed bag, as I made firm friends but I also struggled enormously with one or two conceited narcissists.  Some of my Khmer friends with a long history working in international NGOs such as MSF confirm that it can be extremely difficult to work with “the people from the sky” (they fly in, dominate with an air of aggrandized importance then fly out again).

It’s very true, that you find all sorts in all places.  It’s also true that there are different motivations towards pursuits which are seen generally as altruistic.  The best example I have is a French doctor some years ago who, in criticising MSF for not approving an extra day off, declared “They should be grateful to have me!  I don’t have to be here!  I am not a local staff who has no choice!  I am a Ewe-Manit-Eerian!  So are you!  We are both ewe-manit-eerians, ‘Elen!”.  Never had I wanted the ground to swallow me up so badly!  Being ewe-manit-eerian is a running joke within my current team who appreciate the farce of over-inflated ego.

The definition of what makes a humanitarian is also an interesting question.  MSF focuses on emergency relief so that many of our expatriates have experienced war zones, famines, disease outbreaks and natural disasters.  Some of these field workers, after multiple assignments, move into the ranks of management based in first world cities such as Paris, Tokyo and New York.  One recent such visitor from London suggested that “you should not stay too long in one place, because it becomes something other than a humanitarian action if you end up staying for your own reasons”.

With a deep love of Cambodia, I’ve ruminated on this statement greatly.  It is dangerous to be poor in this world – you will be forced to live in varying degrees of peril.  If you are incapacitated there will be almost no assistance outside of your own unqualified and un-resourced family or village.  If you die prematurely, it will likely be as an invisible non-statistic who was never counted anyway.  The billions of dollars going towards medical research in first world institutions across the globe generally don’t benefit anyone but those living in the wealthy world, so that preventable illness, injury and death is a common theme in the poor world.  I have loved realising the experience of making small differences to lives which ultimately, to the powers that be in their own higher society and levels of government but also to most of us in the world, hold little to no value.  Stay or go, like all of us with a choice, I’ll choose what suits me most.  Whether here or elsewhere, my main hope is to avoid becoming one of the “People from the Sky”.

Meanwhile, The Excruciating Fundraiser has surpassed it’s goal and our friend can have surgery with a safe and more comfortable recovery than would otherwise have been possible.  We took the family swimming today at a local resort with a small water park.  It was their first time at a swimming pool and a very happy day was had.  On the way home we crossed a bridge over the mud brown river, where a bunch of children were playing on a black tyre in the muddy water lapping at the doors and floors of their little wood and tin shacks. The contrast with where we were coming from was stark.

This 4 minute video, which I think I’ve shared before, explains why this stark contrast exists.

The Richest 300 People