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.

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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.

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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.

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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.

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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The Excruciating Fundraiser

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

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

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

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

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

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

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

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

The Excruciating Fundraiser

Pimp My Tuk Tuk

may you always do for others

Many hours of many days during my first 2 years in Cambodia were spent adventuring with my good friend, a tuk tuk driver who I blog-named Chom.  He is currently living in Japan to earn $60 per day as a farm worker (10 hours per day, 7 days per week).  This is big money to him and should ensure that his family will be more comfortable than they ever would have been had he stayed in Cambodia for the three years that he plans to be away.  His children were 6yo and 1yo when he left at the end of last year.  He often told me that tuk tuk drivers are considered lowly on the social spectrum here.  Nevertheless only this year did I comprehend the fact that tuk tuk drivers are often very poor.  They usually don’t have enough education to be competitive in the private, government or NGO employment market (where salaries reflect a local “middle class” of US$300+ per month depending on the role and qualifications required).

Under Medecins Sans Frontieres local regulations which state we should not travel by motorbike, I’m reliant on tuk tuks to get around.  I hate negotiating prices and so I tend to find a regular driver and stick with him.  This means I get to know and usually befriend my drivers.  In Cambodia everyone’s story is so far flung from anything we are accustomed to in Australia and the wealthy world, that all of “my” drivers have something foreign and interesting to share.  My housemate, colleague and good friend Theresa, who started a few short weeks after me earlier this year, is a kindred spirit and we have many discussions about the tuk tuk drivers we encounter.  Yesterday none of our regulars were around and very unusually, we had to walk towards the corner of our street to hail a tuk tuk.  We didn’t make it to the corner.

A few metres out of our gate, a driver passing on the crossroad spotted us, making a quick half-u-turn into our street to approach us hopefully.  In our rudimentary Khmer we negotiated a price and hopped on.  It’s become an impulse for me to assess the state of the tuk tuk I am in.  This tuk tuk had old, worn out upholstery.  One of the arm rests was completely missing so that the only thing separating the loose seat cushion and the road below, was thin air.  The carriage’s suspension was distorted so that I seemed to be sitting on a slant.  We got about halfway to our destination when his moto stopped at an intersection and no matter how many kick starts he gave, it refused to restart.  He called out to a passing driver and swapped us into another tuk tuk.  As we drove away I looked back to see him pushing the vehicle into a driveway and turning it around.  With any luck the downhill slope helped his bike to un-flood.  It can’t be a fun work day when that’s your lot.

Two years ago I was stranded in Skun en route to Kampong Cham.  Pushing my case along the main road, voices from a passing tuk tuk shouted “hello” before pulling over.  Full of people and luggage, they were amazingly traveling from Phnom Penh to Kampong Cham to visit their grandmother and offered to take me.  They squeezed me in Khmer-style and saved my skin.  I promised that I would always use Dad (the tuk tuk driver who I’ll call Sam,) whenever I was in Phnom Penh, and so Sam has become my regular guy in the city.  A quiet and unassuming guy with better English comprehension than we realise because he only uses it when we give him no choice, we recently went halves in the cost of replacing his torn tuk tuk upholstery.  Since then, with our regular custom, he has pimped his own tuk tuk somewhat, adding a plastic wire guard to reduce the chances of bag-snatchers and we now travel with Cambodian flags flying from the back seat.  Our conversations with Sam are always fun, particularly by telephone when we recite what we have to say before calling, always hopeful that his reply will be a simple “yes” or “no” because the minute any detailed information has to be shared, we’re lost!  He knows our regular routines – the family I visit on the outskirts of town every few weeks; the other family Theresa and I visit together near our office; Theresa’s weekly swim lessons; our occasional social hot spots; our various strange little ways.  It’s so much easier having someone who knows where we want to go and who we don’t have to negotiate with.

Around the same time that I was befriending Chom in Kampong Cham over three years ago now, I met Rav in Siem Reap who I have also become very fond of, along with his friend Seth and their wives and young families.  He impressed me when Kim and I were in need of assistance to communicate together the day I bought Kim’s wife a sewing machine.  Rav not only translated for us, but he drove us to the market, negotiated a decent price for the machine we wanted, guided me over the busy street, and was generally very kind and helpful.

Theresa and I currently have a Rav-Seth project underway with a group of Khmer graphic designers building a website to promote their tuk tuk services.  Siem Reap is a very touristic place with a focus on the temples of Angkor Wat stealing from the other attractions of the province.  Hundreds of tuk tuks vie against each other and low season means many days are spent with no income.  We are working on promoting attractions off-the-beaten-track for tourists interested in a more authentic experience of Siem Reap.  Plans are still underway but may include overnight stays in Seth’s floating village, where he grew up on a small boat which he says “sometimes had a roof but sometimes the roof would break and we didn’t always have enough money to make a new roof.  I like sleeping under the stars but it is too hot under the sun and so bad under the rain”.  Rav is from an equally impoverished background and we have been discussing the fact that sometimes tourists don’t want to see the temples and stay in fancy hotels; the chance to interact with locals, experience local knowledge and connections can be marketable assets which are as yet, untapped.  We hope that a website can increase their access to customers in what is an extremely challenging market.  If this website is successful then we plan to replicate the project for another tuk tuk in another resort town who we know and have been trying to help.

Meanwhile you could say that, as with anything, poverty is always relative.  It’s impossible to help everyone and important to remember this when you live in a place such as Cambodia where at every turn you see another level of poverty.  Waiting at the intersection yesterday, in the ricketty tuk tuk which wouldn’t kick start, an elderly man rested on his decrepit cyclo which Theresa suggested for emphasis, “was built by the Russians”.  A few hours later, waiting for friends near the corner I wondered at the story of the many small children working the busy streets to collect recyclable rubbish or sell fruit from plates atop their little heads.

Rav’s family often say to me that they feel lucky to know me, because of the little things I’ve been able to do at no sacrifice to myself, for them.  A conversation with his sister yesterday went along these lines: “you help us so much”, no I only help you a very little “no, it is little for you but it is big for us”.  Rav recently said “there are 15 million people in Cambodia, so it is amazing that I could be the one who met you”.  I reminded him that he met me because he was helping Kim, so any gratitude he has for his so-called good fortune ought to be for his own willingness to help someone in need.

Do good and good will come

 

Bongs and Tycoons

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

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

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

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

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

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

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A first they thought would never happen: eating pizza

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Hijinx in the restaurant car park with baby sister