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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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