Motorbikes ruin photography here. You get a great shot lined up just in time to photograph the handlebars of a moped, or a chain of blurred bodies moving across the scene you’d intended which saunters out of sight before you can re-focus your lens. Some dedicated photography sessions will be needed to get a few half-decent shots during my time here. Orange-wrapped Buddhist monks under yellow umbrellas. A wooden trailer stacked with a mountain of hay driving through the streets, secured by bodies sitting high on top. Babies perched at the handlebars of motorbikes, cocooned in Dad’s arms with Mum and two or three siblings lined up behind (some of them standing to see over the grip on Mum or Dad’s shoulders). Women in bright baggy pyjamas or tightly wrapped sarongs riding side-saddle. Houseboat lights glistening on the river at dusk. These are some of the scenes I tried to memorise today when for various reasons the camera couldn’t capture them.
In the past few weeks I have presented a few times to groups of colleagues about life and work in Australia. The interest I have in Cambodia is returned many times over by keen eyes and ears at the photographs and information I have shared via my equally interested translator, followed by many questions about our work conditions and Australia in general. The discussions stemming from these presentations have highlighted to me that much of what humans everywhere want has been contorted in the First World into a superficial need that we could do without quite comfortably. An extreme example being the surprised laughter that ensued as I told a group of nurses that ill patients in Australia would never accept a hospital bed without a mattress, pillows and linen on it.
The information I am happy to share about my experiences from a First World life has had to be balanced with an articulated distinction between the things we do or have because they are vital to good nursing practice, with what we happen to do or have simply because we are unnecessarily indulged. Another example that springs to mind is the array of handwashing soaps, hand rubs and moisturisers that are supplied at handbasins in Australian hospitals, where one simple type of soap with some running water, as we have here, is all that is needed for good hand hygiene.
Another difficulty lies in convincing people who are so resource-deficient that they are providing a good standard of health care and that they possess skilled expertise. There is a natural human tendency to assume inadequacy when you lack many of “the basics” that you know exist elsewhere. Yet there are very good reasons that a Tuberculosis Department in Cambodia will have experience and skills that are rare and hard to come by in Australia, where the prevalence and range of clinical disease is rare.
Consideration and care is given here to people’s social circumstances in a systematic way that is not so forthright in most First World settings I have experienced. Supports and measures are implemented here to promote healthy behaviours and treatment adherence as well as to reduce stigma and marginalisation of people struggling with social challenges such as alcoholism, homelessness and ostracism from families or communities. One of our local doctors talks openly about the adversity of his patients from a very personal perspective, remembering the hunger, illness and death he witnessed as a child when many of his friends fell ill and either returned to school eventually, or died.
My impression is that in a place such as Cambodia the destruction of poverty occurs on a pervasive and visible scale which is not limited to racial or cultural minorities or in isolated slums. This connects everyone to the deprivation, perhaps making a socio-medical approach seem more of an obvious requirement than it seems from a position of privilege in the First World, where we might not realise the struggles of our patients simply because they are not so palpable? A point I have made to my colleagues here is that poverty exists in Australia despite our overall wealth. Yet most Central Australians for example, despite being surrounded by it, are unaware of or protected from the hardship and poverty that exists in many of our indigenous communities.