Observations of Poverty

For much of my time here I feel harrowed by the situations I see people existing in.  I regularly have to talk myself out of the tears which threaten to surface as I realise the significance of the poverty I’m witnessing.  But the smiles on the faces of those who own these situations usually manage to knock me out of my precious state of mind.

Today I met a man with some sort of crippling condition in his legs.  He sits on his buttocks with his knees up at his chest, and walks with his hands lifting him up and forward.  He is agile and fast.  His fresh face smiled at us openly as his malnourished teenage daughter lay wasting away in a hospital bed with HIV and Tuberculosis, so thin that her pale skin is pasted to her skeleton and her face is sharp with bones.  As the doctors spoke to them both, asking questions, assessing her clinically, ordering tests, and discussing what they consider to be her biggest issues, all I could think was that poverty is the only real issue at play here.

Her father’s kind and intelligent face radiates gentility and he smiled at me from the concrete floor and communicated with me via my translator.  It was a humbling experience to meet and spend time with him, and I agonised for hours during the rest of the day over what I could do to alleviate their destitution.  They have no access to a bank account and live in a remote area which would be difficult for me to visit.  The fact that he is so nimble and strong tells me that he works in some sort of physical job, probably in the rice fields.  Unlike the First World, here if you don’t work, you don’t eat, so disability is not an impediment to hard physical labour and aids such as wheelchairs are a luxury that most live without.

His daughter will remain with us for some time to come, so maybe over the next few weeks I will come up with a way of assisting them somehow?  But their story is not unique and any help I offer is a drop in the ocean.  In the ward with her at the same time are a 12yo boy who is stunted from malnutrition with suspected TB lymphadenopathy, a 13yo girl suspected of having spinal TB which was finally diagnosed as spinal degeneration due to the heavy work she does in the rice fields and three infants all with varying degrees of malnutrition.  This is the harsh reality of Cambodian health statistics which are not easy to comprehend until you meet them in the flesh.  45% of Cambodian children have moderate to severe stunting caused by chronic malnutrition.  In other words, they are short statured because their bodies have never received the nutrition required for adequate growth.  Hunger is a daily experience for many.  As a colleague said to me the other day “when Cambodian people have no food, we die”.  In his quiet and unassuming way he just informed me that he has witnessed starvation.  I probably have too, as the death of Tom in November comes to mind.  Everyday I see old people hunched over with such severe back deformities that their upper body is almost at right angles to their lower limbs, after years of hard physical labour in the fields.  I guess this is exacerbated by malnutrition which leaves bones brittle.

Thirty five years ago tomorrow, Cambodia was liberated from the Pol Pot regime by Vietnamese forces backing the current government who have been in power ever since.  It is celebrated as a national holiday known as “Victory Over Genocide”.  Celebrations occurred en masse very early this morning.  By the time I made my way to work the ceremony was over but truckloads of people dressed uniformly in blue and white were being driven through the streets as legions of army and police patrols blocked intersections.

Our office is across a park from a government building which has been heavily guarded for weeks now, due to the garment factory demonstrations.  This park disappeared this morning under a lavish arrangement of canvas pavilions decorated with pot plants and truckloads of plastic chairs in neat rows under the canvas shelters.  By the time I saw it, the ceremony was already over and everything was being dismantled onto trucks and taken away again.  Apparently the truckloads of uniformly dressed civilians were conscripted from surrounding villages under government order.  Even the most basic freedoms I take for granted are a perilous thing for Cambodians when it comes to showing support for the ruling administration.  When I mentioned the celebrations to a colleague as we watched from our office doorway and suggested that he must not have been alive when the Victory Over Genocide occurred, he replied that he was not, but that even many people who remember the genocide do not support “this”, as his arm motioned towards the pavilions being dismantled.

Contrary to thinking that everything happened 35 years ago, which is not such a long time anyway, the Paris Peace Treaty was signed in 1991.  The first election was held in 1993 and the Khmer Rouge led insurgencies and continued their terror from the safety of strategically landmined jungle areas until after Pol Pot died in a jungle village in 1998.  Yesterday I was informed “Cambodia was still at war until 2000”.  Tribunals continue today against some of the Khmer Rouge leaders who are all elderly but still defiant.

After work tonight I spent some time at the reopened bamboo bridge (“p’dar”), watching the evening crowds come to life as dusk turned the muddy Mekong waters purple.  Sitting on a park bench above the embankment leading down to the water’s edge I watched a girl of about 6 and her younger brother, dressed in rags, drag sacks bigger than themselves as they climbed the embankment looking for plastic bottles to be recycled for a small payment.  An hour or so later I ate dinner at the Night Market with a housemate and we were approached by two young boys of about 8yo dressed in rags and asking for money.

Today’s news included the headline “After Clashes, Garment Workers Flee Veng Sreng Street.  The few remaining residents of Phnom Penh’s garment factory-lined Veng Sreng Street, where government forces armed with assault rifles shot dead five striking workers on Friday, said Sunday that most workers had since fled in fear for their lives”.
http://www.cambodiadaily.com/news/after-deadly-clashes-garment-workers-flee-veng-sreng-street-50134/
Another article interviews some of the wounded, a number of whom were not protesting, but cooking in the kitchen or walking home when struck by the indiscriminate bullets flying through the street.  Someone else said to me today that the death of one westerner makes a much bigger problem for Cambodia than the death of many Cambodians.  Given that the garment workers’ situation appears to be accepted by most of the international community (activist organisations excepted), this appears to be an accurate conclusion.

It’s hard to find a cheerful note to end on some days.  But tonight’s dinner conversation revolved around the calm dignity of Cambodian culture and the privilege we feel working with such gracious people as our colleagues and our patients.

Lights of Kampong Cham's P'Dar (Bamboo Bridge) at dusk.
Lights of Kampong Cham’s P’Dar (Bamboo Bridge) at dusk.

Author: Helen T

Master of Public Health. Long standing experience with infectious disease surveillance (including influenza-like-illness monitoring), outbreak control, case management, vaccination program management. There is no health without liberty and justice. Ask anyone existing in poverty.

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