Everyday I marvel at the colours of Cambodia. It is difficult to believe that the carrot coloured robes of Buddhist monks, glossy gold and tangerine tiles of temple roofs, dusty bright orange dirt roads and vivid flowers of Poinciana trees in bloom are not deliberately coordinated. White storm clouds strike impressively against deep blue skies and white oxen plough fields which turn radiant green as soon as the rains arrive.
More than the visual colours, are the beaming characters I have the privilege to know and encounter here. I work with articulate professionals, some of whom have hilariously incorrect English grammar. As a boring mono-linguist I have absolutely no right to laugh, yet every day I do so heartily in the pit of my stomach while forcing a straight face. Everyday I am greeted by people I don’t even know, with delighted smiles and “hellos” which buoy the rest of my day. I encounter people at every turn who want to practise their English or simply have an experience with a much-revered Westerner. When I first came to Kampong Cham a colleague told me that I would “be treated like a King in Cambodia”. Whilst I prefer the title of Queen, he was right – the mere fact of being from the Western world affords me undeserved attention and respect.
Last week I spent some time observing members of my team in a number of different health promotion / health education activities. It was an opportunity to learn a little more about the expertise of staff under my supervision. Animated, engaging and extremely well-informed, they can hold an audience on what might otherwise be considered a very dry and boring topic. Except that the subject of Tuberculosis in Cambodia is one which has touched most people’s lives closely, with over 40,000 newly diagnosed cases occurring per year and at any one time >760 cases in every 100,000 head of population (probably closer to a rate of 1% per year if all undiagnosed cases were included).
Oneday we traveled in convoy out to a remote community experiencing very high rates of Tuberculosis and emerging rates of Multi-Drug-Resistant Tuberculosis (MDRTB). We drove for an hour along dusty dirt tracks through tropical villages of thatched straw huts, abundant banana plantations and newly planted rice fields (referred to by a colleague as “the baby of the rice”) waiting for the delayed rains, past many moto-towed trailers piled high with firewood upon which at least one khromar-covered worker sat high above each moto driver. Arriving in the village we entered through a typical ornate archway into the centre of the walled campus of a beautiful village Wat (Buddhist Pagoda). Situated in the central garden area, we set up in the community hall and with a microphone one of my colleagues summonsed all available villagers (ie those not working in the fields), to join us. Approximately 50 people attended, most of them elderly and many supervising young children who frolicked on the edges of the group of adults sitting on the floor of the hall to listen to the 40-minute-long presentation.
A methodical education session ensued, introducing the audience to the presenters, our organisation, our work and the disease, symptoms and treatment of Tuberculosis. This led to a discussion with current and past patients speaking of their experience and others asking questions. At the end of our session myself and the other expatriate were asked if we wanted to say anything and we declined. Later we asked the national staff if they thought we should say anything when asked and we were informed that the Khmer people like to be addressed by foreigners as it gives credence to what has been said by their fellow-Khmer.
Upon returning to the rural office where some of my colleagues are based, we sat under a thatch-roofed sun shelter beside the dirt track leading to the house to listen to feedback on the session. As a colleague with years of health promotion experience delivered his assessment of how the session had gone and how future sessions could be improved upon, I sat behind the fence and watched the local world go by. A decrepid moto towed a rusty trailer upon which a large brown penned pig stood silently looking straight ahead towards his fate at the nearby market. An elderly man whose arms ended at his elbows, presumaby another landmine victim, leaned over the handlebars of a creaky old bicycle and pedalled slowly past us. Another old bicycle ridden by a teenage boy with a cigarette hanging from the side of his mouth cycled past. Two water buffalo sauntered by. Somehow I also managed to catch the gist of the feedback being delivered by one colleague to another!
On the way home we made a quick detour to the family we had visited a week or more ago whose financial debt was weighing them down due to various ill health. After writing about it, two friends each donated money in the hope of wiping the debt completely and I had this money with me in an envelope. We arrived unannounced and were greeted into the dirt floor area where the TB-ravaged husband sits on his bamboo bed base, with Sampiahs, thanks and stories of having paid the debtor. My colleague translated for me that some friends from Australia had heard of their situation and wanted to help, and I passed the envelope with the remainder of the debt plus some extra, to the wife without stating what was inside. Once more she hugged me repeatedly, saying she didn’t know what was inside but that if it was enough to pay the debt entirely then she might afford her blood pressure pills and so she might go to the Health Centre. I left knowing that this week she would get her blood pressure medication and have less stressful days, which can also only reduce her hypertension.
The next day one of my staff delivered education to some newly diagnosed TB patients. Although I had done nothing but sit and listen, as the session ended the patients stood up at the same time as me and bowed low before me in Sampiah gesture, as a way of thanking me. After returning the respect with a bowed head and reciprocal Sampiah, with a few brief words about the level of care they can expect to receive from my team, I turned to walk away and was immediately approached by a young hospitalised patient who spoke directly to my translator. He wanted to thank me for traveling to his country from my country to help Cambodian people because Tuberculosis is a terrible disease and there is much suffering in Cambodia. Again, following the advice I had received the day prior about having something to say, I replied with a brief comment that I appreciate the suffering I have seen and am honoured to be here to help make a difference.
Another session I observed was that of a TB Nurse delivering a Powerpoint presentation to a young village nurse being employed to provide Direct Observed Treatment (DOT) to an MDRTB patient. The presentation was informative and compelling and the young nurse was clearly interested. Predicting that I would be asked to say something at the end, I made notes through the session related mainly to questions the nurse asked along the way and when the time came I had some relevant comments to make. I mentioned that Cambodia is, despite the continuing high rates of TB, considered a success story by World Health Organisation, as the rates of TB are decreasing thanks to the work of Health Centres such as that where this nurse comes from, highlighting the importance of the work he is undertaking. He was surprised by this, asking for clarification that TB does not just occur in Cambodia, but also in other places around the world!
After a riveting work week, this weekend was spent playing tourist with a couple of friends, one of whom visited us from Phnom Penh for two nights. We visited temples, ate at local restaurants, kept a local tuk tuk driver / friend gainfully employed, took a long cycle in the countryside, joined colleagues at a local village home for a drink after coincidentally being spotted by them as we were running for cover during a brief rainstorm, laughed, drank and were merry.
One of the people my “reluctant altruist” Phnom Penh friend is involved with is a young woman from a background of poverty and ongoing struggle, who against all odds passed the exams for Medical School, a goal she could not afford to consider except for the lucky break of meeting my friend in tragic circumstances. My friend successfully arranged sponsorship of her university fees via personal contacts, getting her through four out of six years of Medical School. For different reasons the first benefactor, then very recently the second, both had to withdraw sponsorship and it was looking as though she may have to stop her studies as the fees are not affordable and certainly not something most people could consider assisting with at thousands of dollars per semester. A few weeks ago I approached another friend overseas with a penchant for philanthropy. I shared some of the girl’s story and explained her plight, fully expecting my friend to decline the proposition of helping, but it was worth asking. Tonight this arrived in my inbox:
Just wanted you to know that I am going to sponsor the young girl. Just have to know how to get the money into your friend’s bank account. Will put it in a semester at time. Took a while to think about it. It would have been easier for it to come out of my foundation but that was not going to work. She has come so far and to not finish it would be tragic. So very happy to help out.
Tonight, in my little corner, the colours of Cambodia look hopeful!