After spending more than ten years in the same job – which I loved very much – I was well and truly ready for a change. But being slightly older, settled and happy made for a very cozy comfort zone. One friend jogged me into action. Prompted by regular ambiguous references to my imminent Long Service Leave, she sat me down with a prepared list of negative and positive options for me to review, edit and consider. It was only a matter of weeks from this round table discussion, to my moving out of home and beginning the journey I am currently on. Who knows what I would have done otherwise, it was far too difficult to get my head around actually making a move until this spur, and I will always be grateful for her persuasion. Also for the support and encouragement of many others, from the friends looking after my mail, to those who housed and fed me when I was homeless in the lead-up to leaving town, those who donated parcels and money to Cambodia, those who have visited me here, and those who have maintained contact and friendships across the miles.
Yesterday I finished reading “Bandaid For a Broken Leg”, Australian doctor Damien Brown’s account of some MSF missions he did in Africa in the mid-to-late-2000s. His experiences living in mud huts in compounds with tight security restrictions, in isolated and inaccessible remote locations with gunshots blasting nearby, attending to rival armed guerillas and various other incredibly stressful situations highlighted to me just how much of a “Coconut Mission” I’m on. We live in a huge house, each with our own bedroom and ensuite, with all modern conveniences, in a town with decent western restaurants along a tourist-targeted riverside with houseboat cruises coming and going, sightseeing attractions, shops selling wine and cheese, all a few hours very safe bus ride away from the capital city. There are few if any security concerns, which allows me to lead a very normal life and to publish this blog, albeit with some personal limitations related to patient and staff confidentiality.
Yet it has not been an easy experience. I’ve had to learn to live and work alongside thankfully rare arrogant petulance which in a normal life I simply would not have encountered, let alone been forced to spend time with. That is probably the biggest challenge I’ve had, and one which will direct future decisions about whether ongoing MSF missions are something I could do. This experience is dwarfed by the strong friendships formed and great experiences shared with most expats, but may not have been so easily dwarfed had I been living in a tent or mud hut arrangement.
The work conditions are also difficult, not because of my colleagues who have been truly inspiring, but because of the physical environment.
With inadequate resources, waste management is crude at best. Sewerage overflows settle in puddles right at the doorway of where nurses are expected to execute good infection control practices and where patients are expected to recuperate. General waste rots and is then burned at the edge of a TB Department where patients with respiratory illness are exposed to the toxic odours and smoke. Well fed rats and snakes live alongside us, with staff claiming that the rats are very educated because they are impossible to trap. During one conversation about how to deal with the rats, my suggestion of poison was rejected because the corpse can be difficult to locate. A trap was suggested, but then discussion ensued about the type of trap. I asked if they had traps which break the animal’s neck and the translator looked surprised, replying no they get a trap with a door which traps the rat inside. When I asked what then happens to the trapped, live rat, I was informed they are taken somewhere and freed! An American friend and I frequently ask each other “What would Buddha do?” (shortened to WWBD), intended to chill and make us laugh during times of stress. During this rat trap conversation my impression was that Buddha would not unnecessarily kill an animal who could instead be relocated?!
The human conditions of Cambodian people are also challenging to a protected western observer. Homelessness is common, staff are provided trees from which to sling their hammocks, or live in the morgue with their small children who play amongst patients, visitors and beggars on the rubble-filled hospital grounds, because the salary they rely on is not enough to afford rent. Patients regularly die from preventable illness which ravages their system before they receive a proper diagnosis or treatment. With no back-up system in place and unable to afford the cost of health care when illness occurs, people work through their afflictions in order to continue feeding and supporting dependents who range from young children to the elderly and disabled. When the affliction is TB, they stay in the rice fields or factories working while their disease progresses over months, only presenting to health centers or hospital once they have collapsed in severe condition.
Once they do make it to hospital, supplies are limited. The common need for oxygen, which flows through pipes in the walls with an outlet at every bed of every other hospital I’ve ever worked in, requires heavy lifting of large tanks which arrive by truck at regular intervals, but sometimes run out requiring the use of back-up oxygen concentrators. These machines push the ambient air through a system which filters other gases out, amassing oxygen which is passed through tubing to the patient. Their efficacy is basic and relies on a number of machine-related aspects. They regularly break down and have to be sent for repair by the logistics team who perform an enormous range of duties related to ensuring the program continues to function.
When patients are too sick to remain under our care they must be transferred to the “reanimation” ward, where a national policy requires all patients be sent when they are critical, so that staff with adequate resuscitation skills (but next to no equipment) are available to perform any life saving interventions. I knew this happened but it was months before I saw how and I will never forget my shock as I looked up oneday to see a transfer taking place. The transfer stretcher is a strip of canvas with poles sewn along both edges forming handles at both ends. With a nurse on one end and a family member on the other, the patient was suspended in mid air and being “run” in a very bouncey fashion across the rubble with a third person running alongside, holding a bag of intravenous fluids above the patient.
Despite the very basic conditions in the TB Department, where patients lie on wooden slats of bed frames in a stark, high ceilinged, open air building, the building is nonetheless new with a modern and functional design and was not a shock to my first world system when I first saw it, despite being far more basic than anywhere I’d worked previously with the single exception of East Timor. The same cannot be said about visits to other wards at the hospital where patients lie either recovering or dying, on crowded floors in foyers and corridors. There is no equipment such that intravenous fluids are suspended on bamboo poles, and conditions are reminiscent of scenes from the Crimean War in Florence Nightingale’s time. Hospital supplied food is cooked in an open space behind some buildings with massive wood piles leaned up against crooked shacks making a playground for naked children who run about in the smouldering smoke. Huge pots are delivered by moto to each ward from this “kitchen”.
Fundamental supplies such as dressing materials, cleaning products and medicines are also supplied within a system of finite resources on a very low budget. Things which were assumed as “the basics” in my former life are unavailable or restricted and I hear myself having conversations, even arguing for the need, relating to rubbish bags and hand washing products as I wonder where these things came from in my former job, where such thoughts had never entered my mind – things we needed were simply “there”. An interesting manifestation to this situation is the creative, solution-seeking abilities of Cambodian people in general and of my national colleagues in particular. It has impacted me in that for my first few months here, I saw many problems. Now I only see things that require a solution and I usually have full confidence that if one is possible, then in admirable collaborative fashion my team of colleagues will find it!
Just as I finished writing that, Angelina Jolie appeared on my television screen in the 2003 movie Beyond Borders, co-starring Clive Owen as a doctor working for a humanitarian aid agency in various war-ravaged countries! What an extraordinary coincidence! Jolie put Cambodia on the map at the beginning of her involvement here in the early 2000s. She adopted Maddox, her eldest child, after staying here during the filming of Tomb Raider. She has since visited as part of a UNHCR convoy and she established the Maddox Jolie-Pitt Foundation, another NGO dedicated to trying to improve life in Cambodia. http://www.mjpasia.org/about.html
Jolie has also come under fire for her involvement in Cambodia. Following the adoption of Maddox, other westerners flocked here to take advantage of the adoption process, which led to allegations of child trafficking and resulted in changes to the rules about expatriate adoptions. http://www.voanews.com/content/cambodia-says-international-adoptions-will-resume-in-2014/1804051.html There are also accusations that she brokered a property purchase with a former Khmer Rouge official. http://www.theinvestigativefund.org/investigations/international/1568/angelina_jolie%27s_legacy_in_cambodia/
This leads me to the issue of criticisms. I’ve long since realised that there will always be critics. No matter what you do or don’t do, you’re likely to encounter people who judge, criticise and accuse, often with the smallest if any detail. There will always be imperfections to our actions, things can always be done another way, we will make mistakes and there are always opposing viewpoints. But fear of criticism should never rule our actions and others don’t have to understand our journey, as they are not walking our path. Writing a blog is also very exposing. I previously tried to write about my experiences in another forum after a friend encouraged me to share my email writings, but I was accused of “running a sheltered workshop”, condemned and attacked by people based worlds away, driven by their own motives. It took a lot of learning to realise that these detractions were never actually any of my business. The encouragement and feedback that I receive from friends and family has kept me writing, but I promise that once my holiday is over, I’ll stop making daily blog posts!
Another “first” I’m having here is living under the thatched roof of a wooden seaside hut on a secluded white sandy beach with coconut palms blowing wildly and waves crashing loudly outside the window. It epitomises Coconut Mission to an almost comical degree, on the last holiday I’ll have before ending my time here. My biggest problem? The large rat scurrying about on the ceiling above. I’m not afraid of him particularly, but he is destroying the oceanic peace! Is that a First World Problem (FWP)? I’m not sure, but it’s another “first”, and it’s spoiling my Coconut Mission Experience (CME)!