Generosity and Skilful Infants

Today Bea and KT from MSF came with Chom and I to Dara’s grandparents’ village for a toilet inspection.  Chom was on his moto with 3yo Microphone (because he’s so loud!) at the handlebars.  The three expats were on our bicycles.  Thirty kilometers and a sore rear end later, we made it home with new tales to tell, as expected!

The toilet remains under construction with focus now on the pit being dug, in ground which is full of huge boulders.  With no equipment to speak of these huge balls of rock have to be pushed out of the five-foot deep trench using sheer brute force.  Utterly amazing!

Human forklift, Cambodia-style
Human forklift, Cambodia-style

About 10am we turned up on our bicycles covered in sweat and dust and, unlike other low-key arrivals on the back of Chom’s moto, we appeared to attract the whole village.  We stood above the pit, awestruck at the boulder removal process while groups of children stared awestruck at us!  About half an hour later as we headed back up the dirt track on our bikes, at least twenty kids waved us off excitedly.  Latest advice is that the family should have a working toilet by around Thursday.  The builders only work in the morning because in the afternoon they have to tend to their rice field.  Which explains why they are a couple of balls of muscle – their days are filled with hard physical labour.  Chom would not let me part-pay them today “because I don’t want them to buy the rice wine and then they will get drunk”!  His cultural consultancy is hilarious!

Yesterday Phter Koma had our Board of Directors meeting, where a number of good decisions were made.  The most interesting being that we plan to recruit three more children to the house.  There are currently 12 HIV+ children residing with us, all with dire histories and backgrounds and all now, thanks to a stable home environment, thriving and receiving the medical attention and treatment that they need.  The needs of many children in Cambodia are equally dire and even more so when an HIV diagnosis is thrown into the mix.  We are licenced for 15 resident children and so yesterday we decided to “bite the bullet” and take on another three needy children, which is going to take some time to prepare for, including visits to the childrens’ homes, approval from the relevant government ministry, etc.

90% of the >2 million HIV+ children worldwide do not receive the necessary treatment to suppress the virus and avert progression to AIDS.  Treatment is complicated and cannot be well discussed in a short post like this.  Very briefly, treatment halts the disease’s progression but does not offer a cure.  Without treatment most HIV-infected individuals will develop AIDS within ten years of initial infection.  Once AIDS establishes itself, death typically occurs within three years.  Treatment requires specific medications to be taken routinely on a daily basis, sometimes different medications at different times of the day depending on the individual treatment regime.  Poor treatment adherence can lead to viral resistance to the drugs.  “Second-line” medications may then be used, but without good adherence resistance to these drugs will also occur and there are limited options after this.  So without good treatment adherence, the outcome is AIDS and death.  In Cambodia alone, 7,000 people die each year of AIDS-related sickness.  That is about 20 people per day.  Poor treatment adherence is due to many individual and complex factors, but it is inevitably the result of abject poverty.

What exactly is “abject poverty”?  The children of Phter Koma probably could not define it in words if asked, but they have all lived it.  Stories include a very young child brought to hospital with his unconscious father who subsequently died of TB meningitis, caused by AIDS.  With no other living relatives this child’s sole option was Phter Koma.  One of the children now being considered for recruitment is a ten year old girl whose background was written by a Khmer colleague who assessed her situation and reported it to the Board.  I won’t re-write his brief report except to change identifying details, because I think that his choice of words demonstrates his empathy.  “Ten year old  girl is living with her old grandma, 70 years old, in the very hard condition because grandma has to harvest in the field, hired by villagers and do whatever she can do in the village. But she has some relatives who sometimes have given her some support. Girl’s parents were passed away of HIV (father died last year). She is now in grade 2, her study is not good because no one helps or supports her, only the grandma. Clinic staff let me know that daily drugs of child is not good, no one reminds her and her grandma is very old and she sometimes has to work for others. The appointment with doctors was too late, sometimes missed because grandma does not have money. Obviously the day I met her at the clinic she was late about two weeks and her grandma could not come, she was sent with a motor taxi driver who living in the same village“.

This is one of so many stories that are the reality of life in Cambodia.  When I cycle through rural villages I feel acutely aware that I am surrounded by many such existences.  The other day Chom and I stopped on a rural lane and while I was taking photographs of the village scene before me a child’s voice shouted out “Hello!”, goaded by a male in the background to then shout “How are you?”.  I shouted replies back, not quite sure where their voices were coming from.  A young crippled man slowly made his way out of the gate and across the track to meet me and say hello.  Yet another to have been given an injection in his buttock and crippled as a result.  One of the first practical things I learned as a student nurse, is that when administering injections into the buttock you have to inject into a very specific area in order to avoid the sciatic nerve.  Until I came to Cambodia I’d never met anyone who had been incapacitated by an incorrectly administered injection.  In my very first days here I met Paint, who mobilises on his hands because of paralysis caused by this.  Since then I have met two other such casualties.  My guess is that the reasons this seems to be such a common occurrence here, could be due to three factors.  Wasted buttock muscle caused by chronic malnutrition probably makes the sciatic nerve much more difficult to avoid.  Poor practices resulting from a deficit of qualified teachers are very probable.  Thirdly, the capacity for unqualified practitioners to open clinics and administer treatment.

The last point has been highlighted in Cambodian news recently as an unlicenced practitioner in Battambang Province admitted reusing disposable equipment in his clinic.  This has been identified as the most likely cause of an outbreak of HIV in the village where he was practising.  He has been charged with murder by a government who in my opinion are complicit in allowing conditions to thrive which allow this type of practice to occur in the first place.

Phter Koma now have our own Facebook page which we decided was a good idea to try and raise our profile in the hope of attracting more support.

As we cycled home today we followed this ox-drawn cart along the track for a time before the young couple stopped to collect firewood.  As I stopped alongside them the wife jumped off the cart carrying a long stick of sugar cane which she presented to me for no apparent reason other than, in Chom’s translation “she want you to have it as a gift”!  Thankfully, in typical Cambodian fashion, a moto was all we required to get it home.  It traveled with us to a bamboo platformed hut restaurant where 3yo Microphone skilfully carved the bark from the cane with a butcher’s knife!  Six year old Dara joined us for lunch, limping around on his prosthesis and when we dropped him home, the blind lady whose husband drowned while I was away, was there!  Her 2yo daughter ran excitedly up to me and hugs were shared all-around.  She returns home tomorrow after a brief visit to town and without translation I have a very limited understanding of anything to do with her, so Win is lending me his translator skills in the morning.

Peasants giving me a huge stick of sugar cane!
Peasants giving me a huge stick of sugar cane!
Khmer style food delivery
Khmer style food delivery
Knife skills of a 3yo!
Knife skills of a 3yo!

I sat at a riverside restaurant this evening, typing this blog and watching the usual evening drive-by procession of motos and bicycles.  I’m becoming familiar with the elderly man who shuffles past in his black pyjamas each evening gripping his cane, the blind man with an amputated leg holding the shoulders of his young daughter for guidance, the neighbourhood children playing happily, some of them stark-naked, on the sidewalk above the river, the odd short-tailed grubby cat strolling by, the occasional “large mouse” (“we call them rats”) sneaking between gaps in the walls, and the random children shouting out “HELLO” as soon as they spot a Barang.  For such an impoverished nation, it is also an incredibly rich and generous place in so many ways.

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