While it’s not health systems that save populations, but healthy and equitable economies allowing a decent standard of living for most if not all, I still like this quote by Dr Paul Farmer. He is the founder of Partners in Health (PIH), a Non-Government Organisation who work in the poorest parts of the world, having begun from humble beginnings in Haiti after he visited there as a medical student in the 1980s. As well as being a Professor at Harvard and working out of the Brigham and Women’s Hospital in Boston, he is the Director of PIH, a physician, medical anthropologist and humanitarian. PIH are now one of the best known international medical NGOs, known especially for their philosophy of health being a right for all, which sees them bringing high quality, modern medicine, to poor populations in places such as Haiti, Rwanda and prisoners in Russian jails. Tracy Kidder’s biography of Dr Farmer, “Mountains Beyond Mountains” goes into more detail and is worth a read. Partners in Health work in collaboration with Medecins Sans Frontieres, for example the Tuberculosis Control Guidelines which guide MSF’s day to day TB work were written in partnership between both NGOs.
Yesterday Chom picked me up and we made our way to the blind lady’s village, via a warehouse for 50kg rice which Chom heaved onto his shoulders and dumped onto the floor of the tuk tuk amidst a lot of chatter and laughter. I must get a photograph next time. It was about a half hour journey on beat-up dusty roads through many villages and we had to call a few times for directions. Upon arrival the whole village had a “poorer than most” feel to it. The pagoda, usually a bright and well maintained centre of community life, was dull, dusty and in some disrepair.
We parked on the dust track outside their bamboo shack of a home as two excited children, their mother and her parents all approached to meet us. Her parents are 62 and 63yo. Her gentle faced, very thin father walks on his right leg, but his left leg is a useless, wasted pin which serves solely as a crutch to anchor his next step. He swings it forward and the misshapen foot hits the ground, allowing him to take his next step forward. Sometime into our visit I asked what happened to his leg and the answer was “He has been like that since he was 4yo”. I asked why and the reply was “Back then there were not many doctors. He got a fever and then his leg stopped to work”. My educated guess is Polio but I could be wrong. He greeted us warmly, wearing just a checked kramar like a skirt around his naked waist.
More hilarity as Chom heaved the sack of rice over his back and lumbered his way to the house and up the stairs like a hunchback, groaning with each step up to the front door and dumped it on the bamboo planks at the door about 2 metres above ground. We then sat together on a bamboo bed base under the house, watching a chook sitting on her “eggs for babies” as others bwarked around our feet and the children poked and prodded me. Their mother, who I will call Mini, disappeared into the house briefly and returned with the two My Little Pony toys I had brought back from America in January and we played with them together as the Khmer adults chatted and Chom occasionally gave me snippets of what they were saying.
After telling Chom the story from Mark that maybe her husband had been murdered, he spoke to her and relayed to me that her husband was “very older than her, 53 years old but she is 30. It’s so old!”. He traveled by moto to a specific place where he sold his moto and gave the money to a friend, telling the friend “Use this money for my ceremony because I am going to die”. He was then found drowned in the river so it seems suicide is the general consensus. Nevertheless, there are no laws in place to investigate such things and as Mark pointed out to me “she is very poor and too afraid to talk to the police”.
We also got a more accurate story about the fall she had. She was staying with someone in another village, when the wall of their house fell down and she fell out, hurting her back. Her daughter also fell out of the house. Her own house is a bamboo shack sitting next to (on the same land as) her parents’ home, where we were sitting. She does not stay at her home anymore and Chom pointed out to me “there are no stairs, she cannot go inside”. I am unsure but perhaps the stairs were removed to stop the children or unwanted visitors from entering the empty shack? Chom explained that she has noone to look after her, so she has to stay with her parents now that her husband is dead. He also explained that her sister works in a tobacco field and earns $95 per month and “she helps everyone because they cannot work”, motioning his hands in a circle to include Mini, her daughters and parents. How does $95 feed six people when a 50kg bag of rice costs $30? As an outsider I don’t know, but speaking to Chaz later in the day about this, he told me that most people “like this” forage for leaves that they can eat, and fish in nearby waterways.
It became slowly apparent that the help she had called me for, was food. I asked Chom a number of times “When she called us the other day she said she wanted help?” and he replied “I think for food”. I asked a couple of times more and got the same reply. We stayed for about an hour and I had no idea what was being said for the most part, as Chom laughed and chatted animatedly, offering me rare snippets as the non-translator that he is! As we were preparing to leave I asked again, saying I want to be clear about what she meant when she asked me to help. Chom laughingly said “Oh! I forgot to tell you! She said that sometimes she is bored and she want to ring you and sometimes they have no food. So I think it’s okay that you gave some rice and a little bit money”.
On our way home Chom shouted from the moto at me about other parts of the conversation I had missed out on. “I asked her mother, why do you marry this man when he cannot walk?” Predicting my horror he shouted “In Cambodia we think this is funny, because I say it in a friendly way, not a mean way, and they laugh too because they know it is funny. But she said another man wanted to marry her but she didn’t love him, she loved her husband”. Then “the husband already had three wives, she was the fourth wife for him and he was 53 years old. I asked her, why do you marry a man like this? She said, because she needs someone to look after her. I told her, a man like this will not look after you, that is a bad idea to marry him!”. His insights are simultaneously wise and hilarious!
As we drove there we stopped in a Muslim village to find some children I had photographed on a bike ride at the end of 2013. Chom located the neighbours who recognised the children and promised to give them the photographs. On the way home we stopped at another house to give some photographs to a young family who I had similarly photographed about eight months ago. They remembered me and were happy to see the pictures. They took three plastic chairs and placed them under a tree, wanting to tell me that their 13yo daughter “always get headache”. Since the age of 9, two or three times per month, this young girl has severe headaches. They have taken her to various hospitals including as far away as Siem Reap, but had no luck with a diagnosis or treatment and do I have a friend who is good with “head medicine”? I will ask one of the doctors and see but something tells me it won’t be something we can easily help with.
Days as interesting, challenging, rewarding and heartfelt as these seem to be glueing me to Cambodian soil. Chom texted me last night to say “Dara he staying in Kg Cham now I saw him sit with his Papa”. When I visited Shackville this morning Dad was cooking up a storm in the kitchen, which is just outside the bathroom (rice porridge with loads of vegetables). I’ve promised Dara a treat for dinner this afternoon, perhaps fried rice at the Night Market and a ride on one of the bumper cars. The conversation with Mum appeared to be that his leg is painful and he is on medicine for it – another infection I guess. Which as you can see, is not exactly surprising.