Existence would be intolerable if we were never to dream
~ Anatole France
These words could have been written specifically for Paula. After developing severe, chronic abdominal pain during pregnancy in 2011, her interim years have been a living hell. We met on one of her most wretched days, approximately 16 months ago. She had already undergone five surgeries and her gaping wounds, oozing faecal liquid onto her abdominal wall, have caused constant pain, immobility and severe malnutrition. The family spent thousands of dollars seeking medical care for her mysterious abdominal symptoms. They sold their home and later, their grandfather mortgaged his home so that it is currently owned by the bank. With over $5,000 owed, her father moved to Malaysia and her brother to Thailand. Both send their wages home to cover the repayments. The family (Mum, seven children and Paula’s son plus various other extended family) live in the home of Paula’s aunt while she too, is in Malaysia where she can earn more than is possible in Cambodia. When she returns, the family will be rendered homeless and do not know where they will live. The debt will take them three years more to repay before they can begin to think about re-establishing a new home.
Not long after Cambodian surgeons informed Paula that there was no hope, and that she should go home to die, she was diagnosed with pulmonary tuberculosis. She began standard TB treatment, which in a “dying” patient is more a public health protective measure, than a life saving intervention. A few months later culture results from her sputum specimens confirmed that her TB was resistant to one of the standard drugs, and she came to us in order to begin a drug resistant (DRTB) treatment regime.
A beautiful young woman with a dedicated and loving family, her story seems to have evolved into a very rare instance of DRTB actually saving a person’s life. Without the TB diagnosis she would have remained at home waiting to die. Instead, she came to the attention of people with “outside connections”. A rare and unlikely opportunity for an impoverished rural villager from Cambodia. She has featured in two separate reports on TB in Cambodia by Spain’s largest newspaper, El Pais and also in a fundraising brochure for a European branch of Medecins sans Frontieres. She’ll never know the existence of such paradises as the hillside home of Patricia Wells in Provence, near the medi-eval village of Vaison la Romaine, with it’s clifftop castle and ancient cobblestone laneways. Yet it was in Patricia’s beautiful garden of lavender, herbs, vineyards and summer blossoms, where Paula’s fate changed dramatically, one sunny day in June this year.
Since that astonishing day when I heard the words “my husband could probably fix her”, followed sometime later in the same conversation with “if her husband treats her for free, I will cover the additional costs”, I have had many doubtful moments. Awaiting confirmation of charity care from the treating hospital in America; sending Paula, her mother and our Khmer translator (my ex-colleague, “Samantha”) into the US Embassy in Phnom Penh to obtain visas; seeking medical clearance from the airline and many other stages in the process of getting her here. Amazingly, almost a week ago we did get her here. She is hospitalised and investigations all show that her condition is operable and she should return home in good health, to a normal life, reasonably soon!
The astonishing coincidence of happening to have lunch with the very people who could make this happen for Paula, and happening to mention her miserable existence to them without knowing of their connections and abilities in this regard, appears to have set a pattern for Paula’s continuing good fortune. The long haul flight from Cambodia to America was challenging to say the least. She travelled the almost four hour journey to Phnom Penh airport in a minivan with at least 30 family and neighbours. I have no idea how they crowded in together, with Paula lying on a stretcher bed in the same vehicle! By the time we (Samantha and I) arrived at the airport, in our own minivan with Samantha’s hordes, the Paula hordes were already there, crowded around her stretcher bed which they’d positioned outside the main doors. It was amazing to be a part of the excitement and I have never been the subject of so many photographs as I was that night before check-in.
We made it across the Pacific Ocean with her, a 25 hour journey in total including 14 hours of flying time broken by an 11 hour stopover. The excitement of going on an aeroplane was slowly overshadowed by her progressive exhaustion. By the time we boarded our second, much longer flight, she appeared more like a little old lady than the 25 year old beauty that she is. Pushing her tired little bones through Customs and Immigration made for an expedited entry into the USA, with officials showing nothing but compassion and respect. There is a large and tight-knit Cham community here and an Imam met us at the airport with his wife. As they drove us into the city to the hospital we discovered via conversations in Cham and Khmer, that he comes from a village on the opposite shore of the Mekong from Paula. In fact, I believe he comes from the village where Chom and I rolled in the tuk tuk!
This week the world has shrunk even further as a steady stream of Cham visitors have appeared daily, some of whom even come from Paula’s actual village! Their stories seem to be a mix of escaping as refugees during and after the Khmer Rouge era, or more recently, being sponsored by wives or husbands already living here. Their immediate connection with Paula, especially for those who know them as neighbours and extended family members, but even as strangers meeting for the first time, is surprisingly strong, based on a mutual language, religion and culture originating from a distinct area of the Mekong Delta. It has been amazing as an outside observer, and also a little overpowering as someone from a very individualistic culture, to find myself embraced by this community spirit. Karen, paying for the out-of-hospital expenses, has so far had a very tiny food bill because home cooked meals are arriving daily from the community. The hotel we had booked for Paula and her mother post-discharge until she is deemed fit to fly home will probably be cancelled. A choice of family homes are earnestly offered for them to move into for as long as they need.
On Thursday I was asked to spend the night at a family home with Paula’s mother and Samantha, who is also having a very awesome first-overseas experience. We were picked up and transported about an hour from the city to a large family home where extended family and neighbours were either waiting, or joined us later. A large meal was simmering on the stove, conversations flowed in Cham, Khmer and English, beds were organised, a neverending supply of food was served, children played at our feet and talk of Cambodia, America, food, religion, health care, poverty and wealth kept us awake until after midnight.
Yesterday morning we were taken on a tour of the area after breakfast. We were due to attend the mosque and talk to the community about their Cham sister/daughter’s plight but information arrived that Barack Obama was coming to town for dinner and traffic delays were expected. Paula’s mother stayed behind while Samantha and I were driven back to the city in time to avoid the traffic and ensure Paula was not left alone for another night. As we approached the city a phone call arrived to say that the community had raised over $1,000 towards the family’s debt! This morning a follow up phone call has placed this at $2,000! Equally surprising is the information that Paula’s mother, 2 years my senior, has told the community that “my mother will decide what to do with the money”. Naiively accepting this comment, as I vaguely wondered who she meant as her mother died during the Khmer Rouge, I was then informed “you are the mother, so it is your decision”. Brain whirling in horror, I maintained some telephone composure and discussed how the money can best be utilised – by paying it towards the family’s debt, and how to best ensure this happens.
In the early days Paula regularly asked “do you think there is any hope for me?”. My colleagues and I reassured her while in private discussing whether these reassurances were the right approach given her utterly hopeless condition in a country where a prolonged and miserable journey towards death is accepted so often as normal. To have dreamed that an outcome such as this was remotely possible, would have been ridiculous. Yet, the utterly ridiculous appears to be taking shape! If only she were not just one of many thousands with equally harrowing existences.