I had been in Cambodia about a week when one of the MSF expats announced excitedly that on a bicycle ride that day, she’d cycled through an Islamic village with a mosque and many people dressed in Islamic attire. Islamic people in Cambodia seemed a curious thing to our uninformed minds. Since then I’ve learned a little about Cambodia’s Islamic population, the Cham, particularly since becoming involved with Paula’s family and fellow villagers during the preparations to get her to America.
Paula remains hospitalised after surgery five days ago. Apparently she spent a night in ICU at the weekend but has since returned to the surgical ward. At this stage we still don’t know when she can be discharged from hospital. Upon discharge she will need to stay nearby for at least a month or so, to receive appropriate follow up before returning home to Cambodia. The wound is expected to heal only gradually, hindered at least in part by her poor nutritional status. A plastic surgeon has been added to the medical team caring for her. Surgery last Wednesday was a six hour affair involving two highly experienced gastro-intestinal surgeons and their team. The following night at dinner Sean (not his real name), the surgeon, talked about the operation. Paula’s digestive tract was, in his words, “a monumental wreck” and she would have died within the next few months without corrective treatment. They were nevertheless, able to patch the various anatomy together again and he believes she will make a slow but full recovery, returning to a normal life within the next few months.
Last week was highly emotional for all of us. There were tears as Paula was wheeled away from her mother to the operating theatre early Wednesday morning. It was a long and anxious day for those of us waiting in the wings. Sean knew this and we received the occasional phone call from the theatre, to let us know that all was going okay but taking longer than hoped. There were more tears on Thursday when Samantha and I met with an American paediatrician organised by Sean, to discuss her critically ill son. At two years old, he has an undiagnosed neurologial condition. Based on photographs and the story of his clinical picture, the paediatrician was able to deduce that he has some sort of progressive genetic condition which is slowly causing deterioration in muscle tone. That there is no cure and the condition is terminal was tragic but not unexpected news. To have an informed clinician speak at length with knowledge and empathy was an entirely different experience compared with the lack of care or attention he receives in Cambodia. This stems from an under-resourced system in which staff are so often powerless to help. Prior to last Thursday noone had spent more than a few moments at a time filling in scripts for this boy with a mysterious condition, during episodes of acute illness. One Cambodian clinician told his mother, when he presented with probable pneumonia, that there was no point treating him “because he is disabled”. So the time spent with a first world paediatrician, offering her advice free of charge, was a bittersweet pill for Samantha.
On Friday Samantha and I made the return trip home to Cambodia. There were many tears and tight, persistent hugs as we left the hospital, especially with Paula’s mother. She is nearing the end of a very long journey, having spent years caring scrupulously for her no-longer-dying daughter, while maintaining a semblance of family life for her other offspring and Paula’s son. She has also continued to run a small local market stall while her husband and oldest son are overseas earning what is for rich-world-citizens, very small amounts of money to send home. All because of the debts incurred by Paula’s medical needs. Paula and her mother remain in the capable hands of a first world medical team and a strong, supportive Cham community who I spent only a brief but very impressive time with.
What we now know as South-East Asia is made up of a vast and diverse number of ethnic groups. According to UNESCO there are at least 25 ethno-linguistic minorities in Cambodia alone. The dominant Khmer population makes up about 95% of the country’s more than 15 million people. The biggest minority outside Khmer is Mandarin Chinese, consisting of around 440,000 people. Next in line are the Cham, at over 200,000 people.
The history of Cham people is long, involved and complicated, so I cannot do it justice here except to provide a brief history as I understand it. They probably travelled to what is now the central coast of Vietnam sometime before 600BC, from Malaya or Borneo. Developing from smaller tribal groups and growing out of a preceding Kingdom known as Lin Yi, the Kingdom of Champa, as seen in the historic map above, existed from around the 7th century AD until it was completely annexed by Vietnam in 1832, finally rendering the Cham a stateless people. At this time many, following their last King, fled to Cambodia. Here they settled in communities across the Mekong Delta but most predominantly in the province of Kampong Cham, which literally means “Cham Landing” or “Cham Harbour”. Today most of Cambodia’s Cham population live in the provinces of Kampong Cham and Tboung Khmum.
Originally Hindu and Buddhist, the Champa Kingdom began to be influenced by Islamic merchants from the Persian Gulf as early as the 9th century AD. Today most of Vietnam’s Cham people remain Hindu whilst most of Cambodia’s Cham are Islamic. They speak and write their own language, living in their own distinct villages where mosques and goat herds replace pagodas and pigs. Cham villages are interspersed between neighbouring Buddhist villages and Cambodian Cham speak Khmer as their second language. As with so many minority and landless populations across the globe, Cham of both Vietnam and Cambodia have a history of persecution. Half of Cambodia’s Cham were annihilated between 1975 and 1979, targeted specifically by the Khmer Rouge. Many more escaped during or after this brutal period. This exodus from Cambodia saw Cham people scatter far and wide and there are a number of Cham communities across the western world including USA and Australian cities.
After spending so much time with Paula and her mother, as well as other members of the family more intermittently, I have had some interesting experiences. During one of their recent hotel stays in Kampong Cham town, I knocked on the door of their room, opening it to the sight of Paula on the bed against the far wall and an eerie sense of another presence in the room. Kneeling on the white floor tiles, wrapped in white prayer attire from head to toe with only her face visible, her mother was deep in somyang (prayer). Her face appeared at first sight, to be suspended in mid air and I literally jumped out of my skin. At other times, preparing for prayer, she washed her feet in front of me, or had to explain to me why she was fasting (a cultural practice upheld during times of anxiety, such as on the day of Paula’s surgery).
Since the day we met I have known that Paula and her family are Cambodian Cham. Only recently did I realise how strong the cultural implications of this fact were. When we embarked on our “mercy mission” to the USA, I had no clue that I was travelling towards a much more significant Cham encounter in the USA, than I had experienced to date in Cambodia. This lack of experience on my part is entirely due to my “stranger in a foreign land” existence. I am surrounded by Khmer and Cham culture in Cambodia but I see it through western eyes, which very often means I don’t see it at all, short of noticing a beautiful mosque, colourful Islamic clothes, or understanding the occasional superficial observation unique to Cambodia such as the way people greet each other. During our travel preparations Sean’s wife, I’ll call her Cate, located a local Khmer person in USA, who in turn located a Cham Imam. They both picked us up at the airport on arrival and transported us straight to hospital. During this journey we discovered that the Imam grew up in the village directly opposite the shore from Paula’s village. Last week I showed him a photograph of myself standing with an elderly Cham man in this particular village, who he recognised as his neighbour! His parents remain in this village and he visits home with his young family every few years.
I lost count of the number of Cham visitors who appeared in Paula’s hospital room during the two weeks we were with her. We bought almost no food during our time in the US because bowls, containers, pots and pans filled with various home cooked meals, rice, fruits and snacks appeared on a daily basis such that we filled both the hospital and the hotel fridges. My plan to purchase warm clothes for Paula and her mother was cancelled when bags of second hand clothes appeared from multiple sources. My plan to purchase a sim card so I could have telephone access was cancelled when a telephone was loaned to me. As the person acknowledged by Paula’s family as making her mercy mission happen, I was overcome by the fuss that was made of me by everyone coming to meet us. Such that some claimed they had travelled to meet me rather than Paula. An undeserved amount of praise was heaped on me. Statements such as “even though I never met her, she is Cham and so she is my sister and you have saved my sister’s life”, “I have lived in US for 35 years and never once seen a Cham able to come to America for treatment, it is truly amazing”, “every night when I close my eyes all I can see is your face”, “you must be the famous doctor who brought our Cham sister to America”. Every day tears were shed, amazement was expressed, gratitude was articulated in words and gestures. It was flattering, humbling, bewildering, confusing and overwhelming, all in one hit!
At no time during our preparations within Cambodia and journey to America had I remotely anticipated that I would even meet Cambodian Cham people, let alone from villages I know and visit. Some of the conversations were hilarious, along the lines of me looking at a Cham person who in turn was looking back at an Australian who asked:
“Where do you come from?”
“Yes, but where in Cambodia?”
“A province north of Phnom Penh called Kampong Cham”
“I know Kampong Cham, where are you from there?”
“It’s in <specific district>”
“Oh, you’re not from <village name>, are you?”
“Oh! How do you know my village?!”
Beyond my initial sense of neighbourly welcome, we were in effect adopted into a large, strong, collaborative extended family. I greeted the first invitations to spend time with people in their homes, keenly. But my western brain expected these invitations to dry up after one or two meals. Instead, the invitations escalated to the point that it became impossible to see everyone who wanted to meet us! People continued to send home cooked meals, phone calls from strangers seemed relentless, asking when we were free to eat at their home or at a restaurant, insisting on paying for everything and transporting us etc. Samantha, a Khmer nurse, was not only accepting, but very welcoming of the constant array of attention and invitations. Her only regret was that the local Khmer community were not extending the same open arms to her as Paula’s Cham commuunity. She wondered aloud, if she was the patient and not an escort, would the Khmer community have rallied in a similar way for her?
At the same time I began to wonder constantly, when I would possibly get some time and space to feed my western need for solitude and independence! It was only when I began to recognise the slow sense of suffocation that enveloped me, that I was able to reflect and realise I was in the midst of a very affable, yet intense, culture clash! My attempts to step away from the attention were met with more determined invitations, which in turn increased my own determination for some solitude. I didn’t understand why I was being so hotly pursued, and my increasing dissociation from such warm and friendly people, who I liked a lot, was causing an equal amount of confusion. About a week ago I declined an invitation for lunch and received a telephone call from the would-be hostess trying to persuade me to change my mind. Tired and confused, I announced that I was starting to get stressed by the constant intrusions into my time and could they please let me have some time off. I was astounded when she replied with a very kind and gentle tone, “we thought we could share a meal with you. Are you too busy to come today?”. It struck me that as much as I needed some space, this community needed to extend their generosity and friendship to me. I was only in town for a short time, which for me made my time and space more precious, while for them it made their need to see me more urgent! It was perhaps one of the most awakening moments of my life, to be able to visualise my own cultural norms as compared with those from another world view.
Back in Cambodia for a week before winging my way home to Australia, my first mission was to visit Chom’s wife and children at her mother’s village about a three hour motorbike ride from here. He hadn’t seen his now-six-week-old son for five weeks and was waiting for me to accompany him. The journey took us through Paula’s village, where we stopped of course, and many Cham villages I now know a little more about. Chom’s wife is from a village with a pagoda which divides two distinct village populations physically, with Cham homes upstream of the pagoda and Khmer downstream. We took a drive through the Cham side of this village the other night. Looking at the villagers in their Islamic attire, who stared back at me, I ruminated on how I could be in prosperous America one week, socialising with people from this very place and days later find myself driving through their impoverished home town exchanging glances and smiles with their family members. This trip was an adventure in itself and I’ll blog about it later.