In 2013 a wealthy American teenager killed four people in a drink-drive accident.  His defence lawyers argued that he was ill-equipped for real life due to his wealthy lifestyle.  The judge agreed and he was sentenced to ten years probation, with no jail time.  One of his defence team coined the phrase “affluenza” to describe his so-called condition.

In 2007 I went to Ecuador on holiday, my first foray into a developing country.  Many experiences I had there were a little perplexing to my wealthy-world-brain.  A few brief examples include being approached by tiny children wanting to shine my shoes, seeing school children asleep on the base of a statue in a city square, watching an elderly blind man call out loudly as he walked alone through a crowded marketplace.  He was apparently begging and because his fellow countrymen were not offering him anything, nor did I.  I’d do that differently now, but I knew no better then.  Actually something in my sub-conscious did vaguely know, but I’d never had to think about such things before.  It was disconcerting and my responses were far more delayed then, than they would be now in similar situations.

Before traveling through Ecuador I spent two weeks in 1:1 language lessons at a Spanish school in Quito.  Oneday at a restaurant with my teacher I ordered a traditional meal of cuy (guinea pig) for $4.  Teacher, claiming not to be hungry, did not order.  I was busy in conversation with someone to my right when I noticed that a plate served to me from the left was immediately whisked away again.  I turned to see the waitress disappearing towards the kitchen as my teacher explained “I asked them to remove the head for you”.  Very insightful of her!  When the head-free plate returned, with four little paws hanging over the edge, I took one bite and decided that a taste was all I could muster.  Predictably it tasted like chicken and was perfectly palatable.  But it was a guinea pig with dear little paws!  When I made sounds about having had enough, my teacher gently broached the subject of possibly finishing off my meal instead of letting it go to waste.  She admitted that she couldn’t afford to eat at this restaurant, that cuy was a delicacy, and that she usually found her western students leave most of their guinea pig on the plate, so that she could normally score a free meal at this otherwise unaffordable restaurant.  A clever, qualified, employed teacher, unable to afford a $4 meal?  More puzzlement.

On another day, after a small dental disaster while sailing on the Galapagos Islands, I attended the clinic of a professor of orthodontics in the city of Guayaquil.  We walked up a grubby, wide stone staircase in a crumbling city centre building whose windows were open gaps in decaying walls, bringing the noisy street below inside.  I lay on a broken, torn dentist chair in a bare room with no running water as the professor poked and prodded in my mouth.  The grit from his bare hands felt like little stones against my gums.  For a service that would have cost hundreds of dollars in Australia, he charged me US$2, beaming widely when I gave him $10 and said to keep the change.  Again, I felt puzzled.  A few days later a bout of explosive diarrhoea was probably a delayed part of this cheap, unclean but skilled service!

My next visit to a developing country was at the end of 2012 when I volunteered in Timor-Leste for three weeks.  Walking to work one morning, a small boy appeared from nowhere holding a stained and dirty plastic cup out at me, with a begging look in his eyes and tone to his voice.  I gripped my bag tighter and uttered no in confusion at what he could possibly want.  Only as I walked on, did it slowly dawn on me that this kid was obviously begging me for a cup of water.  I had a bottle in my bag but when I turned back I couldn’t find him.  It jolted me, that I was in a place where children weren’t just hungry, but desperately thirsty!

During three weeks volunteering at a medical service in Timor-Leste, I learned a lot about health, illness and various third world conditions which we don’t see in Australia, but which are common only 600km from our northern coast, or even closer if you look at the distance between Cape York and Papua New Guinea.  But mostly what I learned about, was poverty.  I stayed with Australian friends whose Timorese housekeeper had not turned up to work for a few days.  Husband decided to terminate her employment.  He drove to her address, finding a one-room, mud-floored shack.  Inside the housekeeper was tending to her sister, who had given birth that morning on the mud floor.  We were all on a steep learning curve, with our perceptions of the world challenged on a daily basis.

In Timor I first saw Tuberculosis in it’s historical textbook presentation of “consumption”, meaning the patient is all-consumed by the disease – malnourished, weak and struggling for breath.  TB is a classic disease of poverty which no longer burdens first world countries the way it once did, but continues to afflict the poor world.  Despite the very low rates of TB seen in rich countries, in 2015 it surpassed HIV as the world’s leading infectious killer, mainly because AIDS mortality has declined.  I created the table below to show some of the significant differences between TB as I’ve observed it most commonly in the poor world, compared to my observations of it in the wealthy world.

TB Table

The differences are due to many interconnected factors related to living conditions and health care access.  In Australia if I become unwell, I am starting from a baseline of good physical health and there are few obstacles to my attending the doctor.  I have paid sick leave and access to a health system which I have insurance cover for.  Any excess I may have to pay does not threaten my survival.  The quality of medical and nursing care is high, incorporated into a system of legislation which helps to ensure professional standards.  My health system is adequately resourced inside a wealthy economy.

In contrast, everyday Cambodians have many reasons to avoid attending the doctor.  Paid sick leave is unavailable to most.  Food security relies on the family’s adults (and often adolescents or even children) turning up to work every day.  All health care interventions cost money which most cannot afford.  Many if not most Cambodian families are in financial debt because of health care costs.  The health service employs inadequate standards with few resources.  Medical and nursing practices are much more reliant on the individual because there are few professional codes.  This environment shapes individual predicaments which often shocked me.  People frequently die from TB – a curable disease – because they hope to recover without medical intervention and insist on working until they collapse.  When you are already malnourished, as a high proportion of the Cambodian population are, there are no reserves for weight loss.  Early diagnosis and treatment are one of the most important interventions to prevent transmission of TB, meaning the phenomenon of avoiding a visit to the doctor until you reach death’s door, contributes to high rates of infection between family and community members.

The differences between everyday life in Cambodia and everyday life in Australia, are stark.  In Cambodia I have observed a common networking between people, of financial or food loans.  Friends or family base loans to each other on a trust that the money, which is never spare, will be returned quickly.  This results in a cyclical pattern of loan – repayment – reciprocal loan – repayment between people, depending on relationships and need.  Salary advances are also accepted practice (at least within NGOs who have a reliable source of income).  In Australia on the other hand, it is very rare in my experience to ask for or extend, a loan to someone in your social circle.  Financial security inside a robust economy is the norm here.

In Cambodia most people survive inside micro-economies where food security is a standard concern.  Most employed people are either on meager salaries requiring strict budgeting to ensure food remains available throughout the month, or higher salaries, usually with NGOs, which are attached to contract work only, leading to threats of unemployment in the short to medium term.  Many people are not in paid work, meaning they have to conceive ways to generate an income such as scavenge for recyclable plastic and cans, grow and sell fruit or vegetables, busk or beg in the streets.  The options are extremely limited because it is impossible to accumulate customers when everyone around you is also poor.

I often wonder about the lost opportunities, in a world where so many are forced to struggle for their own survival while in the rich world we thrive.  As an example, look at the Nobel Prize winners for 2015:
Nobel Prize in Physics – Japan and Canada
Nobel Prize in Chemistry – Sweden, USA, Turkey (based in USA)
Nobel Prize in Physiology or Medicine – Ireland, Japan
Nobel Prize in Literature – Ukraine
Nobel Peace Prize – Tunisia
Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel – UK (based in USA)
It is good to note that both peace and literature prizes were won by people from developing countries.  Still, of the world’s 7.1 billion population, only 1.2 billion live in “the wealthy world”, showing an over-represenation of accomplishment in prosperous nations.  This supports my point that we all lose out when a large proportion of the world are forced to focus on survival rather than attaining higher goals which we could all benefit from.

The struggling population in Cambodia and the prosperous population in Australia are so polar opposite on so many levels that it is difficult as an Australian, to imagine such insecurity as exists in the poor world.  In Australia, our threshold for stress is a very different beast.  We don’t look outside our windows to sights of poverty in every direction.  Our families are not hungry.  Our children are not at risk of illiteracy due to an education system we cannot maintain or afford.  There is a publicly funded safety net for those facing unemployment, financial distress or illness.  None of it is perfect, but it exists and it functions.  Charities raise money for such things as Make-A-Wish and medical research which will probably only benefit wealthy nations, because there is no need to fund the primary needs of our population, all of  whom have access to shelter, food, education and health care.

As a consequence of this relative safety and comfort, we are all at risk of suffering from affluenza.  It probably won’t make us offenders in the criminal justice system, but it could (and does) make us ignorant of reality as it is for our fellow human beings, and of the part we play in that reality, for example as consumers looking for affordable (cheap) products made in third world nations.  We could and should play a much more positive role, which would be as much to our own benefit as to anyone else’s.

Poor and rich side by side

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