She lives in a tin hut in a back alley filled with makeshift shacks stacked beside and atop of each other. Roosters crow, ducks, chooks and skinny kittens peck around for morsels in the same muddy piles of trash, dogs laze in shaded patches, and pigeons coo from a cage. A neighbour is crouched over a bucket of soapy water, scrubbing clothes. Suds spill over into the dirt as we step over the rivulet of foam trickling downhill and seeping slowly into the damp soil. She broke her wrist about two months ago. I ask did she see a doctor? “No, she has no money for that”. Does she have any painkillers? “No, she has no money for that”. How long ago did it happen? “Maybe two months”. How old is she? “Eighty eight”. At the nearest pharmacy I purchase a 75c sheet of Paracetamol and we give it to her for the pain. Her friend is hunched over awkwardly and when it comes time to tell her story, she lifts her shirt, showing a spine crumbled into a hunched back which she explains happened after she started treatment for TB three years ago. I tell her this was caused by her disease and not the medicine. When I return the following day with the organisation’s doctor I see her walking, her torso at a right angle to her hips. These are just two of the people our small and under-funded organisation are assisting. Recently their biggest donor died, slashing the monthly budget in half. After salaries for a doctor, a program manager, a social worker and a driver, remaining funds are used by prioritising competing needs, which includes obtaining necessary medicines, supplying food to the hungry, paying school fees. I hear my colleague explain a number of times to different clients, that “we can no longer offer the same support as before, because our biggest donor died”.
For some years now I have dreamed to volunteer my time and skills in a local community and finally I’m able to do so, albeit temporarily. My national colleagues are some of the world’s heroes. In one area known as “Ghost Village” because the men can earn money by preparing dead bodies for cremation, I’m told that during the Wet Season the shacks can only be accessed by walking in waist-deep water. When I state that “I won’t be able to visit here when it is like that”, she says without so much as a sideways glance at my prima donna comment, “It’s okay you can stand on that high part there and I will walk in to check the people”. She then says to me “Even I am poor but sometimes I know I am not as poor as these people and I give my own money because it is so difficult if we don’t help”. Learning that due to lack of funds this month’s food parcels have been delayed, I offer to cover this cost. As she receives the money from me she says “I really hope you can continue to support us”. I reply that I will try and I will tell as many others as possible about the need.
We meet an HIV+ woman looking after her neighbours’ children while their parents are looking for recyclables in the city streets. Another woman with Multi Drug Resistant Tuberculosis gets in the tuk tuk when my colleague stops to talk with her. She wants to tell us about her uterine prolapse and in passing her TB diagnosis is mentioned. Our doctor is not there so I work out from the vague details shared in broken English by people with limited health literacy, that she has MDRTB and is not receiving the required treatment because she cannot tolerate the side effects of the medications. I explain that she must take the medicine or the TB will kill her and that meanwhile she is spreading it to others. She replies “I am not so worried by coughing blood, my biggest worry is that I don’t know how I can eat tonight if I don’t find any money and my prolapse is very uncomfortable but I cannot afford the treatment”. This is what those books and articles mean when they say that “TB is a disease of poverty“. She is in fact, sick with poverty, and TB is just one of the symptoms, albeit the symptom most likely to kill her. Perhaps the person with limited health literacy is in fact, me?
We go into a tin shed where a 60yo man and his wife are caring for their 2yo grandson who is swinging in a hammock slung between two posts at grandad’s bed. Grandad’s feet are badly burned, the wounds open and festering. His story is that he needs to take this medicine (he pulls a packet of Gliclazide which treats Diabetes from a plastic bag hanging from the window above his head). This medicine makes him feel better, but he cannot always afford to buy it. Recently he was worrying a lot about his family’s finances because the shed costs $40 per month to rent, so he found a construction job that paid $5 per day. He only had a pair of rubber thongs to wear so he went to work in them and during the day the hot concrete burned his feet (which are numb from having too much sugar in his bloodstream, caused by his Diabetes). Without our MD’s help he would be at very high risk of losing his legs due to these injuries, or dying from blood poisoning caused by the infected wounds. But our doctor can treat his Diabetes, his hypertension and his wounds because he has been identified as a high priority case.
On the shore of the Mekong River we meet an elderly woman who my colleague identifies as one of the ten neediest community members who we try to provide monthly food parcels to. Previously she could earn $1 per day by cutting fish for sale at market. Now she is old, sitting down for long periods is not possible so she can no longer do this job. She searches the ground for cans and plastics to recycle, but the area she lives in has few recyclables, so she only earns about 25c per day in a place where the cheapest meal costs 75c. She lifts the scarf on her head above her ears, revealing a cheap pair of gold plated earrings in her pierced ears, stating “I feel very worried about food but when I get hungry enough I have these earrings and I will be able to sell them for a meal”. Leaving Australia last month I packed a small silk bag with my unused, unwanted jewelry, thinking “someone in Cambodia will be able to make use of this trash”. On day one volunteering I met that someone.
It’s easy in the “rich world” to think that if you don’t have a spare $50, you therefore don’t have anything to offer to charity. But amounts as small as $10 can make huge differences to people who have nothing. Part of the problem from rich countries is knowing who / where / how to donate. This seems to drive most people to donate to large organisations while small NGOs employing locals are often capable of offering much more accessible services with better impact but for their lack of funds.