As the year comes to a close, I feel compelled to write something. My head is full of thoughts, but I can't seem to put them in words. No surprise - this happens to me all the time lately.
It's been an interesting year, that's for sure. Never a dull moment, even when I desperately wanted one. While the scenery of my life has changed over the last year and a half, I'm still who I've always been. I still have a tendency to gain weight too easily, to talk too loudly, and to succumb too easily to inertia. I still want to feel useful, and still struggle to decide if I am. I still worry about money at odd times. I have tested all my social skills more than ever - trying to find a balance between my inner introvert and my bouts of extroversion, like I have some kind of social bipolar condition.
Because wherever you go, there you are. And here I am, still struggling with the same things I've always struggled with, still changing my mind from one day to the next about whether I'm meeting those challenges successfully.
In our early months here, I sometimes felt lonely for people who really knew me. Not necessarily anyone in particular, just people who knew I was reasonably competent at something, people with whom I had a history that allowed us to make references to past shared experiences, people who knew my kids, people who knew my shortcomings and still chose to be my friends. And people my own age. At 49, it's easy to feel old here, because I am easily 15+ years older than most of the people in my current social group. They're very tolerant of my advanced age, but still, there's no one to commiserate with about menopause. In any case, there are now people here who know me, and I like that a lot.
As 2011 draws to a close, I spent part of the day organizing - putting away the few Christmas decorations we have, straightening out my desk and rearranging things in the guest room. It's my default coping mechanism for feeling like my internal life is a little too chaotic: make order on the outside, and hope it seeps in. But as usual, making orderly piles of paper and stacking books and towels doesn't really touch the jumble of emotions that swirl in my head and my heart. I am so grateful to be here, and sometimes so frustrated by being here. I love that our kids are all grown up enough that we can be so far away and know that they are fine, and I feel guilty for being so far away from them. I think about all the things I thought I would have accomplished by now but haven't and I feel like a failure, and then I remember the things I have learned and have done and I feel some satisfaction, possibly even some pride. I sometimes think about the things we sacrifice by living here, and then I am quickly reminded of all the great joys and privileges that come with this life we chose.
So I'm feeling something, but can't easily label it. Maybe I'm feeling everything. Maybe I'll stop trying to organize my thoughts and just let them be.
Resolutions? I usually avoid them, unless they're general and vague. One year, my resolutions were to "exercise, moisturize, and economize." I felt pretty successful at those, at least for a good long while. This year, perhaps I should aim for some structure and self-discipline, however I want to implement that. I know what kinds of things make me feel better: getting enough sleep, getting some exercise, reading and writing, learning new things. I just don't do those things often enough. Why is so hard to start doing the right things? Once I get started and have some momentum, it's not that hard to keep going, but starting is the tough part. And if a new year isn't a good excuse for starting things, I don't know what is.
So, no promises, people, other than to give it a good shot. To wake up every day and take a few minutes to think about what will make my day feel worthwhile in the end.
As for this evening, we will enjoy Cambodia's last 2011 sunset from our balcony and spend the evening with friends, doing our best to avoid the mayhem of all the drunken backpackers downtown. And when I wake up in the morning, I'll think about how I'd like to spend the first day of 2012.
Wishing you all the best in the year ahead. Who knows what adventures it may bring?
Saturday, December 31, 2011
Thursday, December 15, 2011
All I want for Christmas/Hannukah/Kwanzaa/Solstice/Festivus...
Never mind all the time I spend window-shopping on Amazon.com, creating ridiculous wish lists like a little kid - what I really want are emails from folks at home. And I realize that's asking a lot. You're all busy and stressed with holiday preparations of your own, so I don't care if those emails come now or in February or whenever you have the time to sit and write something. Every one of those emails, like every single one we have already received since we got here, will be a gift. A wonderful, heart-warming gift.
Because absence DOES make the heart grow fonder, and I feel better every time I hear news from home about how life goes on like we remember it. Knowing that those of you back home are still doing what you do and being who you are somehow makes it possible for me to be here.
So, what are you up to these days???
Monday, December 12, 2011
"How long will you stay in Cambodia?"
I am shocked to realize that I haven't posted anything in almost over a month, but considering how busy it's been and how much time it takes me to write a post, I guess I shouldn't be so surprised. There's so much to write about that I think the best I can manage are some bullet points, in no particular order. And because I've written this over the course of a week or two, I've added some updates to my update in italics where needed.
- The weather has made the full transition from rainy season to dry season. In fact, we are just now enjoying the beginning of "cold season" when we wake up to temperatures in the 70's. No more air conditioning needed at night, no more puddles to splash through when driving around town, no more worries about leaving the windows open when we leave the house and risking the rain coming in. Instead, we have to remember to water the plants on the balcony every day and sweep a bit more often as the road dust settles everywhere, but for now, the raincoats can be safely packed away for another six months. (Update: This morning it was 64 degrees and still only 68 at 10:30 am. Crazy! On the other hand, we had two days with rain last week, completely out of the blue.)
- It is interesting to notice that even though the length of the day here doesn't change nearly as much from season to season as it does back home, there is a noticeable difference. Darkness sets in completely by 6:00 pm, when it used to be still dusky at 6:30. Also the angle of the sun as it sets is different and the giant sun shade we hang on the balcony in the afternoon no longer blocks it completely.
- I ended back in Phnom Penh twice more since the first trip when we took two children for surgery. The first return trip was unplanned. One of the children had problems develop about ten days after surgery - it turned out he had a tear in the artery behind his knee. We had moved him to a guest house in Siem Reap (from his village about 90 minutes outside of town) to be near the local children's hospital while they tried to figure out what was causing his pain and swelling, and one day when I went to change his bandages, he started bleeding more than I have ever seen in my life. We were very glad to be in town, and after a couple of days staying at the local hospital, we determined that he needed to go back to Phnom Penh for the repair. It made for a crazy week, having to drop everything else to go and making last-minute travel arrangements, but everything went well for him and he is now happily back home, though drastically more anemic, despite his several blood transfusions. (I am very happy to be blood type O, so I can donate to anyone who needs it.) We returned to Phnom Penh again last week, as scheduled, to return the other child for her second surgery. Things went as expected, and I was able to observe interesting surgeries and help out at the hospital a bit. If all goes as planned in the next few months, we won't need to go back to Phnom Penh again for a long time, and while I grew to enjoy the city more over time, I won't miss it.
- In the middle of all this running back and forth, Marissa came to visit from Portland. Her trip was planned very suddenly - she booked on a Sunday and left that Wednesday - and she stayed about two weeks. I think the lesson we took from her trip was that as much as we love Cambodia, we cannot assume that everyone will. We promise not to try to convince anyone else to come who isn't already chomping at the bit to buy a ticket.
- And speaking of visits, the next month or so promises to be full of people returning to visit Siem Reap. Our friend Richard from London, who was my co-worker and our housemate for a few months last year is arriving later today. (Richard is here, and we are as thrilled as ever to have him.) Other friends and acquaintances are returning, among them our friends Mark and Nora, who were here for a few months and now live in Canada and Korea, who are coming on Christmas Eve for a week. My friend Karen, a Cambodia veteran whose company I enjoyed so thoroughly back in July will be back here in time to ring in the new year with us. And to top it all off, my dearest friend Miriam is coming to visit in early January. (Miriam came here with us in 2009, so she knows what she's getting into.) My hope is to work less and play more over the next few weeks and enjoy time with all these amazing and amusing people.
- Soon after the floods receded for good in Siem Reap, there was a huge fire just a couple of blocks from our house. There is an area along the river where people have built dozens of stilted houses perched over the water, living in the back and running small businesses in the front. They are all there illegally, and the government has been trying to move them out for a while, so when they started to go up in flames one night, there were lots of theories about how the fire may have started. As far as I know, there was no foul play and no one was hurt, but those people lost every single thing they owned and nothing was left of their houses but the charred remains of stilts reaching up out of the river. In a show of typical Cambodian resilience, people began rebuilding the very next day, and within a week, you could hardly tell what had happened there except for one spot where a charred pile of wood remained. One of the scary things about the fire was how well it illustrated the lack of emergency services here. There is no central fire department, and no 911 to call in case of emergency. When the fire started, people were posting on the Siem Reap Ex-Pat Facebook page asking how to call a fire department. When one department was called, they demanded $400 before they would even show up. Luckily, there is a very posh hotel quite close the fire and that place has its own fire truck, so they were quickly on the scene. It's amazing that even more houses didn't burn down, considering they're essentially made of dry kindling materials (bamboo, wood scraps, and thatch, for the most part) and packed in tightly together. I still don't know how to call a fire department, but our house is concrete and tile and there isn't much in it that could burn, so I don't worry too much.
- Speaking of emergencies and lack of services, there was another scary example of that sandwiched in between my last two trips to Phnom Penh. An American guy who had arrived in town about ten days earlier went missing one night when he was supposed to be riding a motorbike between Siem Reap town and an area about 25 minutes away. The guy he had been staying with (but had only known for a few days), Joel, started calling and looking around town for him. About 36 hours after his disappearance, he was found at the local government hospital, with an obviously serious head injury that they were completely unqualified to treat. He was found lying there with a IV of tylenol, barely able to be roused and unable to tell you his name or even what country he was in. I ended up spending several hours that day trying to help Joel figure out what should be done with him. The International Hospital was the obvious choice, except for the fact that all they would want to do would be to airlift him to Bangkok (at the cost of $10,000 or so), and we were pretty sure this guy had no insurance and probably not much money. We got him out of the government hospital as fast as we could, taking him to a private clinic for a rudimentary CT scan, and I started calling every doctor I know in town who might be able to offer advice, while Joel got busy calling the embassy. Many, many calls later, having cashed in a lot of favors and asking for help from a variety of sources, we arranged to take him to a hospital in Phnom Penh that most people agreed would be the best choice. The clinic that did the CT scan wanted us to pay $400 to hire an "ambulance" to take him there, but since an ambulance here has no equipment, no medicine, and no trained staff, we just hired a van to make the drive. Joel dropped everything he had going on here in town at his business and went along to Phnom Penh. When Joel came back to Siem Reap a few days later, I was getting ready to go to Phnom Penh for my next work trip, so I visited daily and brought food. (Hospitals here don't feed you, or do much else, for that matter.) While we were genuinely afraid for this guy's life in the beginning, he is recovering slowly but surely and is now back in Siem Reap. The interesting thing has been watching his brain function start to return, and without having known him at all before his accident, I have no idea whether the personality traits that are most obvious are pre-existing or still a function of his brain injury. I suppose time will tell. He is, without a doubt, an interesting guy. The lesson in all of this is that travel medical insurance is a good idea and no one should come here without it. (Don't worry; we have it.
- Probably the biggest news of the month is Jaz and Sovann's plan to leave Cambodia and go to Vermont. After an expensive eight-month process of applying for visas and filling out forms and collecting appropriate documents, Sovann was approved in early December for a visa. For those who don't know (as I didn't know just a few years ago), the US is very reluctant to grant even tourist visas to brown-skinned people from poor countries. Most Cambodians we know who have ever tried to get a tourist visa have been declined, even after paying exorbitant fees for the privilege of applying. Knowing all of this, Jaz and Sovann went another route and applied for a fiance visa, which means that for him to be able to stay in the US, they will need to get married within three months of arrival. While that's certainly not what we would have chosen for them to do if given any alternative, Jaz has always marched to the beat of her own drummer and found a way around the limitations that the world tries to place upon her, and this is yet another example. So off they go in February - February in Vermont! Poor Sovann. Despite countless conversations to prepare him for this weather shock (let alone culture shock) I can't imagine that he can really conjure up a clear picture of what he's in for. But an American visa is still the dream of many around the world, and this is his shot at it. Family and friends back home have been supportive and welcoming, and they have a place to stay (with my very generous aunt, Sara.) Jaz will transfer to UVM in time for summer semester, and Skyler is working on finding Sovann restaurant work as soon as he can get his green card and is legal to work. While he waits for that legal work status, I'm hoping someone will teach him how to use a snow shovel and a dishwasher so he can make himself useful around Sara's house. (He certainly can cook - he made an excellent French onion soup last night!) To those back home, I ask you to please make him feel welcome and buy him some long underwear and some rice...
- That will leave Steve and me here all on our own for the first time, which means we're starting to plan our next trip home, probably in June. It will be strange to be here without Jaz, and without Sovann - they've both been a huge part of our lives here. In preparation, I'm starting to learn how to deal with some of the details of everyday life that Sovann has always taken care of for us - how to buy the giant bottles of water and transport it home on my motorbike, how to call the gas company to bring over a new tank when ours runs out, etc. We'll figure all that stuff out, I'm sure, but we will miss them terribly.
- We miss everyone at home, some days more than others. People often ask us, "How long will you stay in Cambodia?" We get the question from local people here and also from family and friends at home, and it's odd not to have a definitive answer. When we first hatched the plan to come to Cambodia, we planned to stay "a year, maybe longer." That quickly morphed into "a year or two, maybe longer." Now I answer by saying, "We'll stay as long as it works for us, and when there's a reason to go home, we will." But what will the reason be? When we run out of money? When our kids start having kids and we can't bear to be so far away? When the everyday annoyances and frustrations of life here overwhelm the sense of privilege of being here? When we no longer feel we have something to offer and contribute here? I think that having at least one of our kids around has been a part of the equation of what works about being here, even if we missed the other three so much. When they're all half a world away, then what? Living abroad (and maybe particularly in a developing country) requires asking questions of oneself about motivation and priorities and purpose on a regular basis. There are so many things about living here that are delightful and interesting and affordable and satisfying, and there are also so many day-to-day challenges and frustrations and unmet longings for familiar friend and family and food. I try to remember that quote I love so much, and just try to live the questions and wait for the answers to reveal themselves in due time. (And what the hell would we do if we went home? I'm pretty sure I would have to give up afternoon naps and get a real job...)
- I know there was much more than this that I wanted to say when I started writing this entry a week ago, but if I wait until I remember it all, I'll never post anything. That probably wouldn't be such a terrible thing, except that occasionally I get reminders from people that they're awaiting the next blog entry, and I hate to disappoint. I still have multiple half-finished blog entries and random scraps of paper with prompts for things I intend to write about - everything from exorcisms to Khmer body-building extravaganzas - and maybe someday I'll get to those. Or maybe (if you're just dying for an excuse to buy a plane ticket) you should just come over here and hear about them in person. We could show you a good time. :)
(And I know, photos are long overdue. I'll get to it, I promise.)
Thursday, November 10, 2011
I wish someone had been there to see this
Being a visiting nurse is what I did for a long time before I came here, so it feels familiar and comfortable.
And I like familiar and comfortable, because so often in my life here, I'm not sure of things. I know what I would do back home, or I know what my past experience tells me makes sense, but this isn't back home and often things that make sense there don't make sense here. So even in that familiar role as a visiting nurse, there are countless challenges and moments of confusion and doubt.
But some things are clear. When a child who has had surgery needs her bandages changed every couple of days, that's pretty straight-forward. There is room for improvisation within the general principles of what should be done, but there are those general principles, and they seem clear and obvious and without need for cultural considerations. Take off the old bandages, clean the wound, put on the new bandages. A simple, technical task.
Back in in my VNA days, we all entertained ourselves and each other with tales of odd things that would happen in home visits. Everyone had stories of challenging situations, surreal environments, and general WTF moments. I have my share of stories. And now I can add to them. Here was my "only in Cambodia" moment of the week:
I went with the translator to the home of one of our kids who had surgery last week. The first thing that caught my attention was his announcement that the girl would be at home waiting for us, but her parents wouldn't be there because they were out harvesting their rice crop. Which doesn't sound so odd, except when you realize that this meant she was home alone all day, unable to walk or move around. No neighbor or grandma standing by to take care of her or bring her food and drink or carry her somewhere when she had to pee.
So we arrived that morning, and there she was, under the stilted house, lying on something that looks sort of like a very rustic dining room table, cobbled together out of random boards and bits of bamboo, with a few stray nails poking out here and there. I was relieved to see that she wasn't exactly alone: there were half a dozen other kids crowded around, admiring her new markers and coloring book from her hospital adventure. The kids all stared at me, as kids here so often do, particularly out in the countryside. A few smiled in response to my greeting, but some just stared open-mouthed.
Our little patient was looking quite comfortable, but a bit dirtier than than when I had seen her 48 hours earlier. Both of her feet and ankles were still bandaged, but the outer layer, which was once white, was a serious shade of dirt. It was hard to imagine how it got that dirty so fast, especially since she can't move around at all, but then I saw that her legs were resting on a pillow that looked like it had never been washed in all its years of existence. But she actually had a pillow, which is a bit of a luxury item, so all was good.
I went about setting up the supplies for the dressing change. This means pulling out all the gauze and scissors and tape and irrigating solution and gloves that I might need and laying them out on a clean surface where they were easily accessible. I had brought one of our clean bathroom towels just for this purpose, and in a couple of minutes, everything was arranged and ready to go. I put on gloves and started to unwrap the bandages from her feet.
At this point, a scrawny but very energetic chicken appeared from over my left shoulder, flapping and squawking and landing right in the middle of my supplies, sending a flurry of gauze and paper and gloves and saline flying in all directions.
In my previous life, I learned to make sure that a client's dog or cat wasn't in the room when I did dressing changes. I figured out how to change a C-section dressing while a mother was nursing her newborn. I've worked where the lighting is poor or the room is cramped or a nervous parent was watching. I know how to handle a variety of situations. But nothing in my past experience had suggested I needed to chicken-proof my plan.
Oh well. All in a day's work.
I just wish someone who could appreciate the situation had been there to witness it - because, of course, no one who was actually there even batted an eyelash.
And I like familiar and comfortable, because so often in my life here, I'm not sure of things. I know what I would do back home, or I know what my past experience tells me makes sense, but this isn't back home and often things that make sense there don't make sense here. So even in that familiar role as a visiting nurse, there are countless challenges and moments of confusion and doubt.
But some things are clear. When a child who has had surgery needs her bandages changed every couple of days, that's pretty straight-forward. There is room for improvisation within the general principles of what should be done, but there are those general principles, and they seem clear and obvious and without need for cultural considerations. Take off the old bandages, clean the wound, put on the new bandages. A simple, technical task.
Back in in my VNA days, we all entertained ourselves and each other with tales of odd things that would happen in home visits. Everyone had stories of challenging situations, surreal environments, and general WTF moments. I have my share of stories. And now I can add to them. Here was my "only in Cambodia" moment of the week:
I went with the translator to the home of one of our kids who had surgery last week. The first thing that caught my attention was his announcement that the girl would be at home waiting for us, but her parents wouldn't be there because they were out harvesting their rice crop. Which doesn't sound so odd, except when you realize that this meant she was home alone all day, unable to walk or move around. No neighbor or grandma standing by to take care of her or bring her food and drink or carry her somewhere when she had to pee.
So we arrived that morning, and there she was, under the stilted house, lying on something that looks sort of like a very rustic dining room table, cobbled together out of random boards and bits of bamboo, with a few stray nails poking out here and there. I was relieved to see that she wasn't exactly alone: there were half a dozen other kids crowded around, admiring her new markers and coloring book from her hospital adventure. The kids all stared at me, as kids here so often do, particularly out in the countryside. A few smiled in response to my greeting, but some just stared open-mouthed.
Our little patient was looking quite comfortable, but a bit dirtier than than when I had seen her 48 hours earlier. Both of her feet and ankles were still bandaged, but the outer layer, which was once white, was a serious shade of dirt. It was hard to imagine how it got that dirty so fast, especially since she can't move around at all, but then I saw that her legs were resting on a pillow that looked like it had never been washed in all its years of existence. But she actually had a pillow, which is a bit of a luxury item, so all was good.
I went about setting up the supplies for the dressing change. This means pulling out all the gauze and scissors and tape and irrigating solution and gloves that I might need and laying them out on a clean surface where they were easily accessible. I had brought one of our clean bathroom towels just for this purpose, and in a couple of minutes, everything was arranged and ready to go. I put on gloves and started to unwrap the bandages from her feet.
At this point, a scrawny but very energetic chicken appeared from over my left shoulder, flapping and squawking and landing right in the middle of my supplies, sending a flurry of gauze and paper and gloves and saline flying in all directions.
In my previous life, I learned to make sure that a client's dog or cat wasn't in the room when I did dressing changes. I figured out how to change a C-section dressing while a mother was nursing her newborn. I've worked where the lighting is poor or the room is cramped or a nervous parent was watching. I know how to handle a variety of situations. But nothing in my past experience had suggested I needed to chicken-proof my plan.
Oh well. All in a day's work.
I just wish someone who could appreciate the situation had been there to witness it - because, of course, no one who was actually there even batted an eyelash.
Sunday, October 30, 2011
I am only one, but still I am one.
I just spent a week in Phnom Penh. I was supposed to be there for three days, but this is Cambodia after all, and the ability to be flexible is a survival skill. Also, the whole reason for being there was to bring a couple of kids for surgery, and since I may have mentioned already how messed up the medical system is, it shouldn’t be surprising that things took longer than expected.
Aside from the medical component, a week in Phnom Penh meant that in my free time I had dinner with one friend, went to Cambodia’s only movie theater with another friend, and spent a lot of time on the back of motos criss-crossing the city as I went between my hotel and the hospital. Arrangements had been made for me to stay at a guesthouse very close to the hospital, but considering that place rents their rooms by the hour, and was lacking a few basic amenities like toilet paper and clean surfaces of any kind, I high-tailed it out of there after the first night. All those moto rides were like a crazy game of chicken – traffic in PP moves much faster, the streets are wider, but the same (lack of) road rules apply. Also, many drivers don’t speak a word of English, so I often had to do my own navigating, clutching my map in one hand and the bike seat with the other, announcing where we had to turn right or left. I especially loved the grizzled old driver who got sick of the traffic jams and just drove right up on the sidewalk.
The plan had been to bring two Safe Haven children to a hospital in Phnom Penh for orthopedic surgery. They had been seen there in July, and were told to return on October 24 for surgery, which of course got delayed to the 25th and 27th. I will say that the children were lucky to have excellent surgeons who were there there visiting from Oxford – a plastic surgeon and a trauma surgeon – and those docs welcomed me and allowed me to spend a lot of time in the OR watching all kinds of surgeries. It was like watching a Discovery Channel medical documentary live and in person, and I circulated between the three operating tables in the one crowded OR. Our kids’ surgeries went well, though they face more in the future, but at least they’re off to a good start.
After our horrific experience at the local government hospital last week when Sovann’s father died, it was encouraging to see that medical care can look better than that. Visiting surgeons were training the local staff, and the Khmer surgeons looked quite skilled in comparison to any other Khmer doctors I’ve seen in action so far. However, the whole hospital experience is still a far cry from a Western experience.
As I mentioned, there is one operating room with up to three surgeries happening simultaneously.While crowded, this room looks pretty modern, and sterile technique is observed as it should be. (Heck, there was even running water in the scrub sink, which is more than you can say for the hospital here in Siem Reap!) Outside of the OR is a treatment/recovery room with four gurneys squeezed side by side and absolutely no privacy of any kind. Patients come in here about 15 minutes before surgery to get an IV started and get their clothes removed. They also come into this room to get dressings changed in the days following surgery, and this is also where they come when their surgery is finished so they can be monitored for a few minutes as they come out of anesthesia. So imagine small children, who are already terrified of their impending surgery (as are their parents), coming in here and watching bloody bandages being changed, listening to other children scream and moan, and seeing fresh amputations and burns being unwrapped and re-dressed.
While it’s a children’s hospital, there were actually plenty of adult patients. One woman has been there for many weeks – she was the victim of an acid attack which burned away most of her face and a good part of the skin on her torso and arms. There were patients with injuries and problems old and new – people with deformities from birth or as the result of traffic or other accidents, children with old untreated burns that left disfiguring and debilitating scars, kids with untreated club feet having their bones cut apart and pinned back together in new configurations, adults with tumors left to grow to the size of watermelons before seeking medical attention. For someone who is squeamish, it would be an absolute nightmare. Luckily, I’m not squeamish, but I still saw people with conditions that are hard to imagine living with. And the fact that there is no privacy for these patients and no attempt to protect other patients – even children – from seeing all of this was almost as hard to take in as the problems themselves.
Outside of that room is yet another larger room which is the post-surgical ward for those still needing daily attention of some kind. This room had close to 20 beds with barely enough room to walk between or around them, and sometimes more than one patient in a bed. (And by “bed” I mean a frame with a vinyl-covered mattress. No sheets, no privacy curtains, often no pillow, definitely no call bell for a nurse.) Each patient needs a family member present at all times to take them to the bathroom or bring them a bucket, to go out and buy them some food, to hold on to and dispense the medicine that the nurses give out once a day (when they remember.) Family members sit up all night propped against the bed, or if they’re lucky, they find a spot on the dirty floor under the bed in which they can stretch out on the bare concrete. The room smells like blood and sweat and tears and other unidentified body fluids. Children cry and are sometimes scolded by their parents for being too noisy. One man who was trying to sleep offered one of our kids the equivalent of $2 to shut up in the middle of the night when he was crying because he hadn’t had any pain medication in far too long.
Parents are given medications in a small plastic bag and told how often to give it to their kids. They don’t know what the medicine is for, and they often don’t understand the instructions. Telling someone to give something “every six hours” isn’t very helpful if they can’t tell time and don’t have a watch. No one checks in to see if the parents have given the medicine correctly, but if they figure out that they’ve done it wrong, they’re very quick to chastise them for it. If a parent runs out of medicine, they’re far too scared to ask the staff if they should be given more. Pain control is not a priority, and since my role, in part, was to be an advocate for our kids, I quickly became a thorn in the nurses’ sides, no matter how respectfully and politely I asked questions. One nurse was reasonable and approachable, and the other refused to acknowledge me after the second day, literally ignoring me even when I greeted her in the morning in the most respectful way possible. After day three or four, I gave up and went out and bought the same medicine that the nurses were occasionally dispensing and just gave it to the kids myself. The nurses never seemed to notice and never dispensed any medicine again once we stopped asking for it.
The uncomfortable thing about this was that besides our two kids, there were those other 20 or so patients in that post-op ward. (Sometimes there was more than one patient in a bed, if the patients were small enough.) They saw me as “staff” and sometimes asked for help, and there was little I could do but lead them to the nursing staff and say, “I think this patient needs to talk to you.” There was nothing for patients to do but lie there and stare at the ceiling. Occasionally, a small TV mounted in a cage on the wall was turned on and people could watch karaoke videos or wrestling, if they were lucky enough to be able to see the screen through the chaos. We brought paper and markers and coloring books and a few toys for our kids, and found things to prop them up with, and encouraged their parents to get them drinks and food. At one point, in sheer desperation, I pulled out my iPad and let them watch a few Pixar short movies as a distraction, and soon their shared bed had a crowd of other patients and family members watching as well, laughing and pointing and enjoying the show.
One of our kids was born with club feet, a not-so-uncommon deformity that can usually be easily remedied as an infant by wearing a series of casts for a few months. This girl had had some casts put on as a baby, but when her parents had no money to return to the hospital in Siem Reap (this means they lacked $1.50 for moto fare), the treatment ended. Now eight years old, this girl has been walking on the outer edge of her feet and ankles her whole life, and she’s only one of thousands in this country in this condition – maybe tens of thousands? So for lack of a few dollars in moto fare and lack of understanding about what this would mean long-term, this girl now faces multiple painful orthopedic surgeries. – and she’s one of the lucky ones who will actually get help. Thankfully, the treatment at this hospital is free, but the cost to bring the family here and coordinate the care and do the follow-up visits so that she heals appropriately isn’t cheap – just the transportations costs alone run in the hundreds of dollars.
As with any organization, communication is a challenge. As I already said, the visiting surgeons were great at what they do, but they’re busy in the OR all day and the communication with the local staff was difficult even for them. Because I was talking with the surgeons often, I knew what they intended to have happen in terms of frequency of dressing changes and timing for a cast to be put on, and I often had to run interference when the Khmer staff attempted to do something completely different than was asked. (I guess this explains why I was not so popular with them at times.) Discharge and follow-up plans changed hour-by-hour depending on who I talked to, and I finally asked the visiting docs exactly what they wanted and then stopped caring what the local staff thought of me and relayed the plan to them as an “order.” If I hadn’t, I think we would still be there, wondering what was happening and going to happen, listening to kids crying in pain and fear, and sitting in that awful ward sweating and being pissed off. And that’s exactly what some patients are still doing right now, and that pains me to think about.
Eventually, our kids were discharged from the hospital and we brought them back to Siem Reap to stay in a guest house for a couple of days. They both live outside of town and it’s easier (and cheaper) to keep them close by for a little while rather than have me spend all day driving to go see them at home. They looked so much happier and so much more comfortable, stretched out on beds with sheets and pillows, watching TV. (Not that they have beds or sheets or pillows or TV at home...) They were getting appropriate pain medications every 4-5 hours, thanks to my wonderful Khmer project manager who was calling the parents every time they needed to give the kids their next dose, and I could change the dressings for the girl who needed it without her wailing and grimacing in agony. I am in my element, being a visiting nurse, and this makes me feel useful at least to these children.
But what about the others? What about the ones who never get any medical attention? Or the ones who do, but who don’t have someone in their corner advocating for pain control and appropriate follow-up? What about those who don’t have an NGO with a nurse and a PT who will provide what they need after they go home, if they are even lucky enough to get the care they need in that terrifying environment? How does one effect change in a broken system of care...?
And who am I to think I know what can work better? People here are doing the best they can, and the constant dilemma is this: What is good enough? What are culturally appropriate expectations? How do you help a country in which most of the adults have some degree of PTSD to understand that it’s not OK to "joke" with a 7-year-old kid that the remedy for their completely treatable foot abscess is cut off their leg? (Haha-fucking-ha.) I’ve seen this exact scenario more than once, even among Khmer staff who have had a lot of training from Western doctors.
Some things are cultural differences that deserve respect and understanding. Some things are just wrong. Telling a kid you need to cut off their leg when you don’t need to do any such thing is just wrong. How do you change that? How do I make myself useful in those conditions? Is it good enough that I might help a small handful of kids have a slightly better experience than they would have had without my intervention?
These are the same questions I asked myself over the years working in Maternal Child Health at the VNA. I console myself with this Helen Keller quote:
“I am only one, but still I am one.
I cannot do everything, but still I can do something;
and because I cannot do everything,
I will not refuse to do the something that I can do.”
All I know how to do is to be my little tiny drop in the bucket. I can make sure two kids have reasonable post-op pain control. I can bring them something to distract them from their distress. I can tell their parents that they are doing a good job when that is true, and I can help them to do better when that’s possible. I can tell doctors not to scare children with jokes about amputation.
There are a few things I can do - I can help someone pay for their education, or finance for their father’s funeral, or practice their English. But I can't do everything. I am only one, but I cannot refuse to do the something I can do. Because as much as I support the current cultural upheaval in our Western world, I am still part of the 1% as far as the big picture goes. What can I do?
What can you do?
Sunday, October 23, 2011
Goodbye, my friend
Sovann's father, Sambath, died yesterday morning in the local government hospital after 12 hours of needless pain and suffering. Many things in this country are broken - the healthcare system, the education system, the government - and now the hearts of his family and friends are broken as well.
He was my friend, if it's fair to call someone a friend even if you have no common language. I spent time at Sovann's family home several times, and I was always treated as an honored guest. The whole family has been extraordinarily gracious every time I visited, and it has always been a privilege to have a glimpse into their everyday life in the countryside. Sambath and I could only speak with the help of Sovann or his brother-in-law translating for us, and we didn't even know each other's actual names until my last visit in September. He had asked me to call him "brother" and he always called me "sister."
He was born around 1958, which meant he was a teenager when the Khmer Rouge came into power. At some point he was shot while trying to cross the Thai border. His life wasn't easy.
His arms were covered with magic tattoos to protect him.
He had seven children, five sons and two daughters. He and his wife, Chandy, farmed a piece of land in Battambang Province, growing vegetables and then converting the land into an orange farm. In recent years, they bought a generator and ran a family business charging car batteries for people in their village, where there is no electricity. (Thanks to him, I know now that you can even charge an iPad from a car battery.)
Sambath was a man of traditional values. He drank a lot of tea and smoked a lot of cigarettes. Though his wife banned alcohol at home, he was known to sneak off and buy a case of beer on important holidays, sharing it with his children and friends behind the house while his wife carefully ignored them all. When Chandy became a traditional spiritual healer a few years ago, he supported her work with enthusiasm. He was known for having long serious talks with his children, who listened attentively and with respect.
His final hours were difficult and he died less than 24 hours after first feeling ill. His wife and most of his children were at his bedside throughout the ordeal, trying to make him comfortable and trying to get a doctor to help him. Due to the unimaginable inadequacies of the Cambodian medical system, there was no help to be had, nor any compassion or kindness. His family was left to carry his body to a van for the long drive home to Battambang. A day-long funeral ceremony and cremation followed within hours, as is custom.
Sambath, my brother and friend, you will be missed. Though our language differences meant that our conversations were limited, the language of kindness crosses all barriers, and your kindness to me will never be forgotten.
He was my friend, if it's fair to call someone a friend even if you have no common language. I spent time at Sovann's family home several times, and I was always treated as an honored guest. The whole family has been extraordinarily gracious every time I visited, and it has always been a privilege to have a glimpse into their everyday life in the countryside. Sambath and I could only speak with the help of Sovann or his brother-in-law translating for us, and we didn't even know each other's actual names until my last visit in September. He had asked me to call him "brother" and he always called me "sister."
He was born around 1958, which meant he was a teenager when the Khmer Rouge came into power. At some point he was shot while trying to cross the Thai border. His life wasn't easy.
His arms were covered with magic tattoos to protect him.
He had seven children, five sons and two daughters. He and his wife, Chandy, farmed a piece of land in Battambang Province, growing vegetables and then converting the land into an orange farm. In recent years, they bought a generator and ran a family business charging car batteries for people in their village, where there is no electricity. (Thanks to him, I know now that you can even charge an iPad from a car battery.)
Sambath was a man of traditional values. He drank a lot of tea and smoked a lot of cigarettes. Though his wife banned alcohol at home, he was known to sneak off and buy a case of beer on important holidays, sharing it with his children and friends behind the house while his wife carefully ignored them all. When Chandy became a traditional spiritual healer a few years ago, he supported her work with enthusiasm. He was known for having long serious talks with his children, who listened attentively and with respect.
His final hours were difficult and he died less than 24 hours after first feeling ill. His wife and most of his children were at his bedside throughout the ordeal, trying to make him comfortable and trying to get a doctor to help him. Due to the unimaginable inadequacies of the Cambodian medical system, there was no help to be had, nor any compassion or kindness. His family was left to carry his body to a van for the long drive home to Battambang. A day-long funeral ceremony and cremation followed within hours, as is custom.
Sambath, my brother and friend, you will be missed. Though our language differences meant that our conversations were limited, the language of kindness crosses all barriers, and your kindness to me will never be forgotten.
Wednesday, October 12, 2011
A selfish post
Greetings, dear blog readers;
I write to you today, as usual, from Siem Reap, where the sun is shining and the water is just starting to recede a bit from the third (or is the fourth?) flood of the season. We're off on a little adventure to Phnom Penh this weekend to attend TEDx Phnom Penh, which should be interesting. We're all busy with work and school and sweeping and trying to keep our feet dry, and life is generally very good.
I feel a little awkward about posting this particular entry, but I am motivated by the fact that from time to time, people ask if they can send us something to help out in our various endeavors. Steve knows a few former volunteers from Australia who have generously sent items for his classroom. Last year, in time for Christmas, our friend Miriam and her family sent a box of medical supplies. Our friend Alison and her kids came in February and fulfilled all kinds of wishes from our list at the time. You can't imagine the joy of receiving a box of stuff here - it's better than Christmas ever was, even as a kid! Since our friend Miriam is coming for a long-overdue visit sometime (probably) in December, and has reported that she will have room to bring things in her suitcase, I thought I would put the word out.
If you have ever thought about wanting to contribute something, but haven't been sure what to send or how to send it, I have created a solution. I spent some time on the Amazon.com website and made a "Wish List of things I can't get in Cambodia." (It totally reminded me of the hours I would spend as a kid pouring over the Miles Kimball catalog, making lists of items I lusted after.) If you want to spend $3 or $10 or $25 or anything at all, you may find something on that list that fits.
I have no expectations whatsoever here. I don't want anyone to feel any pressure or obligation or anything else unpleasant. This is really meant as an opportunity for those who have expressed interest in "doing something" and nothing more than that.
There are a number of medical and health-related items on the list, which are my top priorities. These can be used in both of my jobs and also in my "freelance" nursing role here in town. Most prescription drugs are available here cheaply over the counter, but other things are impossible to find or enormously expensive.
There are also arts & crafts items on the list that can be used by the girls at the shelter. I don't write about the girls that often, in part out of respect for their privacy, but at any given time there are between 5-20 girls age 5-17 years old who are studying and recovering and getting counselling and preparing for the next stage of their lives, and nothing makes them happier than creating something - and I think it's therapeutic as well.
(I must confess that there are a few selfish items on the list. Feel free to ignore them, but I couldn't resist the urge to include a couple of things we could use around the house. They are lowest on the priority list for sure.)
So if you're interested in "doing something," take a look at the list at this link. You will be able to see my comments and priorities on the right side of the page. You can sort by price or by priority. You can have the items sent directly to my friend Miriam's address, avoiding any troublesome logistics. Many of the items listed are just examples of things needed and you can easily substitute something else bought locally - or better yet, if you happen to have something already lying around the house unused, send that. I guess that idea works better for some things than others - a used blood glucose monitor is a fine idea, but maybe used rubber gloves are not...
Have questions? Ask me. Have something else in mind that you want to send along? Just ask me to make sure it's a good use of Miriam's suitcase space - you can never predict what is and isn't available here, and some things are dirt cheap. And if there's something you'd like from Cambodia, I bet Miriam will have suitcase space on the way back too. Just ask me!
I'm sorry I can't offer you a tax deduction for any contribution you make, but I promise that anything sent will go to the best possible use and I'll be able to tell you all about how amazingly helpful it is.
In the meantime, I am missing my friends and family and Vermont foliage, but feel honored to be able to be here trying to do my small part in the world. Perhaps our next trip home to Vermont will be for yet another wedding, as Skyler has just proposed to his wonderful girlfriend Jenny and there is another wedding in this family's future!
With heartfelt gratitude and warmest regards,
Jess
I write to you today, as usual, from Siem Reap, where the sun is shining and the water is just starting to recede a bit from the third (or is the fourth?) flood of the season. We're off on a little adventure to Phnom Penh this weekend to attend TEDx Phnom Penh, which should be interesting. We're all busy with work and school and sweeping and trying to keep our feet dry, and life is generally very good.
I feel a little awkward about posting this particular entry, but I am motivated by the fact that from time to time, people ask if they can send us something to help out in our various endeavors. Steve knows a few former volunteers from Australia who have generously sent items for his classroom. Last year, in time for Christmas, our friend Miriam and her family sent a box of medical supplies. Our friend Alison and her kids came in February and fulfilled all kinds of wishes from our list at the time. You can't imagine the joy of receiving a box of stuff here - it's better than Christmas ever was, even as a kid! Since our friend Miriam is coming for a long-overdue visit sometime (probably) in December, and has reported that she will have room to bring things in her suitcase, I thought I would put the word out.
If you have ever thought about wanting to contribute something, but haven't been sure what to send or how to send it, I have created a solution. I spent some time on the Amazon.com website and made a "Wish List of things I can't get in Cambodia." (It totally reminded me of the hours I would spend as a kid pouring over the Miles Kimball catalog, making lists of items I lusted after.) If you want to spend $3 or $10 or $25 or anything at all, you may find something on that list that fits.
I have no expectations whatsoever here. I don't want anyone to feel any pressure or obligation or anything else unpleasant. This is really meant as an opportunity for those who have expressed interest in "doing something" and nothing more than that.
There are a number of medical and health-related items on the list, which are my top priorities. These can be used in both of my jobs and also in my "freelance" nursing role here in town. Most prescription drugs are available here cheaply over the counter, but other things are impossible to find or enormously expensive.
 |
| I love doctors with "skills." I once saw a sign for a doctor who advertised "Using real otoscope." My best advice: Don't get sick here. |
There are also arts & crafts items on the list that can be used by the girls at the shelter. I don't write about the girls that often, in part out of respect for their privacy, but at any given time there are between 5-20 girls age 5-17 years old who are studying and recovering and getting counselling and preparing for the next stage of their lives, and nothing makes them happier than creating something - and I think it's therapeutic as well.
 |
| They make the most amazing things with just colored paper, but imagine what they could make with other stuff...! |
(I must confess that there are a few selfish items on the list. Feel free to ignore them, but I couldn't resist the urge to include a couple of things we could use around the house. They are lowest on the priority list for sure.)
 |
| Sometimes, you just want a little familiar tea for your sore throat. |
Have questions? Ask me. Have something else in mind that you want to send along? Just ask me to make sure it's a good use of Miriam's suitcase space - you can never predict what is and isn't available here, and some things are dirt cheap. And if there's something you'd like from Cambodia, I bet Miriam will have suitcase space on the way back too. Just ask me!
I'm sorry I can't offer you a tax deduction for any contribution you make, but I promise that anything sent will go to the best possible use and I'll be able to tell you all about how amazingly helpful it is.
In the meantime, I am missing my friends and family and Vermont foliage, but feel honored to be able to be here trying to do my small part in the world. Perhaps our next trip home to Vermont will be for yet another wedding, as Skyler has just proposed to his wonderful girlfriend Jenny and there is another wedding in this family's future!
With heartfelt gratitude and warmest regards,
Jess
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