This past Sunday, we spent our time with a friend known by our daughter as "the entrepreneur." It was a family occasion, with two of her sisters, her mother, a cousin, one brother-in-law, and nieces and nephews. The two sisters own what I would call makeshift restaurants next to each other on the road to Angkor Wat, less than a kilometer short of the monument. The restaurants are little more than covered platforms over the water on the side of the road, held up by logs with bamboo slits for a floor and thatch for a roof. Had it rained, it would have kept us dry. They could not have been expensive to build.
Both restaurants provide hammocks for guests. Cambodians seem to love hammocks. They use them as a chair, with both feet on the floor on the same side or on opposite sides, or they place one foot on the floor to push back and forth while the other is doubled under. Or they have both feet in the hammock either crossed or stretched out above, which is great for the hamstrings, I found. Since you are elevated in a net when lying down in one of these hammocks, whatever breeze may be blowing pretty much cools all of you, over and under. Despite the heat of a Cambodian day, the breeze blowing off the nearby rice paddies feels delightful and is conducive to taking a nap. Taking a nap is of course the best thing to do in a hammock. Taking a nap in the morning, before lunch, is an unparalleled treat available only to the retired. Please: Don’t try this at work.
We ate lunch there on mats spread on the bamboo floor. The kitchen was out back, about twenty feet down a little trail, in a covered shack with three burners, two of them wood and one gas. Only the gas burner was lit before lunch when I was in the kitchen. Two large coolers kept food refrigerated. The ice in the coolers is purchased from an ice distributor who carries it around town in a truck, cuts it with a large saw, and sells you whatever size piece you want. (If you were in Thailand with me back in the day, you will remember this.) In this small, sparsely furnished kitchen, the cook made for us stir-fried vegetables, pork curry, fried fish, steamed shrimp, Vietnamese pancakes (called banh xeow in Vietnamese and banh chheav in Khmer), Vietnamese pork meatballs, large trays of fresh vegetables (lettuce, cabbage, green tomatoes, cucumber) to go with the pancakes and meatballs, prahok (the indescribable national dish of Cambodia), and rice. It was good, and the setting was good, and being included in their family gathering was good.
There is a hospital here, however, and I want to start talking about it. My first official act was to teach three English classes last week.
While Cambodian hospital staff speak Cambodian to each other, the Angkor Hospital for Children (AHC) has lots of English-speaking visitors. Any number of doctors and nurses and people with other useful skills visit for short or long periods of time to provide either general or specialized services to augment what the Cambodian staff provides. Thus the common language that everyone needs to know is English. In addition, the internet is a useful source of medical information that is available to the doctors and nurses in English but not in Khmer.
The hospital provides English classes on a regular basis at several levels of difficulty. While staff sign up for classes appropriate for their level, anyone at the hospital, no matter how much or how little English they know, can attend any English class they want. Sometimes people with little training come to an advanced class, or more advanced people attend a less advanced class for a refresher. This makes the classes somewhat mixed in terms of their skill level. I assume this laissez faire policy is meant to encourage staff members to come to class whenever they have time, even if it is not appropriate for their level of training.
There are two things, however, that tend to make the students homogeneous despite their different levels of familiarity with English. One is the reticence of most students at any level to participate actively in class. Cambodians are not the sort who strain to get your attention so they can answer a question in class. (Everyone who grew up in America remembers little Becky who always had the answer and wanted to be the first to let the teacher know it. The rest of us hated little Becky.) No, Cambodians are reserved, and the teacher normally has to drag answers out of them. Moreover, anyone who fails to understand is not likely to let the teacher know.
The second thing is that the books available for teaching English as a second language are based on foreign settings and foreign cultural norms. As an example, one lesson I taught included a short newspaper story about a vicar who finally passed his driving test after 17 years, 622 lessons costing over 9000 British pounds, and 56 tests. He was finally able to go visit his parishioners who lived in the villages outside town.
Very little of this story was intelligible to any of the students, starting with headline: "Here Endeth the Lessons." Then there is the vicar. What is a vicar? You have to go into a long-winded explanation of vicars and monks and how they are different because the religions are different, and you know the students are not following you. Then there is the matter of driver’s licenses and lessons and tests. Why would a vicar drive anyway? What is that all about? And visiting parishioners? Without being invited to perform a ceremony of some kind? None of it fits the Cambodian cultural context, and that just makes it more difficult.
I also accompanied a nurse making home visits on Friday afternoon. The hospital now makes home visits to about 160 patients who need follow-up after hospital visits. There are five home-visit nurses and two vehicles to carry them. They try to visit most of these patients twice a month, some once a month. Friday afternoon’s visits were to patients who live south of Siem Reap toward the landing for boats traveling back and forth across the Tonle Sap between Siem Reap and Phnom Penh. The boy in the middle of the first picture, the one who looks completely forlorn, was the first patient. He has an immune deficiency and is being taken care of by his aunt, in the background on the left. His aunt is doing a good job of caring for him, giving him antiretroviral medications on schedule. He appears to be doing well. I understand that the medications are provided by the US Agency for International Development (USAID) through CARE to the hospital.
The other children gathered around exemplify Cambodian curiosity. Wherever the nurse visits, a small crowd gathers. In this case, it is only children because, I think, we are on the porch of a house that is separate from other houses and adults would have to climb up a stairway and be really nosy in order to listen in.
I might mention that HIV/AIDS is one of the ten most frequently encountered problems at Angkor Hospital for Children. Cambodia has the highest HIV/AIDS rate in Asia: 1.9% of the population or 123,000 cases by the most recent estimate. You will be pleased to know that USAID has just signed an agreement with Cambodia to provide $30 million for HIV/AIDS, infectious diseases, child health care, health systems, and upgrading the technical skills of Cambodian health care workers. I would imagine that AHC will receive some of that money because of its participation in the public health care system and its role as a teaching hospital.
The second patient is shown in the next picture with her grandmother and the AHC nurse. Her mother is out of the picture on the right. All the "gold" that appears in the background is misleading; they live in a tiny bamboo shack about two feet off the ground surrounded by other similar shacks. Consequently a small crowd of adults gathered to listen and watch. Nothing is private here, it seems.
The nurse, on the left, spoke mainly to the mother, but the mother-in-law, who looked rather fierce, gave me the impression that she makes most of the decisions in that tiny household. Both the little girl and her slightly bigger brother are suffering from malnutrition. When breast feeding was insufficient, the family turned to sweetened condensed milk, because they could afford it, rather than formula, which they could not afford. The sweetened condensed milk did not provide needed nutrition, and children as young as they were at the time should not have cow’s milk anyway. Hence the malnutrition. By the way, malnutrition is another of the ten most treated maladies at AHC.
The boy had four or five marks on his tummy. I asked the nurse what they were and he said they were burn marks. He said that Cambodian folk medicine recommended burning as a healing agent. AHC nurses tell the mother and grandmother at every visit that burning doesn’t work and can cause serious infections. These two children represent another example of the effect of ignorance and poverty on health care.
I hope to make home visits a regular part of my stay at Angkor Hospital for Children for the insights they give me about health care here.
Finally, I have a picture of Nida Villa so you can see the impenetrable jungle, mysterious ancient monuments, and wild beasts that surround us. We’ll clear a trail for ya.
Please note that I have links above to Angkor Hospital for Children, the Cambodian embassy in Washington, the CIA Factbook on Cambodia, and the Peace Corps, if any of you would like to see what information may be there. Peace Corps is coming to Cambodia in 2007!
