Phnom Penh 2007 (2)

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2007 Trip: Getting ready, Hong Kong, Burma, Thailand, Phnom Penh (1) & Phnom Penh (2), Luang Prabang

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Phnom Penh - 3rd week
Phnom Penh, Cambodia
Jun 23, 2007  05:42 ( local time )

From Leslie


Hello All,

I just want to send an update while I have a computer to use. The laptop I have in my office is on the blink and the IT Dept. is way slow to respond (it's Friday and I made my report last Monday, rats!). Photo: at front gate


All is well here. Charles is teaching 2 or 3 times a week for 2 hours per session both with the nursing staff in the hospital and those in the HIV/AIDS treatment facility. The incidence of AIDS here is extraordinarily high and mostly transmitted through heterosexual contact so there are many infected babies and children as well. It seems that so many men must leave their hometowns to work in the city to provide for their families and are gone for long stretches of time. So they "visit" prostitutes, then return home and the rest, as they say, is history. There are big educational and treatment programs here that seem to be working (the new anti-retroviral drugs are truly a miracle and are widely available, it seems) so that's positive. But I'm telling you, to be really ill or terminally ill in a place this poor is rugged. The patients in the AIDS hospital have no air conditioning of course and sleep on the still popular wooden platforms so comfort is not a major consideration but there isn't money enough to change that. Family members often provide the care for their ill relatives but the care provided by staff seems to be good. As is still common in the States, there is a struggle to get the doctors to manage pain adequately and so the nurses really agonize about the suffering (some unnecessary) that the patients endure. Charles is working with a German doctor who attended Harvard to do some training with the Hospice doctors re pain management so maybe that will help.

The level of education brought here by foreign doctors and nurses is beyond impressive. The lead Surgeon who is from Switzerland is already an MD with a surgery specialty who is in the last semester of her Masters Degree in Public Health; the German doctor is an Internist, Harvard grad with postgraduate training in Infectious Disease funded by Brown University who has been accepted at Tufts in Boston for a 3 year program specializing in Infectious Disease which will begin in 2008. Another Belgian internist has been accepted by the London University School of Tropical Disease, the premier school on the world for that subject. All are receiving large salaries to continue their studies so don't incur any debt and can afford to live in Boston, London, etc. And then the local staff are trained by those returning so it's a great teaching resource. Photo: from far right trash, washed nebs, mop, neb masks, washed trash baskets, neb hoses and below, bedpans


I have been successful at funding a scholarship for the grand daughter of the family that has been so wonderful to David and with whom we've stayed this month. Mony(her name) took the entrance exam at the private school selected by her grandfather and scored extremely well- she may skip level 8 altogether but I hope they'll reconsider about that as she is already the youngest in level 7 so will just continue getting younger if they proceed this way. Still, she is so excited and it's a pleasure to be able to do this for the family. And I consider it an investment in Cambodia if I can help produce a highly educated local who can take a place of responsibility in this society.


We (David is coming with us) will leave Cambodia in a week and go to northern Thailand where it's rumored to be cooler (read less that 90-+) where we'll stay for 4 days and then fly to Luang Prabang, Laos where it should be equally cool. We are meeting 2 friends of David's for UT Austin and Rice there for several days and then David will return to Phnom Penh and we fly to Hong Kong and then home. David is due to come home late in August but is considering a job with USAID for another year so we'll see. If he stays here that long, we will explore our own options but I'm trying not to borrow trouble. Maybe they won't select him!


Must go and get to work. Please share this with Dad and be sure to give him and Mildred my love.


Write when you have a chance. I don't think the odds are good for email in Laos so don't worry if I'm out of touch a few days.


I miss all of you and love you.



Rain, at last, rain. We’ve had two hot, dry weeks after starting out with rain every day in Hong Kong, Burma, and Thailand. In the middle of one still night in Bangkok I got up to go to the bathroom and through the open window overlooking the front of the house could hear the rain off in the distance coming closer and closer and I stood by the window listening and then it was raining hard into the window. Photo: IV on moto 
Today when we left work the skies were heavy with dark clouds. In a few blocks it was raining harder and harder – a huge storm and the electric in the van went out but it kept going and we were home in the downpour. Five hours later it was still coming down. For the first time since we left home, we’re truly cool. Night –Night.
Hak Nam – a place in the Walled City – Just finished Idoru for 3rd time.
Vanida flew in from BK via Luang Prabang today. She said she was coming in at 9am, but at breakfast Davie said the Air Asia flight BK-PP always comes in at 8, so I hurried away on a moto – which got lost and then the transmission started slipping so we crept along the side of the road and got to the airport after 9. Vanida was already outside. We got a tuk-tuk to the Okay Guesthouse (where David stayed for awhile). Her room was fine and after checking in we went for a walk along the river right above where the Tonle Sap River intersects with the mighty Mekong. We ended up at the National Museum – a beautiful building full of religious and cultural artifacts. Then we took a tuk-tuk to the Russian Market, walked around in the heat and then to where Leslie and I stay. We ended up back at the Okay, having a good lunch of curry, ginger chicken and spring rolls.

I came back to our room and we got dressed for part 1 of David’s birthday party. Sokhom, Juedi, Mony, and Sophea were dressed up and had had their hair done. We had classic Khmer curry (except less oil and fish sauce) with cool noodles, pickled vegetables, and French bread; then cake and fruit. At the table were Samnang, Leslie, David, Mony, and Sophea. Sophea sat next to me, which was nice, because she finally began talking some. Much of the dinner was filmed so there is a film record of my less than good hair blowing in the wind of the fan right behind me. That was just great. Photo: Vanida at museum 
The party ended with karaoke – the first time for Leslie (duet with Mony – “Oh Carol, I am but a fool. Darling I love you, though you treat me cruel”) and the first time for me (Hotel California with (air) guitars by 9 year old Sophea and 62 year old me). It was a great party.
After that party it was of to the Intercontinental Hotel where some of David’s friends came for part 2. It was an international gathering for sure:
o Jenny and her 17 year old daughter Jane are Chinese from Indonesia. They live at the hotel so that Jane will be safe while Jenny is working late or out of town.
o Andrea is a missionary from the U.S. and has been here for >3 years.
o Rith and Sophea are from Cambodia, both working in travel industry.
o David is Khmer-American.
o Leslie and I are from Texas.
o Ces is from the Philippines and works as an HIV/AIDS prevention consultant.
o Igor, Sheila, and Kial (short for Ezekial) are the band Blue Avenue – they play 6 nights a week at the hotel and live there as well. Good band, nice people.

It was another good time and everyone was very nice. I was touched by Jenny saying that their living situation was the best ever (since she and Jane started on their own >16 years ago) because of Igor, Sheila, and Kial, who have watched over and been friendly and kind to Jane. Photo: Ces, Igor, David at Art Cafe

Another day of showers and naps – simple pleasures for simple people. That night we had dinner with Dan, Elexa, and Cornelia. Dan is the new hospital director, Elexa is his wife and works in administration, and Cornelia is a surgeon from Switzerland. It was a warm and stimulating evening. Elexa came to the U.S. when she was 12, speaking no English. Her brother taught her to say, when she didn’t know what the other person was saying, “You bet!” or “So what?”
At one point, Cornelia, who had been in Rwanda right after the slaughters, said (I wrote this down right after she said it), “It’s very difficult working in a genocide situation.” When she said it, it was EXACTLY like an old vet saying, “It was a hell of a battle.” Her time in Rwanda had a huge effect on her and out of her experiences there, has ended up here for 7 years, committed to the mission of HOPEworldwide – bringing hope, of course. Anyway, there we were in high company again. You Bet! Photo: Cornelia and Leslie

Monday was the Queen Mother’s birthday so we worked half a day. We had lunch at a small patio restaurant (dog sleeping next to a table, the works) on a corner near the market. Some children came by to beg and we finally moved away from the edge of the patio – did I write something about “no more turning away” the other day? One of the waiters then gently shooed the children away, but of course they came right back. A few more people came in the restaurant and the waiter kicked the dog out of the way, which gave a loud cry. Leslie immediately said/almost shouted in a very loud voice, “Stop that!” In a quiet, strained voice, I said, “Leslie, don’t.” Later, David said he was shocked when:
o The man kicked the dog.
o Leslie said, “Stop that!”
o He realized that at first, he agreed with me.
And that’s Cambodia for you. David also pointed out that awhile back I intervened when a woman was whipping a boy. Bleeding busybodies.
This week I’m working on some planning and resource development things for palliative care and for Nursing Service. It’s interesting and exciting – tremendous potential here at Hope.

Random notes:
It feels so good to leave our room and leave the aircon on and come back 30 minutes later to a dark, cold room. Ahhhhh.
Traffic signals, lanes, and so on are just suggestions. When drivers come to an intersection they never stop to check oncoming traffic – just move on through the intersection adjusting as they go. Big things trump little things – from the bottom up: pedestrians, bicycles, xyclos, motos, tuk-tuks, cars, SUVs, trucks … the bigger always has the right of way – until the smaller gets an edge, and then, like sparrows, the motos or whatever, flood through. The other day two small children on foot were stuck in the middle of an intersection and car after car pressing by them and nobody letting them by until Dara, the best hospital driver, stopped, beeped at them and let them walk in front of us. Good work, Dara.

Fruit we’ve eaten this time around: soursop, mango, dragon fruit, mangosteen (my favorite), lychee, watermelon, longan, papaya, rambutan, banana, grapes, jackfruit, guava, pomelo, apple, and a couple I have no idea what the names are. Photo: mangosteen rubble 
Our room has about a queen-size bed with 2 feet between the wall and foot, 4 feet between the wall and bed on the side and up against the wall on the other side and the head. In the evenings for about the past week Leslie, David, and I have been piled up like bunnies. Every evening Mony comes in for about 30 minutes and snuggles up next to Leslie. David is on the other side and I’m at the foot. One night David’s electricity was off and he stayed with us – these are good times.
I’m in an internet café right now, hot, no fan, raining outside.


Picked up Vanida at the Okay GH on the way to work (she’s just back from 2 days at Angkor). She spent the day at the hospital, touring the hospital with me, then Leela. Vanida went to lunch with Leslie, David, Miriam, and me at Hagar (lettuce, clean, safe lettuce). Leslie and Miriam are two peas in a pod – so much in common – justice, quality, etc. Too bad Leslie hasn’t been placed with Miriam in infectious diseases. Back to hospital where I did a SWOT analysis (thanks, Carol), which very well.
And speaking of people with things in common – Phalla is the person I work with the most. She and I have very close values and aspirations. Seldom have I had a better working partner



Stories from Phnom Penh
Pnom Penh, Cambodia
Jun 29, 2007  03:33 ( local time )

Finished, at last.

These are not your usual travelogue entries, but they do reflect part of what we've been doing. I wrote these for Chhavelith - who can use them, change them, or not use them. Up to you, brother. Will someone (Elexa or Victoria) please send this link to Chhavelith - thanks. The second story seems dark, but within the darkness is dazzling beauty and light ... Photo: in a slum

“As you know, I did not think I would be alive. I was so sick”
(Chanthy’s story)
In her 40 years of life Chanthy has been in a forced labor camp, worked as a farmer, been a wife and mother, been a beggar, and now supports herself with a small business. She also has HIV infection and has survived multidrug-resistant tuberculosis (MDR-TB).
Chanthy was 8 years old and living in Svay Reang Province when the Khmer Rouge came to power in 1975. She endured forced labor, starvation, and the murder of her parents before the Khmer Rouge regime was overthrown. She married young and had three children before she and her husband, a farmer, separated. By age 19, she was in Phnom Penh with three children, looking for work in construction. She and her children lived outside a temple wall, with other homeless people. There was little work for women and she ended up as a beggar, making 5,000 riel on a good day and 2,000 riel on a bad day (4,000 riel = $1 US). She met a man, also a beggar, and they set up a household against the temple wall. This man she calls her second husband beat her regularly and gambled away what little money they made, but also gave her a sort of stability – and he gave her the virus. “I learned I am infected since 1998 when my husband became sick.”

Her husband died in 2000. She took care of him as diarrhea and AIDS wasting syndrome took his strength and then his life. It was at this time that the HOPE home-based care team became involved with Chanthy. “I felt sad when he died because I didn’t see his face anymore ... I told his family he was dead, but nobody came to join with the funeral.” Photo: sewing 
After her husband died, Chanthy continued begging, and she began gambling. But something was different. The HOPE home-based team was involved and they encouraged her to enlist in their program for widows and children. Working in a partnership with the Friends Program, they supported her, counseled her, and found a place for her to live in a slum. The counseling led her eventually to the idea of purchasing a scale (for $8) and she went from place to place weighing people for a small fee. On a good day she made 10,000 riel and on a bad day, 5,000 riel. Her situation was also improved because she was able to follow strict program guidelines, including no drinking and no gambling. Unfortunately, her HIV and tuberculosis were not well-controlled and she had difficulty working – “I was sick and coughing too much.”

Counseling and treatment continued, and as her condition improved, she saw greater possibilities for herself. In 2004 she asked for and received assistance in buying a foot-powered sewing machine. With the sewing machine she was able to make bags for Friends to sell in their shop. She has been sewing for three years now and every month she is able to put some money in the bank. Chanthy has gone from begging to the bank.

Chanthy is far from wealthy or even comfortable. But her two daughters are in school – well past the age when she left school – and her son is employed. The HIV and tuberculosis are controlled and she feels good almost everyday. She ticked off what she has today: a place to live, money in the bank, a job, and clothes. “I have more power than before ... thank you so much.”

Nhey’s Story

This story is based on two visits to Nhey's home. Her story is dark in some respects, but also shows a reality and beauty seldom seen. When I left this woman's home I told her that Í had been thinking about her since I first met her three weeks ago. I said, I know you're like the rest of us - in some ways good, in some ways bad - and most of all, I know you have a beautiful spirit and I have been and will continue praying for you ...

When we pulled out of the hospital on Bounthy's motorcycle on the way to make a home visit, there was a man, naked, emaciated, sitting in the dirt outside the gate. As we stopped, another man came out of the hospital grounds and put a patient gown around the man in the dirt and began gathering his few rags and papers. As we drove away, Bounthy said, “I remember 10 years ago when it was like this a lot” (dying people outside the gate). Photo: the man outside the gate ("for I was naked and you clothed me ..." 
Nhey is 42 years old. She lives with two girls in a small house built atop an apartment building in Phnom Penh. The girls, age 10 and 11 are the daughters of a woman who took care of Nhey during the Khmer Rouge regime. After the Khmer Rouge, the women went their separate ways. Around 2002 Nhey’s friend became sick with HIV and came to Phnom Penh with her daughters to live with Nhey. The woman’s husband, who gave her the virus, disappeared and she does not know what happened to him.
At that time, effective antiretroviral therapy was not widely available, and the woman took about a year to die. She stayed in the small room where we were talking and during much of that year she had severe diarrhea. Nhey smiles, “I was sewing and could work at home – so I can stop and help her.” Nhey keeps talking and Bounthy translates, “She feels like difficult, but she has compassion because she don’t know what will happen to her in the future.”
Eventually the woman became too sick to stand and Nhey carried her to what was then the only hospice in Phnom Penh. “At that time I was strong.” The children were not allowed to stay with their mother and so stayed with Nhey.
In 2003 one of the woman’s daughters was diagnosed with HIV and in 2004, Nhey was also diagnosed. The other daughter is negative. With help from the HOPE home care team and another organization Nhey continued caring for the girls. In 2006 Nhey’s second husband died (her first husband was killed by a landmine). During the funeral, her daughter drowned. It was more than she could bear and Nhey feels that she has been mentally ill since then. She is sad and forgetful, and sometimes panics and runs confused through the streets. She cries as she talks about the two girls and what will happen to them when she dies. “Before I was strong. Now I’m weak.” The weakness is only in her body ...
The man who was dying outside the gate was gone when we returned.


Phnom Penh Reflections
Phnom Penh, Cambodia
Jul 03, 2007  06:49 ( local time )

Reflections and random thoughts on our time in Phnom Penh. We're in Chiang Mai, but this was written in Phnom Penh and on airplane ...
Song of the day: Standing on the Moon.
It’s raining every day.  Cooler, but still a price to pay (in sweat) for being outside. I’m to where I hate that wet back feeling. Big baby. We get pretty close to zero exercise. Photo: Victoria examining child ("for I was sick and ...") 
This is our last week in Phnom Penh. From here we are off to Bangkok for a few hours, then Chiang Mai, then Luang Prabang, back to BK, HK, and home.
The first time I was in Phnom Penh I experienced it as dark and menacing. The second time it was much less negative. This time I caught the stark yin and yang of it – Hagar and the slums. HOPE and HIV. Samnang and the hangers on the corner. Chhavelith and the cops stopping random (poor) people. The sick, naked man and the man who covered him. Light and dark, kind and cruel, stark.
Except for being with David, it is almost like this (time in Phnom Penh) is separate from the rhythm of my life as I imagine it might unfold in whatever comes next. Phnom Penh does not seem to be where Leslie or I fit. If we were more with patient care we would surely feel differently. Most things here (in healthcare) are seriously stuck in the past and it’s like few people seem to care that 1950s style medical care and not rocking the damned boat will have little impact on what matters the most (<morbidity/mortality). And I don’t have the strength to swim against the tide.
Working on the classes I taught at the hospital I used my Terminal Illness website over and over again. Also the Refugee Health site. It was almost like much of the work I did on those sites over the past few years was in anticipation of this time in Phnom Penh.
On our last day at the hospital, there was a farewell lunch for Leela and me at In Many’s (say In Mah-knee’s) home. People there were Phalla (nurse educator, ER nurse, my best friend there), Many (hospice), Rotha (director of nursing), Hong (educator), Rassi (educator and the guy I hung out with in the office), Leela (true servant, from Amherst), and a couple I didn’t know. The food was good: big hot pots of soup with meatballs, to which each person would use their chopsticks to add whatever they chose from the vegetables, noodles, beef, shrimp, cuttlefish, and then take whatever out of the pot and put it into a small individual bowl, season with pepper, chilis, salt, garlic, lime, etc., and eat it and then add some more, and so on. In a graceful gesture, Many had a new bottle of ketchup for me. For dessert we had fruit and little pumpkins stuffed with coconut jello(?). Leela and I were given some nice gifts - book, lamp, krama. It was a good party and a great way to leave.
As we left the hospital several people talked of how unusual it was for a family to volunteer together. It also was significant to people that David is Khmer. Photo: party

On our last evening we went to the Art Café, where David and Antone played Mozart and a French composer whose name I don’t recall. Igor and Ces came by, bringing Leslie and me a beautiful bouquet. David has made some good friends here.
I hear a cry of victory,
Another of defeat,
A scrap of age-old lullaby,
Down some forgotten street.
Standing on the moon,
With nothing left to do,
A lovely view of heaven,
But I’d rather be with you.