Sunday, November 29, 2009

Home Stay!

Pha is 58, looks like a weathered 68, but bounds up the wobbly ladder to his wooden house-on-stilts like a sprightly 18 year old.

Inside is surprisingly spacious – essentially one big room, with a cooking area at the far end and a sleeping section to one side. The first thing that strikes me (apart from the low beam above the entrance) is the flooring – planks of wood, but unlike floorboards I know, these springy strips are only 10cm wide, with a good 1cm gap between each one, so you can see right down to the ground area below. It’s only as the day hots up that I appreciate the way this allows air to circulate – and that the gap is ideal for rolling marbles, and for disposing of cold tea and fag ends!

Pha introduces me to the family – as far as my stuttering Cambodian tells me, he and Veum are the grandparents, and one of their daughters Payap also lives there with her husband and sons, the well-mannered and slightly shy 12 year old Botay, and the cheeky showman Titao, half his age but twice the volume!

I’m not sure though - it’s all rather fluid, how I imagine a northern English terrace in the 1960s, with kids and adults popping in and out as they like and the parenting a shared task between all the adults and the older children. I think the sparky 6 year old Rizar actually lives next door, but spends most of her time with us, making good use of the pens and paper I’d brought as a gift – though she seems slightly exasperated with my lack of skill in writing the khmer alphabet.

Food is a nice surprise – fortunately VSO tipped off the families in advance that many of the volunteers on the homestay are veggie, so I’m presented with a delicious feast of rice, tofu with beansprouts, a bowl of green oniony things and some red spicy sauce – horror stories of pig’s feet and cow’s insides abate. I eat on the floor, in the middle of the room. The family watch me, then retreat to the floor of the kitchen, presumably to discreetly tuck into fishier fare. Pha stays back to fortify me with copious glasses of black tea – he may not realise just how much that homely touch was appreciated.

After lunch is time for sleeping of course, so I do as the locals and bed down on a slightly hard wicker mat for a couple of hours of shut-eye. It’s a bit hot though, and I’m not quite at home enough to strip off my rapidly dampening t-shirt. Pha’s on the case again though, popping up with a brand new electric fan (I say brand new as it was still in its plastic wrapping, but I think Cambodians like to keep things this way as long as possible – either way, it does the job perfectly).

In the afternoon, Pha takes me and Botay for a manly walk in the fields. His placid face becomes animated as he jabs at the worms eating the wheat crop and prods the parched paddy field where the irrigation river has run dry. I think he’s doing ok though – he’s very proud of his 7 cows, which must make him well off around here. And I’m happy – in the middle of the fields is an overgrown area with red and white posts at each end - the nearest I’ve seen to a football pitch yet!

Later I go for a walk myself to watch the sun set over the Mekong. With such a beautiful view, I’m surprised that the village’s attention faces away from it towards the rice fields. Maybe admiring the scenery is a luxury afforded only to visitors, though the men in the family still wax lyrical about the setting as they pass my camera round later on.

The evening food gets more interesting: as Veum relieves the local women of their 100 riel notes at cards downstairs, the men tuck into what looks like a bucket of raw turnips, complete with clods of earth. Once the muck is peeled off, however, the white roots are surprisingly tasty, especially when liberally smeared with sweet brown gloop which I’m assured is palm syrup – you heard it here first.

And so to bed – after all, it’s 8pm already. So it’s back down on my straw mat, hoping my barbie-pink mosquito net will deter the various beasties who are already circling with intent.

The cock crows at 6 in the morning, a fine traditional countryside awakening – if the howling dogs hadn’t been at it since 4am. Still, I’ve had a good 8 hours sleep, so feel fine. Pha chats to me a little – it doesn't take me long to ask if he speaks English (he doesn't), but eventually it transpires he knows some French – wish he’d told me earlier! Whatever the language, I must speak a little too much (or too close), as he abruptly marches me to the downstairs bathtub-room making rigourous teeth-cleaning gestures. I assume my oral hygiene is his concern, though on reappearing he presents me with a heavily-sugared coffee – who am I to reason why?

And that’s it – 24 hours in the home of a Cambodian family, a fascinating insight for me and great preparation for the move to my new home in the rural north-west next week. That's was it was like for me - I wonder what they made of it all?

Sunday, November 22, 2009

Sport in Cambodia - anyone for flipflop petanque?

So what do Cambodians do for sport then?

Most people here work in the ricefields all day, so sport is probably a low priority. However, I often hear Cambodians described as ‘playful’, and I’ve already witnessed a fair bit of jocular jaunts and rollicking recreation...

Flip-flops are the main ingredient of the most inventive sports I’ve seen here – being thrown, kicked, kept in the air and generally not worn on the feet. Groups of guys also play a ‘keepy uppy’ game (sepak takraw) – not usually with a football, but rather using a strange contraption in the shape of a shuttle-cock with a spring-loaded base. Credit is given not just for keeping it in the air, but also the artfulness of the flick, using the back of the heel or sole of the shoe (or flip flop).

In practice, this seems more played than football – I’ve seen surprisingly few pagoda pitches. However, as with pretty much every country in the world, footy is still the top game, and the easiest common denominator for building (male) conversations. If, like me, you can say you come from Manchester, that helps a lot – though insisting you’re an Oldham Athletic fan isn’t so clever.

Surprisingly, volleyball seems to be the most popular ‘traditional’ sport, attracting sizeable crowds - though they seem less interested in serves and smashes than a spot of gambling. There are pitches on bits of waste ground in most towns and villages, and now the rainy season is over, makeshift courts are also promised on the sandy riverbanks – have I really chanced across a hotbed of beach volleyball?

The most fun sport I’ve seen so far is the al fresco keep fit classes in Kampong Cham, just north of Phnom Penh. Against the gentle backdrop of the Mekong river at dusk, giant speakers pump out dancy music, a young guy stands on a platform gyrating to a keep-fit routine, and before you know it there’s a lycra-mob mirroring every stretch and thrust. I will join them just as soon as I’m fitted for my pyjama-leotard.

As this is Asia, I was expecting to see martial arts, particularly at the gym near our language school. However, it actually specialises in body building - isn’t there something a bit wrong about the image of a muscle-bound Cambodian? On a run round Phnom Penh last week there were also a good number of thai chi-ers – it was an arresting sight as they saluted the sun as it rose over the river at dawn. Cambodians also seem to spend hours glued to thai or k’mai boxing on tv - generally when they’re meant to be serving me in their shop or hotel.

The best sport here has got to be cycling – lots of Cambodians use bikes, though usually for practical rather than sporting reasons. But it’s a wonderful way not only to exercise but also to see the luscious (and flat, and generally car-free) Cambodian countryside.

Apart from that there’s also a smattering of badminton between girls or siblings on the pavements at dusk, plenty of rowing during water festival season, and the particularly popular sport of parking Lexus cars in the middle of basketball courts.

So there’s a plenty here to keep me active – my first plan is to sign up for a 10k run in a couple of weeks time. It’ll be a bit warm, but as the route winds through the majestic lost temples at Angkor Wat at sunrise, I think I’ll manage.

Thursday, November 12, 2009

A glimpse of what's to come: military funding, static ambulances, external fixators

Health is the key focus of my time in Cambodia. Over the last week I've had the chance to visit a few facilities in NW Cambodia, talk with patients and staff, and view first-hand some of the challenges which await me...

On arrival in the remote Banteay Meanchey province it's clear this is a long way from the bustling metropolis of Phnom Penh, or indeed the 'khmer lite' of Siem Reap. This is the 'real Cambodia': poor, underdeveloped, and very rural - challenging territory indeed.

The dirt road north is bumpy, hazards include wandering herds of oxen and water buffalo, and the dust is choking - though I shouldn't complain as come the wet season it's an impassable mudbath. Happily tarmac is promised which will greatly improve access for the people here; sadly for me it's unlikely to be finished in the next couple of years.

An hour north of the regional town of Sisophon, the sleepy rural village of Thmar Pouk lies on the watery plains stretching to the Thai border. This is the remote north-western corner of Cambodia, and the referral hospital here will be my main base for the next two years.

The hospital here is best described as 'basic' - a huddle of low-lying buildings with stark wards and sparse support facilities, built around a volleyball pitch and outdoor cooking area. Unexpectedly, the largest group of patients have respiratory conditions. I was told things are improving here, but it still looks pretty rudimentary - no consistent water or electricity supply, wards certainly not modern, spacious or particularly clean (think 'ïnfection control nightmare'), and basics such as drugs in pretty short supply.

On the positive side, there is a well-respected lead doctor, and already they have a promise of funding for a much-needed paediatric ward, so one of my jobs is to make sure this actually gets built. Interestingly, the money is coming from the US military - why would that be?

On the way back to Sisophon is the village health centre at Svay Chek, another eye-opener. Cleanliness here is even more of a challenge, and the IT infrastructure is limited to a rather imposing old Olivetti typewriter. However, there are trained midwives delivering babies here, and a TB outreach programme - there's definitely hope.

Part of my role will be to help improve the system for referring patients between local health centres and hospitals. Mercifully, I will be encouraging people to access care rather than trying to limit it, as I was having to do back in the UK. The chief explained that a well-meaning Christian group in Thailand donated the centre's ambulance to help transfer patients, but there was no provision for diesel - so unless patients can pay for fuel they stay where they are.

In fact, there was a sobering theme of well-intentioned but useless help - the Japanese had funded the health centre's water supply, but the cheap tank didn't work properly. Meanwhile the kindly-donated lab equipment sits firmly in its box as there's insufficient electricity to run it.

In contrast, we travelled south of Sisophon to the new flagship hospital at Mongkol Borei, an altogether more successful gift from the people of Japan. Whatever the motives for the donation, it's clear why this is where visiting dignitaries are directed. Beyond the bright signs and topiered hedges are shiny new wards and equipment, and also impressive systems such as health records and plans to introduce networked health information - good luck with that...

Not that it's perfect - away from the gleaming front, we wandered round the side of a stagnant pool to the deserted ophthalmic ward, and on to the shabby children's unit, with roof but no walls, rickety beds pushed tightly together, all kids on the ubiquitous drips, and toilets firmly locked (presumably to keep them clean).

Overall, it's clear some things will take some getting used to. Alison, my nursing advisor colleague, noted how few nurses there were - partly, it would seem, as all personal care such as feeding, washing, and emotional support is provided by family members - or if not possible, neighbours, or the gardener - a rather different approach from what we are used to.

One story in particular revealed some of the challenges ahead. The orthopaedic ward was full of young lads smashed up either on the roads or in the fields (more to come on road and occupational safety I'm sure!). Several had impressive bits of mechano-like metalwork sticking out of them ('external fixators'), keeping the bones in the right place. Most of the guys were recovering well, so we asked why they stayed in hospital. The doctor explained that they couldn't afford to pay the deposit on the kit so needed to stay - otherwise unscrupulous private clinics would remove and sell them on, leaving no equipment for future patients.

Altogether a fascinating week - I think I'm going to be busy.

Wednesday, November 4, 2009

Water Festival in Phnom Penh

Cambodians take their public holidays very seriously (all 24 of them), and none more so than the annual water festival.

The Bonn Om Tuk festival celebrates the natural phenomenon of the Tonle Sap river actually reversing its flow due to pressure of water at the end of the rainy season. Or perhaps it celebrates the November full moon. Or the beginning of the fishing season? Whatever it is that is celebrated, it’s certainly done in style, with a bumper 4 day holiday.

The highlight of the festival is the spectacular boats racing through Phnom Penh – to see them from the faded colonial charm of the Foreign Correspondents Club of Cambodia is quite something.

VSO, however, went one better, and actually crewed a dashingly colourful dragon boat, allowing 40 of us to experience it from on (at times nearly in) the water - a truly memorable, if sometimes amusingly chaotic experience.

Our crew of volunteers – bolstered by a few brave k’mai colleagues - produced a heroic effort. In fact, our rhythmic chants of ‘moi, pi, moi–pi-moi’ fused with the tactical wizardry of our captain led us to clinch a remarkable victory over our astounded Cambodian competitors.

Well, sort of – the current was actually so strong that we couldn’t even get far enough up the river to the official start point, so were given special permission to start halfway down. We were then overtaken not only by the boat we were racing against, but also both boats in the next race. We drifted into a far-off shore, without quite making it between the two finishing line marker boats.

Notwithstanding the minor details of the start, middle and end, all went remarkably well – it was great fun for us, even more so for our Cambodian hosts – a boat-full of ridiculous barraing westerners, sporting bizarre lifejackets and pointedly failing to keep time must have made it difficult even for the watching King of Cambodia to keep a straight face.

It was all about the taking part of course, and the whole event reflected very well indeed on VSO –the only overseas organisation to participate, we got great publicity in the Phnom Penh Post, raised over$1000 for and, and made plenty of friends along the way.

The boat race is also a great excuse for the whole city to party, with revelers thronging the streets of Phnom Penh. Dancing into the early hours on the roof terrace of the Tamarind, we were treated to some star DJing from the present health advisor whose shoes I fill from next month – an altogether better performance on the decks than earlier in the afternoon...