Sunday, February 21, 2010

What Awful Weather!

I do apologise - really, awfully remiss of me. Terribly un-British as it is, I havn't yet found time to talk about the weather.

So, terrible weather we’ve been having, eh? Well no actually - sorry to rub it in, but it's been reliably jolly nice ever since I arrived.

At first it was strange that the sun rose and set at the same time each day (and indeed that the sun was actually visible every day). From this, I concluded that there aren’t really any seasons here, that it just stays the same all year round.

But I was wrong about that – I’ve no idea why (can any meteorologists in the house enlighten me?), but whilst day length remains relatively constant, there are still three fairly distinct seasons here. When I arrived in October it was the end of the ‘wet season’, which in Phnom Penh at least was actually quite agreeable, as it only actually rained for an hour or so most days with the rest being warm and pleasant. As we moved into December and January we’ve been in the hot, dry ‘windy season’, apparently the most pleasant time to be here. And now it’s meant to be dry but progressively hotter and muggier until around April, when the welcome rain will arrive and we’re back in ‘wet season’ for the rest of the year.

All fine in theory Mr Kettley, but after a lovely day chilling out with my volunteer friends Jen and Deirda in Sisophon this weekend I headed for an internet cafe to try to Skype mum and dad, only to find there was no power ‘due to the weather’. This was concerning, not only as would I miss out on my weekly update on the moving and shaking in Delph, but also as it appeared that we’d managed to export to Cambodia a particularly poor British excuse for stuff not working.

By 5pm I had to give up, as it’s a good hour’s moto journey back to my village of Thmar Pouk, and as mentioned it gets dark every night at 6pm sharpish. I also had a prized pack of two-ply supersoft toilet tissue – unheard of back in my village - and a bag of marvellous mangos to escort home.

On leaving the town of Sisophon the tarmac quickly disintegrates into the dirt track of the fancifully-named ‘National Route 56’ to Thmar Pouk (there’s also an ‘Olympic Stadium’ in Phnom Penh – maybe one day they’ll both live up to their names). Just moments after setting off something most unexpected happened – it started to rain. Actually it started to thunder, lightning and fair tip it down. I THOUGHT THIS IS MEANT TO BE THE BLOODY DRY SEASON!

It wasn’t fun at all. The dirt road quickly flooded, and I was suddenly competing with motos, taxis and lorries a the small strip of non-waterlogged surface in the middle of the road. The dust I so disliked before managed to become something even worse – clingy, slimy, treacherous mud. Progress slowed markedly, and before long I had to steer round a series of trees in the road, I assume felled by lightning. And it was starting to get dark.

Fortunately I’d had the foresight to have my moto serviced last week, including the addition of a big thick nobbly tyre on the back wheel to help deal with poor road conditions. Unfortunately, as only seems to happen after major servicings and upgrades, progress was counterbalanced by something which previously worked fine now going wrong – in this case my front tyre, which was flattening with alarming speed. Now really wasn’t the time to be getting a puncture.

With darkness well and truly upon me, I finally made it back to my village after over two hours on the road. I tried to turn onto the dirt road where my house is, just too late to realise it was now an impassable mudbath. I just about managed to dismount as the bike slid gently into the ditch. Only with a combination of wheel-spinning, brute force and a proportionate contribution of choice language did I finally get myself and my blessed vehicle home.

Home sweet home. Only, as I stood dripping and muddied in the doorway, my landlord cheerfully explained that I couldn’t get into the house as the lock was broken. In fairness he managed to get me in after a few subtle hits of an iron bar (him on the door handle, though I would happily have used it on my bike, him or myself by this stage).

Finally inside, I didn’t even mind that my mangos were mashed and loo rolls squelched. Stumbling through the dark (no electricity here either tonight), I merrily trod think clods of mud through to the bathroom, and at long last enjoyed a shower which wasn’t from the sky with water which wasn’t from a puddle – bliss!

At least I can now feel proprly British again - jolly terrible weather one’s been having, what?

Wednesday, February 17, 2010

The Passive Genocide of Children in Cambodia... (In Praise of Dr Beat Richner)

“Every year more than a million children receive first class medical care in one of the world’s poorest countries, and it’s all down to the work of a Swiss doctor and his cello”.

Dr Beat Richner is quite a performer – the founder, director and chief fundraiser of the Kantha Bopha group of children’s hospitals in Cambodia, he is passionate, eloquent – and a rather good cellist.

Every Saturday night Dr Richner attracts a large audience for his free ‘Beatocello’ concert at the Kantha Bopha 3 hospital in Siem Riep. The crowd, almost entirely tourists dropping in on the way to the nearby Angkor Wat, are treated to some lovely Bach, interspersed with an impassioned lecture in defence of his controversial approach to children’s healthcare in Cambodia.

He doesn’t pull any punches: the international community, through the World Health Organisation, is accused of accepting and even promoting a situation where countries have to match the quality of their healthcare to their wider economic situation.

But that seems fair enough doesn’t it? As I heard him speak, I couldn’t help thinking that it’s only reasonable that we live within our means - if you’re a poor country you can only afford to provide a certain level of care. It’s not nice, but it’s the way things work – isn’t it?

No, absolutely not said Dr Richner, anticipating the objection and swiping his cello bow dismissively. This may be how things are, but it is not how they have to be. In fact, accepting this situation, in his view, amounts to a policy of “poor medicine for poor people in poor countries”. If we tolerate this, we are complicit in nothing short of a “passive genocide of children”. Strong words.

But what is impressive about Dr Richner is that he backs up his words with actions. When both Cambodian and international authorities dismissed his approach as unworkable, he was unbowed. Through a mixture of charm, smart strategy and dogged determination, he went ahead anyway, and helped to re-open the first Kantha Bopha hospital in Phnom Penh in 1992, following its distribution by the Khmer Rouge regime. There are now 4 Kantha Bopha hospitals in Phnom Penh as well as the one in Siem Reap.

Dr Richner is no stranger to the challenging situation in Cambodia. Unlike me and many others he isn’t a recent, peacetime arrival in Cambodia, but in fact was here helping the most vulnerable people during the depths of its miserable recent history. Footage in the documentary which accompanies his performance shows a slimmer, fresher-faced but equally committed Beat treating children in 1975 as a Red Cross volunteer, even as soldiers fight and Pehom Penh falls to the Khmer Rouge right outside the hospital.

The Kantha Bopha hospitals themselves are impressive – they are big, modern, with well-trained staff, equipment including scanners, and supplies of reliable medicines (which he explains are all imported from Thailand, as - shockingly - 80% of drugs in Cambodia are potentially dangerous fakes). Most impressive of all is the approach: Kantha Bopha hospitals are completely free for all children in Cambodia – unlike state hospitals here, there are no (officially sanctioned) payments for treatment, or (unofficial) payments to staff for care or to grey market pharmacies for drugs.

And the result? Whereas many Cambodians are put off from accessing state hospitals early (or at all) partly due to these costs, there are no such issues at Kantha Bopha. As well as avoiding official fees, the staff are also paid decent wages, taking away the temptation to charge patients, to steal and resell drugs, or to moonlight in other jobs to supplement their wage, all of which seem to be major problems elsewhere in the country’s hospitals.

Dr Richner rattles off an impressive range of statistics to demonstrate the success of his hospitals: every day across the 5 hospitals they see over 3,000 children as outpatients, admit 300 inpatients and deliver 26 babies; the cost averages only $240 per patient; and the contribution is sustainable, including the ongoing training of 63 medical students.

I was impressed by Dr Richner, as a man and as a visionary. He is a smart operator - when he built his first children’s hospital in Siem Riep, he managed to secure land either side of the only road connecting the town’s 5 star hotels with the temple complex. Every day a stream of wealthy potential donors passes through his hospital – clever guy!

This approach is controversial, and the presence of such hospitals may even be embarrassing in a country whose state healthcare provision is otherwise still pretty basic and whose system suffers from endemic corruption. Personally I think good on him for having the vision and the guts to fight the good fight, but I’m sure he’s made a few enemies here along the way.

And he’s not sitting still either – only last week, believing that the Cambodian government are not responding properly to a recent cholera outbreak in the southern Mekong area, Dr Richner took out a full page advert in the Cambodia Daily newspaper calling for immediate action and the declaration of a state of emergency in the area. It won’t make him any friends in the government – but it might save the lives of children, which has to be more important.

If my contribution here – to health (or even to music!) - is a fraction of that of Dr Beat Richner then I’ll be a very happy man.