Saturday, July 30, 2011

London, it's the new Phnom Penh!

I knew something was odd as soon as we landed in London.

It wasn’t just the tropical heat, or even the unusual scent of jasmine. It certainly wasn’t that it took hours for my bag to arrive. It was more basic than that: with no trains or busses - or even black cabs - how was I to get into town?

Then I noticed a group lolling in hammocks and playing chess, under a handpainted ‘Tower Tuktuks’ sign. These were no chirpy cockney cabbies, but a bunch of itinerant Yorkshiremen, come to the big city to drive their battered British Leyland tuktuks.

“Where yer go?” an old guy asked sleepily.

St Paul’s Pagoda”. I felt I should explain: “To the new exhibition at the Tate T’mai”.

A friendly shrug and we set off. We circled the airport twice before I realized the poor bloke had no idea where he was going. “Just follow the Tonle Thames uncle” I growled.

We chugged along the riverbank with its colourful tourist dragonboats, past the sparkling new Cambodia-Britain friendship hospital at Hammersmith and the Cameron Academy at Chelsea.

Suddenly a monstrous black machine roared past us, forcing us towards the ditch. “Lewisham Lexus lout!” cursed my driver.

At the corner of the Royal Palace a uniformed man with a black breast-shaped helmet stood in the road. It was reassuring to see a friendly London bobby, even with a cigarette on his lip and shirt rolled up exposing his belly.

“Road closed brother” the policeman barked. “MyBoy London Marathon today!”. To my astonishment my driver nonchalantly slipped a dollar bill into the officer’s outstretched palm, and drove on. Surely there isn't now corruption in Her Majesty’s Constabulary?

To recover I asked him to stop for food. Sadly my favorite chip shop at Phsar Covent had developed an unpleasant fish-sauce stink, and a pack of skinny dogs lurked menacingly outside Khmer Fried Chicken. So I went round the corner to Pret a Mango for comfort food - what wonderful sweet sticky rice they now serve!

Finally we reached the pagoda and I thrust a few dollars at my grateful driver. The South Bank was as vibrant as ever, with stalls of pirate DVDs jostling for custom with “”Same Same” t-shirt vendors, tastefully accompanied by the latest asiapop from huge sound systems.

Outside the Tate, gallery staff played volleyball, resulting in an unruly scrum for tickets within. In fairness demand was high: they were cheap thanks to cultural development aid from Cambodia. And the subject was popular – the public gazed adoringly at the beautiful mountain of plastic bags which engulfed the turbine hall.

I soon retired to the Apsara Arms for a litre of imported Kingdom Ale. What a day! This was still the same London, but it was also now so different.

As I swatted half heartedly at mosquitoes and idly pushed icecubes round my glass, I finally realized what was so surprising about all this.

It wasn’t so much that London had suddenly become like Phnom Penh.

It was simply that everyone had started smiling!

Wednesday, July 20, 2011

Thank you for smoking

These are challenging times for those of us who love and profit from smoking in Cambodia.

Happily this country remains one of the most free in the world. The ultral-liberal regime may still permit pretty open sale of guns, girls and ganja, but it also means you can still enjoy a guiltless cigarette just about anywhere.

Two key forces ensure such freedoms continue here, in stark contrast to their growing erosion worldwide.

Firsty - well, it’s the Economy, stupid!

Conditions for business here are close to ideal. Staff costs are unbelievably low, workers do as they are told, and there are no irritations such as employment or health and safety legislation. What a breath of fresh air compared with the unionized, nanny-states of the west!

What’s more, there is virtually no tax here! Tell that to any businessman – be he selling cigarettes or lung-cancer drugs – and his greedy little eyes will light up! In the absence of a legal framework, informal payments are necessary to ensure the right permissions and the avoidance of complications – but it’s just business, and everyone has their price. We’re not complaining - and we’re not exactly going to start a moral crusade are we?

This is the crux of our commercial success here. As long as tobacco is understood to be good for the economy, employing staff and contributing to government finances, then we will be allowed to go about our lawful business in peace. In Cambodia we still draw in over 40% of adults and turnover more than a hundred million dollars a year – not to be wheezed at!

Fortunately the alleged ‘’costs’ of smoking - dubious estimates of healthcare expenditure, days lost to work and low productivity of dying smokers - are far less tangible (and largely borne by poor individuals not powerful politicians). Do you know how many Cambodians die every year from smoking-related diseases? Thought not – nor do the Ministry of Health! As long as we bankroll wages and proffer‘’informal payments’ our position will remain strong.

Secondly, Education. Everyone knows cigarettes taste good. They are sociable, and sexy, an ideal cash cow in a country where half of the population are under 30. A pack of cigarettes is cheaper than a bowl of rice – it will even help stave off the hunger pangs!

It’s true that cigarettes aren’t quite as integral to society as they once were. At weddings, Cambodian brides rarely offer their groom a cigarette, nor are packets placed on guests’ tables. In pagodas, it’s rare to see monks smoking, and not so common to offer tobacco on spirit houses. Even prime minister Hun Sen no longer puffs in public.

However, thanks to successful advertising, everyone knows of their choice of products and are reminded of the benefits of particular brands. Advertising penetration is both deep and culturally sensitive – not merely billboards in towns, but traditional banners in villages, and best of all scrolling messages on ubiquitous karaoke videos – genius!

Of course we need to be smart: illiberal western-style legislation is threatened, and even a sympathetic government and a public rightly skeptical of authoritarian measures taken ‘for their own good’’ may be forced by the powerful international health lobby to ban adverts.

Don’t worry – most people here don’t see smoking as bad for their health – after all, with an average life expectancy of barely 60, folk have more immediate threats. Smoking is still widely socially acceptable – even in hospital wards (even by hospital staff in hospital wards!).

Rest assured we will not sit idly and allow the interfering health lobby to prevail. We will protect our profits and the rights of smokers. Nobody does smoke and mirrors better than us! We are already diversifying our message delivery: see if you can spot our sponsorship of soap operas, paid-for magazine features, even teaching awards; look out for more subtle branding of Thai fashion products, subliminal pop and harnessing the addiction to khmer boxing.

Even stronger than adverts are role models. Most children still see their parents or close relatives smoking, quietly preparing our next generation of customers.

Better still, an astonishing number of westerners in Camboida give priceless help in reinforcing the message that smoking is cool. It couldn’t be better: despite countless reasons to think otherwise, white people are still held in great esteem and their actions closely watched and mimicked. So it’s a godsend to our industry to see so many pale puffers (some even working for NGOs with health programmes!) in the trendy bars of Phnom Penh and Siem Reap. This is advertising that money simply cannot buy. Thank you so much for your support!

So whilst the smoking freedoms of the rest of the world risk being extinguished by attacks from unelected anti-smoking lobbyists, I’m heartened to report that it’s business as usual here in Cambodia.

So thank you, once again, for smoking.

Sunday, July 17, 2011

Go To Jail

Ever played Junior Monopoly?

For children, it’s a great introduction to the famous game: properties have become themepark rides, but you still have the fun of building houses / hotels and awaiting reluctant guests, albeit in a simplified way.

Money remains paramount - the aim is still to secure a monopoly by crushing all others. You soon know which children will be foolish public sector workhorses and which have the financial incompetence / dastardliness to become bankers!

It’s not quite the real deal though. Coloured plastic counters replace the metal dog, car, iron (what’s the fun without squabbling over who gets the boot?). You can no longer win second prize in a beauty contest.

Worst of all, there is no GO TO JAIL bombshell, replaced with a harmless visit to the restrooms!

Back in Cambodia, a world away from benign boardgames, I spent this afternoon in a very real jail – the provincial penitentiary in my nearest town of Sisophon. It was quite an experience.

It all came about thanks to Mary, a VSO education volunteer who just doesn’t understand that when the schools break for summer that’s the cue to swan off on holiday.

Rather, she stayed behind to dash round with the energy of a seven year old rolling the dice (she’s nearer seventy), trying to cajole and persuade anyone who will listen that they need to help improve the lot of women prisoners.

It’s a hard task. There’s not much in the way of a Community Chest, and I don’t detect much sympathy for prisoners here. Perhaps people have enough to worry about. There certainly seems to be a great deal of shame and lost face if a friend or family member is jailed. And maybe people think criminals get what they deserve: as a victim of a few petty crimes myself I have some sympathy with this view.

But things aren’t quite like that here. Most inmates are young and uneducated. Many are convicted of smuggling drugs from nearby Thailand (they are the ‘mules’ of course, those in charge don’t generally end up in prison). It’s not right, but it’s pretty clear to me they were driven to it through poverty and helplessness, for the lack of any other way to make a living. Or they may be completely innocent - framed, or taking the rap for someone else - but if they are poor they’ll get banged up just the same.

And they are all poor, by definition: in a country which ranks 154th out of 178 in Transparency International’s latest corruption perceptions index, you can be sure that the only people in prison are those who can’t afford to bribe their way out of the so-called ‘justice’ system.

The prison itself is a series of low yellowy concrete buildings on the edge of town. The buildings themselves are fairly new, and on first sight it could have been a school or hospital (two other hotels with generally reluctant guests!).

But inside it’s pretty desperate. There are 12 cells holding a total of 123 women (you can do the maths). Each prisoner has even less than the paltry 2 square metres minimum demanded by international law. The walls and floors are bare concrete, with a shared toilet and sink in the corner. A hose pipe is as near as they get to a shower.

We were kept waiting for half an hour before being allowed to see the prisoners – apparently for them to be searched ‘for your safety’. I’m not convinced we were in much danger from the shy, innocent-looking girls who crammed into the corridor to gaze at us - though like zoo animals in tiny cages I guess such cramped conditions are bound to lead to stress.

We had come so Katja could talk with the women about health, particularly how to avoid sexually transmitted diseases. The session was actually really good fun - as we appeared they gave us an impromptu round of applause, and we got big laughs as we put condoms onto cucumbers and I produced a phallic carrot for the demonstration.

But behind the smiles I’m sure were heaps of sadness. The guards were charm itself, but I couldn’t help thinking of stories of brutality once our backs were turned.

Perhaps worst of all was the sight of children in prison - 17 in all. Whatever their mums may have done, they are innocent and seeing them grow up in a prison is heartbreaking.

Their life is a long way from the fun of a Monopoly game. I hope, through the good work of Mary and those like her, they may get out of jail and take a chance at a better life.

Friday, July 1, 2011

Who needs electricity?

What happens if you don’t pay your electricity bill?

Well your mail from United Utilities may turn a bit red. If you’re not careful you risk a sharp phone call or two. If you really fail to pay you endanger your credit rating.

The ultimate sanction is for the power company to stop their service – to ‘cut you off’. Fortunately that’s pretty rare – after all, we accept electricity as a fundamental requirement for living. We need it to run essentials like flatscreen tellies and hairdryers (along with little luxuries like lighting and heating).

At least, that’s how it is for a householder in somewhere like the UK. But what if the customer is a hospital. And you’re in Cambodia?

Well, one thing is your ‘need’ is pretty great. Your lights aren’t just for reading to the kids, they allow midwives to deliver them. The machines being powered are xrays not xboxes.

And yet, rather than being seen as somehow more important than a private home, when my hospital got into a dispute with the local generator company over unpaid bills, what did those with the power do?

That’s right - they pulled the plug on the entire site! Can you imagine the scandal if a power company cut off your local hospital? It’s unthinkable, and rightly so. Sure, we must all pay our dues. But never should disputes get to the stage that the ultimate sanction is enacted. That would be stupid, not to mention immoral. But it’s exactly what just happened here.

So I now work in a hospital which has no electricity. Well, that’s not quite true – we do have an ‘emergency’ diesel generator, and this is begrudgingly booted if a pesky patient needs an xray (and casually cranked whenever a government bigwig needs fanning).

It's little consolation that I'm now receiving better-late-than-never praise for getting some solar power working in the hospital. Thanks to generous donations from back home we replaced the batteries in 4 wards just last month, and persuaded the donor to install panels on the new surgery unit at the last moment. Why oh why isn’t solar fitted as standard on important buildings in a country with such poor infrastructure yet such brilliant sunshine?

As weeks turn to months we seem to be no nearer a solution, and it’s getting more and more difficult to look after patients. Even a low tech hospital uses electricity for a surprising number of things. When Katja asked the nurses why there was no documentation for a women who had been beaten almost to death by her husband, they had a novel excuse – how could they keep records when they can no longer use the photocopier? Even more basic: the new children’s ward has a scruffy handwritten note on the locked door to its beautifully appointed new toilet block: “no power, no water, no entry”.

What can I do? Well, I’ve tried to understand what caused the initial dispute, but having asked ten times I’ve now heard a dozen different stories, and sense I’m no nearer the truth. The bottom line is that if they thought I could assist they would have asked me by now. One thing I’ve learned here is that trying to impose my ‘help’ when it’s not asked for will only make my colleagues embarrassed and me frustrated.

So I gave a big sweaty shrug (no power means no fans either), and carried on. Maybe it’s not so bad. For one, our hospital doesn’t have much fancy electrical equipment - very few 'things that go bing'. What’s more, electricity isn’t the only source of power - small bits of kit often use batteries, and the fridges in the lab actually run from gas cylinders. We certainly don’t need heating, but cooling would be nice, and the fans do need power - but they weren't turned on for patients even before we were cut off (“too expensive”). And lights aren’t really used much either – when it’s dark you go to bed, don’t you?

Nevertheless, I really hope we get our electric back soon, not least for the selfish reason that I want an office with power. If not, future blogs may need solar internet or gas-powered computers. Dare I suggest my blogging may be a little like my power supply – it may not light up your world, but you might just miss it if someone pulls the plug.

In praise of… A Great Volunteer!

Like your family, you can’t choose your colleagues, but some of us do get extraordinarily lucky.

This was the final week for my colleague Alison as a VSO volunteer, and today was her bitter-sweat last visit to the hospital at Thmar Puok.

To put it simply, she is the best colleague I’ve ever had. With her, my experience as a volunteer, whilst bumpy at times, has been enormously rewarding and eternally memorable. Without her, well, I’m not even sure I’d be here writing this.

I actually met Alison’s partner Paul first – on our training at VSO’s charmingly creaky Harbourne Hall (the greatest course I’ve ever been privileged to attend by the way – bar none). We had to role-play culturally difficult situations: he depicted a dirty old man and me a heartless young playboy – no typecasting there I assure you!

I then met Alison as we flew to Cambodia – only thrown together in the same group of volunteers at the last minute when placements in Indonesia were withdrawn.

My first impressions were of Alison’s laughter and joie de vivre – something I was to grow not only to love but also rather depend on. She has an irresistibly happy face, and her dirty laugh is equally infectious!

Our placements started inauspiciously – together with another amazing lady, the marvelous septuagenarian Mary, the four of us wedged into an overloaded truck for the 8 hour journey to our northern province. By then we knew that cramming vehicles high with goods is a local sport, so we were surprised to be stopped no fewer than 14 times by the police for ‘’overloading’’ – swiftly resolved by our first introduction to ‘informal payments’ (otherwise known as a bribe).

As we started work in our respective hospitals, I found myself relying heavily on Alison as a respected colleague and confidante. Our focus as health volunteers was (in theory at least) on improving child and maternal health, so Alison’s skills as an experienced children’s nurse were invaluable. I helped make the new children’s ward more child-friendly and advised on quality assessment, but only she had the expertise to advise on administering drugs and the knowledge to tell the right end of a sphygmomanometer.

One of her greatest innovations – inspired by her assistant Sokha – was education sessions for carers, initially at her base hospital in Mongkul Barey. Family members provide personal care such as feeding, washing and toileting as well as vital emotional support, and to tell the truth can spend hours just hanging round waiting for their loved ones to recover or die. As such they are a prime target for an opportunistic health promoter! Soon carers flocked to the events, and not only learned important messages about hygiene, nutrition and preventing disease, but were also given the power to raise issues and even complain – a rare sight in Cambodia.

So popular were the sessions that they soon became a weekly event, and Alison was able to hand over the organization to enthusiastic local staff. In her ever self-depreciating manner she joked that in the end she was only wheeled out to talk about two things Cambodians just can’t get their heads around – stopping smoking and starting wearing moto helmets!

The fact that the sessions are now owned and run locally is no accident – it is a key part of Alison’s approach to volunteering, and one of the most important lessons she taught me. Now, whenever I think of starting a project or running a workshop I hear Alison’s voice asking “and which Cambodian colleague will be leading this with me?” It’s easy but short-termist to just do stuff, much harder but far more useful to build the capacity of others. I knew the theory, but Alison showed me how to do it in practice like no other volunteer I’ve met.

So much for praise about her work. More important than anything was that I could always escape my village to be welcomed into Alison and Paul’s boutique shack, where she would patiently counsel me on the latest frustrations whilst I greedily consumed their home comforts – in particular Alison’s cupcakes and cheese salads, not forgetting Paul’s expertise as trumpet player, piano maestro and whingeing Liverpool fan. They even put up with my all-night internet sessions and squealing whenever a mouse joined me in bed – that goes way beyond just a good workmate!

There may be a useful lesson here for volunteer organizations: if you are clever or lucky enough to find the personal fit, there are enormous benefits in the support, encouragement and camaraderie of other volunteers. I certainly learned a huge amount and believe that the best contributions we have made have been working as a team.

So as we hang around for a ‘taxi’ to take her down the bumpy road to Sisophon one last time I feel thankful not only for the skills and knowledge but also the kindness, companionship, positivity and humanity I have been privileged to enjoy from this exceptional volunteer.

I’ll miss you Alison – Thmar Puok’s loss is Phnom Penh’s gain, but there will always be a welcome for you in this remote corner of Cambodia which you helped so much and which misses you already. Thank you, to the best colleague ever!