A new life?

Between us, Katja and I volunteered for over 4 years in Cambodia.  We wanted to do something, however modest, to help people less fortunate than ourselves to have new, better lives.

Fine words, but not always easy in practice! 

In my remote village of Thmar Puok, the director asked me to help breathe new life into his hospital, which had gently drifted since it was cobbled together in the aftermath of the Khmer Rouge nearly 30 years ago.  

I offered to help them to improve the care they offered to patients by using a quality improvement system in their ward or department.  Happily, the tool we used was not imposed by well-meaning outsiders, but was developed by Cambodians themselves and agreed by their own Ministry of Health.  And it wasn’t me doing the assessing – rather, I helped ward chiefs to score their own area against a detailed list of good practice. 

Another benefit of this approach is that - unusually for hospitals - we could actually measure improvements.  We agreed the present situation for equipment, documentation, hygiene, and patients’ views of their care.  These scores could be compared over time, or at one point between wards (healthy competition!).  Where scores were high we gave praise, and where not we focused on improving things - a manager’s dream!

It wasn’t perfect:  some of the scoring was strange, like getting hygiene points simply for toilets being unlocked, or for having a ward free of motorbikes.  And some staff ‘played the system’ - from giving their ward a rare clean just before the inspectors arrived, to making up documentation such as vital signs and medical notes in retrospect (it’s called fraud where I come from).

But if staff were playing, so were we - it was a ‘percentage game’, with at least some of the improvements made in advance of the assessment continuing afterwards.  Some things just dropped back to their original level - even basics like turning up for work, wearing uniform and washing hands.  Yet my heart leaps when I still hear doctors explaining diagnoses and proposed treatments.  And many of the issues which affect patients most - hygiene, nutrition, medication, finances - continue to be discussed in wonderful staff-led carer education sessions, which continue every Tuesday morning.

I would have preferred that staff enhanced care through a sense of empathy or professional pride.  But if in fact they made things better because they liked to get points, look good or avoid getting into trouble – well, so be it.  The fact is, things still improved for patients.

Appropriately for our planned renaissance, the best progress was in obstetrics. The midwives were the most receptive of all staff, and this year they agreed to be assessed against tougher (‘level 2’) standards.  They did really well – despite having a shabby old ward they kept it clean, maintained decent records, and gave a good quality of care to mothers and their newborn babies.

This was particularly pleasing as maternal health is (in theory at least) the key focus for all VSO health volunteers in Cambodia.  And it is richly symbolic:  if the whole aim was to give new hope and new life to the poorest people in a poor country, what better way than helping to bring babies into the world with more chance of a better life than their mum?

So, after two years, our thoughts also turned towards new lives, this time our own.  Katja returned first to the UK, to continue the theme of re-birth by starting two years further training to be a midwife herself.  The main reason she gives for taking on this tough extra study is not just that she loves babies, but also that she feels this is the best way she can help poor people in the future.  Now you can see why I admire her so much!

And for me too a new life was beckoning:  the prospect of discovering Oxford, possibly changing job or even career.  Importantly, I also hoped I would have a novel perspective on things – a better work-life balance, a calmer outlook, a clearer focus on what is important.  And, of course, I would be setting up home with the new love of my life - a wonderful, totally unexpected bonus of volunteering!

And so to my punchline.  At this point I had planned to make a happy announcement – of one more new life. 

Around a month before she returned to start studying, Katja and I found that she was pregnant.  We were so happy and excited – this really did mean that a new life would await us back in the UK. 

I couldn’t believe it:  “I’m going to be a daddy!” I chanted.  The thrill of the return home was enhanced by debating when and how to make the announcement, where to live, what marque of superbuggy to covet.  Most difficult of all was names.  Oliver was firmly at number one in the UK baby charts: what good taste parents have.  And these days there is also the issue of the surname, which presented a unique challenge for us – would we really risk condemning our offspring to a life of ridicule by imposing the easily mispronounced ‘Horsch-Shipp’?

But it wasn’t to be.  Sadly, after three months Katja rang me distraught to say she’d had a heavy bleed.  After dashing to the emergency obsterics unit and a further scan it was confirmed she had suffered a miscarriage. 

As suddenly as it had started, our dream was over.  Of course I rushed home, and am writing this in the day unit at Oxford’s John Radcliffe hospital, waiting for Katja to return from her operation, a coldly clinical ‘evacuation of retained products of conception’.  The physical evidence will soon be gone, and all that will remain are our dreams of what might have been.

It would always have taken us time for us to adjust to our return in the UK.  Now, with this wretched, unexpected twist, it may take even longer.  But I honestly feel that if we can survive two years in the most rural corners of a developing country, then we will have the strength to recover and move on. 

Just as we tried to give help and hope of a better future to others in Cambodia, I believe that we too will enjoy and embrace our new life.

The Road

Just before I came to Cambodia my friend and football teammate Jules gave me a book called The Road.  It’s about the struggle for survival in a barren, post-apocolyptic wasteland.  It was a nice thought, but I decided to wait until I returned from rural, post-conflict Cambodia before reading it!

But perhaps that was a mistake:  the thing I talk about, whinge about, dream about more than anything else here is my goddammed godforsaken road.

The 50km route from the provincial town of Sisophon to my village is officially National Road 59 - the equivalent of an ‘A’ road in the UK.

But as you leave town the tarmac abruptly becomes a derisory dirt track. A large, faded sign mockingly pronounces that a new highway has been funded by the Asia Development Bank, work to start in 2006 and finish 2008.

In fact, the running joke here is that the new road will be completed “in just two years”.  A rolling two years, that is, from whenever you ask the question.  It was two years when I arrived here, two years ago, and if it’s even started in two years time I’ll be happy.

So what’s the big deal?

Well, clearly the main reason to improve the road is for my personal comfort!  This is particularly the case since the surface got so bad that even the once-a-day bus service stopped last year, apparently as the vehicles could no longer cope with the journey.  What about me?

There are other, even more convincing arguments.  Watching poor local people struggling through the waterlogged clay it’s clear a new surface would deeply improve their lives.  Everyone works the land, even those with other jobs.  If they are lucky enough to have excess rice then they need to transport it to market.  Equally, a decent road would open up their villages to new goods and services which have never made it up the terrible old one.  Watching children struggle through the mud or market women cover their faces from the dust makes me feel wretched for what they haven’t got.

Our focus here is on maternal health, and if an expectant mother is diagnosed with a condition such as pre-eclampsia (basically pregnancy-induced high blood pressure) then it’s vital this is recognized and treated quickly.  Here, this can mean helping to prevent seizure, such as by giving magnesium sulphate injections and avoiding stimulation.  But the only cure is to have the baby.  As this is likely to be by caesarian, mothers need to be transferred to a larger hospital for this major operation.  And how to get there (still avoiding stimulation of course)?  The only way is in the back of our ancient ambulance, feeling every bump and rut in the hellish 50km route.  It must be an agony for a poor woman in such a condition - another compelling reason for the road to be improved.

Sadly, some of those who are meant to be helping the poor also seem to be a little shy of the present travel conditions.  Whereas nearby Siem Reap is heaving with well-meaning charities, very few indeed can be persuaded to help the real poor people in my area.  Is it coincidence that they work where there are already great new roads which join the fancy hotels to the amazing temples?  I understand why of course - the most important thing for any NGO is to ensure their shiny white four-by-fours don’t get muddy.

So much for the poor then.  But surely the rich dollar-earning tourists have more influence? 

You see, my road is also a key link for anyone wanting to visit the pre-Angkorian temples at Banteay Chhmar.  The site is being restored by the UN Heritage Fund, and there are impressive plans for a ‘’community-based’’ approach to tourism there (no hotels, but rather staying with local people and getting an insight into how they live, eat and even travel – courtesy of an ox-cart ride!). 

But for now, few tourists brave a 100+ kilometre round trip on bone bashing boulders when the alternative is the smooth, straight tarmac direct to Angkor.  Surely the tourist income will help persuade the authorities to build a new road?

There is one other factor:  the N59 runs parallel to the Thai border, from the south up towards the area of disputed temples.  With a new government taking power in Thailand it is hoped that the will be no more fighting – but the military’s desire for a good transport link for troops and equipment must make it of some strategic importance.

So why then does this road – my road – remain the only unpaved national road in the whole country?

Money is bound to be an issue – over 50kms of road doesn’t come cheap, and funding is scarce in the present economic climate.  Apparently the original plan was bankrolled by Thailand, who pulled the plug when the recent fighting broke out.

But I have another theory. The people up here are close-knit, independent and proud.  The government in Phnom Penh closely oversees roadbuilding, knowing the political value of being seen to bring new infrastructure to a region (Prime Minister Hun Sen is said to insist on personally opening every new bridge and highway in the country).  So it’s simple – there’ll be a new road just as soon as the unruly folk of my area start voting the right way!

There’s an upside to all this:  a new road would certainly help development, but it would cause problems too.  Evidence suggests that better roads actually lead to worse traffic problems – more people will drive cars and lorries, they will go even faster, and they will maim and kill even more people.  They will also cause more noise and pollution whilst contributing nothing to the communities they zoom past.

So as I slither along the mud track to my village backwater I know in my head that a new road will on balance be good for the people here.  But in my heart I’m very glad that, at least for my time here, I will enjoy the peace and safety of a car-free existence. 

A peace I will enjoy on my balcony, watching people walk or cycle by, and reading a good book – anything other than The Road!

The Noble Art?

The evening of June 8th 1985 is clear in my mind for two reasons.

As we gathered excitedly round my granny’s telly, Barry McGuigan finally got his shot at a world title against Panama’s Eusebio Pedroza. It was so exhilarating that even my mild-mannered dad and brother were on their feet yelling ‘hit him, hit him, hit him!’.

But I also remember my mother’s entrance: carrying a tray of cocoa (it must have been one of those summers), she was clearly shocked by the atavistic blood-lust of her menfolk. “What a horrid sport!” was her typically polite criticism. She was right, but we told her to shut up anyway – it was just too exciting.

Twenty six years later, and I finally got round to watching another boxing match (in fact two in a matter of weeks). I'll remember these too, but I will also have the same mix of emotions about both of them.

At the most recent, we again huddled round the tv, but this time the drink was beer, the company soldiers, and grandparent’s house was Ta Mok’s.

Sounds like another cosy evening? Well, not if you’re from this country: Ta Mok’s name still strikes fear into the hearts of ordinary Cambodians. Widely known simply as ‘The Butcher’, he was possibly the most brutal of all Khmer Rouge leaders. He orchestrated appalling massacres in the southern zone from 1973, and led horrific ‘purges’ from 1975-1979.

His stronghold was the small northern town of Anlong Veng. I spent a week working at the (former military) hospital there, and had the dubious pleasure to visit his old home. Overlooking a lake, reflecting the Dangrek mountains, the setting could be beautiful – if it wasn’t that hundreds of slave labourers died cutting the trees and damming the river just to give him the lovely view.

The army commander who had taken up residence gently insisted we stay to watch some ‘pradal serey’ - khmer boxing. So we crowded round the battered old telly - it fact it could almost have been my granny’s old set from a quarter of a century earlier!



As for the boxing itself, I was struck by the shifting movements, and the use of elbows as well as feet: that’s got to hurt! And this particular bout was between two women - nice to see equality extends to the right to maul each other for public entertainment.



But I came away with very mixed feelings. It’s hard to relax in a mass murderer's lounge. Watching a boxing match in the home of a notorious killer is certainly one of the most unique memories I will take back with me from Cambodia.



My other recent experience of boxing, in the infamous Thai seaside resort of Pattaya, was also a memorable but ambiguous experience. Having fulfilled the aim of our visit (Katja’s crazy bungee jump!), we celebrated with a night on the notorious Walking Street. In between the sleazy bars we found a ring, with two young boxers about to put on a show which we hoped wouldn’t stray below the belt.



This was the first time I’ve seen boxing in the flesh, and it was alarmingly vivid - they pounded each other with frightening power. It was impressive and repulsive in equal measure, and (probably like the clients of the neighbouring girly bars), I felt both excited and a little ashamed to be there.



Part of me is undeniably drawn to boxing. Whilst I’m not quite sure how Mohammad Ali could liken it to the pursuit of a beautiful women, I can almost see why it has been described as ‘the science of sweet bruising’. I can certainly understand how writer James Lawton concludes that “in its atavistic rages, its often beautiful skill and the implicit courage of the protagonists, boxing takes men and women into areas that are untouched in other areas of legal spectacle”.



As a cinephile, boxing combines the brutality of Raging Bull, the passion of On The Waterfront, and the simple excitement of Rocky. As a health worker I note it is great for fitness (though not for brain injuries). And as a social activist I believe it offers a positive outlet for kids who would otherwise be punching dolphins or grannies.



I even had a go myself recently – no sparring of course, but I put on gloves and had a good go at my mate Pete’s punchbag. Throwing a punch is deceptively hard: there’s a whole art in placing the feet, positioning the legs, rotating the hips. It's almost like golf, in that it's much more about technique, balance and concentration than power. And landing a good blow gave the same exquisite feeling as hitting the sweet spot when striking a football or shuttlecock.



But the main attraction for me is simple. It is that boxing is the most basic of all sports - having a scrap.



Having said all this, another part of me - the larger, more rational part - really abhors boxing. The health arguments are compelling. And socially, there’s something not quite right about a couple of poor lads knocking lumps off each other for the amusement of sneering cigar-smoking bankers at the ringside.



In fact it doesn’t really need much debate: let’s face it, boxing is unpleasant, uncivilized and unsafe.



I guess it will eventually be banned - but not for a long time here in Cambodia. For one, nothing much gets stopped here, however bad it is. But also, it’s a national obsession, and it would take a brave fighter indeed to knock it on its head.



Perhaps the reason why it continues also reflects my mixed feelings about the whole thing. As Lawton concludes: “You can stop many things, for many reasons. But not included among them is a man's instinct to fight - and that equally compelling urge to watch”.

Free the bears!

“How we treat our animals reflects how we treat each other”.

So Ghandi got there before me, but I've always believed that how we care for fellow creatures is a good indication of how civilized we are (or are not) as a society.

On this measure, Cambodia had a head start through its buddhist heritage, with a sense of respect for other living creatures.

But these days, few Cambodians fear being reincarnated as a dung beetle, and when they hear me insisting on just veggies with my rice they often quiz me. My view - that it is cruel and unnecessary to kill animals to eat them - is met with uncomprehending stares: “But cow intestine taste so good!”. I learned to say “You know, like monk?”, and somehow it makes sense. (It’s a bit like when I go for an evening stroll and friends press me to hop on the back of their moto to get there quicker – explaining that I like to walk confirms me as a crazy barrang, but somehow “You know, for sport?” does the trick).

My sense is that Cambodians have become much more practical in their relationships with animals, with compassion (squeemishness if you like) now repressed from a young age. Basically, if a beast is useful to them in some way it will not be mistreated – not because cruelty is wrong, just because it makes sense in order to continue the benefit.

Thus water buffalo are well tended given their usefulness for plowing rice fields and pulling carts – but only as long as they work or reproduce. Pigs are well fed as they grow and breed, but are imprisoned and later killed (or transported in a tiny bamboo cage for someone else to do the dirty work). Dogs are tolerated as they help deter unwanted visitors (both real and imagined), but they live outside, scavenge food, menace visiting white men, and are routinely beaten.

The same goes for wild animals – they are valued only in as much as they provide a material benefit. Once the national animal, the kouprey (grey ox) was killed for meat. It is now extinct. Elephants were only useful if tamed, and again are now rare. The main hope for survival of dolphins in the Mekong is if locals can make money from them through tourism.

Cambodia still has a richly abundant animal life, and is home to 14 globally endangered species, including the Asiatic black (moon) bear, Malaysian (sun) bear, Asian elephant, Indochinese tiger and the Pileated gibbon.

Take the bears: these impressive creatures are threatened because until recently their value has been seen here only as a commodity to sell for public entertainment or private pets, for meat (paw stew anyone?), or - even harder to stomach - for farmers to cage them, insert metal catheters into their gall bladders, and sell their bile as dubious ‘medicine’.

Thankfully there is now a sanctuary for bears (along with elephants, snakes, parrots, minor birds and decidedly scary tigers) at the Phnom Tamao Wildlife Rescue Centre, 40km south of Phnom Penh. As a leaving present for Katja we both volunteered to be ‘bear keepers’ for a day. What a fantastic experience!

We made up the feed (green beans, biscuits and jam mashed up in a bamboo pole and stuffed with morning glory leaves), and got to hide them in the enclosures to give the bears a stimulating search for food. A real effort has been made to create an interesting environment in the enclosures, not only with forest and plants, but even pools and hammocks!

We then got right up close to the mix of sun and moon bears, learning their different ages and personalities. They’re beautiful and look so cuddly - though I wouldn’t get too near as they have serious claws! We were fortunate to see a baby, which was of course adorable - but we also loved the dark black adults with the distinctive ‘v’ marking, and an older, more orangey female. Thanks to the sanctuary, these wonderful creatures will be safe from cruel practices, and a release programme begins soon in Cambodia’s western Cardomom mountains, working carefully with the local communities.

I thought it was great, and there were plenty of Cambodian visitors enjoying it too. But I couldn’t help thinking that the reasons I cherish the bears - for their beauty, but also what I see as the intrinsic importance of preserving the country’s natural fauna - may not be shared by many others here. Rather, I think they are valued more because of pressure from foreign aid organizations, or as western visitors like us pay good money to see them. Put bluntly, they are only in the sanctuary as they are worth more there than for pets, meat or bile.

Returning to Ghandi’s point, I feel the moral relativism about animals is now also applied to people here. I often feel colleagues at my hospital care for other humans no better or worse than other animals. If they treat them well it is because it is better for themselves to do so. Is it going too far to suggest that that nurses tend patients because they are told to, and because they risk reprimand if they don’t, but not through compassion to relieve the suffering of fellow beings?

So I think the bear sanctuary has an importance beyond preserving wildlife, giving really important hope for this country: if future generations see animals now being treated with compassion, just maybe it will encourage them to care for each other in the same way too.

Preah Vihear is our temple!

Temples I have now seen many, but never before have I been led through the ruins with an armed guard. Holding my hand.

Preah Vihear is undoubtedly an important and impressive historical monument. Unusually for low-lying Cambodia, this temple is imposingly perched high on the Damrack mountains which form the border between present day Cambodia and Thailand.

The elevated setting makes access tricky: from the Cambodia side there is not yet a proper road, with diggers and cement mixers still busily building a route up the steep slope. In stark contrast, the wealthier (or more organized?) Thais had long ago built a tarmac access road. But to no avail: as the battered blue and white sign at the entrance proclaims "Preah Vihear is our temple". The Thai road stops abruptly just short of the hill, and visiters can go no further - the border has now been closed to Thais.

Our taxi only took us the foot of the mountain on the Cambodian side, where we transferred to a motorbike, who skillfully maneuvered us up the increasingly steep and treacherous slope. We had to get off and walk at one point, but overall it was an impressive effort!

The mountain is so high it was shrouded in mist – another rare experience for lowland Cambodia. This added a mysterious, atmospheric feel, as it swirled around the ancient Hindu ruins. It also meant that the temple unfolded gradually, each of the five sections progressively taking shape as we climbed.

I call them ruins, though it at least seemed little damaged from the Khmer Rouge period – or indeed little restored since. However, the soldiers took me by the hand (literally) and pointed out new bullet holes and smashed sections of ancient friezes, clear evidence of the conflict earlier this year. It was really saddening to see this happening to a UNESCO world heritage site even now, in 2011.

It was similarly depressing – if hardly surprising – to see the clumsy nationalist rhetoric on signs around the temple: “I have pride to be born as Khmer”. What nonsense! You can’t be proud (or ashamed) over something over which you had no control. It like saying you’re proud to possess opposable thumbs or have an inward-pointing tummy button.

A truer description of what it was really like came from speaking to an old soldier. He showed me where, just a few weeks earlier, he had sheltered from missiles. No bravado here: “I was really scared” was all he said.

None of this could take away from the beauty of the place though. We admired the intricate (and highly phallic) carvings, enjoyed banging our chests with the soldiers in the ‘’echo chamber”, and amused ourselves by haggling over how much we should pay for our ‘tour’.

Fortunately the only fighting now seems to be among the semi-wild dogs who lurk around the shabby military tents and bunkers. And the news from Thailand is positive: with a new prime minister elected, it is hoped people can get back to admiring this temple for its charm and history.

To brighten our mood further, as we started our decent the cloud cover lifted, revealing a fantastic panorama of dark green forest and lowland rice fields across both Cambodia and Thailand below.

As we stood admiring the landscape, I realized there was another view right in front of me, one which summed up my mixed feelings about the whole visit: leaning against the ancient wall was a peace offering of quietly smoking incense sticks; next to them was propped a rifle. Let's hope the incense wins out.

A Deadly Cambodian Crime Spree

I was shocked – horrified – baffled – on my arrival at the hospital this morning. Unbelievably, we seemed to have been attacked by vandals. It was not a pretty sight.

Fires still smoldered around the flagpole, and the shop under the tamarind tree, the social centre of the hospital, had not only been destroyed, but virtually all evidence of its existence removed.

Touring the wards there was more damage: one of our alcohol dispensers at the entrance to obstetrics had disappeared, blue dye had been smeared around the lab, and the bins outside paediatrics had been upturned and the contents strewn everywhere.

Worse still was the scene in the new xray room, only open a few weeks as part of our state of the art surgery unit. Someone had taken to the walls with black paint, daubing every surface possible, including the shiny new sink and once-sparkling white tiles.

It was a scene of devastation, and my heart sank.

Perhaps worst of all, the staff appeared to have been scared away by the attack, with no more than half a dozen to be found in the entire hospital. What a disaster!

This crime spree was all the more shocking as I don’t consider Cambodia to have much of a problem with vandalism, or any other criminal activity.

Although, of course, there has been one almighty crime here, which dwarfs even hospital vandalism: the Khmer Rouge regime committed unspeakable atrocities during their reign of terror from 1975-1979, and it is only this year that the first person was held criminally responsible for their part in it (that was Comrade Duch, who led the infamous S21 prison and torture centre). Four more senior leaders are just beginning their defence in front of the snappily-titled 'Extraordinary Chambers in the Courts of Cambodia for the Prosecution of Crimes Committed during the Period of Democratic Kampuchea'.

As it happens, I had just finished reading the latest of Shamini Flint’s southeast Asia-based crime novels, and this one is set in Cambodia, against these trials.

Flint’s tale takes this backdrop to showcase her likeable detective, the portly, white-sneaker wearing, chain-smoking, curry and beer loving Inspector Singh. There are some telling descriptions of Cambodia, and a plot which skips along nicely despite the dark background. Singh struggles to understand or work with his Cambodia counterpart, Colonel Menhay – a difficult relationship which echoes many of the joys and frustrations I have felt in working in this beautiful, beguiling country.

Thinking of such frustrations reminided me of the crime spree at my hospital - it was time to start some detective work of my own.

After gently interrogating a couple of nurses it appeared that the staff weren’t scared of a ferocious felon as much as taking a ‘well-earned break’’ whilst the Director was at a training day.

In the absence of the normal handyman, a random bloke from the pharmacy had decided to try his hand with the petrol strimmer, burning his mini-mountains of clippings and plastic bags, and starting various grass fires around the flagpole. He had also, he explained proudly, seen off the wild dogs who had been upsetting the bins.

The blue stains also turned out to be staff-inflicted - apparently something to do with malaria testing (my Khmer language didn’t get me any further than that),

Then the man who used to run the shop appeared, looking decidedly unhappy. It transpired he had been made to leave, but by the hospital rather than any vicious vandal. It seemed this was ‘because of the new surgery ward’ – I think as he used the previous building to store his goods and to sleep in when his shop flooded.

My fears of a crazy criminal were fading, but there was still a scene of devastation in the new xray room. Bang on cue the radiographer appeared – not in fury or despair, but rather with an unexpected grin on his face. “You like new paint room Mr Oly?” he beamed. “Need black, no light for develop film”.

My jaw dropped – he had done that to his own room! In fact, they’d all done it: perhaps there weren’t even any crimes to speak of, nor any destructive delinquent (or at least, only the staff themselves).

Though there was still one unresolved issue - what happened to the santizer in obstetrics? On interrogation the midwives shrugged and tutted a lot, wringing their unwashed hands, but there were no witnesses, no clues.

So the absent alcohol gel remains a mystery. Perhaps we will be needing the services of Inspector Singh here after all…

Let's talk about sex!

A young western guy comes to Cambodia looking for kicks, and – along with drugs and guns – he gets them from hooking up with a pretty local girl in Phnom Penh’s infamous Heart of Darkness nightclub.

Then it starts to go wrong. He falls for her, asks her to stop selling sex; she demands money, asks him to stay in Cambodia and get married.

This, I hasten to add, is not about me! Rather, it’s the plot of the recent film Same Same But Different. The girl’s later revelation that she has HIV certainly complicates matters, but the depiction of Cambodia as a destination for sex tourism is undeniable.

So what’s the problem?

Well, much of the debate is the same about the sex trade in any country. When it comes to child abuse or slavery these are clearly terrible crimes.

But why shouldn’t a women (or man) be free to sell her body if she chooses to? Indeed, why shouldn’t a man be free to buy sex, as long as it’s between consenting adults? And by making all or parts of it illegal, don’t we just drive the inevitable (the oldest profession) underground, away from lawful taxpaying and towards organized crime?

Yet where is the freedom for poor, young women with nowhere else to go? And isn’t there something not just distasteful but wrong about the rich and powerful being allowed to buy even the bodies of the poor and powerless? Shouldn’t the most vulnerable be protected, from both abuse and diseases such as HIV? Below the belt it may be, but the clincher for me is the old chestnut: would you be happy if your mum / sister / daughter were a prostitute? Of course not.

The approach here in Cambodia, as with most things, is ultra-liberal. Anything goes, if you have money you can buy it, which is why sex tourists swill around downtown Phnom Penh and Sihanoukville.

Whilst many of the punters are westerners, it is worth noting there are plenty of Asian sex tourists too. And Cambodian men, who by day lecture me about the importance of marriage and traditional values, by night find it totally acceptable to pay for sex in euphemistically named ‘karaoke bars’.

Prostitution is one thing, but what about longer-term relationships between Cambodians and westerners?

Part of me really welcomes these: the cultural exchange, the overcoming of national boundaries, the romance of love beyond borders. Last month I went to the wedding of a young American volunteer with her Cambodian boyfriend, and it was great. I really admired how they stuck with it despite opposition from friends, families, employers and the police (who even tried to evict all the westerners from the village the night before the ceremony, until a call was made to a suitably well-connected acquaintance).

Even with the more common older white man / younger Cambodian woman match, I know a number of very honorable men who have come to Cambodia and genuinely fallen in love with beautiful but also smart and articulate Cambodian women – what’s not to like?

But there are doubts – most such couplings are older, richer, uglier white men with younger, poorer, prettier Cambodian girls. Isn’t this somehow distasteful? Though is it any worse than if they were both western? Or both men? Or a rich woman and a poor guy (that happens too, though less obviously and probably much less often).

Perhaps it is because, bluntly, the relationships often amount to long-term prostitution – the girl gets money (a house, a passport, an income) and the man gets the girl. I confess that my heart sinks at the sight of shuffling ‘sexpats’ and their bored, compromised escorts.

But maybe they settled for the best they can get? Or even feel they made a good catch? And – tellingly – if I were a 60 year old single bloke I can’t honestly say I wouldn’t be tempted to enjoy the company of a stunning Cambodian beauty less than half my age – can you blame me?

So what about volunteers? What are our rights and responsibilities here? Interestingly, a straw poll showed a significant gender split.

Female volunteers seem to be pretty clear that their male counterparts should be very careful about ‘dating’ Cambodian girls. A casual affair for a volunteer may be ruinous for a local girl’s reputation, not to mention relationships at work and the reputation of our organization. And they are generally downbeat about the chances of romance with Cambodian men, who they see as having rather too ‘traditional’ views about the place of a women.

Male volunteers responded rather differently. We’re here to play as well as work, and Cambodian girls can be both stunningly beautiful and irresistibly playful. We’re not here to put our lives on hold – and in fact what better way to learn more about the culture, the language, the ‘real Cambodia’ than to date a native? Those from other Asian countries such as India and the Philippines may be particularly likely to slip into the karaoke bar culture – it may be distasteful to western women, but they can hardly be accused of going against the local values! Meanwhile, younger western volunteers laugh that the girls are just bitter because of their own slim pickings.

So where does that leave us?

As always it all comes down to role-modeling. Put simply, if our sexual behaviour is abusive, insensitive, destructive then it’s bad. If it’s loving, sensitive and productive then it’s good.

If in doubt, we would do well to remember the apocryphal story of the American visitor giving a welcome address in Khmer, who proudly stated he had come “to help the Cambodian people”. Unfortunately he mixed up the verb to help (chooi) with that for fuck (choi).

Let’s talk about, let’s enjoy sex. But let’s not forget we’re here to help.

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!

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.

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.

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!