OPERATIONAL DISTRICT: KIRIVONG
HEALTH CENTERS: KROPUM CHHOUK, PREY MELONG
Breakfast was at the same place as Wednesday morning. The lady who made beef with rice remembered me, and smiled at me with her toothless smile and one hollowed eye. She asked me if I wanted a receipt again this time and I said yes. So, she happily signed her name and wrote down in Khmer on my pseudo receipt: "BEEF. RICE." It only cost me 75 US cents, and tasted just as delicious as I remembered.
Today is Z's first day alone, so we drop her off at her session. As we are preparing to leave, a village man jumps down from a palm tree onto the road. He is carrying a stick over his right shoulder, with strings hanging from it. At the end of the strings, cut-open plastic one gallon bottles are hanging from it. In it, a fluid that is opaque, and a light yellow tinge in color.
D says "Ooooooh" in his classic "dark o" sound and he says to me, "Hey Jason, have you ever tried palm juice?"
The man had just picked the palm juice fresh from the tree and was preparing to go sell it in town, and so D flagged him down to pour us some of his harvest. He gladly obliged, and for the first time I had organic palm juice. The flavor was not too sweet, and kept at perfect ambient temperature. You could taste the palm tree in the drink, and it was the most fresh juice I've had in a long time. We all gathered around the man, helping him to pour his juice into our bottles. But, before we could close our bottles for the road, everyone had already finished their share.
The countryside constantly provides me a source of vitality that I don't get in the city. Something about being free and unbound by decorum refreshes my soul. Today, I joined D again on his journey, as he wanted me to see Kirivong, a poorer operational district in Cambodia, to really see the current state of Cambodians. He told me that in the city you don't get to see this aspect of Cambodia -- the "real" Cambodia -- and that I should see it to better understand the country. To get into the first site, the car wasn't able to pass through the small country roads that were rendered oblong and undriveable through the dense rains and tractor imprints. So, we hired two mototaxis to take us to the health center.
When I sit in the car and look out, I observe the countryside and the people. I see the farmers picking their crop for the season, and their friends hanging around, relaxing, and taking shifts in the process. I see the landscape stretch for acres and see the palm trees, the national symbol of Cambodia, interspersed in the fields. The rice is planted in a linear fashion and as you drive by and if you look directly down the line, you notice the perfectly parallel lines flash by. You notice the rigidity to the field. But, when I'm are on the motorbike, it's different. I'm no longer observing the countryside but a part of it. I look out into the fields with the sun shining on my face and I feel a part of this earth. Each bump in the road is felt more intensely, and the fresh country air hits your face. No pollution, just open dirt roads and peace. A calming peace that you don't find in the city, or city parks.
As we travel, my driver doesn't say much to me but navigates the muddy roads. I look to the left and the lotus blooms are in. The flowers are a deep purple and arise from the green lillies, adding a depth of color that is so rich against the deep blue sky. Egrets are walking through the fields and congregated in a flock, perched atop one leg. We pass by strangers and they look at us carrying our boxes; people in the country stare because they know you're not from around the area since it's such a communal space and intimate community.
After the lillies, we pass a woman raising small ducklings that are caged off by some loose netting strung around four stakes. There are about 300 ducklings all chirping at different pitches, creating some orchestrated choral sound. 50 meters down, we see their parents walking around, also kept around a similar corral. The landscape blows me away, it spans out and you are just a single point in the world at that moment. There's nothing but you and nature around you, and it's such a classical agrarian experience. There is a romanticism to the countryside that is characterized very differently than that of the 'quaint' variety in the West. It's not cute, small, or cozy. It's absolute freedom and serenity. D and his driver are in the motorbike in front of me, and I see him chat up with the driver. I'm amazed at his ability to engage so naturally with his people, from farmers to health care workers to nurses alike. There is unwavering compassion and humor in his tone that puts people at ease. I sit behind on my motorbike and watch him perch two hands on his thighs as opposed to the back handles meant for passengers of the bike. It's a sign of trust, given the bumpiness of the road and the possibiliy to fall off. I look and see how at ease he is among Cambodians, with the backdrop of Cambodia constantly changing before my eyes..
When we arrive, D chats to me briefly. "You see that tree, Jason? The one I said is good for making houses because it is straight and cylindrical?" I nod, yes, they all look the same to me, "Yes, that one is used for making houses.. I can't think of the Latin name right now. But, that one a bit behind it, also straight and tall, with a darker color, is perfect for boats."
"In Khmer, that tree is ___. The other one is ___. I don't know how we can translate them to English." He knows the Khmer name for them because it's a big part of his culture. He knows the Latin names because he is a botanist at heart, and smart enough to remember them like a scientist. And he shares all this info to me because he is man proud of what the landscape has to offer. He shares with me with a slight didactic tone that is undermined by sincerity.
When he arrives to the health center, he has a way of conducting his session. He will always say hi to the director of the health center and introduce himself, and me. The Directors will always look at me a bit and be confused that I"m not Khmer, and then return talking to D about what we're doing. With his demeanor, he puts them at ease and has felt he has done his job well. "I know we have authorization to be here from the ethics board. But what's more important is to engage my local community; to understand how the center operates and understand what are the benefits and shortcomings for the people. Even if we have ethics approval, this is not enough." He shares a story from yesterday, when he talked to a man who had come to the health center to pray to Buddha. He thanked Him for the delivery of their healthy son, and D talked to him about his experience at the health center. He said that health center had 20 new births last month. I sit there and watch him deliver the session in Khmer. A resounding echo of Jat and Bat ("Yes" for women and men, respectively) are scattered throughout as they fill out the questionnaire. He laughs to me. "you know, when I talk about incentives, all they want is a bicycle!"
While waiting for the session, D says "Hold on, I'm going to go confirm lunch." After the session, we walk out of the village compound and head to a random house with a rosewood table carved out. 5 rosewood chairs, carved as stumps, serve as the chairs. I only know it's rosewood because D tells me while sitting down. Two kids are learning mathematics on a makeshift blackboard hung on their living room wall. Their dad is teaching them. When lunchtime comes, the kids take a break and bring out the pot of rice, helping their mom. They run out to serve us and greet D and me with a warm smile.
Along the meal the family members stop by and chat with D. They tell him that all of the food was picked in their backyard and prepared fresh. They serve us riparian fish, baby bamboo cooked in a light broth, and baby mango strips. Later, another man stops in and talks to us as well. I'm grateful for the hospitality of the people in the countryside. The villagers are all really friendly and spare the time to help out when they can. The man who sits down and gets talking to D offers to take us to the next health center at no cost, the three of us riding together on one scooter, so we agree. We continue eating and chatting for a while -- D is talking and I am sitting eating the fish. I see the kids pick up their backpacks and get back to school -- they must have been on a break. A few more other locals stop in and eat and chat with D. After a while, we leave. The man who has offered us a ride puts on his communist looking hat, aviator style prescription glasses, then tells me and then D to get on. The ride to the next site was just as beautiful, passing through some small villages. The pictures, similar.
Along the way, I see small plastic bags strung along stakes in the field. They look like little lanterns. What it actually is is a bug trap. The lanterns are lit with anti-bug stuff and so when insects are drawn to it at night when lit, they will get zapped and fall into the water. A simple way to keep the bugs out. Just a small note for my memory.
Doing a total 180 here, one thing I noticed is the purity of the Khmer language. I'm sitting in the new clinic while D is talking to the Director, and notice that not one word is written in Latin script. Even words like hydroencephaly. I ask D, "When you speak Khmer, you don't use a lot of English. Is that true?" He goes on to explain how most of the things will tend to be descriptive, if not an actual term. Hydrocephaly would be "the disease that makes your head big." They don't have a centralized language unit that approves new words like China does, but he says they are working on it. There are still, however, remnants of the French Colonization era. For example, when they need to get a vaccine, they will say it in the French pronunciation (pronounced: vax-ong). "It's a shame. We should make a Khmer word for it, especially if it's a health term. This is important for health literacy." I suppose with the historical legacy of Cambodia and its dense cultural impact on many parts of Southeast Asia, you would have a purity in the language untainted by Western influence. Words with stronger Western origins have just managed to sneak in.
While waiting for the bus to pick us up, a schoolgirl is taken into the clinic and all of her friends accompany her to the clinic to make sure she is ok. The school is just 20 meters down the street and so there is effectively no commute. She gets checked out, and then gets dismissed. There is a small girl running around the clinic who is the daughter of one of the village health workers, and she is naturally curious. She peeps into the room where I am working, and then to the room across the hall where the director is sitting. She then runs around outside with the other kids.
As the only health center serving the village, it has effectively become a communal space for everyone. There are no waiting lines, no bureaucracy, and no busy staff running around all the time. There are three rooms, one with a scale hung from the building to weigh newborns. The other one is an exam room with the director, and another examination room. They are not sterilized and clean white rooms, rather, they have a desk in there with some informational panels and sheets in Khmer about various topics. There is a small wooden dildo on one of the desks, presumably to teach how to use condoms. Completely grassroots healthcare, the ultimate in primary care. The gatekeepers of village health.
We end up waiting for three hours as the nearest province from which T is coming is that far. A lady who is 19 comes in and D starts talking to her. They talk for hours, a majority of the time that we are waiting. I do my Chinese exercises. When they finish, D comes out and tells me her story. "You know, she's only 19. She wanted to thank you and me for the work we are doing. She says she always wanted to be a nurse because of what she can provide for her village, but after graduating high school she didn't have money to attend university to further studies."
"Her mom is actually one of the health staff at this clinic. Recently, she had a heart attack and cannot do the night shift as planned so she was taking her place. I encouraged her to still try to find a way to be involved with healthcare out in the rural areas - she is quite young. Her experience now should be very good for what she wants to do, even if it's not formal medical education. But that's the reality, I guess" he sighs and shakes his head, and 'tsks' quickly, "you see, Jason, this is how it is sometimes." The woman was to be there the entire night, to serve as the main liaison between the village clinic and the nearest hospital. Although she hadn't any training, she was the main provider that night.
As we are getting ready to leave, a woman rushes in with her daughter (or granddaughter) who is cradled in her arms. The girl is put to rest on one of the beds placed right at the entrance of the clinic. The girl has her eyes closed, as if unconscious. She thrusts her body a couple of times (the kind when you cough, and your chest sinks back in) without making any coughing noises; at other times, she coughs out loud. "It's been like that for three days, and it's getting worse." says the elderly lady. D volunteers to take her to the nearby hospital as a slight detour because there is no other form of closed transport (car, truck) that can take her at that hour. It's about 22:00. The young woman of 19 takes the young girl's vitals -- all normal -- and writes the referral letter. It takes 5 minutes, a shockingly short time when compared to the facilities in the west. The woman hurriedly sits in our van and D is in the front, while T and I are sat behind the lady with her child. We drive 20 km to the hospital.
When we get there, I can already feel the difference between the hospital and the village clinic. There is a gate at the front, and we need someone to open it. They look at us for a second, consider, and then open the gate. We drive in, and ask where to put the small girl. While deliberating, the woman cannot hold onto her child any longer and so we put a pillow on the outside benches and had her lie outside on the table. A few seconds later ,the doctor tells us to put her on the bed in one of the examination rooms. The doctor takes a few minutes to come out. From there, that's all we can help. We leave the elderly woman and the child there, and then left.
All along it was D's idea to take the girl to the hospital. A, our driver, and T gladly complied. They asked me for permission but I told them for this situation we did what we had to do, whether or not it was 'work.' D's conversation about community engagement rang in my head. "Jason, just now did you see that little girl?"
"Yes, she was very sick, I hope she was ok."
"No, did you see and hear what she did?"
"No." I didn't think that she had the energy to say or do anything since she was just lying and coughing the whole way to the hospital. Turns out, she was pretty conscious through most of it, but had not said a word.
D gestured to me to show me what she did. He put his two palms together, fingers loosely separated, but still close. He raised his two thumbs to his nose. "Arkoun, Arkoun (thank you, thank you)." Hands raised at the level of respect to the King. He just nodded to me and did not make anymore comments on it. There wasn't any basking in glory about the 'deed' that we did, nor any mention of the fact that it was a 'good thing' that we did at all. It was just a service we could provide, and we were in the right place at the right time. I nodded back and acknowledged his humility, without words (mostly because I didn't know what to say). We went to get some beef kebabs on the roadside afterward.
We arrive in Kompot at night to stay. It takes another 1.5 hours to get in. The nights always drag on but never feel like a drag. You get swallowed in to the darkness and time seems to cease movement. We pick up the rest of the team, and go to eat. Kompot, the city of Durian, is rather touristy. We go down the 'high street' since it's the only thing open at 12:30, with the night crowd rushing in. I see my first prostitute since I've been here. What would normally be a familiar face, I also see for the first time: a white person. He is sat at the end of the table eating with us. T tells me this area is very touristy and it will be common to see foreigners, and often some of them will go home with the massage girls. I get my first glimpse of a city in Cambodia. Shortly after, we go find a guesthouse, and check-in.
Tomorrow is Saturday and a day for rest. I forget my laptop in the car and have to wait for A to finish showering so I can ask for the keys. T and W wait with me in the lobby, both having taken a shower, wrapped in towels only. When A comes out, he is also wrapped in a towel just after his shower. He's smiling, as usual. T tells him that I left my laptop and he needs to open the car, so A tiptoes through the building lobby so as to not wet the floor, and out towards the car wrapped only in his towel. I notice an abrasion on his right shoulder, but make nothing of it.
T says to me, "Did you notice that scar on his right shoulder?"
I say, "Yes."
"That was from the era of the Khmer Rouge. He was running away from the bombs being dropped by the U.S. and Khmer Republic at the time."