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The Complex Citizens of Cambodia
by Anette Wig
I am not a doctor, nor a medical student. In fact, I don’t have any kind of medical background. I am not a journalist either. I am an observer. A 19 year old observer from Norway who got the chance to come to Cambodia to observe, try to understand and disseminate my experiences. I didn’t really know what to expect. All I knew was that I was going to travel a long way to a floating clinic with a staff, and that we would sleep and eat there. I had no idea what kind of people I would meet along the way or how the clinic would function.
January 27th I met the River team for the first time, and the following day the adventure commenced. With motorbikes we went from the village where we had spent the night (situated about 2 hours from Phnom Penh, and 6-8 from Siem Reap), to the river. Chantrea, the boat driver, met with the TLC-3 boat and brought us down the river, to Okarlev village.

This village has approximately 30 families and right now the houses are on piles on land. During the high water season, these piles will (most likely) keep the houses above water. The word “house” is an exaggeration. These constructions are pieces of wood put together with dried leaves as their walls and roof. To enter the house, you have to climb a ladder which doesn’t really look too safe. Nevertheless, the villagers climb these ladders with such grace, even with a baby in their left arm, a bowl of water in the right and sticks balanced on their neck.

As we approached the clinic with the TLC-3, a group of 5 kids had been waving and shouting “hello!” from the shore. The first thing I did when we arrived was to get my camera sorted and climb up the small hill from the clinic to the village. There the children stood waiting. At first they seemed a bit skeptical. When I said «sooe s’day» (hello in Khmer) with my bad pronunciation, they burst out laughing. One of the girls pointed at my camera and said something that I assume meant “take pictures”. It is funny how they put on their serious face for the shot, and when they get to see the result afterwards they just point at themselves and laugh.
This boy was the very first to visit the clinic, along with his mother and his brother. Please note the boy in the background with the swollen stomach.
 The floating clinic in Okarlev
In Khmer culture the family and groups of communities are highly important. This is very visible once you set foot outside the big cities, where the focus is mainly set on tourists. Everybody has a responsibility to contribute to the family’s survival. While the men (and some women) are out fishing with some of the children, a couple of women would sit with meter long fishnets and lurk out the fish and put them into large bowls. Others scrape out the inside of a coconut and prepare a meal, some wash clothes in the river. Everybody has a task, and often the children help out. As a recently graduated student it is hard to imagine a life without education. Here, exactly that is a reality. None of these people will ever become doctors, lawyers or engineers. There are mainly two obstacles for this area. 1: there are no schools here, and this is probably because of point number two. 2: in Cambodia, education is expensive. The government doesn’t give out any kind of subsidies for education, and getting a loan in the bank is difficult. In poor areas like this, the children learn things that are related to what they will be doing in life. The tasks the villagers do on a daily basis look rough from a distance.
After lunch, around 2:30 pm, the clinic was opened. During that day, it was quite clear that the tasks don’t just look rough from a distance. People were in pain; muscle pain, headache, stomach ache and bad knees were common issues as well as general illness, such as diarrhea, runny nose and coughing.
When arriving the clinic, the patient would first have to register at Pov’s desk outside. He works as the registrar and security for the clinic. Then the patient would be called either to Dr. Brett and Sreymom, or to Dr. Sopeak. Brett and Sopeak are both doctors, and Sreymom is a nurse and a midwife. After consulting with either of them they would be checked for their issues, and one of the doctors would prescribe a medicine (sometimes several medicines). He or she would then deliver this prescription to Sophon, who is a nurse and a pharmacist.

Pov registers the very first family visiting the clinic


 At the end of the first day, when I sat outside the clinic and did some writing, an old lady came paddling in her boat. When she noticed me, she dropped her oar, put her hands together and gave me a wide smile. Even when she was smiling she looked tired. She had problems with high blood pressure. The average life expectancy for women in Cambodia is 65 years. This one is 82. I heard Dr. Brett saying “Wow, she’s seen everything”.

When the clinic was closed, the team had a very good time together. We had a Norwegian – English – Khmer lesson, and after that I went back to the village to see what was happening. The young men were in the middle of their daily volleyball game, the older men were watching with the kids. The fact that they have the energy to play volleyball after a long day of working and fishing is impressive.
As I walked a bit further into the village (a bit further meaning a few meters), there were some large grills with hundreds of fish, between 12 and 14 allocated on each skewer. This is a “specialty” in this area, and the grilled (smoked) fishes are edible for 5 years.

On the second day the clinic opened after breakfast, around 10 am. The first patients were a mother and her son. The woman weighed 40 kg. Her son is 10 kg. The boy looked so small, I would have guessed 4 years old. He was 6. He had been coughing for 3 days. The woman (the one in the pink t-shirt in the picture below) was shot 30 years ago. She’s been feeling the pain ever since, and she had also been bothered with cough the past 4 days, which made her feel the pain even more than she usually does. 

After spending some time at the clinic, I went for a walk with Sophon in the village. I met the girls from yesterday’s photo shoot and the 6 year old boy with the cough. They were playing at the volleyball court; they ran from one side, jumped up at the middle and touched the net before they continued to the other side.  They do whatever they can to entertain themselves because no one else is going to do it, except for those very few times when a stranger shows up with a camera.
The little boy, whose name I unfortunately do not know, told Sophon that he loved me and that he wanted me to come back. He grabbed my arm and led me to his mother and two other ladies. They were sitting on the ground taking fish out of the net. He pulled a note out of his pocket. 500 riel (12.5  cents) and proudly showed it to me; it had some writing on it and on the other side there was a drawing of two heart with arrows going through them. Then he put it back in his pocket, shaped a heart with his hands and stretched his arms towards me.
  In addition to Okarlev, there was another village nearby which was dependent on TLC. 30 families all together make the village of Beungsbov. During the high water season, this village is under water. In August/ September last year it was impossible to live here. You can clearly see the water mark on the wall on the picture below.

The children of Beungsbov were very eager to help out. They carried the heavy tables and boxes with equipment from the boat and up the small hill.
As soon as the “clinic” was ready, the villagers started lining up in front of Pov’s desk. This village had a large amount of babies compared to Okarlev. Some of them had abnormal belly buttons. I asked Sophon about it, and he said: “It’s because of dirty equipment when cutting the umbilical cord. They give birth, and have to cut it with whatever they have. It might be a dirty scissor, it might be a worn out razor blade”. 
These people work hard. This is their life. They suffer from diseases that can be treated easily - as long as the knowledge and right equipment are provided. The of lack of choice, the importance of honour and “saving face” as well as responsibility for one self and a whole village, make these villagers a complex people.
Here, in the suburbs of Cambodia, a “clinic” is not about a clean and white office, white scrubs and a waiting area with Duplo and magazines. In Beungsbov I got a whole new impression of what a clinic could be like. Blue plastic chairs, a few tables and basic medical equipment in the shadow of the village’s largest tree.
Julie D., who’s been working with TLC for a while, told me a story from last year that I remembered when I was watching the villagers, the patients, and I thought “this must be hard”. She had asked a man if it was difficult to live the way he did, as a fisher in a poor village on Tonle Sap Lake. His answer was: “No, living another place would have been difficult”.

By Julie D.

Last week (14th to 17th of june), was a huge week for me ! Important one ! I’ve been waiting for it since almost 4 months! I was about to meet one of the most important member of TLC’s staff.
She is impressive. She is quite old though…
Sometimes she needs to consult a doc or several doc but I cannot tell you all her secrets, I’m sure you understand… But I needed to share this one with you: you have to understand that she has spent the last few months in a specialized hospital…
So, you can imagine how happy I was to finally meet her, just before I will have to leave TLC and Cambodia in a couple of weeks…
I went down to Phnom Penh to meet Jon. He had just spent 10 days with her, helping her to leave the hospital and holding her hand to get back on her “feet”.
I have to tell that I was a little bit shy and impatient… She is an important lady, she was a Charming Duckling but she became a Swan…
Yes, TLC-1 is an important Lady.

The motorbike taxi dropped me where the boat was tied. She was hidden but I could still see her prow… Few more steps and here I was, on TLC-1…
She needed to be cleaned up a little bit, of course after several months of renovation she wasn’t in her best shape ever but still… we did a part of the work.

Jack, Jon’s friend and tuktuk driver and Jon himself have tried the engine, started it, fixed some details


and, after few hours, we were ready for a cruise. We had to test the engine for real, on the Mekong to be sure that TLC-1 was ready to go back to work.

What a good and amazing feeling to see the shores  fading away…


but didn’t last a long time… soon, Jon said that something wasn’t right, the sound of the engine wasn’t smooth… I couldn’t said, I don’t know anything about boat… We were about to live an adventure.
After a 30 minutes cruise along the shores, TLC-1 decided that she was tired and stopped. She stopped in the middle of the ferry line…

She couldn’t had found a better place to manifeste how disagreed she was.  We couldn’t start the engine anymore. Or when we did, it only lasted for few seconds or few meters.
We had to wave out the ferries, make sure they saw us…
At the beginning, the winds and the streams maintained TLC 1 straight but things change… And step by step, minutes after minutes we were dangerously drifting… The shores got closer and closer… We couldn’t do anything to stop it, to avoid it.
Jon has tried to cast the anchor but it couldn’t grab the bottom so we have kept moving…

… At the end…we’ve hit the shore. Smoothly but unavoidably…


Jack and Jon have spent hours to try to fix the engine, to make it work again. Sometimes it seemed to work but… no. Plus, we were stucked in the mud. Even with all their efforts and willing, they couldn’t start TLC-1. She has quite a foul temper! We only had one solution left…

We called for help. Three mechanics came and have tried to fix the engine.


When they thought it was fixed, two of them have left the boat, the third stayed with us, thank you for that. Yes, indeed…TLC-1 has never been able to drive us back. Something was broken, we didn’t know what. The mechanic was angry, he couldn’t fix it, very very annoying.
Sometimes the engine started only for few minutes, we had to jump into the Mekong and push TLC-1 in order to deliver her from the mud. (Mekong’s mug is really really soft by the way!!)

That was an experience! It’s probably one of the most amazing sunset I’ve ever seen. Not because of a burning sky, not because of a colorful one but because I was IN the Mekong, standing next to TLC-1, water up to my chest (mostly up to my hip…), looking at the sky, Phnom Penh in front of me. This kind of things does not happen a lot in a lifetime, not in mine anyway!


Around 6:00 pm we knew we couldn’t do anything more, we had to call for rescue, the sun was going down, only 30-45 minutes of sunlight was left, we didn’t have any other choice.
When they arrived, we were a little bit worried, they came with a small boat… but everything went fine, they tied the ropes, and tug us to our departure point.

We arrived at 8:30, exhausted and frustrated.
The next days, mechanics, Jon and Jack have tried, very hard, to find out what was broken, what was the cause of all of those troubles.
After 2 days of work, after two days of frustrations ( I should say after 10 days actually), TLC-1 went back on a cruise. Everything should have worked well. It didn’t. Water pump wasn’t working.
TLC-1 is still sick, she needs some more surgery but we all hope that she will get better as soon as possible.
Today Jon is back in Siem Reap, TLC-1 will go back on a test cruise next week. Please, wish her luck and success.

June, the 20th 
Julie D.

By Julie D.

Every week, thursday to saturday morning the River Team is back on the floating clinic. Ready to work, ready to take care of the villagers, ready to serve the underserved of the Stung Sen River.

It had been a while since I had been there, the first time - and the last one until now -  it was at the end of march.
I had just spent 4 days on the clinic with Chanthrea, his wife and children, Sakhem, Sathya and Phertra, it was great but most of them had left on wednesday morning. I was just very happy when I saw the Dolphin coming back, on board: the River Team. Mom, Pov, Sophorn, Sathya, Sokmali and two nurses from the health center.
As soon as they arrived, first thing to do, clean the place, arrange medicines, prepare everything for the afternoon.

Lunch. Thursday wasn’t a hot day, it was just the right temperature.
1:30 pm, the first patient arrives.

This time, the two nurses from the health center have come with the team for immunization.
We were 8 on the clinic and Chanthrea, his wife and their two children even if they’ve shared our meals and spend some times on the clinic, slept in the Dolphin. The clinic is big but not big enough to sleep 12 people !
All the afternoon the clinic was crowded, the team has seen 40 patients this first afternoon. As usual, women, men, children.

It’s really funny when the villagers notice my camera, they laugh a little bit and then they stop moving, waiting until I take the picture.

Sometimes, someone points at someone else, an other adult or a baby. They really like when I take pictures of the children or the babies! And when I start, they come, one by one, always shy at the beginning, but they want a picture! When I show them the result, they smile or they laugh! It’s always the same scenario.

When I’m not taking any picture, I just stay around them, with them, they look at me, they talk to me, I really try to understand but that is my frustration, I can’t understand… I need to learn more…

During this first afternoon I have to admit that I’ve paid a lot of attention to the immunization program.

Children and babies. Some of them were very quiet and brave, some other were just angry like hell!! A small child couldn’t stop crying and screaming. When the Sambun, the nurse from the HC tried to approach him, to comfort him, he got really mad and pushed him back like if he was the devil! It was funny to see his rage!
I remember my brother, when he was very young: he hated needles and vaccins.  Every time, it was a real nightmare for my mother. Once, when we had to consult our pediatrician, my brother got away from the office. He didn’t go far but he took off, he disappeared. Screaming and running in the clinic… Today, he’s an adult who will turn 35 at the end of the year, and he’s not afraid of needles anymore… I don’t have any memories regarding myself, I’m sorry for that… It would have been a pleasure to share them with you!
Anyway, I can understand those little children, injections are not funny, and sometimes it hurts, it burns, it stings. When it’s the very first time it can also surprise you. You trust your parents, you trust the nurse or the doctor and BANG!
Today, thanks to TLC, the villages we serve can discover the pleasure of immunization. I’m not a pro-immunization, I mean I don’t think we need vaccination for everything, we should leave our body developing antibodies. BUT for some illness, immunization is a must.  And that is what the staff from the health center provides when they join the River Team. That is what we can provide since TLC works on the Stung Sen...
Friday, the clinic was open from 6:50 to 11:30 and from 1:30 to 5:00 pm. 100 patients have been seen.

It was a very hot day, believe it or not, it was more than 55 degrees Celsius… (131 fahrenheit)… No need to tell how each single move was painful! I was not the only one who was sweating, even the villager were… While we are inside the clinic, it’s ok, 3 fans are enough to help you cool down a little bit. And you bless the shower….

Friday afternoon, more men came for immunization. Only a picture can express what I would like to express:

Yes, definitely, injections are painful even for a tall strong man.

At the end of the day when all the villager had left the clinic, Sophorn, Pov, Sambun and myself went to fish a little bit.

Just across the river, few meters from the clinic. 30 minutes before sunset.
The “boys” caught some fishes, this one, the puffer fish had his life safe… him and his fellow went back into the water…free to go. The other ones… ended up in our plates…

You know, I really like to share those moments with the team. We joke, we laugh, we talk,  sometimes we don’t know how to say what we would like to say but at the end, we always find a way to understand each other.
On the shore of the Stung Sen River, I felt good, I was happy.

A look on the clinic, a look upon to the sky, a look on the river and a look on the village. At this moment you understand something, I mean, you feel it in your body, in your bones, in your heart, you know that despite all the difficulties, you know that despite all the obstacles, you know that despite all the challenges that you have to face and that you WILL have to face and deal with, you’re doing the right thing.

I’m just an intern here with TLC, I’m just here temporary, for few months, but I can feel it. 
It is not your title, your position, your job description, your background or whatever who makes you who you are, it’s how you feel about it, how involved you are in what you do, how you care about what you do. It is the difference between a duty and a desire. Of course we need to work to live, lucky are the people who live their work like a passion.

It’s also a state of mind, some people will simply go to work in the morning, do what they have to do and will come back home without any other kind of “devotion”, and they are happy like this, lucky them too!
There is not right or wrong, it’s up to every one.
But every body doesn’t have the chance, the opportunity, or even the right to choose, so, again, those who are able to do so are lucky.
Saturday morning the clinic opened for its last morning, few patients later we’ve left.

This last morning I was very scared for few seconds, but it was long enough for my blood to froze from the bottom of my toes to the end of my hair.
A 65 years old man came to consult because he had an infection on his toe.

Sokmali has started to treat him, some cuts, some disinfection… The man was stoic, didn’t said anything, didn’t complained, didn’t move. And suddenly, his eyes rolled upwards, he looked like he was dead. Again - I felt panicked for few seconds - but fortunately, doctor and nurses were there and didn’t loose control. As I told you, it lasted only for few seconds. They did what they had to do and the old man woke up. Yes, he “just” fainted… He told the team he felt asleep, he told them that when he’s at home, he falls asleep the same way…
The truth is that he really collapsed but he couldn’t say it, it was just inconceivable, do not loose face, never.
He was the last patient.

We’ve packed everything, and we left.

It was the end of my “Eight days’s week” on the floating clinic on the Stung Sen River.

For this, I want to thanks TLC. For this and everything else of course...