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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







 Sophon

 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”.