~Featured Writer: Lynda Renhamcook~
Having left England on a cold December day, I arrived at Siem Reap in Cambodia on Christmas day late in the evening. The heat hit me immediately. As I was still wearing my warm clothes I was quite relieved to feel the cool breeze on my face as I took my first Tuk Tuk ride to my accommodation. I had never been to Cambodia before and I was struck by the poverty of the country almost straight away. My stepson greeted us and took us back to his apartment where we were shown to our very comfortable bedroom. I decided over the next few days I would see the poverty for myself. I had not imagined, however, the extent of it and was very surprised. What affected me most was seeing the children living in such squalid conditions. I found it difficult to visit the markets where children would beg me to buy their goods. On my third day I walked into the local village to visit the people there and to take photographs. Here the poverty of the people was very apparent. Children were running around barefoot avoiding skinny cockerels that hustled for food and shouting hello to us in loud voices. Everyone we passed smiled at us and asked how we were and some even offered us food despite their poverty. Both my husband I were very touched by this. We passed small huts that looked like they would crumble to the ground should there be one large gust of wind. I saw children being washed under taps while they fought to escape the parent attempting to clean them. How do these children stay well, I wondered and what do they eat? Cambodia is a poverty stricken country, where the average wage is seven dollars a week. Everywhere you look there is poverty and malnutrition. There are also many children. Where there is poverty, there are health problems. I glanced at the small stalls selling food and tried not to grimace at the flies that hovered there.
The Khmer Rouge
So what has ravaged this beautiful country and left such poverty in its wake? I knew something of the Khmer Rouge regime from things I had read but I realised I had no clear idea of what happened between 1975-1979. How could I not have been aware of such a terrible genocide? I was of an aware age. I thought back to what I may have been doing during this time and was ashamed of my ignorance. The Khmer Rouge killed nearly two million Cambodians from 1975 to 1979 spreading like a virus from the jungles until they controlled the entire country. They destroyed and dismantled in the name of a Communist agrarian ideal. Today, more than 30 years after Vietnamese soldiers removed the Khmer Rouge from power genocide trials are still going on, a bitter sweet moment for the impoverished nation still struggling to rehabilitate its crippled economic and human resources. It is this legacy that the children of Cambodia have inherited. Under Pol Pot’s leadership, and within days of overthrowing the government, the Khmer Rouge embarked on an organised mission. Children were taken from their parents and placed in separate forced labour camps. Factories, schools and universities were shut down; so were hospitals. Lawyers, doctors, teachers, engineers, scientists and professional people in any field (including the army) were murdered, together with their extended families.
If you are unfamiliar with the Khmer Rouge there are many books to familiarise yourself with this cruel and terrifying regime. ‘First they killed my father’ by Loung Ung is an emotional insight into one child’s experience of the horror of The Khmer Rouge. I was lucky to be given this book by my stepson and his wife while in Cambodia. Both the book and the country have touched me on a deeply emotional level. Seeing this beautiful country after this terrible rape by the Khmer Rouge makes it impossible not to be moved by the people’s positive attitude and their continual smiles. Knowing that thirty years ago the country lost most of its educated people and Doctors I was curious about the health situation in Cambodia.
Meeting Arun Sinketh at The Angkor Hospital for Children
A few days later I myself was very sick with a stomach upset and again I found myself wondering about the health system in Cambodia and along with my husband went to ‘The Angkor Hospital for Children’ (AHC) visitors Centre. Arun Sinketh the Human Resources Director, sensing my interest and keenness to write an article offered to give us a tour of the Hospital the following day. I left armed with booklets and information and studied them that night. I was saddened to discover that the life expectancy in Cambodia is just 57 years and that the probability of dying before the age of five is 88 per thousand births. It was difficult to comprehend the figures. The children of Cambodia are the most appealing I have ever met and I fell in love with many of them. As I journeyed back to the Hospital the next morning, many of them waved and shouted ‘Hello’ to us. Some were travelling totally unprotected on the front of their father’s motorcycle. I cannot begin to count how many under-five’s I saw travelling helmetless on a motorcycle with either one or both parents. Heedless of the dust and heat they ride happily along seemingly unaware of the dangers. I immediately found my mind wandering back to what I had read the night before and shuddered. One of the most lasting legacies of the Khmer Rouge and which continues to claim new victims daily, are land mines. They litter the countryside and even the soldiers who placed them there cannot recall where they are. As I travelled through the country the effects are visible in many ways but perhaps most poignantly in the number of children, men and women wearing prostheses or riding wheelchairs. I knew there had to be something I could do to help the smiling people of Cambodia. Where better to help the children than a hospital?
The Hospital Tour
With the statistics in my mind I pushed open the door to the Visitor Centre again where Arun was waiting for me. With a kind smile and a warm welcome she began my tour of the ‘Angkor Hospital for Children.’ The first thing I see is the hospital logo, a green symbol in the shape of a heart. Arun has worked at the hospital for 11 years. She first began her career there as a nurse in 2001 and continued nursing for two and half years. Her biggest pleasure is the children. She later moved to be a PA and volunteer coordinator. In 2006, she worked full time as a PA. Arun is still studying in her spare time and was very inspirational.
I would now very much like you to take the tour with me. I was desperate to see how the hospital cared for these vulnerable children of Cambodia. We left the coolness of the visitor Centre and headed outside into the stifling heat where Arun pointed out the entrance gate and explained that the gate opens at 6 a.m. but people will have been queuing long before that. I asked her how many children are seen in one day and was stunned when she told me 400 children a day attend the hospital outpatient department. Almost half would have travelled more than 50 kilometres in the back of a pick-up truck or by motorbike. Most likely they will walk. I tried to imagine travelling from my home in Oxfordshire back in England for thirty miles or possibly even fifty to sixty miles to get to an outpatient department and shudder when I imagine trying to get a child there when I have no transport. It is unimaginable. Transporting a sick child all that way in a Tuk Tuk does not bear thinking about. I later visited a rural village in a Tuk Tuk and the roads were so uneven that I felt certain we would never make it. I came home with a mild headache from the heat and the uncomfortable ride. How much worse for a sick child. I followed Arun into the waiting area of the outpatient department, past crying children, anxious mothers and siblings to the triage area.
‘The majority of children who come to the hospital are less than five years old. The three main diseases are respiratory, diarrhoea and malnutrition. After triage, the child will see either a nurse or a doctor depending on the severity of their symptoms. Because waiting time is so long, up to many hours, we provide a play area for the siblings of the sick child. 400 children a day coming to the Hospital means a long wait.’ Arun explains.
And I thought we waited a long time in England. I make a decision not to moan about our healthcare system again.
The inpatient ward I found quite upsetting. Arun who previously nursed at the Hospital looks at the children affectionately and tells me how much she enjoyed nursing the children. I see a young baby suffering from Pneumonia and watch as his mother assists with the Oxygen mask. The baby looks very small and helpless and it is very distressing to see a young baby so sick and I have an overwhelming desire to pick her up and make everything all right. But, of course, I can’t. Arun tells me the parents are encouraged to nurse their children and to be as active as possible in their recovery. The inpatient ward has 55 beds. I feel helpless when seeing so many sick children and decide to later ask Arun how I can help. We pass the smiling Doctors and nurses and as we do so a mother looks to my husband gratefully, thinking he is a Doctor. On walking back through the waiting area she immediately poured out her gratitude to us, bowing and showing us how deeply grateful she was. I looked to my husband and saw from his face how deeply moved he was by this. The friendship and generosity of the Cambodian people was quite a revelation to us and we instantly warmed to them.
Arun tells me that nursing these children is very satisfying. I am amazed to hear that more than 30,000 patients were seen in the inpatients department in 2010 with 2,356 admissions. Almost 100,000 have passed through the Intensive Care Unit. Frightening statistics.
Arun introduced me to Nean Pisitmony who comes from Preah Vihear Province, more than 100km from Siem Reap. His parents brought him to AHC to uncover what was making their seven year-old boy so sick. They had taken him to other hospitals, even as far away as Phnom Penh, but no one had been able to help them. At AHC he was quickly diagnosed with congenital heart disease and the Hospital was able to send him to Malaysia for corrective open-heart surgery. After a successful surgery he returned to Cambodia and had no complications. One day, while traveling through Kompong Thom, he saw the AHC logo on a donation box and immediately recognized it as the big green heart that had saved his own heart. Mony started saving money to someday donate to AHC because he thought that this was the best way he could help.
In February 2010, Mony returned to AHC. He had an abscess on his face, with severe swelling and an infection in his left eye. Even though physicians in his hometown treated him, he was not getting better. His parents decided to bring him back to the hospital with the big green heart.
At AHC, he was taken care of by the eye doctor, treated with antibiotics and improved quickly. He thanked all of the staff at AHC for saving his life once again and was finally able to donate the $100 he had been saving. He hopes that his donation will help save lives of other children, and it will.
With the growth of their own surgeons and the help of generous volunteers many children with heart conditions like Mony are now being treated right at AHC. In 2009, 24 open heart surgeries were successfully performed in the hospital’s own Operating Room!
The most interesting aspect of the Angkor Hospital for Children for me was the Homecare programme and I immediately found myself wondering how I could return to Siem Reap and follow the homecare team who go directly to the patients in rural communities because they are too weak and fragile to travel. The homecare programme provides not only medical assessment and treatment but also provides support and education. The first step in prevention of further health problems is to educate the people. This includes giving seeds to grow vegetable gardens, mosquito nets to prevent malaria and dengue fever and even school uniforms. 70-75% of homecare patients are HIV positive. Often in Cambodia those living with HIV are marginalized and in some cases children have been expelled from school. Other patients suffer from malnutrition, congenital heart disease and neurological pathology. They all require assessment and care. I began to wonder if I could write an article about such devastating health problems and still remain positive. I soon learnt that in the Angkor Hospital for Children there is much to be positive about.
Because the families admitted to AHC have needed to borrow money just to get there, they arrive with little or no food. All eligible families are provided with food and cooking supplies. There is a community kitchen at the hospital where families gather to cook meals. A whole family will stay with a sick child and the hospital arrange cooking classes twice daily to show mothers how to make food like bor-bor, a traditional Khmer porridge and other nutritional foods. There is also a demonstration garden adjacent to the kitchen which displays a variety of nutrient rich vegetables that can be grown locally. Seeds are given to the parents to take home. I found this very positive indeed. In fact my whole visit was a very uplifting experience and the smile on Arun’s face as she showed us around warmed me immensely. I could see that the poor malnourished children I had seen on the streets could and would be helped. All thanks to a New York based photographer named Kenro Izu who first came to Siem Reap over fifteen years ago to photograph the Angkor temples. However, it was the images of the children that would capture his heart as they have done mine. He was compelled to dedicate himself to improving their lives. With little more than the will to effect positive change he founded ‘Friends without a Border’ and was able to raise the seed money for ‘Angkor Hospital for Children’ Read more about Kenro Izu here.
I finished my tour with a look at the Dental Clinic. Arun told me that few children in Cambodia own a toothbrush! Arun also told me 40 children a day see the dentist. I then, visited the Eye clinic where monty was treated.
The children of Cambodia need your help and there are many ways to offer. Izu founded the Friends Without A Border non-profit organization in 1996. Since that time AHC has treated more than 800,000 children, performed over 12,000 surgeries, educated thousands of Cambodian health workers, and improved the quality of healthcare in the countryside. In 2010, the AHC’s satellite facility opened at Sot Nikum Referral Hospital in Dam Daek in order to bring compassionate, high-quality care into other parts of Siem Reap Province.
I was so uplifted by the children of Cambodia that I know I have to see them again. If I can help them in any way, then that is what I want to do. The Angkor Hospital for Children gave me hope and uplifted me. The Angkor Hospital for Children is doing a wonderful job in what is a very difficult country. It is an organisation that I very much want to support. Please read more about Friends Without a Border and help in any way you can.
Seeing the country and learning about their history and how they lost their doctors and educated people thirty years ago in the most horrific of circumstances leaving them in poverty made me feel uncomfortably privileged and humble at what I take for granted. Cambodia and the children of Cambodia changed my life for the better. I am so pleased to be able to help them.
Read more of Lynda Renhamcook at http://lrcook.wordpress.com/