I have been thinking about writing this for a little while, but I was nervous about sharing these thoughts. I have always been nervous about sharing what I write. And then I decided that that was a good enough reason to post it! After all, these are thoughts, not written in stone, but they may mean something...
When I was younger, I wondered how one knew that you were in a particular "phase" or "stage" in life; how you knew that you had moved onto the next? What were the key markers for the various stages we travel through in our life times? What is the awareness or the psychological state of the people we become as we travel from being infants to adults and the various colours of adulthood?? What happens on the inside to change actions or attitudes or percpectives when we travel into another layer?
I'm starting to become aware of a process...once you you have completed a phase - that is, you have done the work, struggled through the self-actualization and gained a few more precious moments of patience, you are introduced to a new aspect of reality, of the human condition through your own life. Your life becomes bigger than just you and it becomes less and less about you. The rights of passage.
...I'm not sure if I am currently in the midst of finishing or beginning a new one. But suddenly, a number of things that were distant echos of others' voices are becoming forefront in my conciousness and they are becoming a knowledge base within which I'm functioning rather than only listening as a distant observer. You live in it daily and it goes beyond words on paper.
...I remember a few years ago I asked the question "is there any new, untouched themes in the human drama that can be explored"?...at that time I thought there was...actually, I was quite convinced there was. But now I'm beginning to realize that the excitement comes from depth of experience - it is exciting because it stimulates the intrinsic senses and reveals truths. The divine path was made for humans, not the gods...says the monk.
There are basic and fundamental laws (or truths if you will) and when we discover them as something that is a part of us, they take on a new meaning, provide a new filter to see the world with and enhance the depth at which we function with ourselves and with one another.
I went away to a small town of Kep this weekend, which is located at the southern end of Cambodia. I spent the weekend travelling to a couple of health centers and the one hospital in this area that aims to service a population of approximately 40,000. "What are the rehabilitation needs of the people living in this area?" I asked several individuals (ie doctors at the hospital, volunteer staff worker at the health center, medical students from Canada doing other types of health related research in Kep). Various answers, some common themes: "...anything would be good since there is little or next to nothing".
My hosts take me on a small tour to visit a village (one of 16) that makes up Kep...former Khmer Rouge soldiers live in this particular village. "THis area was opened up (for tourism) only since 1996...this is the house of the General that was responsible for killing 3 Canadians when this are first was open to tourism..." explains my host and guide as we drive down the dirt road and infront of this General's house. I shake my head at the juxtaposition of realities. We ended up at a small cluster of grass homes. At the "entrance" is a cement floor - just that, no walls, nothing else, just the floor of a house. Apparently this is where the house of the traditional healer once stood. But when he left to go to another village, he literally took the whole house with him (except for the cement floor). The people occuping this small piece of land in the middle of a field and jungle on either side are people with AIDS and their families. Initially, there were many, now there are 6 families remaining. I ask where the rest are. They've passed away quite voices explain. When they pass away, they are burned "over there" and a finger is pointed off in one direction at a large field and horizon with scattered palm trees and sillhoutes of moutains. It was striking. I wondered about the ghosts...The entire visit was layered with various aspects that are a reality-current running through Cambodia - corruption, explotation, lack of basics (ie medicine), the ability of humans to adapt to such an incredible range of circumstances and living conditions, to be able to smile and make small talk. I found myself on an internal emotional rollercoaster - the fact that people live in such conditions is phenominal. And unacceptable. But now that I've decided that, what am I going to DO about it. That is the question.
One of the patients was charged $6.50 for an IV by the local medic (when at the market it costs no more than $2). There is $5 in my pocket - I'm kicking myself for not giving it to his wife to cover the cost...and then we westerns fall into philosphical conversations about "what is the right thing to do"...it seems absurd and yet an important conversation; important because it enables us to realize the meaning behind our actions and the meaning becomes and intense motivating factor. Absurd because precious time is taken adn it often enables us to explain away and wipe our hands clean. Such an intense reality.
I ask about the lesions I see on their bodies - I thought they were from AIDS (I ask because I realize I have been with an AIDS patient only once before and he did not have any leisons)...but these leisons are actually mosquito bites. So many, one of top of the other...the group begins to explain that their mosquitto nets are very old and have wholes and the mosiquittos are extremely bad after dusk. I ask to see the nets - they have wholes, big wholes. Some are patched up. How much are mosquitto nets at the market? I ask. $3 explain, my hosts...I'm trying to understand why these people are sleeping with these old nets. The answers are simple, the processes complex...even for getting 10 mosiquitto nets. And this is one element of many...a smaller element of a much grimmer picture. They need a doctor, they need more food, they need electricity, they need for the bathrooms to be fixed...and what do I DO about it? What do WE DO about it???? I find most of us get stuck, frozen by these realities. I am all the time...but I'm also realizing that that is part of the process. The next phase is to DO - how and what is a personal decision. Something, anything. I am beginning to embrace that SOMETHING is better than nothing. And consistency in that something is the other half that needs to be present. Because many SOMETHINGS will add up to change. They will impact at least a human life...and at the end of the day that is what matters.
I'm glad that Nimol, my Cambodian friend who is a nurse, came with me this weekend. She has not seen this before. She begins to contemplate her life set against this context. Part of the process.
After this visit, we go swimming in the warm, salty waters of Kep beach. Balance is key. You can swallowed up by the despair, but then you are of no use. Balance is key, so we go swimming and tell funnies, build sand castles with the kids at the beach.
Being here- working, doing, sleeping, eating, laughing, massaging, listening, watching, learning, teaching, breathing, touching...it all feels so normal. I feel so ordinary.
Monday, June 27, 2005
Tuesday, June 21, 2005
Broader perspectives on Cambodia
Siem Reap is a small city in Northern Cambodia and is a key tourist attraction due to the famous Angkor Wat ruins that lie there. On Friday June17th, 4 young Khmer men entered into an International School in Siem Reap and took the students and teachers hostage. Their demands: $1000 and a car. By the end of the day and by the time all was said and done, a tank rolled in to manage the situation and a little boy was dead.
The following is a letter from my flatmate and friend Bronwyn Blue on the events of last friday in Siem Reap and general battles and problems faced by many in Cambodia - the people, the government and the foreigners working for NGOs...
I am not sure who has heard about the tragic events that took place in Siem Reap a few days ago: the shooting of a child during a failed theft/hostage taking in an international school. A mail I got today from a friend made me put down a few thoughts. Living over here is not all roses and this is example of a time when everything has to be rethought. I thought I would share it. Bronwyn
Hi Liz,
There is nothing worse then the senseless death of a child. This was a tragedy, but I would consider it a bigger tragedy if it did not force us to question the veil of stability that has descended over Cambodia and the situation here.
I was at the home of a friend last night. She has two small children, as do the other couples present, in the International Schools here is PP. Both couples have established lives here and have invested many years and dollars into the country, building businesses, lives and homes. In this context, it is frightening how quickly the events were rationalized, this sort of thing "happens everyday all around the world". However, the frequency or ‘normality’ of these tragic events should not dull our response to them.
This event was a reality check for all, questioning how effective the aid dollars and development poured into Cambodia have been, the efficiency of the NGO sector and the inefficiencies of the government in maintaining and developing services and standards. This situation certainly highlighted the lack of training and investment into public services. While the rest of the world is throwing money into anti terrorism, why was a tank brought in to take a child out of the arms of a terrified 22 year old opportunist-‘terrorist’? No matter what started the ‘crisis’, that there was no one, or group with the training and ability to diffuse the situation without the loss of a child, reveals just another flaw in Cambodia’s ‘stability’. The mismanagement of the situation is as much a tragedy as the rest.
Most of work done through the international NGOs here aims to relieve the financial and general desperation Cambodian people experience on a daily basis. Through various sectors, they attempt to create employment, industry and a sense of ownership among Cambodians. The aim at its most basic, is to avoid having people arrive at a level where they feel it is a ‘viable option’ to hold a kindergarten hostage for $1000 and a van. NGOs in Cambodia were never intended to become a permanent frame work of support to the government. The question remains, how much longer can these international organisations continue to band-aid over the unaddressed responsibilities of an ineffective government?
So what next? In the context of the tourism sector’s string of slow ‘high seasons’ due to SARS Chicken flu and now general bad publicity, this situation's direct impact on the commercial success of Siem Reap (where many have investments) ought to force those in positions to implement constructive change, to do so. On the other hand…it may not.
Recently, I have been questioning my own role as a trainer. Has the way I have been working bee the most efficient? Am I learning from my experiences? How can we find ways to be more effective? How much impact are we really having? No matter what our successes may be, there is no room for complacency. This tragic event is a harsh reminder. I guess I want to say something like “international development is everyone responsibility”, but actually mine is a simple aspiration. It would be great to know that most of us are making the most of each day to make life better, at any level that we can. What do you think? Too ambitious?
Love Bron
The following is a letter from my flatmate and friend Bronwyn Blue on the events of last friday in Siem Reap and general battles and problems faced by many in Cambodia - the people, the government and the foreigners working for NGOs...
I am not sure who has heard about the tragic events that took place in Siem Reap a few days ago: the shooting of a child during a failed theft/hostage taking in an international school. A mail I got today from a friend made me put down a few thoughts. Living over here is not all roses and this is example of a time when everything has to be rethought. I thought I would share it. Bronwyn
Hi Liz,
There is nothing worse then the senseless death of a child. This was a tragedy, but I would consider it a bigger tragedy if it did not force us to question the veil of stability that has descended over Cambodia and the situation here.
I was at the home of a friend last night. She has two small children, as do the other couples present, in the International Schools here is PP. Both couples have established lives here and have invested many years and dollars into the country, building businesses, lives and homes. In this context, it is frightening how quickly the events were rationalized, this sort of thing "happens everyday all around the world". However, the frequency or ‘normality’ of these tragic events should not dull our response to them.
This event was a reality check for all, questioning how effective the aid dollars and development poured into Cambodia have been, the efficiency of the NGO sector and the inefficiencies of the government in maintaining and developing services and standards. This situation certainly highlighted the lack of training and investment into public services. While the rest of the world is throwing money into anti terrorism, why was a tank brought in to take a child out of the arms of a terrified 22 year old opportunist-‘terrorist’? No matter what started the ‘crisis’, that there was no one, or group with the training and ability to diffuse the situation without the loss of a child, reveals just another flaw in Cambodia’s ‘stability’. The mismanagement of the situation is as much a tragedy as the rest.
Most of work done through the international NGOs here aims to relieve the financial and general desperation Cambodian people experience on a daily basis. Through various sectors, they attempt to create employment, industry and a sense of ownership among Cambodians. The aim at its most basic, is to avoid having people arrive at a level where they feel it is a ‘viable option’ to hold a kindergarten hostage for $1000 and a van. NGOs in Cambodia were never intended to become a permanent frame work of support to the government. The question remains, how much longer can these international organisations continue to band-aid over the unaddressed responsibilities of an ineffective government?
So what next? In the context of the tourism sector’s string of slow ‘high seasons’ due to SARS Chicken flu and now general bad publicity, this situation's direct impact on the commercial success of Siem Reap (where many have investments) ought to force those in positions to implement constructive change, to do so. On the other hand…it may not.
Recently, I have been questioning my own role as a trainer. Has the way I have been working bee the most efficient? Am I learning from my experiences? How can we find ways to be more effective? How much impact are we really having? No matter what our successes may be, there is no room for complacency. This tragic event is a harsh reminder. I guess I want to say something like “international development is everyone responsibility”, but actually mine is a simple aspiration. It would be great to know that most of us are making the most of each day to make life better, at any level that we can. What do you think? Too ambitious?
Love Bron
A visit to Siem Reap
As I travel out of Phnom Penh, the landscape takes on a vastly different appearance from the city: flat lands of rice patties with scattered palm trees reach towards the horizon where the round bellies of mountains look like grey-blue shadows against the sky. There are often silhouettes of people against this backdrop - kids walking from school in their dusty blue and white uniforms, lost in their own worlds singing, skipping and finding various things along their path to amuse themselves with. People walking along the ridges between the rice patties, walking cattle home, plowing fields with an ox-pulled plow.Women sitting under grass roofs to stay out of the sun selling fruits and breast-feeding their babies. People in the swamps collecting snails...hammocks and more hammocks.
My first night in the town of Siem Reap I head out to the old market. Walking about, I literally stumble upon a small concert being put on at the land mine museum. This museum is a large room with white walls and white tiles, light up with fluorescent lighting. The man that runs the museum, a Cambodian, has spent a number of years going into the jungles around Siem Reap and de-mining the region. On one of the walls is a quote of his "I want this country to be safe for all Cambodian children". Children and their parents who have suffered amputations because of these land mines which were planted during war times are putting on tonights play and concert.
The orchestra is a group of young boys who play traditional Khmer instruments. The actors are the kids and the adults...they play young Khmer Rouge soldiers (who were often kids) and prisoners (who were often young people as well), crying mothers, teachers. It is a very organic experience - there is no set boundary between the stage and the audience. No great effort is taken to disguise that they are playing roles - they change character while on stage. And somehow this make their performance more real and penetrating. I think it feels real because they are playing out pieces of themselves- they are acting out something that is a part of them. The little ones, 4 maybe 5 years old, are also a part of the play and they move in and out of the scenes or the audience and become the connection between the past and the present, the reality and the acting. Through the skits and songs, these children tell the story of their country... stories that have left remarkable marks on their bodies - missing body parts which were blown off by land mines which were scattered through out the country side and jungle, planted with the intent to hurt the inocent.
The next two days I spend visiting the Angkor Wat temples. They are stunning, unkept, raw, frozen in heaps of tumbling rocks, sunken into the jungle; tree roots of the spung tree have coiled themselves into and around the rocks. A symbiotic relationship seems to have developed between the jungle and these monuments - the trees live of the moss that grows on the rocks of the temples.
As the group of tourists moves away, the jungle comes back to life - lizards crawls around on the tree roots and temple rocks, numerous butterflies flutter about, sounds of birds become distinct as voices become echoes in a distance. Their is a sense of sinking, of calm and stillness.
As with most spectacular places, they look nothing like the pictures on postcards or in books. Their sheer size is breath taking and reality enables you to see a dimension that is never quite captured in pictures. These temples are majestic and calm, unphased and unmoving. Many of the exquisite carvings have been washed away by the elements but the expansive foundations remain. THe carving that are still present are layered, intricate and endless. A number of carvings have been hacked away by robbers to sell these artifacts on the black market somewhere.
I return to a few of the temples and realize that you take them in in layers - there is so much involved and so many aspects to draw upon and absorb that one walk through only teases the curiosity.
On the Saturday evening, I go to a cello concert, given by a Swiss doctor who has established 3 private, NGO children hospitals in Cambodia. His nickname is Beatocello. Between pieces he talks about the health condition of children in Cambodia - it is bad. He expresses his frustration at the fact that as the world becomes consumed with SARS a couple of years ago, which effected (not killed, but effected) less than 1000 people, 9000 children where severely ill from Denge Fever and nothing - no media, no money. He provided the reasons for this imbalance: children, especially poor children, do not have power, they do not have any lobbying power, they have no voice in the mainstream media. He talks about the fact that the West comes in after conflicts and wars that it supported or caused as acts of charity. The work that needs to be done by western countries should not be acts of charity rather they should be an obligation, an act of justice, after what is left from these wars. He picks up his cello and plays another piece by Bach.
A day prior to my arrival in Siem Reap there was a hostage taking in one of the international schools here. A group of bandits (young Cambodian men) came into the school and demanded $1000 and a car (so they can get to Thailand). Before all was said and done, a Canadian boy was dead. Bronwyn, my flat mate here, was very effected by this event...her thoughts are in the next blog.
My first night in the town of Siem Reap I head out to the old market. Walking about, I literally stumble upon a small concert being put on at the land mine museum. This museum is a large room with white walls and white tiles, light up with fluorescent lighting. The man that runs the museum, a Cambodian, has spent a number of years going into the jungles around Siem Reap and de-mining the region. On one of the walls is a quote of his "I want this country to be safe for all Cambodian children". Children and their parents who have suffered amputations because of these land mines which were planted during war times are putting on tonights play and concert.
The orchestra is a group of young boys who play traditional Khmer instruments. The actors are the kids and the adults...they play young Khmer Rouge soldiers (who were often kids) and prisoners (who were often young people as well), crying mothers, teachers. It is a very organic experience - there is no set boundary between the stage and the audience. No great effort is taken to disguise that they are playing roles - they change character while on stage. And somehow this make their performance more real and penetrating. I think it feels real because they are playing out pieces of themselves- they are acting out something that is a part of them. The little ones, 4 maybe 5 years old, are also a part of the play and they move in and out of the scenes or the audience and become the connection between the past and the present, the reality and the acting. Through the skits and songs, these children tell the story of their country... stories that have left remarkable marks on their bodies - missing body parts which were blown off by land mines which were scattered through out the country side and jungle, planted with the intent to hurt the inocent.
The next two days I spend visiting the Angkor Wat temples. They are stunning, unkept, raw, frozen in heaps of tumbling rocks, sunken into the jungle; tree roots of the spung tree have coiled themselves into and around the rocks. A symbiotic relationship seems to have developed between the jungle and these monuments - the trees live of the moss that grows on the rocks of the temples.
As the group of tourists moves away, the jungle comes back to life - lizards crawls around on the tree roots and temple rocks, numerous butterflies flutter about, sounds of birds become distinct as voices become echoes in a distance. Their is a sense of sinking, of calm and stillness.
As with most spectacular places, they look nothing like the pictures on postcards or in books. Their sheer size is breath taking and reality enables you to see a dimension that is never quite captured in pictures. These temples are majestic and calm, unphased and unmoving. Many of the exquisite carvings have been washed away by the elements but the expansive foundations remain. THe carving that are still present are layered, intricate and endless. A number of carvings have been hacked away by robbers to sell these artifacts on the black market somewhere.
I return to a few of the temples and realize that you take them in in layers - there is so much involved and so many aspects to draw upon and absorb that one walk through only teases the curiosity.
On the Saturday evening, I go to a cello concert, given by a Swiss doctor who has established 3 private, NGO children hospitals in Cambodia. His nickname is Beatocello. Between pieces he talks about the health condition of children in Cambodia - it is bad. He expresses his frustration at the fact that as the world becomes consumed with SARS a couple of years ago, which effected (not killed, but effected) less than 1000 people, 9000 children where severely ill from Denge Fever and nothing - no media, no money. He provided the reasons for this imbalance: children, especially poor children, do not have power, they do not have any lobbying power, they have no voice in the mainstream media. He talks about the fact that the West comes in after conflicts and wars that it supported or caused as acts of charity. The work that needs to be done by western countries should not be acts of charity rather they should be an obligation, an act of justice, after what is left from these wars. He picks up his cello and plays another piece by Bach.
A day prior to my arrival in Siem Reap there was a hostage taking in one of the international schools here. A group of bandits (young Cambodian men) came into the school and demanded $1000 and a car (so they can get to Thailand). Before all was said and done, a Canadian boy was dead. Bronwyn, my flat mate here, was very effected by this event...her thoughts are in the next blog.
Tuesday, June 14, 2005
On the edge of violence
The acid burns and the entire culture of their occurrence is shocking me. I ingest it piece by piece. I can only take in pieces at this point because I find it disturbing in a way that leaves me stunned and at a mental crossroads. I hit points of saturation daily; at which point I need to mentally switch gears or walk away for a breath of something else because otherwise I become ineffective and get swallowed up by various thoughts and emotions that would not have any immediate benefit to anyone - the staff, the patients or you.
I'm not sure how prevalent or common acid attacks are. The statistics are varied and generally not very reliable. To clarify - acid attacks are the intentional act of pouring acid on a person to cause them harm. Although they are a criminal act, it is not common for the acid burn victims to take their assailant to court. Some reasons why (as explained to me by various individuals) are: the victim is very poor and uneducated so they are not aware of their rights. It costs too much money for lawyers and the victim is poor therefore cannot afford a lawyer. The victims are afraid that the assailant will do more harm to them. A couple cases were recalled where the lawyer ended keeping all of the money awarded to the victim. The explanation was simple - the system is corrupt. This is by no means the beginning or the end of reasons.
Talking to the acid burn survivors (through translators such as the nurses) and reading assessment questionnaires from the Acid Burn Survivors Support Group (ABSSG) here at ROSE, I begin to learn pieces of stories of these individuals. Personal stories that give a human face to impersonal statistics or numbers.
Acid attack seems to be an act based in jealousy or revenge, usual in context of personal relationships; a way of dealing with family or marital problems. Often women are the victims, however, there are also a number of men. The specific situations which have been related are: the husband has a second wife (a mistress) and the first wife is jealous or not happy with this situation and "deals" with the problem of infidelity by pouring acid on the second wife. Sometimes the husbands are the victims of such emotional reactions. Sometimes the attack is based on suspicion - the wife thinks here husband is having an affair. Sometimes it is an act of anger - the man who is denied by a woman he fancies strikes back by pouring acid on her. Or a husband who is angry at his wife because she wants a divorce pours acid on her. Sometimes the attacks are more random - a case of mistaken identity or accidental (it was really meant to strike the person next to you).
I often travel between two worlds - the one I can relate to and the one who's realities I am beginning to grasp: I cannot imagine pouring acid as a way of dealing with marital problems or problems in general. At which point does an individual cross over and become capable of this type of violence? To a person with whom you share a home? With whom you have created children? Where is this type of brutality born out of ? As I write this, it feels surreal. However, when I leave this computer and massage the extensive, deforming, life altering scars caused by the acid which had burned it's way through flesh and muscle, it is very real. I feel with and in my hands, I smell the scars, I see the eyes of these patients as they struggle to move on in their own ways.
The response of the society to acid burn victims is to look away. People are scared of the scars, disgusted with the disfigured appearance. A common trend within this group of individuals is that none of them are able to find work. Their abilities are secondary. The primary factor is that they are disfigured and therefore people do not want to work with them or hire them, afraid of the impact it would have on their businesses. I am curious to explore this prejudice, this reaction more. In a conversation with a foreigner, they pointed out that part of the reason why disabled individuals have a such a difficult time is that people believe that bad things have happened to them because of karma - they were bad in a past life and now this is what happens. I am exploring this more...
And it goes on...the scars are so extensive and the damage so deep. There is little to no social support for these individuals. Many have their families which will support them. Many do not - those will end up living out their days making money off their scars and deformities as beggars...enough money for one meal a day of rice and maybe some fish and vegetables.
The Khmer people are kind. They are soft. They do not act or carry themselves in an aggressive manner. At least that is the perception of this female foreigner. But there is an underlying edge here, a potential for violence that exists within. I think they are not inherently violent or aggressive - humans are not born to kill or hurt. We are taught the violence. Hence this edge of violence maybe a result of the violence that on a social scale these people have experienced and endured. Oppression, suppression, poverty and years of blood shed - the social wounds and scars leave their marks on generations and surface in various ways.
I'm not sure how prevalent or common acid attacks are. The statistics are varied and generally not very reliable. To clarify - acid attacks are the intentional act of pouring acid on a person to cause them harm. Although they are a criminal act, it is not common for the acid burn victims to take their assailant to court. Some reasons why (as explained to me by various individuals) are: the victim is very poor and uneducated so they are not aware of their rights. It costs too much money for lawyers and the victim is poor therefore cannot afford a lawyer. The victims are afraid that the assailant will do more harm to them. A couple cases were recalled where the lawyer ended keeping all of the money awarded to the victim. The explanation was simple - the system is corrupt. This is by no means the beginning or the end of reasons.
Talking to the acid burn survivors (through translators such as the nurses) and reading assessment questionnaires from the Acid Burn Survivors Support Group (ABSSG) here at ROSE, I begin to learn pieces of stories of these individuals. Personal stories that give a human face to impersonal statistics or numbers.
Acid attack seems to be an act based in jealousy or revenge, usual in context of personal relationships; a way of dealing with family or marital problems. Often women are the victims, however, there are also a number of men. The specific situations which have been related are: the husband has a second wife (a mistress) and the first wife is jealous or not happy with this situation and "deals" with the problem of infidelity by pouring acid on the second wife. Sometimes the husbands are the victims of such emotional reactions. Sometimes the attack is based on suspicion - the wife thinks here husband is having an affair. Sometimes it is an act of anger - the man who is denied by a woman he fancies strikes back by pouring acid on her. Or a husband who is angry at his wife because she wants a divorce pours acid on her. Sometimes the attacks are more random - a case of mistaken identity or accidental (it was really meant to strike the person next to you).
I often travel between two worlds - the one I can relate to and the one who's realities I am beginning to grasp: I cannot imagine pouring acid as a way of dealing with marital problems or problems in general. At which point does an individual cross over and become capable of this type of violence? To a person with whom you share a home? With whom you have created children? Where is this type of brutality born out of ? As I write this, it feels surreal. However, when I leave this computer and massage the extensive, deforming, life altering scars caused by the acid which had burned it's way through flesh and muscle, it is very real. I feel with and in my hands, I smell the scars, I see the eyes of these patients as they struggle to move on in their own ways.
The response of the society to acid burn victims is to look away. People are scared of the scars, disgusted with the disfigured appearance. A common trend within this group of individuals is that none of them are able to find work. Their abilities are secondary. The primary factor is that they are disfigured and therefore people do not want to work with them or hire them, afraid of the impact it would have on their businesses. I am curious to explore this prejudice, this reaction more. In a conversation with a foreigner, they pointed out that part of the reason why disabled individuals have a such a difficult time is that people believe that bad things have happened to them because of karma - they were bad in a past life and now this is what happens. I am exploring this more...
And it goes on...the scars are so extensive and the damage so deep. There is little to no social support for these individuals. Many have their families which will support them. Many do not - those will end up living out their days making money off their scars and deformities as beggars...enough money for one meal a day of rice and maybe some fish and vegetables.
The Khmer people are kind. They are soft. They do not act or carry themselves in an aggressive manner. At least that is the perception of this female foreigner. But there is an underlying edge here, a potential for violence that exists within. I think they are not inherently violent or aggressive - humans are not born to kill or hurt. We are taught the violence. Hence this edge of violence maybe a result of the violence that on a social scale these people have experienced and endured. Oppression, suppression, poverty and years of blood shed - the social wounds and scars leave their marks on generations and surface in various ways.
Tuesday, June 07, 2005
Acid burns - her story
Chan is a woman. She is one of the acid burn patients here at ROSE Charities that I have been treating. She is 33 years old and has a 10 year old daughter - a beautiful girl with chocolate eyes and an enchanting smile. Every time she sees me she beams a smile and laughs out "hello". Before her sister-in-law poured acid all over Chan's face, arms, torso and genitals, she was a potter with her husband. She tells her story during an interview a couple of days ago - the interview was to assess the suitability of the acid burn patients for a potential weaving-training project.
She sits, bandage over the right eye socket (the right eye was removed last week because the acid had caused too much damage). She plays with her hands and looks at her knees. We ask the standard questions - how old, place of birth, how many children she has...She answers them all quitely. When we ask about what she is going to do when she leaves the hospital on friday, she begins to cry and her story comes out through her tears: she had problems with her sister-in-law and there was a family dispute of some sort, which the sister-in-law decided to settle by pouring acid over Chan. Now, because of the acid burns, her husband wants to divorce her and look for another wife. She has no family - both of her parents are dead and she has no siblings. She has no place to go now. She continues to cry, softly and quietly, while she speaks in Khmer. The nurse, Nemol, translates. She wants to die, she says. Begging is the only thing she will be able to do. She is going to go out on the streets with her daughter and will become a beggar and die somewhere on the streets because there is not other choice for her - nobody will have her. After she finishes translating this, the nurse laughs. I have been told many times that when situations are very uncomfortable or disconcerting, the Khmer response is to laugh. Half of my brain recalls this piece of information at this very moment and the other half is having a melt down at the bizzare response. I look at the nurse and explain that I realize this is a difficult situation however it is not funny, and laughing is not the response this patient needs. I think she understood because she quickly continued to inquire about further details of Chan's immediate situation.
Chan's daughter is beautiful and if they end up on the streets, she will quickly be swept up by someone and sold into some sort of child/sex trafficing situation...the idea is untolerable. She is quick, bright and lovely - like her mother. I have never met a patient as compliant as Chan- she has done everything I have asked her do regarding exercise routines, scar massage, wearing pressure garments... and her future is the streets, out of necessity, out of lack of choice. In this very moment I am greatful to have Will (an Aussie nurse) sitting across from me. It's silly really, but I'm acutely aware that although this is Cambodia, where "Cambodian" things happen, I realize that this situation is not a case of a "canadian" and a "cambodia"... what is happening here is so completely human - this has nothing to do with culture or history or nationality. This story is not uncommon in many places. These are daily occurances in many culture. Dispair, poverty, lack of basic necessities for life are the result of human activity. The places and cultures only give it a differnt colour. Helping and supporting one another is a human ability - not one determined by culture or history or nationality. I think our tolerance of violence and inaction is more cultural. I'm suddenly acutely aware of how closely and profoundly we can affect each others' lives and how most of the time we do not realize or recognize it or respect it. She is ready to slip through the very fat fingers of a system that shrugs it's shoulders at such circumstances and realities; "people here are poor and that is what happens. It's normal".
One thing I made up my mind about right now: she is not going to end up on the streets and her daughter is not going to be exploited by some sex tourists. I looked an Nemol (the nurse) and explained that we can help this woman and we are going to. Please tell her, I ask Nemol to translate, that she will have a place to live, she will find a job and her daughter is going to go to school.
The nurse translated this to Chan. Chan put her hands together to say thank you. She continued to speak softly. I know she is still in shock over all of it - how she looks, her life as she knew it is over, her husband is leaving her to find a second wife. She has no home, no money, nobody to turn to. What does she hang onto?...I don't know. I can't and won't pretend that I do. But what I do know is that for her and her daughter the streets are not the place where they will carry on their days. That is not an option.
Will and I make a few phone calls to expates working in NGOs here in Phnom Penh...we are referred to Hagar Shelter - a shelter for woman and their children. The next day we pack up Chan and her daughter into one of the trucks and head off to Hagar for an assessment interview. Will keeps the daughter close to her side and Chan hangs onto my hand. She has put on new clothes (a pajama set) and wrapped a towel around her head in the traditional Khmer way. She is wearing glasses I gave her to keep the dust and dirt out of her left eye that still cannot completely close because of the scars. Nemol does all of the talking and translating - she is fantastic. We walk around the shelter - looking at the bedrooms, the kitchen, vocational training rooms (sewing and haircutting), the shool rooms with kids couting in english. Chan's daughter counts along with them and shyly edges towards one of the rooms. Hagar shelter is an incredible place. The woman showing us around is gentle, understanding, soft spoken and very aware of what these woman go through...she knows their stories and accepts them.
Today, Chan comes into the recovery room for scar massage and dressing changes. Her scars are coming along well. Her left eye can almost close completely. Her neck range of motion is good and has maintained. She is always wearing her pressure garments. She says: I want to get fat. So when I get fat what do I do with this (pointing to the pressure garment)?". I explain she will get a new one. Nemol asks how she is. "I am happy. I don't want to die", she responds.
On a personal note: This very moment has made this entire trip worth while. This very moment is changing my life. I cannot express the happiness I feel in my heart - it is a happiness filled with relief and hope. It is a sensation where you need to take a deeper breath, your heart beats a little faster and harder, and you want to bow to what is infront of you. Chan accepts my hand as we walk back to her bed, where she has begun packing her few belongings.
She sits, bandage over the right eye socket (the right eye was removed last week because the acid had caused too much damage). She plays with her hands and looks at her knees. We ask the standard questions - how old, place of birth, how many children she has...She answers them all quitely. When we ask about what she is going to do when she leaves the hospital on friday, she begins to cry and her story comes out through her tears: she had problems with her sister-in-law and there was a family dispute of some sort, which the sister-in-law decided to settle by pouring acid over Chan. Now, because of the acid burns, her husband wants to divorce her and look for another wife. She has no family - both of her parents are dead and she has no siblings. She has no place to go now. She continues to cry, softly and quietly, while she speaks in Khmer. The nurse, Nemol, translates. She wants to die, she says. Begging is the only thing she will be able to do. She is going to go out on the streets with her daughter and will become a beggar and die somewhere on the streets because there is not other choice for her - nobody will have her. After she finishes translating this, the nurse laughs. I have been told many times that when situations are very uncomfortable or disconcerting, the Khmer response is to laugh. Half of my brain recalls this piece of information at this very moment and the other half is having a melt down at the bizzare response. I look at the nurse and explain that I realize this is a difficult situation however it is not funny, and laughing is not the response this patient needs. I think she understood because she quickly continued to inquire about further details of Chan's immediate situation.
Chan's daughter is beautiful and if they end up on the streets, she will quickly be swept up by someone and sold into some sort of child/sex trafficing situation...the idea is untolerable. She is quick, bright and lovely - like her mother. I have never met a patient as compliant as Chan- she has done everything I have asked her do regarding exercise routines, scar massage, wearing pressure garments... and her future is the streets, out of necessity, out of lack of choice. In this very moment I am greatful to have Will (an Aussie nurse) sitting across from me. It's silly really, but I'm acutely aware that although this is Cambodia, where "Cambodian" things happen, I realize that this situation is not a case of a "canadian" and a "cambodia"... what is happening here is so completely human - this has nothing to do with culture or history or nationality. This story is not uncommon in many places. These are daily occurances in many culture. Dispair, poverty, lack of basic necessities for life are the result of human activity. The places and cultures only give it a differnt colour. Helping and supporting one another is a human ability - not one determined by culture or history or nationality. I think our tolerance of violence and inaction is more cultural. I'm suddenly acutely aware of how closely and profoundly we can affect each others' lives and how most of the time we do not realize or recognize it or respect it. She is ready to slip through the very fat fingers of a system that shrugs it's shoulders at such circumstances and realities; "people here are poor and that is what happens. It's normal".
One thing I made up my mind about right now: she is not going to end up on the streets and her daughter is not going to be exploited by some sex tourists. I looked an Nemol (the nurse) and explained that we can help this woman and we are going to. Please tell her, I ask Nemol to translate, that she will have a place to live, she will find a job and her daughter is going to go to school.
The nurse translated this to Chan. Chan put her hands together to say thank you. She continued to speak softly. I know she is still in shock over all of it - how she looks, her life as she knew it is over, her husband is leaving her to find a second wife. She has no home, no money, nobody to turn to. What does she hang onto?...I don't know. I can't and won't pretend that I do. But what I do know is that for her and her daughter the streets are not the place where they will carry on their days. That is not an option.
Will and I make a few phone calls to expates working in NGOs here in Phnom Penh...we are referred to Hagar Shelter - a shelter for woman and their children. The next day we pack up Chan and her daughter into one of the trucks and head off to Hagar for an assessment interview. Will keeps the daughter close to her side and Chan hangs onto my hand. She has put on new clothes (a pajama set) and wrapped a towel around her head in the traditional Khmer way. She is wearing glasses I gave her to keep the dust and dirt out of her left eye that still cannot completely close because of the scars. Nemol does all of the talking and translating - she is fantastic. We walk around the shelter - looking at the bedrooms, the kitchen, vocational training rooms (sewing and haircutting), the shool rooms with kids couting in english. Chan's daughter counts along with them and shyly edges towards one of the rooms. Hagar shelter is an incredible place. The woman showing us around is gentle, understanding, soft spoken and very aware of what these woman go through...she knows their stories and accepts them.
Today, Chan comes into the recovery room for scar massage and dressing changes. Her scars are coming along well. Her left eye can almost close completely. Her neck range of motion is good and has maintained. She is always wearing her pressure garments. She says: I want to get fat. So when I get fat what do I do with this (pointing to the pressure garment)?". I explain she will get a new one. Nemol asks how she is. "I am happy. I don't want to die", she responds.
On a personal note: This very moment has made this entire trip worth while. This very moment is changing my life. I cannot express the happiness I feel in my heart - it is a happiness filled with relief and hope. It is a sensation where you need to take a deeper breath, your heart beats a little faster and harder, and you want to bow to what is infront of you. Chan accepts my hand as we walk back to her bed, where she has begun packing her few belongings.
Saturday, June 04, 2005
Full Circle
The operating room is very cool and smells very sterile. It is a potent smell - a little like vicks vapour rub, but with less peppermint. The patient, a little boy, lies on the operating table. A group surrounds the table - 3 physicians, two assistants, one nurse observing and myself (observing as well, although I must admit I wanted to get my hands in there too!). The surgery was a release surgery of the left hip and right foot. The little boy sustained extensive burns to the front of his body (face, torso, right arm and hand and both legs on the front) about 4 years ago. The scar grewing into a thick mass. As the wound closed after the burn, the scar that formed began to pull the edges together, causing contracturing at the hip, the left hand, and both feet such that the toes on both feet and fingers on the left hand were literally pulled backwards of the top of the hand and feet. On the ears and the left mandible, the wounds developed into massive keloid scars. This was the second surgery - a release surgery which is done to release the scar and the joints can be moved back into proper position.
Back to the operating room...I walked in towards the end of the hip release part of the surgery. The doctors where preparing to cut through the solid mass of scar tissue on the foot. First, discussion about the incisions - direction, depth, how many to make along the longitudinal lines. The boys head and torso is covered. Only the leg is exposed. They move the leg about in all directions, examining, considering. There is no resistance from the boy...I'm intrigued as I've never worked with such a limp body - I'm used the body responding, moving, resisting, releasing or contracting in response to what I do to it. Here, there is not resistance or response - it seems much more maluable....there is not personality to that leg, no sensation to guide you...only the pure anatomy dictates what must be done.
The discussion ends, the scalpel is passed from one set of hands to another and the first incision is made. At first I feel my pusle rise as the scalpel enters the flesh, but that quickly passes and I lean in a little closer. I'm surprised at how little blood there is...one of the medical students is ready with a bloody gauze to clean up and absorb up the blood that does bubble up to the surface. The skin splits and gives away quickly from the tension of the scar. The white of the underlying fascia and tendons becomes visible. The doctor releases the adhered scar from the underlying tissue with an insturment he inserts under the scar and pulls up, tearing it away from the underlying tissues. I'm amazed that no muscle was cut, no tendons nicked or damaged. The incisions are made in a Z-pattern along the dorsal surface of the foot and quick, efficient movements sew the opening up. Large needles are inserted into the toes to stablize the toe joints...how quickly and easily they go in. I wonder what type of resistance the tissue gives to the needles? What the doctor senses as he pushes deeper to guide him and ensure the needle is not damaging any bones or blood vessels...? The toes are so small and his hands so large. I'm amazed at how steady his hand is.
In the recovery room the boy starts to wake up. He throws up. The next morning there is significant bleeding in the left hip region. In the dressing room, the nurse starts to take off the bandages while the boy screams bloody murder in pain...I realized he probably was not given any pain killers. The surgeon comes and it's decided that the grafting will be touched up under anasthesia because it is too painful otherwise. The parents are quite, somber, helpless.
In the afternoon, the boy starts to wake up again. He's holding down fluids. He smiles at a picture I show I took of him the other day kicking a ball.
In surgery you literally open the body up and look inside; I spend my days "looking inside" with my hands. It was amazing. I feel like I've gone full circle: in the surgery room I saw the layers, the colour, the thickness of the scar. When I look and touch now, there is a whole new dimension to my understanding of what I am palpating...now it's more tangible for my mind to capture what my hands sense...
Back to the operating room...I walked in towards the end of the hip release part of the surgery. The doctors where preparing to cut through the solid mass of scar tissue on the foot. First, discussion about the incisions - direction, depth, how many to make along the longitudinal lines. The boys head and torso is covered. Only the leg is exposed. They move the leg about in all directions, examining, considering. There is no resistance from the boy...I'm intrigued as I've never worked with such a limp body - I'm used the body responding, moving, resisting, releasing or contracting in response to what I do to it. Here, there is not resistance or response - it seems much more maluable....there is not personality to that leg, no sensation to guide you...only the pure anatomy dictates what must be done.
The discussion ends, the scalpel is passed from one set of hands to another and the first incision is made. At first I feel my pusle rise as the scalpel enters the flesh, but that quickly passes and I lean in a little closer. I'm surprised at how little blood there is...one of the medical students is ready with a bloody gauze to clean up and absorb up the blood that does bubble up to the surface. The skin splits and gives away quickly from the tension of the scar. The white of the underlying fascia and tendons becomes visible. The doctor releases the adhered scar from the underlying tissue with an insturment he inserts under the scar and pulls up, tearing it away from the underlying tissues. I'm amazed that no muscle was cut, no tendons nicked or damaged. The incisions are made in a Z-pattern along the dorsal surface of the foot and quick, efficient movements sew the opening up. Large needles are inserted into the toes to stablize the toe joints...how quickly and easily they go in. I wonder what type of resistance the tissue gives to the needles? What the doctor senses as he pushes deeper to guide him and ensure the needle is not damaging any bones or blood vessels...? The toes are so small and his hands so large. I'm amazed at how steady his hand is.
In the recovery room the boy starts to wake up. He throws up. The next morning there is significant bleeding in the left hip region. In the dressing room, the nurse starts to take off the bandages while the boy screams bloody murder in pain...I realized he probably was not given any pain killers. The surgeon comes and it's decided that the grafting will be touched up under anasthesia because it is too painful otherwise. The parents are quite, somber, helpless.
In the afternoon, the boy starts to wake up again. He's holding down fluids. He smiles at a picture I show I took of him the other day kicking a ball.
In surgery you literally open the body up and look inside; I spend my days "looking inside" with my hands. It was amazing. I feel like I've gone full circle: in the surgery room I saw the layers, the colour, the thickness of the scar. When I look and touch now, there is a whole new dimension to my understanding of what I am palpating...now it's more tangible for my mind to capture what my hands sense...
Wednesday, June 01, 2005
Grandma, say hi to Buddha
A couple of days ago I received one of those e-mails that leaves you slightly numb for a few moments and then you feel a rush of blood going straight up to your head. The e-mail was entitled "Death of Grandma Stenia". It was an e-mail from my mother informing me (and my brother) that my grandmother, the one living in Krakow, had passed away. I received this on Sunday. Being in Cambodia, I felt rather ridiculously isolated from the entire thing, like there is some sort of an imaginary wall between life here and the "back home"...I wanted desperately to speak to my parents - to hear something more beyond a couple of paragraphs about her passing, funeral plans and so on...but to no avail. Perhaps I am that far away here.I cried a little. I think that is normal - to be sad, to feel that familiar empty space...I went out into the city for some sort of comfort.
Finding myself amongst unfamiliar faces which are carrying on like nothing has happened is somehow comforting. I ended up at an orphanage. Spent some time feeding, bathing, changing and playing with the little orphan babies with the nuns that run it. I brought over some baby powder and clothes a friend gave me in Canada. I dedicated my day to my grandma.
In the late afternoon I felt I needed to be somewhere holy, somewhere spiritual so I could say good bye. I ended up at Wat Phnom - a Buddhist temple on a hill in Phnom Penh. I walked around the complex until I got up to the very top. I watch what people were doing in the temple. I asked a woman selling lotus flowers and incense if I could pray to Buddha as well. She smiled, said yes, and handed me lotus flowers and incense. "Two dollars" she said with a pretty smile. I guess we humored one another-she that I wanted to pray to Buddha, I that even at teh temple everything has its price.
I lit the incense and as it smoked I placed it between my hands, knelt in front of Buddha (making sure my feet were not pointing in Buddha's direction). I thought about my grandmother...that she had beautiful wings to take her soul wherever it need to go to be at peace. I placed the incense into a large bowl, like everybody else. The bowl is full of ashes from burning incense...ashes to ashes, dust to dust. I walked a little more into the temple, a little hesitant and self conscious because I did not want to be disrespectful to Buddha or those praying. A nice man indicated that I should place the lotus flowers in a vase next to Buddha. My gift to Buddha. My gift to my grandmother on her grave. Buddhist believe that Buddha was born out of the lotus flower hence it has a very strong symbolic and religious meaning. I gave the lotus flower to my grandmother's soul. Rebirth, birth, death - a continuation of the cycle...beginning or end I don't know. I left the temple and walked back down the hill, the heat and monkeys reminding me gently where I was. I felt lightness in my heart. I did not feel sad anymore. The emptiness is still there, but it doesn't make me want to cry.
Finding myself amongst unfamiliar faces which are carrying on like nothing has happened is somehow comforting. I ended up at an orphanage. Spent some time feeding, bathing, changing and playing with the little orphan babies with the nuns that run it. I brought over some baby powder and clothes a friend gave me in Canada. I dedicated my day to my grandma.
In the late afternoon I felt I needed to be somewhere holy, somewhere spiritual so I could say good bye. I ended up at Wat Phnom - a Buddhist temple on a hill in Phnom Penh. I walked around the complex until I got up to the very top. I watch what people were doing in the temple. I asked a woman selling lotus flowers and incense if I could pray to Buddha as well. She smiled, said yes, and handed me lotus flowers and incense. "Two dollars" she said with a pretty smile. I guess we humored one another-she that I wanted to pray to Buddha, I that even at teh temple everything has its price.
I lit the incense and as it smoked I placed it between my hands, knelt in front of Buddha (making sure my feet were not pointing in Buddha's direction). I thought about my grandmother...that she had beautiful wings to take her soul wherever it need to go to be at peace. I placed the incense into a large bowl, like everybody else. The bowl is full of ashes from burning incense...ashes to ashes, dust to dust. I walked a little more into the temple, a little hesitant and self conscious because I did not want to be disrespectful to Buddha or those praying. A nice man indicated that I should place the lotus flowers in a vase next to Buddha. My gift to Buddha. My gift to my grandmother on her grave. Buddhist believe that Buddha was born out of the lotus flower hence it has a very strong symbolic and religious meaning. I gave the lotus flower to my grandmother's soul. Rebirth, birth, death - a continuation of the cycle...beginning or end I don't know. I left the temple and walked back down the hill, the heat and monkeys reminding me gently where I was. I felt lightness in my heart. I did not feel sad anymore. The emptiness is still there, but it doesn't make me want to cry.
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