Guest post?

Replace gunfo with prahok and watching paint dry with killing mosquitoes and you've got Cambodia. This post by another PCV in another continent is remarkably accurate to my own experience. As he said, every PCV has a different experience no matter how close or far away you are from each other, but I think there are collective similarities which may be abstract, but which bind us together in the end.

http://waidsworld.wordpress.com/2011/08/07/the-real-peace-corps/

Most people I know wouldn't be able to tell you what month it is if you asked them for the time.

Chikungunya

Chikungunya has nothing to do with chickens. Instead, it has a lot to do with primates. Ever since I got my invite to Cambodia I've heard the term Dengue more times than I can count. Dengue is the big bad. When you get it your fever is so high you could hallucinate. The pain in your muscles and bones is so intense that they call it "bone break fever". On top of all that, you end up sleeping with your toilet because it causes vomiting.

Chikungunya is not Dengue, but it's similar. It's transmitted by the same mosquito and it has similar symptoms. There's fever, pain, rash, and maybe vomiting. It's so similar that a lot of children with it are misdiagnosed as having Dengue (generally Cambodians believe adults cannot contract Dengue because most of them had Dengue as children and are immune). It's probably a cause for the 300% increase in Dengue cases this year. The arrival of Chikungunya 2 months before my departure was an interesting coincidence.

In early June, I was probably tested for dengue and malaria for the 500th time and both came back negative again. I was one of the first ones to get it in my village, probably because of my complete lack of immunity. My host niece also got it. About a week after I got the disease patients flooded the health center with the same symptoms. Patients from all 20 villages in my catchment area. Very few adults had immunity and so the disease spread quickly. Just last week one of the midwives at my health center was bed ridden with rash, swelling, and an intense headache.

This week I found out that chikungunya causes arthritis for months possibly years. I thought I was just getting old. I hope it resolves itself soon, but as with any disease it can have unintended consequences. I'll take this moment to tell everyone to vaccinate their children! Vaccines protect children from lethal and disfiguring diseases and you never know where they might catch one or who they may give it to. Unless you want to be the cause of the next measles epidemic then be sure to vaccinate your kids.

Now, my case isn't confirmed yet and I really wouldn't be surprised if I got another negative test result. Being sick so often here has really given me a deeper understanding of how medicine really works and how the best doctors are also the best detectives and magicians.

politics?

Being in a rural village in Cambodia means you can live in your own little world. I never watch tv anymore and I don’t have a radio. Newspapers and magazines aren’t sold in my village and most people can’t read them anyway. My only source of news comes from the internet and that only happens if I truly try to seek it out. It would be easy for me to remove myself from all the politics happening in America and from this perspective I can tell you that everyone in America seems a bit crazy to me right now.

Seeing American politics from Cambodia brings to mind a number of things. On the one hand I think Americans tend to argue over the most arbitrary things. I’m in Cambodia dealing with child malnutrition and maternal mortality, but those seem to be forgotten in America even though almost half the kids in the Bronx rely on food stamps. Instead, our media and our politicians are creating hot issues for us to obsess over.

On the other hand, elections in Cambodia...let’s just say I can’t comment.

I read two articles, one recently and the other a few months ago, about how flip floppy American politics is. There seems to be no politician or American who isn’t a flip flopper if you actually look at the history of the current political hot topics.

One of the articles was about the history of the birth control movement and the backers of the movement over time. At one time many religious organizations were the ones promoting birth control options. Unfortunately, I couldn’t find the link.

http://www.newyorker.com/reporting/2012/06/25/120625fa_fact_klein

I think the New Yorker article highlights one of the great ironies of the American mindset. “Maverick” “Rogue” Two words that have been thrown about with great pride in America since the days of the founders. These are the words that the Republican party used to gather a great number of FOLLOWERS. Once a “Maverick” has groupies are they now the “Mainstream”? As usual, our brain is doing a lot of the behind the scenes work before any individual decision comes to our conscious mind. I think that once we realize that we can take a step back and really look at the issue instead of going with our gut.

The strangest thing...

A lot of people ask me questions like "What's the strangest thing that's ever happened to you?" My answer is usually " I don't know." I've touched upon this before, how strangeness is really relative. The nature of stangeness means it can never be commonplace and yet it occurs often enough in my life that I no longer take the time to remember those moments of strangeness that happen on a daily basis. It's a paradoxical feeling of knowing that what is happening is odd and I don't understand it, but simultaneously it's expected to happen and not important enough to talk about.

I only realize this paradox in certain instances when I experience of do something that is strange and I think to write it down. This is such a moment. Just a few minutes ago I was wearing my head lamp (it's noon), cleaning my swiss army knife with hand sanitizer and proceeding to cut off parts of my foot. Let me backtrack a bit in case this seems alarming to you. A few days ago I was in Phnom Penh for routine medical checkup. We all get a thorough physical right before we finish our service. I've had a wart (looks like a callus) on my foot for years (I always thought it was from walking so much in nyc), but turns out it's caused by a virus that's infected my foot. I know at least 5 other volunteers with the same issue. To remove these warts you freeze them with liquid nitrogen, wait for a blister to form, then cut off the top layer of the blister. Normally, a medical professional does this procedure which occurs over a 3 day period. Unfortunately, I had to return to site and the PCMO felt confident that I could cut the blisters off myself.

So, after lunch today I proceeded to attempt this with my available resources. One thing I've learned in Cambodia is that I really dislike afflicting pain upon myself. One day not to long ago I was ordered to test myself for malaria. I had to poke myself about 8 times before I drew blood. It really takes a lot of conviction to stab yourself. Anyway, removing the blisters seemed straightforward enough except my swiss army knife is about the size of my pinky and has never been sharpened. Eventually, I started using the mini scissors which were much sharper, but there's a reason doctors use scalpels. Scissors, apparently, tend to make many small cuts and if you're not precise (I am not) you end up cutting in different places. Cutting the blister itself really doesn't hurt until the raw skin underneath is exposed to air. Then it really really stings. This entire time my leg is falling asleep because I have to be curled in a very awkward position on my only chair (made to fit a 5 year old) in order to see the bottom of my foot. All the while, I'm squirting hand san onto toilet paper (which I don't use for the toilet) in order to clean my instruments. Eventually I get to the part where I have to swab things with this giant q-tip of iodine. So now I have on my head lamp in the middle of the day, I'm sitting in a child's chair curled into an odd sitting position, in my left hand are tiny tweezers from my knife, my right hand is holding a giant q-tip dripping brown liquid and a swis army knife with tiny knife and scissors deployed. Next to me is a pile of toilet paper and a bottle of hand sanitizer. Not to mention I'm in Cambodia. If that isn't weird then I don't know what is, but for a while I didn't even notice how odd it all was.

In the future, if you ask me what the strangest thing is then expect an, "I don't know" because I really probably don't even remember the weirdest thing that's happened.

Tuk Tuk drivers

Tuk Tuk drivers are ubiquitous in Phnom Penh and Siem Reap. They are so common that I think most volunteers forget to write about them because we have to deal with them all the time. A typical walk down a city street consists of every tuk tuk driver yelling at you to ride their tuk tuk. There are so many drivers that any given block will have at least 3 or 5 guys (they are all male) yelling at you. Sometimes its a simple "Tuk Tuk!" or a "Lady! Lady!". If they mistake me for being Khmer they'll yell "Hey Miss!" in Khmer. Hearing this for 2 years really wears on you, but I wouldn't mind so much if it was just yelling. I'm from NYC and I have perfected the ability to ignore things around me.

Unfortunately, tuk tuk and moto drivers are also very aggressive. If a tuk tuk or moto is passing by sometimes they'll drive straight into you, pausing maybe 2 inches from hitting you, and then yell "Tuk Tuk!". I've had times where I'm trying to cross the street and the guy stops in front of me and forces me to walk around him.

The worst part is when you're getting off a bus or a taxi. Before you even get out the guys are chasing the bus or car down the street. They follow the vehicle until it comes to a stop and they knock on the windows yelling "Where are you going? Take my tuk tuk!" Once I saw the moto guys in my village reach into the trunk of a car (it was too full to be closed) before the car even stopped and try to take people's luggage so they would have to take their moto. When you get off the bus/car you are literally mobbed by men. All of them asking the same questions " Where are you going? Take my tuk tuk? Where do you want to go? Do you have a hotel room? See angkor wat?" If you try to ignore them they just follow you around like a really annoying large puppy. If you say, "No I don't want a tuk tuk" they still follow you around, not believing that you wouldn't take their tuk tuk. Part of this aggressiveness might be caused by sheer boredom. These drivers spend all day sitting in their tuk tuk just shooting the shit with other guys that are just as bored. The only excitement they get all day is chasing down buses.

I'm actually really curious as to how a tuk tuk driver lives. Lets say that you actually want to take a tuk tuk. Fees here are always bargained and depend mostly on distance unless you have a large number of people. I've gotten so sick of bargaining that I always do the "walk away." I say a price and if they don't agree I walk away and most of the time I get the price I want. Sometimes they follow me a few blocks to keep bargaining. I learned this after months of trying to reason with people. Tuk tuk drivers use every excuse known to man to overcharge you. They've been saying " gas prices are so expensive now" for the last 2 years. On the one hand, I can't trust them. If I ask them to go a place which I know is not far at all they'll say "3 dollars" and then complain how far it is. Normally, I wouldn't pay more than a dollar to go somewhere in Siem Reap. On the other hand, they never seem to work and I wonder how they support themselves. However, if a driver gets one passenger a day to go to the airport (about 5 dollars) then in a month they make 150 which is more than most people in my village. Tourists often pay a dollar per person when they take a tuk tuk anywhere. So, one ride alone would be 1 or 2 bucks. It seems like it would be easy enough to make a living without doing any work except excessive yelling. One day taking a tourist around Angkor Wat can range from 10 to 30 dollars depending on the tourist. I've seen tuk tuk drivers so used to being ignored that even through I tried to flag him down after he yelled "Tuk Tuk?"  he kept going. His yelling had become a mere reflex.

I'd really like to read the study of the life of a tuk tuk driver. It might convince some people to make changes and prevent massive mobs of men from attacking people getting out of vehicles.

Traditional Medicine vs. Modern Medicine

I think every volunteer (health and english teaching) faces this issue of tradition vs. modern at least once in their service. As American citizens, we grew up in a culture that values the MD degree, prescription drugs, and a certain faith in science. Often, alternative medicine is seen as a fad and not bearing up to the scrutiny that modern medicine has passed. Coming to Cambodia, we’re faced with a completely different culture.

Modern medicine in Cambodia is not entirely the same as modern medicine in America. The basics are the same in that you are supposed to have an individual that has gone to school to earn a degree. They make decisions based on facts that have been tested scientifically.  Some differences are: there are very few doctors, most health professionals earned their degree after one year of studying, villagers more often visit the local pharmacy for medicine rather than a health center. Pharmacies are a major provider of modern medications to Cambodians. Pharmacies range from modern stores like U-care which provide quality drugs from countries like France and a cardboard box of a variety of medications doled out of a neighbor’s home (her provider is a son who works at a health center).

Traditional medicine is widely practiced in Cambodia. In my experience many Cambodians believe that spirits can adversely affect health among many other things like types of food you eat. There are some common practices that some people may categorize as religious, but I think these practices are also critical, from a Cambodian perspective, for their health. For example, putting food on the family altar, wearing ghost beads, being coined. Many of these activities have a superstitious nature to them and their purpose to protect general wellbeing. Horoscopes also play a large role in health. My host mother was told that this year she would get sick often and she has been sick with headache, what seems to be a strained ligament, diarrhea, and dizzyness. To counteract these illness (caused by illfortune) my mother has been through a number of blessing ceremonies in the past month. These blessings are traditional medicine in a way. In addition to blessings, my mother also visits a Khmer traditional healer. I’m not sure what the healer did to her, but she also provided a mixture of herbs that seemed to act like a hot pack and my mother also boils khmer medicine (herbs and bark) to drink each day.

Both modern and traditional medicine is used by almost every Cambodian I’ve met. In Cambodia, it almost seems like modern medicine and traditional medicine work together. My host mother spent a lot of time and money on traditional remedies, but she also takes acetaminophen for her pain. I think this causes some confusion when Cambodians opt to use modern medicine. Often, Cambodians may intrinsically trust providers of medication even though they are handed a medley of random pills in a plastic bag. This is similar to Khmer healers, whose validity is more based on lineage and reputation.  On the other hand, Cambodians often distrust modern medical practitioners especially when modern medicine does not show an effect immediately or does not give the desired affect.

I think, most often, people are just confused about what works and what doesn’t. The older generation is more likely to recommend traditional remedies and Health Center staff sometimes directly contradict those recommendations. For example, after giving birth a traditional remedy is drinking urine and sleeping on a bed that is heated by hot coals. In a country that is already hot, this can be extremely dangerous if the mother is not properly hydrated. It is hard for a young woman to disregard her elders and tradition in order to follow a midwife.  As a PCV, we’re taught to accept cultural practices, but also to teach Cambodians new information. The relationship between traditional and modern medicine is one of the more difficult areas to tread. How do you show cultural sensitivity and help people change simultaneously? Sometimes you can compromise. Tell the new mothers that they can practice tradition, but stay hydrated when they are on the hot bed.   However, this can also be difficult because you are essentially condoning a potentially dangerous practice.

I don’t have an answer for this issue, but I think what most people would say is that if your community trusts you then they will listen. Unfortunately, it’s difficult to build a relationship of trust with every single person you encounter at the health center. And, it's hard to know how far you can push your trust when trying to change traditions.

COS conference/Snobby people

Our last all K4 PCV training has come and gone. We celebrated on a boat that went in circles on the Mekong. I think in most of my major life experiences things come to an end with a graduation. A day where everyone tries to forget all the teasing, bullying, and gossiping that went on and we all pat each other on the back for making it this far. This conference was partly like that. While this conference did affirm that I know some truly understanding and kindhearted people it also showed me that sometimes we all just tolerate too much. Sometimes people are just real assholes and the only way to stop them is to just stop associating with them. But, I think that's a step most people hesitate to take.

It's good to be nice to people. It's good to have patience with people. But, if you're nice and kind to people that blatantly use and discard other human beings like they're trash then you're condoning that behavior. I just can't pretend to be comfortable with that kind of behavior anymore.

On an unrelated topic, one of my friends is doing fundraising for an event to raise awareness about violence against women (actually not totally unrelated). She tabled outside one of the largest and most popular supermarkets in Phnom Penh and had some interesting encounters. A few of her stories really struck me because they were really unexpected. The basic progression of these stories is like this: person is passing table, friend asks person to donate to help her cause, person says that they worked in Cambodia for x period of time already or they volunteered and they don't need to donate because of that. When I heard that I just thought "what??"

As a volunteer, who has lived and worked in a small village for 2 years, I still actively donate to my friends projects and charities. I supported a friend biking for HIV and I donate to local NGOs that I think have great potential. It's always small, definitely no more than 20 dollars, but I feel good doing it. I choose my donations extremely carefully these days so I know it will have an impact. I have never thought that volunteering in Cambodia would somehow exempt me. It impacts how much I donate, but I've never thought "Oh, I've helped enough."

One moment that sort of highlights the attitude of these individuals is the point in the conversation where my friend shares the little tidbit about how she's lived here for two years. While there are some expats in Cambodia who have lived here many years, the majority of volunteers and development workers will probably not have been here as long as 2 years. It's at this point of the conversation where the proud smile of the person who has just declared that they've worked here for 6 months or volunteered every summer crumbles. Time for them to eat some humble pie.

I think it's ok to be proud that you've lived here for 6 months or volunteered for a long time. But there are some people who come here and feel like they're the next messiah and then there are people who come here and remember that they're here to help people.