Phnom Penh, Cambodia: Tuesday, November 9, 1999: Sally and Pitou came to my hotel to pick me up at 8:00 a.m. It took me no time at all to finish my breakfast—a medium-sized bowl of rice soup with chicken livers, skin, and onions in it. Along with warm green tea, I considered it a real “breakfast of champions.”
We drove a couple of miles from the hotel and picked up a lady government worker who helps Sally and Pitou in their work. Our first stop was the Preah Khet Mealea Hospital on Street 47 in downtown Phnom Penh. It’s a government hospital that the military had commandeered in the past.
About the time I think I’ve seen all there is to see in the world of medical institutions and misery, reality hits me upside the head. That was my experience at the Preah Khet Mealea Hospital in Phnom Penh! It was awful. It was disgusting. It made me sad. It made me angry. It made me cry.
After an hour meeting with Dr. Pvom Kan, the chief of the hospital, we conducted our walking and photo-taking tour. The facility was once a French-style hospital, and during colonial days, it had eight hundred beds. Now it’s the pits.
In recent years, government control of the hospital has changed three times. Anyone is allowed to go to the hospital, but no one gets any medical or professional attention. There are no supplies and no instruments. I didn’t see one ventilator, respirator, EKG machine, defibrillator, monitor, or even a blood-pressure cuff in the whole place. There were almost no nurses, and all the doctors were congregated in one surgery room doing a procedure. The fact is that nearly all the doctors, nurses, and secretaries in Cambodia are dead. They were educated, and to Pol Pot that meant treason. Khmer Rouge soldiers killed off their own medical community to achieve a pure Communist society!
The hospital laboratory was pathetic, with just one working microscope and a sterilizer that works only part of the time. The X-ray machine in the radiology department is over fifty years old, and the technician showed me how they had hung up an old lead vest to shield the radiologist when he fires up the radiation-zapping machine. The roofs all leaked in the campus-style hospital buildings, and even the surgical theater had plaster falling from the ceiling.
When we finished the tour, we stood outside, and I leaned against an old ambulance, which was an inoperative relic from a bygone era. As Pitou, Dr. Kan, and I talked, it seemed like a good plan to bring a group of doctors and nurses from the US to spend about three days out in the villages and refugee camps doing general-practice work. Then the team could spend another three days at the hospital working alongside the few doctors and nurses there. The Americans could be a great encouragement to their Cambodian colleagues. They could also bring donated medical equipment like EKG machines, monitors, and defibrillators with them and train the Cambodian hospital staff to operate the machines. There are lots of details to be worked out, but my eyes are being opened to the tremendous needs in Cambodia.
My hosts wanted to take me next to a new village south of Phnom Penh in the province of Kandal. Some NGOs had persuaded the government to set aside a small plot of land out in a rural area about an hour’s drive from Phnom Penh. People who fled their homes during the killing years settled in the mountains on both sides of the border with Thailand as well as in Vietnam. Now the refugees have been moving back to Cambodia, but they have nothing left and no place to go. Those who arrive in Phnom Penh can’t find any employment or housing, so they collect some bamboo and banana leaves and make squatters’ shelters to get their families out of the weather.
Hundreds of thousands of such refugees have been flooding back into the cities since the political climate became safer. But the refugees are creating big problems for the cities. The plot of land we were going to view was designed to hold three hundred families in little side-by-side bungalows consisting basically of one room and an outhouse. There is just enough room to live, but not to plant anything.
When we arrived, I was told that the land was made available in late August. In a little over two months, more than one hundred of the potential three hundred families have already settled there and are in the process of constructing their dwellings out of whatever they can find. The city of Phnom Penh is supplying some leftover bricks for them to use.
I met and talked with the new self-appointed mayor of the settlement. He showed me where they marked off a spot for a school and a medical clinic. They have no idea how to build or equip a medical clinic or staff a school, but the government promised to furnish them with a nurse if they can get their clinic built.
I spent some time taking pictures of the people and trying to talk to them. They all seemed very happy and excited to think they’ll soon have a roof over their heads. But with no place to plant food for their families, most of them will have to ride a bicycle or walk to and from the city each day to find work.
To show me the other side of the refugee problem, Pitou, Sally, and the government lady took me back to Phnom Penh, and we walked the muddy paths of the shanty communities and the back alleys where people are staying wherever they can set down their belongings. The people are dignified, and I could sense their embarrassment. It doesn’t take much imagination to realize that they once had extended families, jobs, and accumulated possessions. But they fled for their lives to escape the murderous rampage of Pol Pot and exchanged all they formerly possessed to survive.
Near the river’s edge, where the shanty dwellings were built out over the water, we came upon a young couple with two small children. The man had a bicycle rickshaw. He wasn’t riding the rickshaw but was in front of it pulling the carriage through the mud. Inside the rickshaw were piled all their belongings. The wife was carrying two green plastic chairs and helping to push the rickshaw from behind. The two little kids ran and played along behind them.
Pitou helped interpret for me. We asked what they were doing, and they said they had settled in the squatters’ area after returning to the city to try to locate other members of their family. He had obtained the rickshaw to try to earn money pedaling people through the streets of Phnom Penh. But just a few hours earlier, the authorities came by and ordered them to move away from the shanty area or be thrown into jail. They are leaving, but they have no idea where they will end up. The sun was setting, and in the haze of the Cambodian evening, all I could read in the eyes of this refugee family was fear and frustration as they tugged on the rickshaw, slowly moving it through the sticky mud.
Wednesday, November 10
When Sally and Pitou picked me up at the hotel at six o’clock this morning, they presented me with an extensive proposal for locations that desperately need medical supplies and equipment. They even requested an entire mobile clinic from Project C.U.R.E. that will enable teams of doctors and nurses to travel to all the nooks and crannies and villages throughout the country.
The travel agenda for today was, I thought, aimed at giving me a firsthand look at the situation in the provinces surrounding the capital city. Pitou and Sally also invited another Cambodian doctor to travel with us.
It rained last night, and everything was cool and fresh as we started traveling south. They had warned me about the conditions of the roads and said it would take us over two hours in some places to travel twenty-five miles. I found early on that their warnings weren’t exaggerated.
By heading out at 6:00 a.m., we ran right into a sea of motorcycles with commuters heading into the city for work. The cycle density in Phnom Penh isn’t quite like that of Hanoi or Ho Chi Minh City in Vietnam, but the city is rapidly catching up. A new sight for me was to see the way the Cambodians transport their large loads of produce and commodities to the local market. They don’t have the capital to invest in trucks, so they’ve come up with an innovative way of building a metal trailer about ten feet long, with motorcycle wheels and heavy duty springs beneath. Then, like a fifth-wheel setup, they attach a ball hitch to the motorcycle, positioned just above the center of the seat. Then a goose-neck hitch is welded to the front of the trailer to pull the unit.
It looks like a miniature semitruck with a large 250-cc to 300-cc motorcycle pulling the rig. I blinked twice when I saw the first machine, but my admiration for their ingenuity grew as I watched how useful the apparatus really is. Out in the rural areas and jungles, I saw them using the same rigs as buses. They just placed boards from one side board to the other to make benches. There were at least twenty people in one such open bus being pulled by one motorcycle.
We continued on our way to the provinces of Takeo and Kampot. Both provinces are coastal and are largely made up of rice fields and jungles. The people are rural agrarian farmers, and most live in houses raised on short stilts to keep them elevated during the May to November rainy season. I can’t tell you how very much I enjoyed the two-hour trip to the Angkor Chey hospital and clinic deep in the heart of the Cambodian jungle. I knew at each bend in the horrid road that my eyes were seeing things only a smidgen of the American people ever see. And conversely, not many people out there in the jungle have the chance to catch a glimpse of an American in their part of the world.
Water is very plentiful in Cambodia. The Tibetan Himalayan mountain-glacier runoff settles right into the heart of the country, where Tonlé Sap Lake stores the water before many rivers, including the large Mekong River, carry it to the sea. Nearly every house is close to a rice paddy, and pools of water and irrigation ditches are everywhere. The water is muddy, but that in no way deters the children from diving in and swimming. Even little kids who are hardly old enough to walk enjoy playing in the pools and ditches. The ladies wash all their dishes and clothes in the same water. Because the water flows toward the sea and isn’t stagnant, the menfolk throw their circular nets from the banks in hopes of catching some large bass and catfish for the dinner table.
Dr. Khek Vantho, the director of the Angkor Chey hospital, and his deputy, Dr. Prum Daracham, helped us with the Needs Assessment Studies. The hospital draws from an area of about nine hundred square kilometers and a rural population of about eighty thousand residents. As we walked through the simple, almost archaic, and terribly inadequate facility, I felt that Project C.U.R.E. could make a significant difference in the health care for the entire area. No one else is going to be there to help. But we can go with acts of love and deliver terribly needed medical goods in God’s name.
The medical staff gave us coconut milk to drink and sent coconuts home with us. I watched the staff perform several emergency procedures on patients who had been involved in motorcycle wrecks on the rutty jungle back roads.
Our trip back to Phnom Penh took us much longer because we visited several more villages in the two provinces. I still had airplane tickets to purchase and arrangements to make for the trip to Battambang tomorrow. Cambodia has already been an incredible experience.
Next Week: “We don’t have a communication problem – we have a crisis.”