Cambodia

Wednesday

At long last we’re off. That’s my husband Klaus-Martin Rath, my friend Claudia Steigenberger, Reinhard Schlagintweit, member of the German Committee for UNICEF, the freelance journalist Susanne Sgrazzutti and Ingrid Karb from the FAZ newspaper. Many thoughts are going through my head. What is ahead of us? What will we see? Will there be a lot of suffering? This is the first time that there will be really ill people – children. Visits to hospitals. The first time we are confronted with AIDS in real life – not just in newspaper articles, films etc. - And children suffering from AIDS too… The journey goes without a hitch. 10.5 hours flight to Bangkok – some of it tedious – then another hour to Phnom Penh.

Here in Phnom Penh we are given a warm welcome and the first impressions are crowding in on us. First there is a briefing from UNICEF officials.

The briefing is important and it is also our first contact with the people from UNICEF in Cambodia. Those present include the head of station, Dr. Suomi Sakai, originally from Japan, who has only been in Cambodia since 2006; Johanna from Finland – an intern; Leslie from the USA, working in child protection; Marc from France, responsible for PR; Isabelle from France; Haritiana from Madagascar, HIV/AIDS project officer. Everyone describes the work that they do. It is important to get to know people on the spot so that we have a direct contact.

It’s all still facts and figures. We’re pretty tired, by my sports discipline helps me to focus on what is being said. We’re off on a boat trip – I’m pleased that we have to drive there. On the way we see unusual sights, for instance I have never seen a hydrocephalic child. I am also impressed by the transportation being used, such as four people on a motorbike – I hadn’t thought that was possible. The boat trip on the Mekong takes us to a simple fishing village on the water. I had heard that the lack of latrines is a major problem – and here we have a demonstration of this: 30 % of diarrhoea cases could be prevented by latrines.

The trip is accompanied by torrential rain – now we know what the rainy season means. But it doesn’t worry people here, they are used to it...



 The evening is left free for us to do what we want and Mr. Rose, the German chef, spoils us. We are not yet experiencing the poverty in Cambodia. In fact, we find that the main roads look very tidy and it’s only when we take a look at the back streets that we get a different picture.

Thursday

Today we are visiting the National Maternal and Child Health Centre in Phnom Penh. It makes a very good impression on us, given the conditions here. The hospital has 154 beds, 27,000 out-patients and 9,500 in-patients a year, with an average stay of four days. Here UNICEF provides support for “Prevention of mother-to-child transmission of HIV” by means of education, and we are given a practical demonstration. A married couple is sitting in a room. The wife is pregnant. Someone talks to her about proper nutrition, HIV prevention etc. It’s great that both are here to find out about this.

Next door there is a group of approx. 40 mothers and grandmothers with infants and toddlers. They are watching a video that tells them about breast-feeding, family planning and child nutrition. Many children suffer from diarrhoea because the grandmothers say that the colostrum should be rejected and give the newborn babies water instead. But water is a major problem, because many families do not have access to clean water. In this society what the grandmother says goes, which is why it is important for them to come along to the courses too. Another problem is testing people for HIV, because it is a major concern how best to communicate the need for this test. If the result is positive, the women are given drugs so that HIV is not transmitted to their babies. UNICEF helps to fund HIV advice, training of the advisers, the tests, printing of information leaflets and helps with adviser’s salaries etc. Most women do not take the test – a big problem! This type of education is available in another 36 health centres and 17 hospitals in 8 out of the 24 Cambodian provinces. Of course, like everywhere else, there is not enough money to ensure that the information is spread further.

The next place is the National Paediatric Hospital in Phnom Penh, a children’s hospital. When you look at it from the outside you would wonder why we are going here – we finally want to see what is in short supply – but appearances are deceptive. Conditions inside are dire. The beds with children in them are even out in the corridors and one play area is full of beds. We are told that there is no space because of a dengue fever epidemic, and that is happening now because it is the rainy season. Some beds do not have mattresses. The urine simply runs onto the floor. In one room advice and treatment is available for undernourished children. F75 and F100 are combined powders that give the children all the nourishment they need. But they can only be given here in the hospital. Here too we find out that all this is very difficult without education, because children are given or not given food that they can either not digest or that does not meet their essential food requirements, simply out of ignorance. The HIV-positive children are not isolated, otherwise they would be socially excluded. HIV tests are strongly encouraged and anti-viral drugs are administered if the diagnosis is positive. In 2006 there were 751 children in the hospital: 31.5 % orphans, 37.8 % half-orphans, 31.4 % whose mother or father was HIV-infected. We visit a ward with undernourished infants and toddlers suffering from a range of illnesses. Just looking at this makes me so sad, but I have to put a brave face on it. I have an opportunity to talk to individual women.

I am particularly touched by a two-year-old girl who weighs 6.2 kg. She is smaller than her three-month-old brother, who is lying beside her. He is on the road to recovery – before this he had been covered with oedemas from head to foot. Those thin arms and large eyes staring out from such a fragile being. One child is not only undernourished, but also has a hare lip, but that is being treated here in the hospital. Currently there are approx. 200 children, 120 nurses and doctors. I ask myself: How is this being funded? 1 dollar is needed per child per day. The patients that are here cannot pay.

Sometimes the patients are reallocated based on whether they can pay or require financial support. The conditions in this hospital are desperate – we are given a list of items they are short of.

Back to the children. One child is lying there and quite apathetic, so you feel it might not survive the day. A girl of two is lying immobile on the bed. She had been abandoned at a bus stop when she was 18 months old, and she is also paralysed on both sides. What a sad future! A foster mother is now looking after her.

Often the grandmother is here too, but sometimes the husband as well. I would never have thought that the men would look help to look after the children in this culture. The brothers and sisters also come along, but they then have to find their own food. Naturally only the patient receives hospital meals. How does it work? How does the family pay for it? Many of them are from the provinces. It is important that HIV testing is carried out there too! Education, education, education! Here in Cambodia 90 % go to primary school, 43 % make it to grade 6, and 31 % of those continue in secondary education. Do they learn? How good are the schools? In this poor country they are needed to help run the household or to earn money. In the provinces the number of children going to school is much smaller!

A visit to Pius Fischer, the German Ambassador, revives us and is very informative. We were even served German food, including beef, soup and pork tenderloin with fried potatoes – all prepared by a Cambodian cook! Not that I was missing home cooking – I live Asian food – in fact, I found it rather bizarre!

This is followed by the “Inthanou” HIV hotline. Somewhere in Phnom Penh there are three rooms on the fourth floor of a block of flats. That is where nine advisers work a three-hour rota for seven hours a day, with Sundays off. Monday is the busiest day (risky behaviour etc.). 200 calls a day, approx. 65,000 a year. The costs incurred by the centre amount to 1 dollar per call.

A highly sophisticated computer system designed by a French organisation makes call handling and the collection of statistics easier because the operators just need to click on the relevant items during the call. The calls are anonymous and can come from anywhere in Cambodia where there is a telephone. I am surprised that the subject of AIDS is discussed so openly and how efficient the operators are! The whole system is very successful and the number of the hotline has spread well, mostly by word of mouth. The centre has even been able to help a couple so that their relationship did not end in divorce. A woman called in because she suspected that her husband was being unfaithful, but he did not want to take the HIV test. The husband, quite independently, also called in and an adviser persuaded him to take the test. This then turned out negative, as they found out from the wife. She thanked them and the marriage survived.

Cambodia gained its independence from France in 1953. Prince Sihanouk was the head of state until 1970. A putsch brought General Lon Nol to power until 1975. Khmer Rouge took over Phnom Penh in April of that year and introduced a radical version of Communism. Over the next three years they killed 1.7 million people. The country has been brought to its knees by the war and the infrastructure has been destroyed. A peace agreement brokered by the UN was signed in 1991. The first free elections followed in 1993. Cambodia is 129th out of 177 developing countries and 8th out of a list of 10 Asiatic ones. The poverty everywhere is astounding. Cambodia is anticipating major revenue from offshore oil and gas reserves from 2010 onwards!

Almost the entire intelligentsia was destroyed under Pol Pot’s regime in Cambodia. The manager of a children’s hospital told us that out of 400 doctors only 30 remained. A whole generation is missing. Pol Pot escaped by giving false information and maintaining that he was a farm labourer. But he had a problem, because the authorities were checking hands: How to make his hands look like those of a manual worker? He survived as a farm labourer in the country.

The population is around 14 million. In 1980 it was just 6 million. Consequently the population is very young. 34 % of them are living below the poverty line.

Friday

What an emotionally moving day. We make our way into the countryside. Cambodia has 24 provinces. UNICEF is active in 7 provinces. We visit the “Kompong Speu Referral Hospital” in the Kompong Speu province. We start out early. There are a lot of people on the road and on their way to work. Innumerable mopeds, bicycles and tuc-tucs. The streets are colourful, bustling, chaotic. Our route takes us past a large number of factories. Many Chinese factory owners produce goods here for foreign companies. The main goods produced in Cambodia are textiles and shoes. Garbage is everywhere and the city is suffocating in plastic waste. The provincial hospital has plenty of patients. We can see a long queue of people. Women, men and children are waiting. Some of them are sitting on a bench outside with a drip in their arm.

A building exclusively for children is attached to the hospital. This children’s ward is new and one of UNICEF’s pilot projects. It is intended as a model for children’s wards that are to be built in other provincial hospitals. This building was funded by UNICEF Germany.

There are approx. 20 sick children in beds, with mothers, fathers or grandmothers also present. This is the first time I am confronted with an HIV-infected boy. He is 10 years old, and his mother has already died of HIV/AIDS. The father is also HIV-positive – he has accompanied his son. The boy is lying on a bed and breathing with difficulty. The doctors suspect tuberculosis. The medics seem very dedicated. There are three doctors for the children and an additional doctor who has undergone further AIDS training in Botswana. Every three months a specialist from America comes to Phnom Penh to answer specific questions. The system seems to have been carefully worked out. I find it very sad to look at the young boy. AIDS now has a face – but of course I cannot ask why, where, how. At 1.9 % of the population between 15 and 45, 12,000 of them children, the AIDS rate in Cambodia is the highest in Asia.

I notice that all the sick children are lying in the same room. It does not matter whether they are suffering from suspected typhoid, tuberculosis, pharyngitis, HIV etc. – there is no separate isolation ward.

In an adjoining area, a waiting room with two treatment rooms, three children are waiting with their families. One girl and two boys aged between two and 16 – all of them HIV-positive. They are accompanied by their mothers, who are also HIV-positive. I am allowed to talk to them, but really I am at a loss for questions. For some of them the journey to the hospital is a long one, and they need to take their medication every day. Sometimes they go to school and are simply children. The conversation makes me sad. What kind of a future do they have: children that have done nothing to bring about their current situation?

There are other rooms for HIV tests or consultations. A particularly large room provides an opportunity for meeting those affected by the illness, for exchanging information and giving strength and support. This pilot project has convinced me of its effectiveness – there are other provinces that do not have these wards and the journey to Phnom Penh is too long.

On to a temple of the Buddhist Leadership Initiative, which is run by Buddhist monks. We must observe a few rules of conduct. We have to take off our shoes and our feet must never point towards Buddha when we are kneeling down. A monk must never be touched. We are present during a prayer. A large number of women, men and children have joined together in prayer. The monks are trained by UNICEF to provide succour to HIV-positive people, sometimes by going to their homes to talk face to face or in the temple. They lead meditations, conduct supportive discussions or hand out food, they look after orphans and even everyday things, for instance whether people have taken their medicine etc.

The money is initially transferred to a local government agency, which then forwards it to the monks. I have an opportunity to talk to the head monk.

We learn that people can be monks for a while – how practical – you do not have to decide to be a monk forever. This particular monk first worked as a bus driver, has been a monk for seven years and is now the leader of the temple. The community proposes a leader. We are then allowed a glimpse of the life of the monks here – there is a kitchen area and they are particularly proud of the toilet facilities, which are something very special here. The water is collected in clay pots and used for cooking, washing, bathing. They even ask me to take a bath. They hand me a towel that is supposed to screen me while I get undressed, but I decline. A nun, 90 years old and extremely fit, shows us round. The nuns do the domestic chores here while waiting for their death in the presence of the monks.

When we visit another temple we are shown the practical HIV education cards – a very pragmatic demonstration about the prevention of HIV.

We now visit a family. The poverty is unbelievable – a grandmother is sitting in front of a house with her eight grandchildren from two families. The parents have died of HIV and she manages to feed the children by making palm fans. She showed me her hand that she had broken, which means that she is no longer able to work as well as before.

There is a shortage of everything. I sit on the mat with her and talk to her – via the interpreter of course. Sometimes I wonder how anyone can understand this language. The monk is enthroned on a raised bench and is taking pictures of our encounter using the camera on his mobile – a curious situation.

The concluding visit of the day is to a riding club that gives socially disadvantaged children the opportunity to ride once a week – all of this is funded by Angelina Jolie’s “Maddox Jolie Project”.

In the evening we have kindly been invited by Mr. Thomas – a great friend of Mr. Lederer, Schenker Deutschland. We are given such a warm welcome, really enjoy the evening and find out a little about international hospitality in far-off Cambodia.

Saturday

Today we are visiting an NGO – Mith Samlanh – that belongs to Friends International. UNICEF Cambodia has been supporting Mith Samlanh since 1998. The organisation helps to look after street children and their families. Mith Samlanh runs 12 projects for street children with centres in Phnom Penh, Kompong Speu and Kompong Cham. In Phnom Penh there are approx. 40,000 street children – this includes children who live on the streets and do not go home regularly. They are exposed to many dangers, including rape, violence, prostitution etc. Many of them drink alcohol, sniff glue, are drug-dependent or take amphetamines. Many of them are also HIV-positive and the number is rising. Mith Samlanh looks after their education, e.g. in a youth centre, medical support, help with their training, e.g. as car mechanics, electricians, cooks, seamstresses or hairdressers. Mith Samlanh also helps to reintegrate them with their families. Mith Samlanh is a sub-group of Friends International, an organisation represented in Laos and Thailand, that even has an office in Frankfurt. The group runs two very good restaurants, an internet café, a nail studio and a second-hand shop that employ the street children when they have completed their training. The income goes back into Mith Samlanh’s pot – very well though-out – and we can then see for ourselves that it is working. First we visit the youth centre at Boeung Kak Lake. Approx. 30,000 people live here in slum-like conditions.

I have never seen so much squalor and dirt in my whole life. I don’t think that living conditions could be any worse than this. The people are drowning in garbage and dirt, the entire shanty town is next to a swamp that is covered by so much plastic rubbish that it is unrecognisable.

We pass someone who cuts shavings from blocks of ice and sells them. The heat is altogether oppressive. There are approx. 50 youngsters in the youth centre, which is really intended for those over 12 years old. There is an atmosphere of fun, because a social worker is just doing a quiz with them that deals with vital issues:

How do you get HIV? How can you protect yourself against it? The walls are covered with information. There is a very clear demonstration of how to use condoms. A group of youngsters is sitting in another room – where a simple lesson is being conducted with learning cards. One room is used for medical treatment, another for consultations – a fantastic facility. The children are so positive in this desolate environment.

On our way to meet some of the families that live there we pass through narrow alleys, mud, dirt and garbage. Planks form a path to these so-called homes – really they are nothing more than lean-to sheds. And they even have to pay rent for them ($ 15 / month). The electricity is from an illegal supplier, there are no toilets and I have no idea where they get their water from.

In one of the rooms, the last one off an amazing corridor, we visit a woman. I take my shoes off and enter the room. A woman lives here with her husband – both HIV-positive – her brother, who is just out fishing in the swamp, and seven children. The man is missing a leg, like many others we have seen. The prosthetics are so poor. This one comes off and the man picks it up and continues without bothering to strap it back on.

Thankfully the children of this couple are HIV-negative. Mith Samlanh offers a training programme and is teaching women to sew. They are provided with a sewing machine and learn to sew simple items that they can then sell. They have to get the material themselves, but Mith Samlanh buys their products. These earnings can be used to pay for the lean-to and the food, the children can go to school and do not have to work on the streets. Mith Samlanh has come to an arrangement with a school which means that the fees are now lower and the school uniforms cheaper.

So ten people live in this room and a child is just wading through the garbage outside the door. The woman proudly shows me the products she has made. From talking to her I find out that the area is soon to be evacuated. Buses turn up without notice, pick up 5000 people and put them down again 20 km from the city. They do not announce when this is going to happen so that it won’t be covered by the press. A Korean investor has bought the land and is building a lakeside residential estate. The government tolerates this forced evacuation. These people do not have any work on the land, they leave their children with the grandmothers and go into the city to work, where they live on the street, as it is too far to go home. The children do not go to school, they are exposed to many dangers, including prostitution, violence and street work. Many of the people in this slum are HIV-positive, like this woman. Mith Samlanh is working out what they call a future plan for their children while the parents are still alive. The children will either go to relatives or to foster families. I am impressed by the work the NGO is doing – it is well though-out and humane. I visit two more women whose fate is the same. What is depressing is the misery, the poverty and the hopelessness. These are people, after all, who are being forcibly relocated for economic reasons – surely, given the sums involved, there must be some money left over to build new accommodation for these people. The people working at Mith Samlanh have impressed me. They are young, dynamic, committed, and their heart is in the right place. Mith Samlanh is also providing training for medical care or advice regarding HIV tests. Unfortunately most of them do not take the test until some of their relatives die - far too late!

I wonder what kind of a future these people have. It is all the more important that we give them our support, because otherwise they could potentially turn to all sorts of crime at any age. There may be many of them – and sometimes it is enough to drive you to despair – but we can still help some. The eyes are so eloquent!

I must mention one other incident. A girl on a bicycle rang her bell behind us. She was dressed in brilliant white. I instantly asked myself: what work does she do and where in this environment did she manage to get her clothes so white?

We pass a different kind of Cambodian ice cart, and children here love ice cream, just as they do throughout the world. Nevertheless the question is: what water has been used to make the ice cream?!

It is evident that education is still the basis for combating many problems, whether hygiene, HIV prevention, environmental pollution… After all, this mountain of plastic that is littering the place urgently requires an environmental programme to deal with it. There really is a lot that needs to be done!!!

In the evening we fly to Siem Reap.

Sunday

It is now our last day. In the morning we meet Professor Leisen’s students, who are helping to restore the bas-relief at Angkor Wat. This work is being funded by sponsors and the Foreign Office. Angkor Wat is part of the largest temple city in the world and very impressive. Here in Siem Reap it is already very touristy and different to Phnom Penh.

In the afternoon we visit the CWCC – Cambodian Women’s Crisis Centre. This is a women’s refuge that takes in women and their children. Boys are transferred to a different NGO once they reach the age of 10. This NGO has been in existence since 1997. The organisation looks after the education, training and health of the mothers and children, and provides psychological support as well as legal advice. The women who live here are victims of domestic violence or have been raped. The centre also helps the family to reintegrate if that is what the women want.

Currently there are 15 women and more than 40 children here. A very committed teacher shows us through the well-kept house. Lessons for the children are taking place in one room, in another room the women are being taught to sew so that they can use that skill to earn money. They can also train as cooks. The children seem happy. They are playing and laughing – it’s lovely!

Men are not allowed to visit their wives and can only see them in the general office in the city with the centre’s head present. While talking to three women training to be cooks, my attention is drawn particularly to a distressed young girl. She is 15 years old and only recently entered after she had been raped. Her eyes, her clenched hands speak volumes. The women are very upset by their experiences. I am allowed to speak to a 40-year-old woman who has been living in the refuge for four weeks. Only an interpreter (Mister Man, a UNICEF employee) and Ingrid, the journalist, are with us, otherwise it would be too much for her. She is the victim of her husband’s violence – and more about that later. I start off the conversation by talking to her about my children, how many, how old, how many boys, how many girls. We communicate, one mother to another. She has seven children – two live here, two live with her brother, who has five children of his own. Do the others fend for themselves? We don’t find out how, but apparently they are old enough, the oldest being 21.

Suddenly she opens up and tells us that her husband beat her time and again, especially when he was drunk. She shows me the scars. He beat the children too. Then she starts to cry bitterly – her memories are crowding in and she is reliving it all. I feel so sad that I cannot help her. She speaks of feeling suicidal and is so upset. The reason why he beat her, she thinks, is that he was jealous: first of all, because of her work – she sold fish at a market – and secondly because her husband thought she was having an affair. At the market he had threatened her customers with a stick, scaring them away so that they did not buy her fish. He sold the house that they lived in and now stays with his mother.

The community director referred her to the refuge. I think it is good that the CWCC works together with the local authorities and the police as well. In the future she would like to have a small stall at the market where she can sell the food she has cooked. Thank God she is making plans again!

Apart from the HIV-infected boy in the provincial hospital and the HIV-infected mothers in the slums of Boeung Kak Lake, this was the most harrowing meeting of the trip for me. I have been left with vivid impressions – I dream a lot and thank goodness I have a husband that I can talk to about it.

It will be difficult to communicate these experiences to others in Germany, because it is hard to describe so much misery and such sad lives in words, but that is what I have to do now.