The biggest and busiest town on the western front of Thailand, Mae Sot is located in Tak province directly across the Moei River from the Burmese town of Myawadi. It is about 400 km northwest of Bangkok (8-9 hours by bus), and about 250 km southwest of Chiang Mai (5-6 hours by bus). Different ethnic groups have lived in this town for over 100 years: first was the Karens, later the Tais, the Chinese from Yunnan, the Burmans, the Muslims from Bangladesh and northern Thailand, and the Sikhs and Hindus from India. Before the construction of a highway from the city of Tak to Mae Sot over mountainous terrain, it was far easier for Mae Sot’s residents to trade with people of the Moulmein province of Burma. Just west of the Moei River in Burma rise the 8000’ Dawna mountain range and just west of it a historically famous seaport on the Andaman Sea. Under British rule, Moulmein was one of the most important seaports of British Burma.
This historical trading with Burma continues with vigorous vitality today in Mae Sot. It is a community of 100,000 people with estimates of less than half being Thai citizens. Mae Sot continues to be a manifestation of multi-cultural localities where both official and black market economic transactions simultaneously thrive. The Thai national culture has not been easily entrenched here due to the “cultural displacement” of fleeing Burmese from every ethnic group. The majority of shop workers in town - especially in the open markets - speak one of the Burmese languages (of which there are over 100 recognized) rather than Thai. The sheer number of diverse ethnic groups, the bounty of natural resources, and the highly-charged political climate in both Burma and Thailand give this area so many layers of stories and activities that it may take being in Mae Sot for some time before sorting any of them out. There is an undercurrent of animosity toward the Burmese from the Thai people, propagated in part by the nature of trading that has taken place through the years. There are now many Chinese and Thai-Chinese that own businesses in the area, and are involved in everything from gem trading to textile sweatshops to brothels. Adding to the mix of Asian cultures is over 50 international non-governmental organizations (NGOs) that bring in a rotating band of Westerners with varying degrees of sensitivity to local culture. Intentionally or unintentionally, these NGOs aid the organized opposition to the Burmese government, and therefore support the existence of the 2 million illegal Burmese on this western edge of Thailand.
The many benefits of this multi-cultural area are evident as soon as you enjoy your first meal. There is no shortage of incredible places to eat, whether it’s in an organized restaurant or the many tin shacks or stands along the streets and alleyways. The two little tin and cloth-covered shelters next to the Mae Tao Clinic are a perfect example: on opposite corners from each other just 50 meters from the clinic entrance, these Burmese and Thai ladies serve some of the most delicious food in Thailand. You can enjoy papaya salad, sticky rice, barbeque chicken, rice or noodle dishes, wonderful soups, and fruit shakes for about a dollar per lunch. These places are filled with both medics and Westerners working at the clinic – and in fact, serve as excellent places for education of the area, discussions of patients, and plans for social activities. The daily lunch conversations run from which patients the medical students were horrified to see that morning to details of the weekend activities. As an example, today’s lunch was with 2 medical students, 2 public health workers, and a physician from Norway. We discussed the patient that came in with a bite to the face from a black bear in Burma, it took him 2 days to get to the clinic and he arrived with no nose or mouth, and one of our medical students promptly passed out upon seeing him. Fortunately, it was lunch and the details didn’t get too graphic, and we quickly moved on to more mundane topics. These included the upcoming May referendum in Burma and the sham election scheduled for 2010. Also discussed was the corrupt nature of the Thai government financially supporting the building of 3 dams in the Salween River in Eastern Burma that will ultimately flood vast areas of Karen land and destroy dozens of villages. This morphed into the description of this morning’s routine shakedown of illegal Burmese migrants by Mae Sot police, this time in the form of 20 police stationed on a street corner in town stopping every Burmese-looking person and asking for their “papers.” It was suspected that perhaps the town needed some fundraising for the upcoming holiday season. While enjoying my banana shake, the conversation turned to the annual Songkran water festival in 2 weeks. This is the biggest holiday in Thailand – it is their New Year celebration – and almost all businesses are shut down from 2-4 days. Many locals travel out of the big cities to their families’ historic homes, and in Mae Sot virtually everyone gets into the act by throwing water at each other. It’s well known to not bike down the street during these days with anything valuable that you don’t want wet (i.e. laptop, camera), because invariably hoses and large buckets of water will appear. It’s almost impossible to avoid, as you will be stopped in the middle of the road, sprinkled with traditional powder and ceremoniously “washed” – yet all in good fun.
March, April, and May are considered summer here in Thailand (the kids are out of school), with April generally having the hottest temperatures, averaging 105-115F most days. The hot weather arrived early this year, as it was consistently over 105F virtually every day in March. Adding to the heat is the smoke in the air from the burning fields. Last week the airport in Mae Hong Song was closed due to zero visibility, and drought conditions exist virtually everywhere now. We did get a slight break this week though, as an extremely rare rainy day occurred 2 days ago and was followed by the first somewhat clear day seen in over 2 months. The mountains in Burma finally reappeared and a nice breeze made for a lovely day – 95F never felt so cool. One benefit of being here in the dry season is the ability to run or bike virtually anywhere without fear of being stuck in the mud. While being in a constant state of dehydration, I’ve managed to keep up at least short runs daily, and longer bike rides on the weekends. It’s a shame the mountains are not visible most days, because biking on the empty roads along the Moei River with the imposing Burma Range just to the west is some of the loveliest biking around. It’s been great to reunite with my Thai friends in the Moei River Runners Club, and they were equally excited to see me. My friend Aote, whose Buddhist wedding I attended last year, now has a very smiley baby boy and still running quite well. His friend, the best man in his wedding, has qualified for Thailand’s Olympic team in the marathon and comes to train periodically with Aote in Mae Sot. I can’t imagine these are running conditions enjoyed by the world’s elite marathoners – smokey, hot air and a really dilapidated dirt track - but these are really tough runners and inspiring to be around.
While in Thailand last year for over 6 months, I was fortunate to not have any illness, not even an upset stomach. This year the first week wouldn’t pass without receiving my due. It came during a period when almost every Westerner was coming down with something, from just GI distress to dengue fever in 4 instances. While my little episode was not serious in nature, it did enough to drain the energy out of me for most of my first month here. I’m still not quite sure what it was, as it started with GI symptoms, but then struck one afternoon at the clinic like a freight train hitting my cerebral cortex. It was a very wobbly bike ride home as the dizziness created the illusion of twice the number of motor bikes and animals on the road than are normally navigated around during these daily journeys. I spent the next week or so with no appetite and incredible weakness. It was bad timing from a running standpoint as Aote and others from the running club had asked me to join them for a weekend trip to the Khon Khan ½ marathon – the largest race in Thailand. I had registered for the race prior to getting sick and was looking forward to the weekend, but could barely bring myself to running 13 meters let alone 13 miles. In addition, the following weekend was the only road race of the year in Mae Sot (5km and 16km races), but decided that helping the running club by working at the race would be the best option. I had a great time at the race working the finish line area, and as the only non-Thai worker, had a bonding opportunity with fellow runners and workers decked out in our bright pink volunteer polo shirts. While the first few weeks were a bit draining, my health has been fine since then, and on the bright side was able to be at a weight not seen since age 15.
Last year’s solo apartment was replaced this year by a “homestay” accommodation. There are 3 homestay houses in Mae Sot, all are traditional Thai teakwood designs of 4 bedrooms, lovely living rooms, kitchen and 2 bathrooms. One of the best aspects of this lodging, however, is that half of the rent goes directly to the Mae Tao Clinic. Due to the transient nature of the ex-pat community here, housemates can come and go at irregular intervals. During the past 3 months, housemates have included med students from Denmark, Australia, England, Canada, and America, musicians from Taiwan, and a solar power engineer from Scotland. One housemate who has been constant throughout has been Gideon, a Dutch aid worker with Child’s Dream, a NGO that supports children transferred from the clinic to Chiang Mai hospitals for difficult and rare surgeries. His stories of parents and children are tragic, heartwarming, and often gut-wrenching. Much to my delight, also staying here was my friend Andy, who graciously volunteered his month of February to be at the clinic and help out in any way possible. Initially he focused his information technology skills on helping our pharmacy computer conversion for the new central pharmacy, but his greatest contribution ended up being his nightly English classes with the clinic medics. It was great to have a running buddy to commiserate on the heat during our sunset runs, but Andy loves the heat and probably regrets missing these brutally hot days of summer.
I’ve been able to enjoy the company of wonderfully intriguing people during my stay in Mae Sot. The range of social activities includes splendid dinners, art openings, theme parties, and Ultimate Frisbee games every Saturday afternoon. One very interesting man who was in Mae Sot from September to March was an Irish priest named Alo. He had been teaching philosophy in Burma for the past 3 years (after spending 20 years doing the same in Chile), but had recently been asked to leave the country just before the September demonstrations and came here to teach philosophy and English to Burmese students and our clinic medics. He had heard I was also interested in taking Thai language lessons and contacted me about a person he had heard about in the Muslim section of town. We ended up having 10 lessons from Laily, which turned out to be quite an experience. Laily is a lovely Thai Muslim woman who teaches English to primarily Thai kids, and if we had actually received our classes from Laily, both of us would know much more Thai right now. Within the first 10 minutes of our first class, Laily introduced us to her brother Arif, who obviously was not a teacher. He immediately proceeded to take over our little lesson for the day (as unorganized as it was), and we thought perhaps it was just an obligatory gesture on his sister’s behalf. It turned out that Arif taught every class while sister Laily watched intently 10 feet away. Alo suspected that because 2 men were in the class, a Muslim woman would have to defer to a Muslim man to be with them. This would have been fine if Arif had any clue on how to teach. He had such a lack of patience with us that a number of times he would just walk away complaining of a headache and leave us wondering if the class was over . . . indeed, it always was. Alo and I would joke that our ineptness learning Thai couldn’t even keep the teacher in the room, and we would end up going to a nearby Muslim tea shop for their superb Burmese tea. Our conversations ranged from the social/political climate of Burma and other areas of the world to deeper, sobering topics such as the meaning of life. He gave me an interesting book by John Cottingham titled “On the Meaning of Life” which I’ve already read once and find myself going back over numerous pages. Although the topic is deep, it’s presented in a very understandable manner and has helped me attempt to bring some clarity to this madness of humanity we are surrounded by here.
On a lighter note, Alo also had another keen interest – he plays the accordion! I discovered this when telling him how I spent one evening trying to blow off steam after a long day at the clinic. On a bike ride home from the night market to pick up my favorite pad thai from Toom (spelled “Tom”), I noticed a new music store. What really caught my attention was a small used red accordion on the front shelf begging me to pick it up. I asked the shop owner if it was available to play, and he graciously agreed and asked what I liked to play (in very broken “Thai-lish”). I mumbled a few things, and he hustled to the back room to bring out his guitar and play along. Not only the shop owner, he’s also the music teacher and plays every night at a club down the street. He was an excellent guitar player, knew a ton of Western songs and exquisitely finger-picked the blues. I played background to his blues and folk songs and before we knew it, had spent an hour jamming in the parking lot (amid an audience of a few old men and older dogs). With a birthday party at our house that weekend for one of our clinic colleagues, the accordion would either be bought or at least rented for the night. Given the outrageous price he wanted for an old accordion with holes in the bellows making it difficult to generate sound, we negotiated for the latter and left a deposit to ease his concern of losing such a “prized” instrument. The afternoon of our party, I picked up the accordion and went to the homestay house of Richard, a med student from Australia who had purchased a guitar at the border market to play while he was here, and then would give to the music-loving clinic medics. Richard’s house was down the street from Casa Mia, one of our favorite restaurants in town, and the workplace of Charley, a very pleasant Burmese migrant who moved in a speed slightly slower than a snail. The previous week, we noticed Charley’s guitar had a broken string, so we presented him with a new full set of strings the following day. Stopping at Casa Mia to bring lime shakes to Richard’s house, it was hard not to notice Charley in his usual position of hanging out in the corner twiddling on his guitar. I asked him if he would like to join us for a little afternoon jam session . . . never was he seen so animated, he was ecstatic. The party that night turned out to be quite fun, with entertainment provided by 2 piñatas, and the musical meanderings of 2 guitars, one harmonica, 2 bongos, and one scruffy accordion. While we enjoyed jamming along to blues tunes made up on the fly, more entertaining was watching the 64 year old Alo playing Irish ballads with ease. Who would have thought those accordion lessons at age seven would come in so handy in Southeast Asia – thanks Mom and Dad!
Having the ability to relax and step away a bit from the misery surrounding us is critically important to maintaining sanity. We won’t soon forget the contrasts of the week of that party. Within the span of that week, I had given a 3 hour antibiotic lecture to the medics of our inpatient department during which one patient died and one had to be urgently transferred to Mae Sot Hospital (the lecture couldn’t have been that bad), we endured an excruciatingly painful clinic audit where our funding was threatened, the Karen National Union leader Mahn Sha was assassinated across town, and one of our junior clinic medics committed suicide by ingesting 30 chloroquine tablets. Perhaps that’s why the Friday night party turned out to be such a big hit, everyone was ready for a break from reality. That weekend we physically broke from Mae Sot, as 6 medical students, Andy and I visited the 12th Century Thai capital of Sukkothai, which is located just 3 hours east of here. We had a wonderful visit biking through the national park and venturing out to the deaf monk’s hideaway temple visited twice last year. Unfortunately, Mamit was away this time, but we communicated with him by phone texts and he remembered me and was sad to have missed us. We left food for him and enjoyed the peace and relative coolness of his mountain retreat before biking through the noon heat to make our bus back to Mae Sot.
While in Southeast Asia, I eagerly accepted an invitation to visit Cambodia from the Director of Khmer Health Advocates in Connecticut. She would be in Cambodia during my time here and had also invited the Director of the CDC’s National Education Program of Diabetes Translation to join her in a tour of hospitals and newly opened diabetes clinics around the country. Khmer Health Advocates is the only Cambodian health organization in the United States and is located in West Hartford, Connecticut. KHA provides care for Cambodian immigrants in Connecticut and Western Massachusetts, and advocates for holocaust survivors across the nation. KHA is meeting the challenges of outreach to this population through innovative technology tools that could be useful in other settings with marginalized populations. In 2007, KHA was named a Center of Excellence for the Elimination of Health Disparities by the Centers for Disease Control. My volunteer work with KHA will continue upon returning to the States and will focus on developing a cultural competency curriculum for pharmacists in conjunction with the Connecticut Pharmacists Association and the University of Connecticut School of Pharmacy. Involvement will include KHA’s unique telemedicine program which allows community health workers and clinicians to offer clinical supervision of in-home disease management and provide face-to-face education. The opportunity to visit Cambodia and learn about their health care delivery systems and clinical challenges will hopefully add knowledge to the multi-faceted issues facing this population.
Greeted at the Phnom Penh airport by Theanvy Kuoch, the KHA Director, and Jane Kelly of the CDC, we immediately were whisked off to what would be a whirlwind tour of Cambodian health care facilities. Our first stop was lunch at the home of Theanvy’s niece and a meeting with Maurits van Pelt, the Executive Director of the MoPoTsyo Patient Information Center. He was the former country director for Medicin San Frontiere (Doctors Without Borders) in Cambodia during the late ‘80s and 90’s, but now is developing a unique conglomerate of diabetes teaching modules throughout the country. We had a fascinating discussion on the rise of chronic disease (i.e. diabetes, hypertension) in Cambodia and how developing countries have funding solely for a communicable disease model. This model does not work for chronic disease and Maurits has took it upon himself to create chronic disease models focused on diabetes. Non-medical community workers have been trained to provide culturally specific education on the disease, treatment, diet, and lifestyle changes. One of the reasons community health workers are used rather than medical professionals, such as nurses, is because their reimbursement (which is low) is based on the education they provide, not on a drug that is dispensed or disease diagnosed (the traditional Cambodian model). Diabetes is generally not a result of obesity as it is in Western countries, and it may have its origins from many factors that are currently being explored. Some of these areas may be researched in the Cambodian American population, such as potential links with depression and post-traumatic stress disorder, to help explain why the American Cambodian population has a diabetes prevalence rate of 25%, four times the rate of the American population. In Cambodia, diet is a major factor as greater than 80% of calories come from carbohydrates, primarily in the form of white rice. Maurits explained to us that while meat might be a bit expensive to obtain for many people, vegetables are not and they are plentiful. Access to them is not an issue, but knowing which ones to eat and how to prepare them certainly is creating barriers.
Not having a history of a chronic disease model in a developing country results in not have funding, which has led to the use of only two medications for diabetes (glibeclamide and metformin) and very little use of insulin. Other than the very rare person who can afford the $10 vial of insulin, its use is limited to inpatient settings, and we would soon find out that even in those places it is rare due to cost. We were now off to inspect those institutions, and our next journey would be a 5 hour drive northwest to Battambang. The first experience of realizing the depths of Cambodian’s poverty occurred the next morning during a run through Battambang’s neighborhoods. The “colonial” atmosphere of Battambang’s one paved central road quickly turned into dirt roads narrowly lined with decrepit shacks and barely clothed inhabitants washing on the road or searching for their next scrap of food. As a White man running with fancy shoes (any shoes for that matter) through this spectacle of destitution, the sense of entitlement and abandonment was overwhelming. As quickly as the area turned into decay, it snapped back into “Western normalcy” upon stepping on pavement, meandering through children walking to school dressed in white shirts and navy blue pants or skirts. A 45-minute jog produced a kaleidoscope of surreal images which would be further enhanced by that afternoon’s travel.
While Theanvy was enjoying a visit with her family farther north and would reunite with us in Siem Riep the following day, Jane and I were joined by Dr. Patpir, a diabetologist who will be medical director at the new diabetes clinic in Kratie opening the following week. This morning will be spent at Battambang Hospital on a tour led by their diabetes clinic director, who was extremely gracious and patient with us despite his heavy caseload and obvious lack of resources. His diabetes clinic was only in its 8th day of operation and at this point consisted of 2 physicians and 2 nurses, and hundreds of patients. He lamented about their lack of resources and their inability to obtain medication for their patients. While diabetes is treated with only 2 oral medications, for unknown reasons the Cambodian government will pay for one (glibeclamide) and leaves the other (metformin) at the patient’s expense. No outpatients receive insulin because of their inability to afford it, and very few medications are used for hypertension, again due to the physicians’ justified fear their patients won’t purchase it. The medical director explains to us they have no problem with adherence to medications (an unintended benefit of poor access), however their greatest medical barrier in their diabetes patients is changing their diet. As mentioned, the Cambodian diet relies heavily on white rice, not always for economic reasons, as much of their consumption is due to cultural beliefs in the benefits of white rice. As an example of how the grain is so entrenched in Southeast Asian culture, the usual greeting for Burmese is: “Have you had rice yet?”
This clinic is the first example we’ve seen of how the chronic disease model is being implemented in Cambodia. In the diabetes, HIV and TB clinics education is such a dominant theme of their medical management that separate rooms are designated just for medication education. I was particularly impressed with the focus on medication education in the TB and HIV clinics, where multi-drug treatments are a necessity and non-compliance can lead to fatal drug resistance. Strains of highly lethal resistant TB run rampant here, and virtually everyone (patients and staff) on the hospital grounds wear face masks to prevent respiratory transmission. In the TB, HIV and outpatient clinics, patients receive their medication in one room, then are escorted to a specific education room for a lengthy discussion of their treatment. If it’s a returning patient, the health care provider attempts to work through a meticulous process of determining their previous compliance with their treatment. I was so impressed by this service that I told the medical director we didn’t have this level of education in virtually any American hospitals, although it’s not due to a lack of awareness of its importance. With a different payment mechanism in the American system geared toward product and technology rather than education, it was refreshing and inspirational to see a system give so much importance to education. It was also heartening to observe a system that realizes its lack of resources and yet rather than succumb to it, rises above it to explore other ways to improve care. We left the hospital forlorn over the shabbiness of the facilities, and yet exhilarated by the dedication of the workers. It was on to Siem Riep to explore other medical facilities and our mode of transportation would provide yet another educational experience.
Patpir, Jane, and I proceeded to the river that dissected town to find our “speedboat” and smiling driver waiting to trek us up river to Siem Riep. We decided on this means of transport because it would be faster than the 9 hour drive and infinitely more enlightening. The 5 hour boat ride started slowly through a narrow river lined with “floating villages” – not the type romantically written about in so many tour books, this was the reality of rural Cambodia and the stark images of poverty and naked kids frolicking in brown, turbid water will not soon be forgotten. It was a brutally hot, still day, and the plastic tarp pulled over our heads before starting out prevented certain sun stroke. The river was filled with bamboo shanties floating next to the river bank, so no land would need to be claimed. The river bank alternated between thick, rust-colored mud to traces of corn fields or fish remains deposited from the many fish farms floating where shanties were not. Expressions on kids’ faces varied roughly by the age of the child. Although it’s virtually impossible to guess the age of a child here due to their nutritional and resultant growth status, their love of life and the river seem to drain from their faces when they were old enough to realize this was their fate in life. Smiles and waves morphed to blank expressions of wonderment and despair as a boat with two white people and two Cambodians more fortunate than themselves slowly disappeared leaving a thick, mocha-brown wake of water behind. The sights from this river were almost too much to process: clothes, bodies and food being washed in filthy water, pigs jammed into floating bamboo rafts so tightly that one had fallen into the river, houseboats moving slowly in both directions made of any material available, and some with makeshift TV antennae protruding skyward. As soon as kids were able, they were paddling small wooden boats, it was obvious their life was on the water watching them nimbly bounce from boat to boat; perhaps their feet would never touch dry soil in their lifetime. Huge floating fish farms crowded the river, with cranes made of bamboo reaching over 100 feet in the air holding massive nets and large rocks for weights ready to anchor the nets in for the day’s catch. As the river widened further north, the fish farms took the form of fencing and nets, forcing boats to weave around them like a motocross course. The widening of the river allowed the driver to increase speed, but the propeller was not ready to cooperate. Having stopped 7 times already to clean various river “matter” off the propeller, the driver seemed a bit more concerned with the latest cut of the engine. After reaching under my seat for a wrench to pull off the propeller, a quick inspection revealed a noticeably bent wing. He nonchalantly reached for a back-up propeller under Patpir’s seat which was promptly installed and we were back on our way as if this was an inevitable component of the journey.
The wide river soon opened up into a huge lake, in fact it’s recognized as the Great Lake of Cambodia, and a quick transformation of claustrophobic river life to the open expanses of a lake where no land could be seen took place. The boat raced at its top speed (maybe 20 knots) presumably in a northerly direction with very little markers in sight to aid in direction. Within 20 minutes we were at the famous floating villages, widely known as evidenced by the many tour boats in the area from Siem Riep. These were the “upscale” floating villages, a far cry from what we had witnessed for the previous 4 hours in the river leading into this massive lake. We sensed tourists don’t experience the river humanity we had just observed, and this had been made pretty with bright paint and all the amenities of a village on land. We passed floating school rooms, stores, churches, a post office, police station, clinic, and a population that generally seemed to function normally and somewhat prosperously despite their distance from land being at least two miles. While this was very interesting to see, the influence of outsiders was evident here, making the previous stark images of river life much more poignant and depressing. Passing a cascade of tour boats, after 5 hours on the water, we tied our boat to another, and hopped across 5 boats to reach shore. It was nice to be back on land, although a very bumpy 45 minute tuk-tuk ride was ahead to the city of Siem Riep. This is now the tourist capital of Cambodia due to the famous Angkor Wat temples just north of town, and the abundance of hotels, restaurants, and upscale boutiques made it obvious this was not the “real” Cambodia. Tourism has exploded in this town, and its lack of planning and resultant overcrowding has somewhat diminished the spectacle of Angkor Wat. After visiting the temples just one year earlier, this year’s visit would focus on their health care delivery systems.
Our first visit the next day was to Siem Riep General Hospital and the Medicin San Frontiere (MSF) chronic care clinic. This hospital was in the middle of downtown and had surprisingly similar downtrodden images to the very poor Battambang Hospital we had visited a day earlier. Building construction and reconstruction was everywhere, as it was obvious money had been infused from the government to improve infrastructure, but yet was still lacking to procure chronic medical treatment. The chronic care clinics (HIV, TB, and diabetes) were being run by MSF and we had an extensive tour of them by a MSF physician. Everything for the care of these patients is free, thanks to the support of MSF, including medications, transport to the clinic, and overnight lodging. For TB and HIV, all appropriate medications seemed to be available and widely used, and again extensive counseling was provided with each visit. The free-standing diabetes clinic was christened the previous week in an opening ceremony, but was not officially open for business because new staff still needed to be trained. The MSF physician explained to us that MSF would be leaving Cambodia completely by mid-2009, and it was uncertain how this facility, and for that matter all facilities in the country would operate once they departed. MSF’s decision to depart was based on their mission’s purpose to operate in crisis areas, and the apparent determination that Cambodia no longer fit their criteria. Everyone we spoke to was quite afraid of the consequences of MSF’s departure, as they fear the Cambodian government will not respond with anything near appropriate levels of funding to fill the massive void. A recurring theme of governments in Southeast Asia is their rampant corruption, and Cambodia ranks as one of the worst, with its most needy citizens paying the highest price.
Our next hospital visit couldn’t have been more different than how we spent the morning. We spent the afternoon at Angkor Hospital for Children, on the fringes of downtown but light-years away from the decaying facilities of Siem Riep General. It was founded by Friends Without a Border, a NGO founded by a Japanese-American photographer who came to Cambodia on a photo shoot and left so moved by what he witnessed, his mission became this hospital in 1999. It was obvious this hospital opened with huge amounts of funding in place and a public relations and marketing department that would ensure continued funding success. Huge funders were virtually lining up at the door ready to contribute, and so many western volunteers had applied that year (over 1000) to help they needed to refuse some of their services. A building under construction will be used just for hosting guests and sell souvenir items of the hospital. We had entered a new world of philanthropic medicine, one where anything seemed possible with an organized effort to maximize the goodwill of people throughout the world. I couldn’t help but think of the possibilities for the Mae Tao Clinic if they had the luxury of a start like this, or the sophisticated (and paid) manpower to harness the philanthropy that results from their well-deserved reputation. In fact, this hospital’s “Wish List” was so impressively written and designed that Dr. Cynthia has already been made aware of potential revisions to MTC’s similar document. We toured each unit of the hospital and observed pediatric care that would rival any in the western world. As witnessed in other facilities, special attention was given to education of all types. Of all the slick brochures and extravagant technology employed at this hospital, one of the least costly projects impressed us the most. Filling the entire center courtyard of this square-shaped hospital was a huge vegetable garden, with each row of vegetables meticulously groomed and sign-posted. Just off to the side were 12 complete cooking stations. After all we heard in the previous days about the challenges to change the Cambodian diet, here was a glorious new hospital doing exactly what was needed to address the problem, spending their precious space to teach parents about the importance of vegetables, how to grow them, and how to cook them. There may not have been a better way to complete our tour of Cambodian facilities than to view this wonderful example of public health and how it fits into the infancy of their chronic care model.
Invigorated by the hope seen the previous day, an early morning run from our guest house brought me to the imposing moat surrounding massive Angkor Wat before sunrise. A streaming cavalcade of tuk-tuks, tour buses, and bicycles passed by while running in the morning darkness, as any tourist reading their tour book knows a sunrise visit to Angkor Wat is a “must-see”. For me, it was simply an early morning run necessitated by an 8am bus departure back to Phnom Penh. However, the sight of sunrise’s orange glow bouncing off lions’ heads and reflecting across the moat onto the 11th Century temples made for an exhilarating run home, and created one of those feelings that even if a camera came along on this run, the pictures would never do it justice. It would have to be a memory etched in the mind that would carry me through the upcoming 7 hour bus ride to Phnom Penh, the 75 minute flight to Bangkok, and the 8 hour bus ride to Mae Sot. A whirlwind tour of Cambodian health facilities had come to an end, a return to Mae Tao Clinic was soon to come, and reflection on how political atrocities in Cambodia and Burma have so dramatically affected the health of their citizens for generations, and perhaps how the similarities in their health care crisis may allow the building of one system become the blueprint for the other . . .
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