Kampuchea Crossings

Bump to baby on the beaten expat track

Nathalie Abejero

Staying informed

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Ah, to have your quality of life ranked barely a notch better than that of someone living in Tehran… I do wonder about some things.

How do people here stay competitive given that our work is in/with the least developed part of the world? I can imagine one day returning to “civilization”, in which case running descriptives on SPSS as the extent of my statistical skills might not be sooo impressive. If I were to go into the commercial sector would I be marketable?

On another note. Given that Cambodia is slow on the uptake of adopting technology for mass consumption, I’m feeling left out of the cultural loop. There was also an article in The Economist on the virtual epidemiology research conducted in the synthetic worlds of Second Life and World of Warcraft. I barely have a moment’s internet time to sign up for Facebook let alone check out the allure of these communities. Meanwhile the IRS is exploring tax opportunities in these economies. And Reuters even has bureau chiefs there.

Wow.

Phnom Penh ranks in bottom 10th for livability

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Phnom Penh ranked 125 out of 132 cities recently surveyed by The Economist for livability. Criteria include recreational and cultural activity, crime rate, risk of political instability. Just a few changes in the environment can make a big dent in that score, especially with growing interest on attracting foreign investments. People can be especially enthusiastic advocates of change when money is in the horizon. Let’s start with joining the 21st century by improving the communications infrastructure …

Read it here: Where the Grass is Greener

Faces: why we’re here

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Boy and grandmother, courtesy NGO GRET.


This is a family in Kampong Thom who has purchased community health insurance. They are categorised by programmers as “near poor”. Health financing efforts are aimed at those below the poverty line and also those just above it who are at risk of a financially catastrophic event. Photo courtesy NGO GRET.


Khmer kids from the boat communities just across the Tonle. Their desperately poor communities can be seen from the Royal Palace riverfront.


One of the hospitals in the capital city of Phnom Penh, where there is a Safe Motherhood Programme being implemented. Cambodia’s very high Maternal Mortality Rate (MMR) of 472/100,000 did not improve between 2000 and 2005 despite millions in aid money and technical input.


“His Excellency” Tep Lun, the Director General for Health, Cambodia, visiting a hospital.


Yii Chhi are female members of the Pagoda’s community, much like nuns in the West. Pagodas can be a place of refuge in the later years, if women have no family left or if they are escaping problems such as an abusive environment. This Yii Chha is wrapping a beetle nut in a leaf. It is chewed much like tobacco, and has a mild stimulant effect. I’ve only ever seen old rural men and women with this habit, and their teeth and mouth after many years have blackened/ rotted unattractively. Photo by H Kiss.


These Yii Chhi don’t live in the pagoda, and instead traveled there on the 8th days of the Buddhist calendar to make their offerings. After about an hour of prayer and light activity in the pagoda’s Sala Chan (smaller wooden structure on the compound for eating and community activities) they lay down and take a rest. Photo by H Kiss.

just the basic human rights, please

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It seems common sense, but it takes a policy document to implement this mindset. Imagine not knowing your basic human rights. In the health sector the patient-provider relationship inequality foments a host of problems in this area. Because patients are dependent on the provider they don’t question the diagnosis and decisions, or expect (much less demand) safe, quality care. Given their status, providers feel their judgment ought not be questioned. The cycle perpetuates unethical behaviour and promotes dangerous practices in medicine.

Cambodia is just now introducing, in two provinces in the country, the concept that people are entitled to a set of fundamental human rights when seeking health care.

Right to equality
Right to information and health education
Right to health care
Right to privacy
Right to confidentiality
Right to choice and informed consent
Right to express opinion and to participation

Generating demand is one of the approaches to improving proper, safe, quality health services. Developed countries took centuries to develop the level of competence and standards of quality in health care that they are now at. In Cambodia and other poor countries development goals aim at fast-tracking that pace.


A series of workshops were held in the communities within the catchment area of our project intervention health facilities, to disseminate information about Clients’ Rights. Invited are the community leaders such as Commune Council members, Village Chiefs, Womens’ Association representatives, etc. Participants register to receive their per diems, or travel allowance, to attend the workshop.


Low-tech presentation to the community at the meeting hall of a Pagoda in Chakreyting Village. At this site we did not have electricity to conduct the presentation by projector.


At the workshop in another Pagoda in Troey Koh Village, Kampot Province, a facilitator conducts a group pre-test. The pre-test was designed as a questionnaire, but even though all participants are literate, the concept of questionnaires pose difficulty if they have never seen one. So the facilitator obtained answers by show of hands. Ideally, after the day-long workshop a post-test is also conducted to see if participant knowledge increased as a result of the presentations and discussions.
Photos courtesy H Kiss

Omigod-I’m-in-Cambodia

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…continuing the catalogue of follies…

We have this month in the office two interns, one from Hungary who has never been to a developing country (…?) and the other is from Germany. Our deputy director took them out to lunch at one of his favorite spots, a curry noodle shop. The steaming bowls came out and everyone dug in. The girls ate in silence. Before long one of them turned to the other with a small whisper, “Are you eating the ants too?”

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One of the problems in this field is the cut-and-paste methods of some foreign inputs. Of course, if a template exists for say, a patient consent form for surgery, then it is within reason to do this. Documents are translated to Khmer, then inadvertently the original is discarded. When a barang (foreigner) comes along during the course of the project, the document then needs to be translated back to English. The English, translated from Khmer after being translated from English, of an informed consent form:

Knowing that the doctor has done his best but does not know how to do the surgery, I consent to the procedure and agree not to seek recourse.

It’s meant to contain the following elements: The nature of this condition and the present treatment course, the alternate treatment options, possible side effects, and risks have all been explained to me… I understand that no assurance as to the results obtained has been given… With the information I have of my condition and the proposed course of treatment, I authorize the performance of ___ procedure.

the US Agriculture Policy

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CARE Turns Down Federal Funds for Food Aid

An interesting development, and CARE risks much with it. They traditionally employed monetised food aid but have been debating the damage such a system facilitates to the markets (people) which they are specifically trying to help. Essentially, subsidised US farm products (already controversial by its own right) are shipped from the US on American lines, sold by NGOs, the profits of which are used to fund their aid operations. Because aid organisations are not commodities experts, that profit margin is also impacted.

This event is interesting on many levels. It highlights the incredible role of food aid in politics, as leverage, as a weapon, to control the markets. Aid is no longer tied as a matter of official procedure but in practice it’s a different story.

Additionally, phasing this scheme out of CARE operations sends a clear message about the US agricultural policy. You Are What You Grow is an interesting look at the farm bill on a personal level. Why is there a growing obesity epidemic, and why is it largely among the poor? The grocery store, we all know, is a sophisticatedly designed space, the result of extensive market studies and specialised consumer research. Nutrient-poor products are clustered in the centre of the store; junk food and sodas are cheaper because they’re the processed outputs of farm subsidies. Globally, the farm bill impacts public health, the environment, immigration, poverty in the developing world and it fuels damaging agribusiness practices.

The farm bill is renewed every five years. It is now in Congress being reviewed and revised, and it goes to the floor in September 2007.