Kampuchea Crossings

Bump to baby on the beaten expat track

Cambodia: How to do the Poipet Border Crossing

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Border crossing from Arranyaprathet, Thailand, into Poipet, Cambodia, is more stressful than the other way around. The casinos are right on the border, with sellers and market stalls outside. $40 rooms are had here if the onwards journey is postponed and a night’s stay is necessary. Otherwise, the main street just straight out from the border is lined with guesthouses of various price ranges. My $3 room was clean with a solid lock on a rickety door. The bus station was off this main road to the left, if walking away from the border, for my early morning bus ride.

If you purchased a trip from Bangkok to Siem Reap (Angkor Wat) or Bangkok-Phnom Penh, there is the possibility of a scam in Poipet. This can go along the lines of the bus breaking down, so if you want to get to Siem Reap or PP by nightfall, you have to pay extra to get on a bus that was leaving “right now” and happens to have extra seats. That’s an extra several dollars to $15.

If you took the train from Bangkok it will be around 2-3pm by the time you cross the border and need onwards transport. Touts of all sorts will approach you with options. Be mindful of the following ticket prices to adjust your bargaining (Phnom Penh-Siem Reap is roughly the same distance as Poipet-Phnom Penh, and also Poipet-Siem Reap as this latter trip’s road is in BAD shape):

A one-way ticket on a comfortable, clean, air-conditioned bus with a bathroom from Phnom Penh-Siem Reap costs around $12-$16. The cheapest ticket option where locals can ride roofside on a packed ‘taxi’ minibus for this same trip is around $3-6.

Just remember: If you haggle too hard, you’ll get shafted and may end up in another town altogether, late in the evening with no options (like we did, see below). Keep your cool, ask questions, pay fairly, and you’ll get safely to your destination.

My second trip through Poipet:
see my first border crossing into Poipet

First we stopped in Bangkok.

Although K has been to red light districts before, nothing quite prepared him—or me—for the Patpong mob scene in Bangkok. (Ah that mob scene was only the beginning…) That friendly smile…? It translates to “FRESHIE/SUCKER” hereabouts where people need just the slightest encouragement to keep harassing you for handouts or a sell. The gals came twelve-strong to our table in one of the fine evening establishments—with a ladyboy along just in case Keith’s taste ran the other direction—in a show of pressure that other foreigners walking in did not get. Tiny Asian gals crowded around K, who was trying to keep a shocked expression under control (unsuccessfully) at the whole situation and the vaginal acrobatics happening onstage. It was quite the amusing scene, until I saw one of them grab at his money and he let her take off with it.

–I did not! That was small change from the beers— which was about 20 dollars for two bottles, I might add. {{Edit to add upon K’s insistence that the girl only managed to get a 20baht note from him, which is about $0.50}}}.

So the next day I not-so-jokingly mentioned that if he EVER went out to Patpong for a bach party one day I will have to put a lock on him—

–A chastity belt-of-sorts? The boy asks, pleased at my apparent jealousy.

NO, a lock on your wallet, said I crossly.

Bangkok had all the comfort of any large bustling city. I was keen on the chocolate cakes here, which were moist and dense like a good cake should be (Cambodia did NOT get this memo). There is clean food (or minimal rotavirus–hey what’s the plural of virus? virii? viruses? anyone?), malls (there are no malls in Cambodia–not a huge loss, but the AC’d interior of a mall is nice once in a while, not to mention clothing designs that run around the vicinity of “normal”), and movie theaters (my movie critiqueing is getting dull by the day in Phnom Penh–we only have Khmer movies there). Oh and the pagodas and wats and the large Emerald Buddha that the Thais stole from Laos but tell tourists its theirs (the Laotians are quite bitter about this).

Bangkok was nice. But soon I sadly conceded that we must move on from the comforts of the big city. Onward ho, to a Kampuchean adventure.

K canNOT miss out on the experience of Poipet, so we did the do-it-yourself-border-crossing en route to Siem Reap and Angkor Wat in neighboring Cambodia. We hooked up with two female backpackers from the UK and New Zealand for the trip from Poipet to Siem Reap (and Angkor Wat)—for safety, I erred in assuming–and the combination of so much white skin put more than a bit of attention on us. The English hereabouts Cambodia is fine up until the actual exchange of cash, after which suddenly linguistic faculties fail and our deal with the locals to take us to Siem Reap went down the drain. There was no improvement in the road between Poipet and Siem Reap from when I came through a few months ago, so we bounced around the back of the flatbed of the pickup truck transportation we found, hanging on to our backpacks for dear life, which were sitting atop heaps of smelly days-old river catches. Those gaping patches of bridge?—our driver hummed right over them without hesitation. And what we thought was our transport to Siem Reap instead dumped us in Sisophon, three hours short of our destination, for a scam stop.

–As soon as our pickup truck rolled into Sisophon a feeding frenzy of the street sharks descended. Loud, broken English and Khmer were hurled about around us, and all we could make out was that they wanted us to get on another pickup and pay more. Now the thought of leaving the containers of fish I was forced sit on was appealing, but the deal we made was to ride this crowded (fish containers, old Khmer ladies, kids, and some dead unplucked chickens) pickup from Poipet to Siem Reap… not pay more money in Sisophon. The gals were quite aggressive back to our scammers, and they finally talked the guys down to a reasonable fee, but the journey doesn’t go smoother from here.

For some reason the men in the truck decided to abduct us. Having no familiarity with Sisophon, I looked at N, who through her work in the country knew the road we were taking was not the road to Siem Reap, but by then it was too late. They drove too fast for us to jump off, in circles to disorient us, and straight into a slum area, telling us we need to “come in and talk.”

Finally the vehicle slowed down and as the driver changed gears to reverse the truck into a gated house I jumped out of the back and grabbed everyone elses bags. N and the Brit followed suit. Luckily the Kiwi didn’t pass out from fright. Amid angry yelling back and forth from the men telling us we should come back and “be reasonable” we started trekking up the road away from the house, expecting at any moment to have a confrontation. They were demanding payment, for what I have no idea since they didn’t take us anywhere. We were all truly apprehensive about the whole event and I was mentally calculating which of the men needed to go down first should they decide we needed to be rounded up and marched back. I was afraid they might come after us with weapons; from my readings on the web that scenario certainly was not so farfetched in this country. Thankfully they let us be, perhaps they were too dumbfounded at our decisiveness, or they thought we would be too scared to walk out of this neighborhood and come crawling back for their help.

Luckily N had her phone, via which she beseeched upon her Khmer colleagues back in Phnom Penh to guide us back on track. We were in the middle of slum areas, with no idea where the bus station or the city proper was, and everyone on the sides of the road looked for all the world hostile and unfriendly. Four foreigners sporting large backpacks trekking about lost makes for quite a target, but we were not hassled. N called her translator and asked her to tell people around us to point us in the general direction of the bus station, and she sought random women posing relatively small threat to us to hand to phone to so that the translator can instruct the lady to point us to the direction we were seeking to go. She did this systematically several times for over an hour to make sure we were still traveling in the right direction, so that we finally managed to arrive, haggard, hungry, dirty, tired–but in one piece–at the bus station.

The moment we arrived we thought we made another mistake. It was filthy there, with garbage everywhere and stray animals poking their noses into everything, searching for food. Several broken-down stripped pieces of improvised transport littered the area. There were only men there, about a hundred of them, all gaunt, rags hanging off their starved frames, eyes gleaming like hyenas looking for meat. We stuck out like a beacon and they all immediately descended upon us in droves to offer their services, tripping over each other and trying to outscream everyone else in their desperation to make some money that day. Fist fights broke out around us as they beat on each other for our attention, and Nathalie, unknown to me until much later, was punched in the lip in the melee. I steered the other two girls over to where I saw a uniformed officer. When Nathalie saw our intent she hastened over and told us NEVER to seek police help if we were in trouble. We looked around and there is literally NO help available should these people decide to get some mob action started to take our shoes, clothes, bags, or money, and that is the most sinking feeling in the world. In not so few moments I found myself cursing the existence of this country and wondered for the millionth time what my wife was thinking when she plunked herself down on this hellhole.

The Khmer street sharks did not leave us be, crowding around and forcing their services on us–a moto taxi, a hotel room, food, etc etc– and we could not get a moment’s peace to even converse with each other to get a plan in gear. You just can’t think in that situation! Finally N broke away, snarled at the ones who followed her to get away, and got back on the phone. She asked her colleagues at the NGO in Phnom Penh to help us obtain a taxi out of Sisophon. Finally, after what seemed like days, via contacts of contacts from Phnom Penh to Battambang to Sisophon, her friends were able to help us get a legitimate taxi driver at the bus station and negotiate a fair fee for our onward transport. We were back on the road–the right road this time–to Siem Reap when the heavens opened up and poured down a storm.

Welcome to Cambodia! Why did we leave Bangkok???

And all this time with me yelling, “NO smiling! Hard look, hard look! You’re giving them reason to harass us!!!” Poipet is one of the most notorious border crossings, but nothing prepared us for that ordeal. I did not expect the chain of events we went through, and I just thank my lucky stars that I had some Khmer friends just a phone call away to help us.

Despite that nightmare, I am actually still quite taken with this country, which has a lot of potential and promise in its future. K understandably was not so keen on the whole scene, but after spending some time in Phnom Penh with me things slowly got better. It is still quite primitive for what he is used to. I think the way he handled the whole situation just made me fall more in love with him. Sappy I know, but how many people can find a gem of value in an experience like that, especially when it was unnecessarily forced upon him by someone who claims to love him?! What a trooper I married eh?

–Yeah, great experience of a vacation N, thanks– {{I didn’t hear sarcasm in that did I? he he}}}

Thailand: Scene in Bangkok

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People believe that spirits share the space that humans inhabit. When a house is built, a similar-looking smaller house is built and placed at a prominent location on the property, to house the spirits that were displaced by the humans moving in. This is done to pacify them or else bad luck will befall the new tenants. Many accidents plagued the building of the Erawan complex in this photo. These events stopped when this spirit house was built and dedicated.


Khao San Road, the backpacking mecca of Bangkok.


Jasmine vendor. The smell of jasmine is just heaven!


Fish vendor. The smell in the meat market is NOT heaven!


The absolute BESTEST iced tea in the world is at this particular street vendor in Bangkok! Drinks are put into small plastic bags that look like mini grocery bags, they stick some ice and a straw in there, and voila! (Edit in 2007: sadly this site has been developed with four megamalls on each corner so my cafe vendor is gone :(


Iced coffee to go!


Boat Lunge-ing 101. Boats take you up and down the canals and river for a scenic view of Bangkok–for a mere 10cents each way. They come in at a sideswipe angle at high speed. The boat never comes to a complete stop and people just lunge on or off. I have no idea how they don’t fall right in the water and get crushed.


This is at the Reclining Buddha. Keith was smitten by the wats, pagodas, and temples of Asia and we visited as many as he can get us to. These structures are actually resting places for prominent residents and monks.


Young monks were waiting with us for the boat to go down the klong (waterways).


Riverside dwellings along the Chao Praya

Vietnam: Visiting Ho Chi Minh City (Saigon)

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Of the three countries we visited, I think K fell in love with Vietnam. My consultancy back in Cambodia was on hiatus, due to financial mangling/wrangling among the health partners collaborating on the survey. It meant that K and I could not schedule ahead our entire visit with each other and instead were at beck and call of the survey’s schedule. Thus our time in Saigon was limited. However we found that it was the perfect middle ground between the ordered chaos of the big city of Bangkok and the primitive desperation of Phnom Penh. We spared ourselves the harrowing border crossing and went with a reliable tour company this time!

Saigon, or Ho Chi Minh City in bureaucratic speak, is such a great city. The Cambodian side of the border is like the rest of the poverty-stricken country, with just a small shed to shelter border officials and a handful of travelers at the front of the queue. Dust kicks up into your nostrils from passing vehicles while Khmers assemble a truckload’s worth of cargo onto the back of a small moto (moped) via improv engineering using discarded slabs of wood. The Vietnamese architectural eyesore meanwhile, at Moc Bai, looms imposingly above the Khmer dust clouds. Travelers are invited inside the building boasting spic-n-span tiled flooring, a stocked bar, efficiency. Keith was smitten from day one.

The coffee here is one of the best I’ve ever had. The street food was clean, the streets were clean. People moved about purposely, with solid intent, and the city exuded a businesslike edge on the charm of Old World Vietnam. Everyone was pleasant. Eye contact in Vietnam, which in Cambodia instantly pounced an urgent sell on you, was easy and friendly. You did not fear a scam at every turn.

Our travel styles are always in stark contrast to each other. K revels in the details, his camera always at the ready, capturing a quick moment or beautiful piece of work that evades the average eye. He beelines for the pagodas and examines the centuries-old intricacies as well as the way the wind blows the incense fumes against the open doorway. He loves the food and sitting for hours at a cafe sipping his espresso, waiting for the storm to start so he can watch the squid seller and milk vendor adjust to the rain. He’ll poise his camera on one spot and wait for just the right moment when a masseusse bikes down the street ringing his bells, and he’ll stay there watching local life fritter by. I on the other hand like to take in the big picture and walk from one end of the city to the other. I seek out the tallest vantage point to the city and scope out the landmarks. Does the city have a vibrant energy? A rich historical environment? Do they have a lively arts community? I set out on foot in a rapid pace, chasing the ebb and flow of the local schedule from morning until dusk.

The charm of Saigon was in its people. They had so much energy, and they were fierce about it. When we asked for help our hotel receptionist not just gave us directions, she made us repeat the name of the street many times so that we can get it right and get ourselves there via a taxi whose driver probably will not understand our non-tonal Vietnamese. There’s a strong drive towards something, towards a goal, and it was palpable in the air. The bustle on the streets exuded a great energy that was absolutely contagious, that I like going back!



Moc Bai Vietnam/Cambodia border


Covert Viet Cong headquarters, where unsuspecting American soldiers had Pho every day. The nondescript shop’s owners are still running their noodle business as it was over thirty years ago.


Reunification Palace, today a museum where tour guides will give you the Communist government’s official version of war history. Back in 1975, this was the Presidential Palace of the leader of South Vietnam-the target of VC spy Nguyen Thang Trung’s bombing raid on Saigon in the final weeks of the war.


This year marks the 30th Anniversary of Vietnam’s independence.


Fruit market


Market scene, Keith’s-eye view.


It is intended as a curative cocktail, these snake wines have become a tourist draw. Cobras, scorpions, lizards, and all manner of exotic reptiles are bottled and sold at the market.


There are many food sellers around the city. Grills and burners, glass bowls and utensils are carried in the baskets hanging from either end of the pole, along with the rice and food.


Throughout SE Asia these conical field hats are very distinctly Vietnamese, to shield the wearer from the harsh sun.


Would you believe there are durian connoisseurs in this world? There are hundreds of durian species. They range from bitter and pungent with less meat and bigger seeds to the cultivated lines that are super sweet and keep for long periods. My durian-fan friends like the kinds found in Malaysia and Indonesia, less affected by genetic modification or pesticide use, and more bitter and “true”. Who knew…..


Bananas fresh off the orchards.


Motos are the most popular form of transport even in the Socialist Republic of Vietnam.


Saigon Opera House


At night street stalls go up which sell all manner of Pho, the Vietnamese soup.


There are many centuries-old pagodas around Saigon. This particular one has a heavy Chinese influence, Ong Bon Pagoda.


The street food here in Vietnam looks clean (at least there is some measure of hygiene, compared to the complete absence of it in Cambodia!). Not sure what most of this seller’s items are, I’m getting a coconut-jelly dessert.


It’s a pagoda, but there were SO MANY I can’t remember which this was!


The Vietnamese government is phasing out the cyclos (bicycle-driven transportation) and they are not allowed on certain streets in and around Saigon. Unfortunately they’d do better to ban the smog-producing cars and trucks than these more-environmentally-friendly and culture-friendly modes of transport.


There is no way for pedestrians to cross the street except to just start walking. All manner of moving transport will either slow down or zip around you. Or they’ll plow into you.


View from the bus. The fare is cheaper on top of the already-top-heavy minivans and buses– hold on for dear life!


Chickens transported to the market on a moto. At least it’s a better travel alternative for the chickens. Usually their feet are tied and hung to a board off the back of a moto.


A trip to Vietnam is not complete until you get Banh Xeo from Dinh Cong Trang. The alley has two street vendors that became so popular that on any given time of day literally hundreds of patrons will be found sitting around eating these famous Vietnamese pancakes, wrapping them in lettuce leaves and dunking them in a sweet sauce. Heaven on a platter!

Free Trade and Pharmaceuticals

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The average NGO or civic group does not have adequate capacity to actively participate in the increasingly complex policy and legal environment of global trade. This puts decisions and actions taking place in corporate headquarters and multilateral assemblies out of reach of the ordinary citizen. Here is the short-version international legal framework for essential medicines, proprietary drugs, and CAFTA.

From GATT to the WTO
The end of WWII saw the creation of the World Bank (WB) and the International Monetary Fund (IMF) to regulate international economic cooperation. These are known as the “Bretton Woods” institutions, named for the town in Vermont, USA, where negotiations took place. The package of trade rules which came out of this gathering was the General Agreement on Tariffs and Trade (GATT 1947). It began with 23 countries, dealing only with trade in goods, and affecting just 10% of global trade. Thus began international trade liberalizations through progressive reductions of protectionist measures (ie tariffs), ensuring a tremendous momentum of trade growth.

GATT was legally only a provisional agreement and not a governing body. It did such a good job of reducing tariffs and promoting trade that governments had to develop other forms of protections for sectors threatened by overseas competition. Bilateral market-sharing agreements and subsidy structures were then created and implemented in effort to protect domestic products. Unable to respond to the vast overhaul of the global trade environment, the recessions of the 1970s and 80s, and increasing globalization, the Charter’s relevance soon diminished.

Multi- and plurilateral accords between contractual member countries were added to GATT during negotiations called “trade rounds”. At the Uruguay Round of 1986-1994, the World Trade Organization (WTO) was created to replace GATT. This Geneva-based intergovernmental body binds all members to global commercial agreements which are multilateral, mandatory, and permanent. It contains a dispute-resolution mechanism to enforce their mandates. In addition to trade in goods, this new organization added trade in services and intellectual property (IP) to its mandate. Trade in services is covered under GATS (General Agreement on Trade of Services) and trade in IP is covered under TRIPS (Trade Related Aspects of Intellectual Property).

WTO has 148 member countries as of February 2005. It accounts for over 90% of global trade.

WTO/TRIPS
TRIPS covers literary works, phonograms, computer programs. It also covers industrial designs such as copyrights, trademarks, trade secrets, geographical indications, patents, undisclosed information, and is an increasingly important component of trade. Minimum standards of protections against counterfeiting and piracy were laid out at WIPO (Paris Convention for the Protection of Industrial Property and the Bern Convention for the Protection of Literary and Artistic Works). Member states are given a transition period (periodically revised to accomodate country-by-country capacities) to adapt enforcement laws for TRIPS-compliance: 1 January, 1995 for developed countries; 1 January 2005 for transition economies; 1 January 2016 for least developed countries.

A 3rd WTO Ministerial Conference was summoned in Seattle, US, on December 1999 to plan the next round of negotiations, the Millennium Round. But irreconcilable disagreements among the members, aggravated by a massive global movement in protest of the status quo, led to the meeting’s collapse.

WTO/TRIPS/DOHA/Compulsory Licensing and Parallel Importing
The effect of international trade laws on the procurement of essential medicines is a topic of much concern. Patent protections are essential to promote investment and innovation by an industry. But effective legislation must balance all interests and prevent abuse by the patent holder. Pharmaceutical companies, governments, and advocacy groups have been embroiled in legal clashes over this issue, particularly with medicines for the treatment of HIV/AIDS, or combination anti-retroviral therapies (ARVs) for reducing viral load. Almost 90% of HIV/AIDS is in the lowest 10% geographically in terms of GDP.

TRIPS treats pharmaceuticals like any other article of trade, even though these are not just another commodity. These are life-saving consumerables. Pharmaceuticals are covered by patents which grant a monopoly period to the innovator company for 20 years from the date of filing. Without the safety mechanisms in TRIPS, given the existing market structure, drug therapies are not affordable to people of the developing world. The two provisions in TRIPS for health emergencies are compulsory licensing and parallel importation.

Compulsory licensing is a legal intervention for removing the monopoly rights given by a patent, in order to obtain cheaper generic versions of medicines. Parallel importation is the purchase of proprietary drugs from the cheapest source, from someone besides the authorized distributor, because drug prices fluctuate from market to market.

Both of these are powerful tools in creating the competitive environment which forces prices down. These mechanisms must be included in the language of national laws for a country to employ it in leverage against corporate interests in periods of crisis.

In November 2001 at the 4th Ministerial Conference convened in Doha, Egypt, Bush signed the DOHA Declarations under tremendous pressure from developing countries and civil society. DOHA essentially reiterates the right of member countries to break patent monopolies in TRIPS for the purpose of protecting public health, particularly in promoting “access to medicines for all”.

CAFTA/FTAA a.k.a. Monroe Doctrine II…
The Central American Free Trade Agreement (CAFTA) is an expansion of the 1993 North American Free Trade Agreement (NAFTA) further into the hemisphere, and is key to advancing the Free Trade Area of the Americas Accords (FTAA). FTAA talks were shut down by fierce opposition at the 5th Ministerial Meeting in Cancun, Mexico, 2003. Ongoing disputes between the US and Brazil further raises doubts about this pact. Elimination of tariffs as CAFTA-DR is designed to do comes with a theoretical economic boon but have far-reaching ramifications on basic rights, environment, and sustainable development.

Elsewhere, bilateral FTAs are aggressively pursued by the US government. Patent protections for proprietary drugs will be extended beyond the 20 years required under TRIPS. The new language weakens or eliminates a government’s ability to launch generic competition to lower the cost of medicines. It blocks test data from release within the patent period, denying generic manufacturers access to critical safety and efficacy information. It blocks the temporary override of a patent that compulsory licensing allows. CAFTA countries will be required to divert scarce resources to implement more stringent protection infrastructures, in compliance with rules counter to the broader interests of public health. Sanctions by WTO keep signatories from violating these charters.

These priority agendas from the Bush administration are drawing intense opposition from the global South. Even the World Bank has acknowledged the challenges these pacts will have on the participating members. A small number of transition countries who have won landmark legal battles of their own now lead this growing resistance– Brazil, South Africa, India, Thailand.

Fierce lobbying now surrounds this pivotal trade pact. CAFTA is aiming for a floor vote before the July 4 recess of the US Congress.

Free Trade: Patents versus Patients

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It’s been several years since US-backed Big Pharma sued South Africa for obstruction of profit when it bypassed patent laws to provide cheaper generic medicines for its burgeoning AIDS epidemic. The suit was retracted under furious backlash from advocacy groups worldwide. That battle has since stepped up with the ascendancy of IP (intellectual property) and trade imperatives. At issue are patent regimes affecting life-saving pharmaceuticals. It is critical to have flexibilities in global IP rules that accommodate situations whereby a country simply cannot afford brand name originator drugs to respond to a crisis. In protection of public health, and “to promote access to medicines for all”, the WTO TRIPS (Trade Related Aspects of Intellectual Property Rights) contains such provisions, called the DOHA Declarations, which specifically allow countries to break patents without challenge in face of extreme urgency. 2005 marks the year that developing countries are to come to full compliance with TRIPS. LDCs (least developed countries) have until 2016 to establish IP enforcement infrastructures. South Africa was only the beginning.

In the US, lawmakers are now duking out the fate of Bush’s free-trade pact with Central America, CAFTA, an expansion of NAFTA further into the western hemisphere. Fierce lobbying on both sides have intensified for a bill that was signed in the White House last May and stalled in the House and Senate over the past year amid rising opposition. The Congressional Hispanic Caucus has already rejected it. Health advocates cite that the IP protections will confer monopoly-like status to high-priced brand-name drugs in already resource-poor markets, rendering them unaffordable and inaccessible. It extends data exclusivity provisions in TRIPS and creates a more restrictive atmosphere against DOHA.

Outside Brazil’s UN Missions and Embassies this past weekend, AIDS demonstrators called on Brazil to summon the maximum flexibilities accorded by TRIPS for its public health emergency. Efforts to continue discounts for AIDS drugs have been met with enormous opposition from mega-pharmaceuticals (Pharma), despite the legal and voluntary sphere in which Brazil has sought to engage dialogue. This counterweight to the US in the western hemisphere is a model for the Southern Cone countries with its decisive response to its AIDS epidemic in the late 1990s, effectively using DOHA as a bargaining tool to lower procurement costs of ARVs (antiretrovirals) and in creation of a generics industry that is lauded worldwide. In exercising its right to prioritize public health by legally issuing a compulsory license against AIDS medicines patented by American companies, Brazil sits on the IP Priority Watch List for US sanctions. Its status in the Generalized System of Preferences, which bestows favorable trade access to the US market to select countries, is under threat and used as a carrot-stick.

Elsewhere, bilateral FTAs (free-trade agreements) are being pursued by the US that slip just under the radar of watchdog organizations, containing IP clauses which threaten the affordability of life-saving drugs. There is no transparency: the content of agreements are not publicly available before they are concluded. Many lives ride on the outcome of these free-trade pacts, negotiated by legions of American attorneys in language that allows for tightening of IP laws. Developing countries hardly have recourse against the gravitational pull of the Pharma-friendly US government. Thailand is on the near horizon to be sucked into these negotiations, with landmark judgments rolling out of its courts heralding a rough road ahead. Cambodia, the first LDC admitted to the WTO, is excluded from pharma-patenting until 2016.

Pharma influence is pervasive from the international negotiating tables to the consumer spheres. Pharma commands the highest profit margin of any US industry. It has more than one lobbyist for each member of the US Congress. Budgets for promotion to healthcare professionals, direct-to-consumer advertising, and sales forces exceed the GDP of Subsaharan Africa. It pays for over half of American Continuing Medical Education costs. Lucrative rewards are pushed at academics for promising research, with contracts including gag clauses to prevent the researcher from publishing unfavorable results. Leading companies spend two and a half times more on marketing and advertising than on R&D. Even medical journals have become an unwitting extension of Pharma’s marketing efforts. Regulatory agencies– the one consumer recourse– are understaffed, underpaid, untrained in multi-sector evaluations, unknowledgeable in public health concerns, and increasingly under the influence of the big wallets of Big Pharma.

The commerce of medicine and public health is a paradox. It is a complex mishmash of basic human rights, global trade regimes, economies of scale, financing superstructures, back-door legalese– all with ethical and moral underpinnings. It spawns a poverty industry that the development sector falls victim to– or is created for. . . ? Profits are not being demonized here: FTAs are established to safeguard the prosperity of the parties involved. But what good are the safety mechanisms in these negotiations if applying them will incur the wrath of an unstoppable US government?

The Stink of Durian for Newbies, and Adjusting to Cambodia

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A royal decree was issued in the night. Everyone in Cambodia who has shoes is to take them off, and they are to do it inside my room. Groan. Below my hotel window (wide open cuz the one AC unit in the entire town was not allocated to this hut) is a fruit stall enterprise specializing in durian, a treat to wake up to at 6am. It is that time of year when foreigners are subjected to Fear Factor challenges involving this foul mishap of creation. It is the season, they are everywhere, and the Khmers must share. There is particular affinity for this fruit, drawing national pride, cherished reverently, like there is a little god inside the paranormal-looking blob. When foreigners are offered a piece of it Khmer radars within a mile radius zero in and they all whip around to see what you will do. You ought not refuse– their expressions are benign enough, friendly in fact, but it gives eerie pause. If this were a scene in a horror flick or nightmare the wrong response will exact gruesome vengeance straight from the bowels of hell. Think twice, foreigner. Trips to market are now unhappy excursions. Since I have the big SUV my driver is put upon to haul the putrid cargo about, and of course the stench lingers. Usually I stay a few paces behind my translator at the market, who refuses to be seen with me because sellers tack on a “foreigner tax”. But when haggling for durian I don’t mind at all looking conspicuously foreign to jack up the price. Purchases came to a short-lived halt until she caught on.

Gastronomical conquests become a newcomer’s specialty. One of the more infamous aphrodisiacs hereabouts Asia is called balut in Tagalog. It is a fertilized duck egg, harvested just days before hatch date and boiled so that the fetus is fully formed and decadently crunchy. Bugs are also much prized fast food items– spiders, ants, crickets, really anything that moves, the more legs the better. To be fair, the cockroach that went into the fryer in Poipet was not the same creature spawned of urban squalor– they insist it’s a beetle, bred for its crispy, nutty texture, though that is hardly encouragement enough to pop one in my mouth. Everything gets fried, dyed, dried. Colors I normally associate with radioactive elements and glow-in-the-dark objects are particularly popular additives to milks, juices, and sweets. Meat jerkies are common too, and my neighbors occasionally lay things out to dessicate. The ones resembling small rodents sporting extra legs always throw me for a loop, but my inquiring mind is mum, quite content to leave ignorance intact. Flee! Flee!

These lead to sporadic obsessions I can’t shake– pasta, peanut butter, chocolate– {{When the dog bites When the bee stings When I’m feeeeeling saaaaad . . . }}}. I’m still nursing a chocolate craving that won’t go away, initially sadly coincident with the expat exodus from the Khmer New Year, which took with it all the baking talent of Phnom Penh (the French colonialists failed miserably in dessert indoctrination). That precipitated a baking fixation, a difficult endeavor in a country where appliances that generate additional heat are not popular, so you are put upon to make your own oven. Luckily my pal RS was not only able to prevent the forthcoming inferno– he offered use of his oven– his baking skills also far exceeds mine (not a stellar achievement, but desperate circumstances justify disproportionate merit). . . . . mmm, a little piece of heaven can reduce all else to insignificance.

Working off a chocolate binge is a problem. Only tourists wear shorts and/or a tank top in public, branding themselves such by doing so. Best times for activity to avoid that fresh-popped-in-the-oven feeling are either end of the midday heat– around 4am or 11pm. Volleyball courts aren’t optimal, unless diving into pavement is part of your routine. There are two gyms, and two tended tennis courts lacking weeds and cracks to assist the ball out of play. These conditions thwart an already dim resolve to work out. So one weekend I joined the Hash House Harriers, a running club that exists in most cities in response to the expat need for fraternity and drinki– err, recreation. (CW, this group must be in Maputo?). I hadn’t done anything remotely active in many months, but this truth is not impressive so I fibbed about my activity level when they asked what kind of running I do. Bad mistake, my second floor apartment suddenly presented a challenge to twitching legs for a full week.

Work is great. Fieldwork is interesting, especially when theory and practice find detours around each other. And who in public health doesn’t have a story about condom demonstrations. We set up temporary labs in the Provincial AIDS Offices, which conduct condom use programs. A woman came in one day while we were there, complaining of pregnancy. Their wooden penis went missing for a few days, so the peer educators substituted bananas. Apparently the message on where exactly to place the condom went awry, because all bananas in her house now get one. LOL. Not those bananas lady. And have you ever used a translator? I ask a question, it is translated, and immediately translator and subject are engrossed in animated dialogue. Twenty minutes later, pen and notebook in hand expecting some good material, my translator turns to me with: “He said yes.” . . . ?!. . . How long is the Khmer word for ‘yes’??

Being so often on the road reminds me how far off the comfort zone we are. I don’t usually prefer the backseat due to motion sickness, but given that everyone has the right of way here I opt for illness. It seems a widely held belief that increasing velocity will relieve other objects approaching the same intersection of mass, and I find myself in perpetual unease at having to one day demonstrate this theory wrong. There is a prompt– only the Khmers hear these voices– to shove pedal to the metal upon nearing the crossroads. At intersections across the country foreigners riding backseat in all manner of transport can be seen craning our necks in rising panic proportionate to speed, searching for the cause of this lunacy. What’s happening?! Sometimes eyes will meet and befuddlement is mirrored in a split instant– misery appreciates company. Then the imminent peril ends, contact is broken, the junction is past. {{breathe}} I’m alive!!! {{insert maniacal laugh}} Vehicles ought to be equipped with toys and other diversions, soft things preferably, for just such treacherous outings down the street.

Ah the things that guidebooks leave out. Systematic exploration of the emotional topography is Cambodia’s specialty. Theme parks bah!— close encounters with the next life are just a flight away. So come and visit!!! Beyond all this excitement, separation from Keith by the entirety of the planet’s molten magma is quite the trial, especially with the time differential. You veterans, particularly Melanie and Cherry (seems to be a Filipina-Am trend), have an indomitable will and I am inspired. And to fellow colleagues likewise traversing unknown territories by him/herself: the destination is never as exciting is it? Though emails from me are scarce I do read everything in my inbox and print the longer ones for inspiration through bleak spells of no AC, charbroiling temperature, and chocolate deprivation so keep ’em comin’!