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December 05, 2004
AIDS work in Cambodia
Tom Heller is a Seattle physician doing AIDS work in Cambodia. From time to time he writes to his friends with stories and updates about his work and experiences in SE Asia. Even though Tom's work doesn't have anything to do with our bike trip, his letters are quite moving. I thought you might be interested in hearing what he has to say:
December 1, 2004
Dear All,
Today is World AIDS Day. I commemorate it on the Thai-Cambodia border on a
bridge in Poipet on the other side of which is Aran, Thailand. A small
delegation from CDC, the Banteay Meanchey Health Department, the Poipet
Health Center, the military, and government officials meet on the bridge at
7AM with their Thai counterparts to commemorate the day and talk about the
theme this year, which is Women, Girls, HIV, and AIDS. On both sides of the
bridge are regimens of police, military, and school children, all
conscripted to attend the event. After standing for the national anthems
of both countries, there are a series of speeches, with each speaker
addressing by name the various dignitaries on the bridge. I, of course,
cannot understand the speeches, but at a similar event in Sisaphon yesterday
attended by perhaps a thousand similarly conscripted local residents, the
speeches in English made reference to such matters as “gender inequality”
and “public-private partnerships” and other terms that clearly did not speak
to the people. After half an hour on the bridge, the ceremony abruptly ends
to clear the way for the thousands of people who gather at the bridge daily
at that hour to seek work for the day across the border. Thousands of
people, some with wagons carrying wears they hope to sell, mothers with
their babies on their hips, children, young and old, most with threadbare
clothes, downtrodden in demeanor, hunger in their eyes, dust already
covering their skin from what may have been the long trip to the border,
pass like a flood across the bridge as soon as the signal is given that the
ceremony is over. Some of us, slow to get out of the way, find ourselves
surrounded by the oncoming stampede, a tiny island of neatly dressed, well
fed local officials and Westerners. From somewhere in the crowd I hear a
single voice, “Hello, Mr. Rich Man!” I feel a knot in my stomach. How
terribly, terribly true. Here on World AIDS Day are the wealthy “donors”
and the well-off government officials, made better off perhaps by their
connection to the fight against AIDS, essentially giving speeches to each
other in large part to congratulate each other for the efforts they have
made, while the huddled masses wait to cross the bridge to their only chance
for money to survive another day. At the multi-million dollar casino-hotel
where we are staying, the housekeepers work 10 hour shifts for two dollars a
day and are encouraged to work seven days per week. In Phnom Penh Prime
Minister Hun Sen calls for an end to government corruption while he himself
says nothing about how he amassed what some say is three-quarters of a
billion dollars in wealth.
Tonight there was another World AIDS Day commemoration, this time on the
grounds of a school up the dirt road past Poipet’s 23 brothels, which were
clearly in full operation. Probably 15,000 people gathered on the grounds
of the school for a free performance of LeCreme, Cambodia’s most famous
comedian. Interspersed through the evening were speeches about AIDS and
promotions for condom use. Of course, the huge audience was there for
LeCreme, but perhaps the public health message reached some in the crowd.
So how am I? Frankly, it is very very difficult in an environment like this
to feel good. I have set my focus on helping to start an ARV clinic here in
Sisophon (to which I’ve just returned, as it is now Thursday, the 2nd). The
building was dedicated on Tuesday in association with the World AIDS Day
commemoration, and we will open for business on the 15th. There are still
many many things to work out. The Xray machine arrived without the
associated equipment to develop the films; the CD4 machine sat in the
National Institute of Public Health for 6 months waiting for the appropriate
letter authorizing its transport to Sisophon while mold grew in a key
component of the machine. We’re waiting for this component to be replaced.
Plus forms have to be printed and a fledgling staff trained in their
respective duties. I’m meeting with them this afternoon at 2pm, only our
third meeting as a staff, and will be here now every day working with them
and the home based care teams to get ready. There are over 12,000 people in
Banteay Meanchey who are infected with HIV. At least 4000 probably warrant
anti-retroviral therapy. Right now about 200 patients are making the long
trip to Siem Reap to attend the MSF (Doctors without Borders) Clinic, where
they can get the drugs, but there are no services in Banteay Meanchey
itself. Once we open, we will be able to serve about 300 patients. If we
can expand the hours (right now it will be open only 3 afternoons per week),
we could double that number. Meanwhile, I hope in the first half of next
year that CDC will help start a clinic in a neighboring district, which may
be able to treat another 300 to 500 patients depending on availability of
doctors and medicine. It’s a beginning, but there are so many potential
stumbling blocks. The head of the Provincial Health Department won’t put in
a request to the Ministry of Health for more doctors. I couldn’t understand
the reason for this until a few days ago when I learned that there are many
“invisible” doctors on his staff. Doctors are obliged to do two years of
government service before they can pursue private practice. The pay is $40
per month. I gather that many doctors forgo the $40 per month, are
registered as working in a provincial health service facility but don’t show
up, and let the Health Dept (or someone within the Health Dept.) collect the
money. With corruption like this, it is really really difficult.
Lynn has been here in Cambodia since October 7th, but at this moment is in
an airplane on her way back to Chicago to visit her mom (a planned trip).
She’ll be back in Phnom Penh on December 18th, which is when I myself plan
to get back to Phnom Penh. We had a wonderful weekend at the ocean (Kompong
Som (Sihanoukville)) last weekend, which was just so much fun—very much
needed by both of us—after celebrating Thanksgiving with our Maryknoll
friends, and our friend Jody, who is staying with us until early January.
Lynn is studying Khmer very intensively, going to a one hour class five days
a week and spending two hours with a tutor 3 times per week. She is also
teaching English to the staff of a very good NGO whose mission is to promote
responsible sexuality among young people in Cambodia. She has also been
helping out Kathy Tucker at the Patches of Hope, the Maryknoll project that
offers women with AIDS the opportunity to learn sewing skills and sell
quilts they make to provide them an income and sustain the program.
It has been so long since I’ve written to you. There is so much more to
say, but I really have to get ready for this meeting this afternoon so must
close. Know that though difficult, this feels to both of us like a very
meaningful thing to do. Staying here for a long time is much different from
our 5 and 6 week stints we had done before. It calls for more patience and
strength and tolerance of frustration to do this for the long haul.
Sometimes we’re not sure we have all those qualities, but this is all part
of the stretch that we both wanted, and we are grateful for our dear friends
and family in the U.S. and the wonderful people we have met here who without
knowing it do so much to sustain us.
I send my love.
Tom
Posted by ed at December 5, 2004 05:34 PM