Keeping it Real

Having begun to worry that we might never scratch the surface of the ‘real’ Cambodia, and lead a very pleasurable but ultimately uninformative expat style existence in our remaining three weeks here, we manage today to have a conversation with some actual Cambodian people, and we learn a lot.

From N, our Khmer class instructor, we learn some Khmer phrases which enter my head, hopefully - and then instantly exit it, though thankfully I manage to record them on my phone (oh the woefully unromantic digital age) for practice later. Far more importantly though, I get into a conversation with N after the class is over.

I learn that Cambodian women go to the market between 4 and 9am to buy food for the day. At the most they might buy a few days worth, but never a whole week, the way you might in a supermarket in England. Everything is bought fresh on a daily basis.

We learn that gender roles are similar to Vietnam, in that the woman who brings the food back then cooks and cleans for the family, and looks after the children. This is always the woman’s role.

We learn that there are smaller markets who open at 2am and may close as early as 7am, and certainly by 9am.

We learn that now is the time for rice harvest, and that workers in the paddy fields will be up early, working hard to extract the crop that their next meal is dependant on. 80% of Cambodian people work in agriculture.

I brim with further questions, but we have to move on to go to our ‘monk chat’. Before I do, though, N and I have a very satisfying conversation about tourism. N wants visitors to try to gain an understanding of the real Cambodian life and is frustrated by the short term, temple filled flying visits often made by backpackers. I am beginning to despair of gaining the local insights that I want amid a whirl of commercialism, scams and cynicism. I can have a tourist experience. But it’s hard to have much more.

What emerges from this is that N offers to be our tour guide, she has a part time low key tour guide business, and can take us to see the work in the paddy fields, talk to the farmers and experience the local life. I enthusiastically agree, take her number, and we plan to meet up and plan our tour over dinner (N likes to hang out with ex pats and frequently has dinner with the people she meets through the language course.) N’’s affiliation with the Peace Cafe should mean we know we can trust her. And I like her ‘don’t mess about, get down to basics’ attitude. Though of course also it scares me. Just a little.

From the monk, who I shall call R, we learn that the monk’s daily schedule begins at 4am. Between 4 and 6, the monks go out to collect breakfast. Monks depend entirely on the kindness of the local people, and essentially, collecting breakfast involves carrying a bowl and a humble but pleading expression, and relying on the generosity of local bakers, rice vendors and individuals to fill the bowl with food. Breakfast is shared and eaten communally and anything left over is saved for lunch. The monks study between 7 and 11am, and again from 1 until 5. At 5.30 they chant, until 7pm. Monks are forbidden to eat in the evening.

“No wonder”, says M, as we tuck greedily into our dinner later, “monks always look so thin.”

What R explains though, is that many young boys become monks because they are poor and their families seek refuge, education and a future for them at the Pagoda. M and I encountered this also in Thailand. We attended a ‘monk chat’ there too and the monk who turned up had less interest in discussing Buddhism than he did in finding out which football team we supported. Given that we knew nothing about football and he did a good impression of knowing nothing about Buddhism (at least that he was prepared to share), both parties left smiling, but perhaps a little unsatisfied. R is less young, and more interested in Buddhism. He is a volunteer teacher, because he wants to teach poor young monks like he was, and help them, the way he was helped.

He explains that Buddhists hope to follow the teachings of the Buddha to achieve enlightenment, eventually reaching Nirvana, a state beyond the cycle of life, death and rebirth. There are various basic tenets of the Buddhist faith. One is not to kill. This may seem rather obvious until you understand that this extends to all living creatures. M and I understood already that generally Buddhists were vegetarians for his reason, and that some went so far as to refuse to eat onion or garlic, because these are the root of the vegetable, so that essentially you are killing the plant by uprooting and eating it. We found, at least in Vietnam, which also practises Therevada Buddhism, that the concept of ‘vegetarian’ could be stretched a little in various directions. Being ‘vegetarian’ can mean that you abstain from eating meat or fish when the moon is full, but are entirely carnivorous for the rest of the time. It can mean that you don’t eat anything which doesn’t have ‘wings’ (with a spurious excuse being carved out for some monks too allow them to eat rabbit. The ears could be considered ‘wings’ apparently. Don’t ask me. I didn’t make that up.) For R, the logic is that the monks can eat meat or fish except when they know that it has been killed. Apparently if they are handed someone’s leftover chicken on their breakfast rounds they don’t technically know the animal has been killed because they haven’t seen it or heard it. However if R is invited to his sister’s house and she says, ‘excellent, we can have a feast – I will go and kill that chicken for you’, he then cannot eat the chicken. I am not going to get into the curious doublethink involved in these rules, partly because I expect M will have a little rant about it in his blog, and partly because I am conscious of the amount of doublethink we do at home, as humans and especially where religion is involved. (‘Love your enemy but also judge him’, for example, or ‘believe your sins have already been paid for but also somehow end up plagued constantly by the guilt you are supposed to be freed from.’). It’s hard not to double think. Life is complex and full of contradictions, and so are we.

All the same, M and I consume our entirely vegetarian dinners with voracious appetites. And if there is a slight sense of smug virtuousness adding to the taste sensation – well so be it. It’s not often you get to be so very arrogant that you can talk to a monk and still emerge feeling holier than thou.

And finally, Dr Beat Richner. A man whose courage, pig headed determination and selfless energy has saved lives in the thousands, and who took the time to explain to a group of pasty tourists the realities for the sick children of dirt poor families in Cambodia, and what he and the staff at the Kantha Bopha Children’s Hospitals are trying to do about it, - and who had the impossible grace to ask for donations, both of money and blood, without being pushy about it.

I will enlarge.

Dr Beat is a Swiss doctor who came face to face with the poverty in Cambodia whilst working as a young paediatrician in Phnom Penh back in the seventies. Cambodia used to have a sophisticated public health system to rival that of Singapore, at the time. This had been established by a particular monarch I think in the fifties. However in the early seventies American bombs wiped out a lot of the facilities and the people, closely followed by the Khmer Rouge, who proceeded to destroy and evacuate hospitals.

By the time the Khmer Rouge were overthrown, Cambodia’s health system was in tatters, huge numbers of its professionals had been executed, and poverty was rife. I am unclear on how much poverty had existed beforehand, or on precisely what it was that meant Cambodia was not able to restore things in the 35 years that followed, but Dr Beat hints that the systemic corruption was a direct result of this serious of blows dealt to Cambodia and its citizens in such quick succession.

Whatever the cause, the current situation is that there is no public health system, and those who pay for treatment may have to pay not only for the treatment itself but also a serious of bribes levied as extras by various nurses, porters, potentially even cleaners, in the hospitals. This makes health care difficult to afford when you are a poor family, struggling to feed each other and earning a dollar a day or less.

Essentially, children of poor families were unable to be treated because their parents could not afford the upfront cash required. Children were dying in their thousands. It was, to use Dr Beat’s own term, a passive genocide.

Dr Beat Richner has founded a series of hospitals known as the Kantha Bopha hospitals for children. Everything at these hospitals is completely free. Mothers can bring their sick children for treatment knowing two things; that they will not be asked to pay and that there will be no corruption. Dr Richner’s staff at the hospitals are well qualified, competent Cambodian professionals, who are paid, from head Surgeon down to head Cleaner, a fair and reasonable wage to prevent corruption. All the staff know that additional bribes are not tolerated, and in fact the staff both buy into Dr Rchner’s vision of fair treatment for all and don’t need to employ extra tactics to get by. Dr Richner managed to found his first hospital with the support of the then King, and has managed successively to open several more, with the support of the government, the respect of the people and my unmitigated admiration. Thousands of children are being saved. Each day, some 65 operations are performed and around a hundred children are seen on a daily basis. It’s an incredibly busy hospital, but an efficient one, run to western standards and with western quality equipment.

It has not been easy. Dr Beat has some funding from Switzerland, but it amounts to around 10% of what he needs. He has some funding from the government, to the extent that the government can support, but those together do not make up even 50% of the required funding. The hospital exists, hand to mouth, for the vast majority of its funding from private donations. That’s you and me. And most of us are not millionaires. So it’s an excruciatingly slow build up - a few dollars here, a few dollars there.

It’s an incredibly stressful way to live. And Dr Beat is tireless. He runs a concert every single Saturday night for the tourists. He plays us Bach, beautifully on his cello and he talks about his work and shows us a video. Afterwards there are collection bowls held at the door, but not proffered, pushed or even especially drawn attention to. There is no charge for the concert.

But if Dr Beat is to continue to run his hospital, if the children are to continue to be able to come and be treated, free of charge, if the Mothers are to return home, their child safe in their arms, a family tragedy avoided, the money is going to have to keep coming. And Dr Beat can’t keep doing this forever.

He is, in many ways, a man of great controversy. He has identified what he believes is right, and then doggedly, fiercely ploughed towards it. “I do not think this is ever going to work,” says a friend of his in the video he shows us, when he first discusses building a second hospital, “I think it is crazy. There is no resource for this.”

“I think you’re right,” says the Doctor, “but let’s just see what happens.”

The World Health Organisation states that the patients at a hospital must pay. Dr Beat is going against its tenets when he insists on providing everything free. Western health organisations state that the facilities in a hospital should be ‘commensurate with the economic climate of a country’. So poor people, presumably, should have poor facilities. Dr Beat provides equipment and sophisticated practices commensurate with a western society.

Representatives from the west come to visit Dr Beat and see the hospital. Dr Beat quotes the average sum it costs per hospital stay for one child, at 260 to 290 dollars. “That’s far too much,” say the western representatives, staying at the five star hotel  next door, for 490 dollars a night. “That’s far too much to be spending in this country.”

The World Health Organisation advises that before treating disease in a developing country, the people should be taught basic healthcare and sanitation. “They want us to teach them to wash their hands,” snorts Dr Richner, “You could wash your hands all day. It wouldn’t stop you getting dengue fever.”

Much of Dr. Richner’s opinion is heavily biased, but it is laced with intense frustration, which in turn is fuelled by intense care for the children of Cambodia. For all of them. The King’s grandson was treated in one of the hospitals. He received the same level of care as the poorest child there. And vice versa. It remains deeply frustrating that poor children, without Dr Richner, cannot receive good healthcare. That such poverty exists in the first place. That the hospital, doing the work it does, is not recognised by so much of western society.

What matters, is that Dr Beat still works towards his vision. That he manages, in a way that I could not, to stand firm amid such powerful dissenting voices. In that situation I would probably see the logical argument they made, would be discouraged, lose faith and confidence in my convictions, and end up compromising. Dr Beat is a revolutionary, a Jesus figure, for those of us who have a Christian faith. Someone who can see past the accepted reality and forge a new one.

Dr Beat has dreams of opening a similar hospital in Africa. “If it can happen here,” he says, “it could happen there.”

I hope so.  But it isn’t just Dr Richner’s problem.

There’s more, I realise, to keeping it real. It’s not just about understanding the real Cambodia, passively absorbing information and regurgitating it in blogs. Keeping it real is about realising who you are. And where you fit in.

I am not a Cambodian national. I am a tourist. As a tourist I have certain powers. I can spend wisely. I can donate my money because I have more of it than the people who frequent Dr. Richner’s hospital. I can donate my blood. But it’s about more than this.

I am not a revolutionary. I would love to front big initiatives and change the world. But I’m a people pleaser. I know I would be swayed.

What I am, is a professional earning a good wage in the west. The best thing I can do is to go home at the end of this trip, work hard, earn money, and send it to people like Dr. Richner.

It’s not exciting, it’s not dramatic, but it’s the nearest I can get to changing the world.

<If you have read this post and want to learn more or to donate, Dr. Richner’s website is at http://www.beat-richner.ch/index.html>