Succession of Sicknesses

So a big part of living here is managing your own health while in a different setting, with different climate, facilities, and hygiene. In the dryer months Cambodia is dus-ty! I'm guessing (?)accounting partly for the high rates of respiratory illness (20.6% of deaths of children under 5 are from pneumonia, the single biggest cause of death contributing to the under 5 mortality rate of 143 per 1000 (compared to Australia's 1.2% caused by pneumonia of its rate of 6 per 1000 deaths under 5) (WHO 2000 and 2005).

Living here you are most commonly faced with colds, and stomach complaints. These are discussed enthusiastically around the dinner table in intricate detail as your medicine/rest/food/drink regime for battling your complaint is established, assessed and rechecked.

Unfortunately one of the first things to go regardless of complaint, for me at least, is Dop's wonderful cafe dtk do kow dgo (ice coffee) at the Haang Cafe (coffee shop). Delicious, but a little strong on stomachs, and bad for colds with it's inch of thick sweetened condensed milk - very close the consistency of the body fluids you are trying to reduce!! oh yeah, fair call, too much detail.

But dehydration is definitely a biggie here. Since I have been here, two volunteers have been down really hard with dehydration and complications. Both with intense multiple day headaches, and severe vomiting. Week long illness plus convalescence. Countless bags of IV fluid were given them, and on one occasion two trips to the hospital to ensure it wasn't something far worse.

So fair call when Mum and Dad ask each time we speak, how is your health? It is usually pretty good, but occasionally, for some, can be pretty scary.

Apart from all the stories of dislocated shoulders from moto accidents (it seems everyone I meet who has ridden one has at some stage injured a shoulder), emergency trips to airports to get to Thailand for appendicitis....there are the ones that keep us all amused...like...

Strange and undiagnosable.... arm butterfly infections (?!).

Descriptions of evacuating intestinal worms a foot long.... moto burns (apparently all Cambodians and I guess South-East Asians have a scar in that same spot on the calf to prove that you are in moto world...being recently branded I have been told I am officially 'in'.)

So health is sometimes difficult to come by in Cambodia regardless of your situation...the contrast is strong though, that as expats, with health insurance, we know it is only a matter of money, or flights, between us and sound treatment. The frustration and the heartbreak comes when we consider how an average Cambodian would cope with the more serious of complaints.

Aerial Views of RDIC's Site

For a birds eye perspective, see where RDIC is, and what it's like from Google Earth.

Double click on the pictures to get a better view or download and open Google Earth.

Type in Ceramic Filter Factory Phnom Penh, and you should get to the RDIC site.

RDIC Getting Excited!

Everyone at RDIC is getting excited about the EWB Challenge for first year engineering students in Australia! Hannah, Sophie and Da sure are!

First year engineering students at a large number of Australian universites get to analyse real engineering development problems, and design practical solutions as part of their uni course.

We look forward to seeing some inspiring ideas and putting them into action.

If you haven't heard about it, read about it at http://www.ewb.org.au/ewbchallenge/challenge.

Strange Feeling in the Village that Night

‘So the village has a strange feel tonight. Our neighbour passed away. We knew that she was very sick. Many people had tried to help out. Visits to local international doctors indicated the severity of her disease. Visits to traditional doctors, led to investment in hundreds of dollars worth of traditional and western medication. But in these last stages little help was available for her cirrhosis of the liver.’ (my thoughts on - 15 Jan 2008).

Several nights prior to her death, Buddhist nuns were invited to the house to sit outside and under the stilted house with her and her family to pray and chant for several hours. Cables were set up to allow outside lighting. We were asked to turn on our outside light to assist the ceremony. The night of her death a similar process was held. Many friends and family attended the house and ate and talked. The night had a strange feeling. Whilst the chanting filled the air, all else was silent and respectful. Our neighbours sickness and death was shared with all of us. We were all affected by it.

Health care is not a given in Cambodia, it is a battle. There is no system to cover diagnosis and medicine. Some medical visits are available for free, but for the most part to attend a doctor or a hospital, means to outlay significant money. So people often don’t.

When a family member is seriously ill, families then have to consider selling their home and land, as the battle is waged between helping family members and the realities of doctors bills, expensive medicines, and the risk of financial insecurity into the future. A future where there is no unemployment benefits or pension. In Cambodia, your entire life is entirely in your own hands.

Our neighbour was the mother of an RDIC staff member, whose husband also works here. Whilst an elderly looking lady, I found out later she was just 57 years old. Since January, two good friends at RDIC have had to battle with death and illness of similarly young parents. In many cases the outlay of money will not even get you the help you need in Cambodia as it lacks many medical facilities offered even by neighbours Vietnam and Thailand. Families are required to make decisions about possible diagnosis and treatment in Vietnam or Thailand. Expats regularly go to Thailand for treatment and diagnosis, but for Cambodians it comes at great financial risk. For example, just to get a Cambodian passport, you need to pay $150US. With an average salary of $30 per month, this is a significant burden.

Late diagnosis seems to me to be a regular scenario. Disease is not really identified until extensive physical signs are evident, and by that time, even the most expensive medical options may offer limited hope. ...but others know more about this than me.

RDIC faced a similar challenge when assisting and implementing arsenicosis. A disease identified first in Bangladesh caused by prolonged exposure to high levels of arsenic in water. A number of communities in Cambodia have been hit hard by this disease after they accessed new deep water reserves with wells, that were unfortunately contaminated with naturally high levels of arsenic. RDIC was involved in efforts to identify whole communities with this cancer causing disease. However, in many cases diagnosis would not be confirmed until significant external signs were evident. These communities are isolated and are rarely visited by doctors or health workers. Missing a diagnosis, means missing opportunities to treat and manage the illnesses.

Healthcare is a vastly different experience in developing countries. When I pass my neighbours who live simply but communally, with limited possessions I am sometimes challenged to think what it is about their lives that we think needs to change. The ability to access health care, and opportunities for preventative health interventions like water and sanitation, is right up there on the list!

Extending the Factory

RDIC is a fast moving, every changing place. Since I arrived a number of new sheds have gone up, and new processes started. The great advantage that RDIC has over other organisations is its diversity of staff and skills. Combining a full research lab, with agriculture specialists, animal husbandry-ists (hmmm not sure of that word), well-diggers, nurses, teachers, camera operators, puppeteers, directors, artists, scientists...and engineers, which allows projects to be developed integratively.

Not only are the ideas generated, but they can be tested in the lab, constructed and fully implemented with education programs.

So...when construction is needed, the staff can handle it...and some of us get to chip in and learn the ropes.

A big part of the filter factory production process is the drying of filters before they are fired in the kiln. Removing as much water as possible before firing reduces the chance of cracks caused by water in the clay expanding quickly, cracks that would allow bacteria to pass through the filters. Drying takes up a lot of room and RDIC needed more!

So we built a slab. I joined in. A project goal for me, a natural office dweller, is to develop some practical skills that I will be able to draw on in planning and design in the future.

For those interested in concrete slabs.....we:

1) Cleared and levelled the site.

2) Set out string lines to indicate the height required for the base layer.

2) Laid out large gravel on site.

3) Added cement to sand and mixed it thoroughly, then loaded the mixture into wheelbarrows, and spread the mixture over the rock layer.

4) Watered the site well, to allow the cement to react and set.

5) Set out string lines to identify the desired height of the top of the slab slab including to align with existing cement pads.

6) Made small pyramids using a piece of brick, with cement sides, at points across the area of the slab, to indicate the desired height.

5) Prepared a top layer using a diesel powered cement mixer by...

6) Loading buckets of sand and gravel, and water into the mixer and ...mixing

7) Poured the mixture over the base layer, and smoothed with a plank of wood.

Then we sat down in the shade to rest!

The extended concrete slab has allowed RDIC to build many additional drying racks and to therefore increase the number of filters we can dry at a time.

I was also really glad to now have a practical

eye to how concrete slabs are made, so when people need to do it at home for a house, a yard, a building, I know how they do it. I told Mickey so. He replied:

‘Yeah, I have never seen concrete laid like this anywhere in the world before Cambodia, but it seems to work.’...

...hmmm so at least I know ONE method for laying concrete it even if it is employed in only one beautiful, tropical, and fast developing place in the world!

There is nothing one way about it

So here are a few short observations I have made about culture.

Every week Caleb (a fellow long term volunteer at RDIC) and I, each spend time with Makara (our neighbour) to assist her in English pronunciation and vocabulary that helps her in her job tutoring school students. Working through Makara's text books we get to read different stories, lessons and scenarios that are used to teach children English. A few weeks ago Makara and I worked through the lesson on clothing. A picture of a clothes line showed a range of clothing items and their English words.
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We got to pyjamas. For this item a pyjama top and pyjama bottom were attached to the line. The clothes looked familiar to Makara but she had not heard this word before, so I needed to explain. Ummm....they are usually a suit - top and bottom - and they are loose and comfortable, and we wear them to bed....in western countries....ummm of course in Cambodia these clothes are worn during the day, to the market, down the street, etc which is good, very cool and practical. Makara's jaw dropped a little....her hand went to her mouth....she laughed out loud....What? Were the bright coloured, printed cotton button up tops with matching pants considered bed wear only in Australia/Canada/the US! We had a slightly confused pause. Hmmm....were either of our practices a little strange? Inflexible?...or had we just both sensibly adapted an available resource to a practical use.

So reversing this story....I mentioned to friends recently that in 5 months in Cambodia I have worn shoes and socks only about 6 times, when I have gone for a run. Shoes are kicked off at the door of every building you go to, so slip on sandals or thongs are best. I have slipped into a reliable pair of green thongs (provided by my good mates Fae, Cath and Pip as I stepped onto the plane to come here). These thongs are my staple and I wear them all day every day.

So Jane wears thongs in Phnom Penh for work too. They were her staple. Comfy, cool, airy.... until she was asked by one of her colleagues why she was...wearing 'bathroom shoes' all the time. Surely she could come up with something better. Yes I had noticed too but failed to register....that rubber thongs are retained for the privilege of protecting feet from the wet bathroom floors upon which showers are taken directly, and water is generally sloshed around as a form of cleaning....maybe even from the result of those bidet like hoses provided in most Khmer bathrooms.

How could thongs then be considered fashion items along the riverfront when then they provide a rubber glove or a cooking apron-like protection! We look pretty funny to Cambodians too it seems....

Which reminds me...when we discuss methods for sustainably implementing new technologies to communities sometimes we might ask ourselves 'Why wouldn't a community love our new pit toilets, or wet latrines, or water filters?' I have pretty much worked out that those bidet/hose things are beyond my comprehension and are likely never to give me what I need from a bathroom experience. And if I can be so resolute about this new-to-me technology, why wouldn't members of Cambodian communities about our next new thing!

Judy

One of the things I am really enjoying about working at RDIC are the skills you get to, and have to, pick up along the way. An example...

The clay mix process for RDIC's ceramic water filters requires an even mix of components - clay, laterite, rice husks and water. Dried then ground, the clay, laterite, and rice husks are mixed together in a dry mix process. Next it's essential to add the water (12.5L to a mix of about 40 kg of the other ingredients) evenly to get an even clay mix, and consistent performance of the filters.

An automatic water spray system for the clay mix process was set up by Fred an engineer from the US. The system ensures sufficient mixing during the dry mix and the wet, and an even spray of water into the mix. So here's where my lesson came in....I took it backwards from a functioning system to see how the timer's different phases, the float switch, the 2 pumps and the manual switches came together to operate the system....then had to work out how to explain it clearly for use by people with differing degrees of technical background. Some google time later...on electronic diagrams, different switch and circuit techniques I got pretty close...or so Fred tells me!

Whilst engineers and scientists may have some core skills, working in an operational environment often requires you to teach yourself a whole lot of new ones. For someone most experienced at researching, analysing, and assessing at a computer, I find it an exciting challenge!