Times change, and a number of things are coming full-circle for me lately. It’s time to repost the post that started the current version of Tales From the Hood, back in March, 2008 (there was a previous version that was not interesting). Here it is, Kompong Thom:
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It was during the first few days of a trip to Cambodia in October of 1999 that I was at a remote health station in Kompong Thom Province leading a small technical team comprised of a community health consultant and two expatriate colleagues based in Phnom Penh. It was one of those clear, intense, very hot days that you sometimes in see in Southeast Asia during the late rainy season. My itinerary from Washington D.C. had been tiresome: layovers in Chicago and Los Angeles, and an overnight stop in Bangkok, but with not quite enough time to sleep before checking in two hours early for a 7:00 am flight to Phnom Penh. Three days later I was still fighting 12-hour jet-lag and general fatigue. I was tired and cranky and hot and uncomfortable, in need of a shower, a square meal, and a few hours of uninterrupted sleep.
A muddy, pot-hole ridden, unpaved road was the only way in to the unremarkable health station. Inside it was a typical, quasi-open-air third-world clinic: Mosquito nets covered only about half of the windows. There was electrical power to only one or two rooms – one housed an ancient looking refrigerator and miscellaneous lab equipment, and another housed a couple of grimy PCs, presumably for keeping records. The two inpatient wards were just long rooms, each with 6 or so metal beds inside. No mattresses or bed clothing, just woven straw mats.
The general ward housed an assortment of wrinkled old people with I.V.s and bandages. Several recently delivered women occupied the maternity ward, breast-feeding newborn infants while assorted family members looked on. They looked exhausted. Flies buzzed through the open windows, the ground behind the laboratory was covered with disposable syringes, hypodermic needles and plastic packaging. The inside of the building had that smell so common in rural clinics in Southeast Asia in those days: a combination of body odor, sterile bandages, local cooking, and floors recently mopped with river water.
The director of the health station was also typical. He had once, perhaps only a year or two before, been energetic and full of desire to help the people of Kompong Thom, to be a part of the reconstruction of his country. Long days had run into long months and into years and the reality of probably never being invited to an administrative post in Phnom Penh had set in. He was also tired. Tired of the long hours, tired of explaining basic hygiene to illiterate peasants, tired of never having electricity to keep the few precious vaccines cold, tired of old malfunctioning equipment, tired of insufficient medicines, tired of working day after day and month after month with no perceptible improvement of any kind. Most of all – I could tell just from looking – he was tired of Kompong Thom.
Kompong Thom and innumerable districts like it from Latin America to sub-Saharan Africa to the depressed remote regions of the Former Soviet Union to the backwaters of southern and southeast Asia are a nasty trick played upon energetic young medical students. They have dreams. They will travel abroad for professional upgrading or possibly vacation. More often than not, however, they end up in places like Kompong Thom, far from the capital city, delivering babies in the middle of the night, dispensing ORS packets and explaining to iodine-deficient villagers why condoms are an effective means of preventing pregnancy.
And so, as the heat of the day was only beginning wane and the round tropical sun was only then beginning to dip towards the western horizon, and as we were only then beginning to move towards our vehicle having concluded our conversation with the tired health station director, I first saw her being carried into the health station by her mother. She was no more than four years old, emaciated (even for Cambodia in 1999), feverish, listless, lying limp in her mother’s arms. She was most likely suffering from dengue fever or possibly malaria (both were endemic there, at that time). Her mouth hung partially open, her limbs flaccid, her eyes glazed and beginning to roll up into her head. There had been patients straggling in and out of the health center the entire time that we were there, but I remember this little girl and her mother because we not only passed them on the way out the front door, but also stopped to talk with them. We – the director of the health center and our own health technical team – stopped to ask what was wrong with the little girl. How long had she been ill, what had the mother done? The little girl was obviously dying – her breathing was labored and she was barely able to keep her eyes open.
The doctor on our team agreed that without proper hospitalization she would most likely not last through the night. The mother had no money, no means of affording transportation to Phnom Penh. She had obviously spent too long doing the wrong things to care for her sick daughter: this visit to the health station was her last resort.
It would have been only about a three-hour ride to Phnom Penh and a facility able to treat the little girl. The sacrifice required by me to tell my local counterpart and the consultant that we needed to take them to Phnom Penh that evening would have been no more than a few hours’ sleep.
But I was tired, hot, stinky and dying for a bucket bath and an early retreat under the mosquito net. I was hungry. We were all ready to declare the work-day over. And in the end we simply left. We concluded our conversation, climbed back into the company white SUV and began easing back over the awful road to town.
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I have long felt that as humanitarian workers we too often give in to the temptation to overstate our own importance. Too often we overestimate the value and the impact and the general “goodness” or “helpfulness” of what our organizations and programs and projects bring to the lives of those we genuinely want to help. And too often we overestimate our own individual roles in making those changes happen.
We – I include myself – take a measure of pride in our genteel poverty: we are not like our materialist peers in the for-profit sector. We are on the right sides of all the issues. We are making a difference. We sit in the comfort of our homes and offices, whether in suburban America, spotlessly clean Europe, or upscale neighborhoods and apartment complexes in “the field”, and we dole out paltry amounts relief in a desert of human suffering.
It is not that we should be endlessly self-critical. I truly believe that the work we do does accomplishes good. Real, objective good. But I am challenged to remain in a state of confident humility. We must not just sit and watch while the problems of our fellow humans go unattended. There is something called the humanitarian imperative. We must do something, and we must do it confidently. And we must do all of this humbly. If my own experience is at all representative – and I receive regular and consistent confirmation from other aid workers that it is – then we must go about the business of making the world a better place mindful of the fact that we are all still learning. We must keep in realistic perspective the limitations of what we have to offer, not just technically or intellectually, but as human beings, too.
When I look back on over two decades of humanitarian work, it is tempting to feel… almost pride. Pride in grants successfully won, targets successfully achieved, strategies successfully carried out, promotions successfully attained. And in those moments I am kept humble by the memory of a time when I had the ability to make a difference but did not. The image of a thin, brown child lying listless in the arms of a haggard mother under a sinking Cambodian sun remains with me still.