Maintaining focus is a tough business in Cambodia. There are always side-paths here. There is always more need. We have finite resources through which to solve problems. Finite resources to battle the silent monsters afflicting people’s lives.
We do what we can when the opportunities are in front of us.
About two months ago, in the midst of our second engineering visit from Steve Forbes, we began a water quality assessment for the first set of filters we installed in Balang. Between photographing wells at the dusty Pagoda and asking survey questions, one of the young monks approached us and held up his hands. The boy - who was not more than 14 years old - had the wrinkled, gnarled hands of an old man.
He was from a village far away, and after coming to the Pagoda one year ago to study, found his hands began to itch tremendously. Through a slow progression of scratching occasionally, a rash erupted into bumps and eventually into small sores. It had spread from between his fingers, to his stomach, all the way down to his feet.
We asked questions, and found that he was one of many kids that had this problem. We maintained focus and moved on and we finished our study, noting the problem in our journals.
I returned two weeks later to put together a history of the problem, armed with questions from a doctor in town. I drove in one late afternoon by motorbike with Ceda, our precocious project assistant.
We started in Trach village, which is the closest point to the Pagoda and began our survey, walking from house to house back down the red dirt road asking questions. What we found was that every few houses had someone with the same problem, and that nearly everyone along the way knew someone who had it. By the time we had reached the Pagoda, we had found over twenty people with symptoms, four of which were serious.
The Pagoda children were happy to oblige our questioning, which was sober with a little bit of silly. I sat with them in a little concrete gazebo under tattered prayer flags until dusk turned to dark. They lit yellow wax candles and we continued, asking every child and monk what their experience was in the Pagoda and how the problem began.
The story was the same: it arrived a little over a year before, and began as itching between the fingers, toes, and places where there are folds in the skin. As it spread about the body it turned into welts, then open sores. If the children were especially good at itching, their legs were covered in scabs, scars and small open wounds.
I was taken aback by how widespread it was, and how serious some of the children’s problems were. They said it had been a slow gradual beginning, and that now the pain was so much that they could not sleep at night. Every child had it, and as we asked we tracked a transmission pattern between the kids. They slept three to a bamboo mat, shared clothes, and rarely washed their apprentice monk robes. Among the dirty young boys with little hygiene, it spread like wildfire.
Our questions ended with fits of laughter, silly faces, and a ridiculous lesson in nighttime flash photography. We ate a dinner of rice and boiled duck eggs in the darkness, and drank our filtered water on a raised wooden platform where the monks take their meals.
That night we unrolled our own bamboo mats on the floor of the Pagoda and chatted with the kids in my broken Khmer. I unrolled some thick brown paper I had brought also, and began sketching a few of the children sitting cross-legged in the yellow candlelight. It felt good to stretch my hands over the paper, as my opportunities to draw had been overruled by programming, paperwork and engineering.
I finished a few sketches, and the children disappeared into the complex to study before bed. As I lay down to sleep under the odd bright paintings of Buddha’s life, my mind was full of thoughts. I felt progress, momentum. The water project is our path, but there are many ways to get there, some more direct than others. This was another need, another side-path through which to help.
In Cambodia there is a language in movement. When you move forward, the path you follow is never a straight line. You must listen, and adjust, and you must bend with the path. Otherwise you are stopped. Otherwise you lose direction.
I realized this was the same spot where I napped as a tourist, three years earlier when a few ambitious monks pulled me out of the temples, into a world of broken dams and dry rice paddies. I thought about where we had come since then. Soft chanting echoed about the Pagoda as the monks recited their prayers before bed. I could see the night sky and a familiar milky-way, framed and shining through the open window as I fell into sleep.
The next day we returned to Siem Reap Town by motorbike after eating some fruit with the kids, washing in the pump well and speaking with some of the head-monks. They understood that some of the children would be scarred for life, but they had no idea what to do about it. Their only medication was boiling tamarind leaves and soaking the sores in the hot water. This did not help.
We shared the history we developed with a volunteer doctor at Angkor Hospital for Children. She said, after looking at the pictures and our research, the problem was almost certainly a severe form of Scabies, with secondary infections of Impetigo. I was glad, after hearing the diagnosis, we had been so careful during our contact with the children. I was also glad to hear it was something treatable, even if it had become an enormous problem so far out in the middle of nowhere. I found it amazing that such a small creature could manifest into such a serious monster.
I am not a medical professional. I only profess to have the ability to connect people to causes, to help find solutions for problems. In the following weeks, I pursued connections between intense engineering work and a lot of research on
the water-gate project. I kept my eyes and ears open for people to help.
Last weekend, my good friend at the hospital, Jon Morgan, invited me to his farm for a small gathering. While there I met an epidemiologist named Sheena, from Australia, who was volunteering as a lecturer at the hospital. She had just arrived, although she had volunteered in Cambodia many times before. She was bright, spoke with authority, and had a skill-set that shined through.
After finding the three needed medications and developing a plan through a volunteer pediatrician at the hospital, Sheena and I went back out to the Pagoda, and stood in front of the assembled children, telling them what both Scabies and Impetigo were, and what they could do to avoid it. In the next few weeks, we will attack the problem with a potent plan.
We are now, with the monks of HRND and the hospital, developing a system for de-infestation, disinfection, and the training of an expert in the community. Sheena is heading it up, and is staying in HT’s office as our resident health professional. We expect it to be eradicated in a month, and if our plan for education works, it will never come back.
Bend in the path. Focus maintained. Progress made.
Now back to the
bigger monsters.
Labels: balang, Cambodia, Monks, pagoda, scabies
y members of all ages met with HT’s staff at the local primary schools, with children as young as two playing under stacked desks and grandmothers chatting while chewing betel nut. More than 100 community members participated at each of the day long PRAs. The day began with general introductions before breaking into men and women’s groups focusing on daily life, education and agriculture. In the primary education focus groups, 15 women between the ages of 26 and 65 sat in a circle with HT facilitators to discuss the community’s current issues with government schools. Many problems were discussed, but the two top issues brought up by the groups were 1) the lack of teachers / classroom overcrowding and 2) the need for a secondary school in the commune. 
When we began the program last November, over 100 students enrolled. Each student took a basic placement test to assess their English capacity. We received most tests back blank, a
