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Cambodia: The Lake Clinic

March 1st, 2008

VIEW IMAGE GALLERY OF FLOATING VILLAGE

The sense of time is different. “Hurry up” is a process of continual slow motion versus “normal” which is regularly punctuated with pauses for conversation, cold drinks, or simply moments of rest. In almost 14 years, Jon Morgan has adapted.

“Have you heard of CWA?” he asked.

“No matter how much you plan, how well you set it up, or how hard you push there is always CWA. Cambodia Wins Again.” He shrugged. It’s what you do afterward, he said, that matters; how you pick yourself up from the dust and go back to it. For Cambodia has changed him. (at right: Morgan on the slow boat to Moat Clas)

“I used to be a person who maintained all my relations because I never knew when I was going to be working with them again,” he went on. “But they have a saying over here; if you see a snake you kill it. Or you run away. Because if you don’t, it will kill you.”

Cambodia may win more often than not, but Morgan has shown that with tenacity, patience, and strategic alliances one can persevere. (at left: the town of Kampong Chleang. Rainy season flooding necessitates putting houses on stilts; even the road is under water making boats the only means of transport.)

Morgan and his wife Mieko returned in 1995 to Cambodia with the intention of staying for two years. One thing led to another and they’re still here. A nurse by training he has managed to reinvent himself several times. With each rebirth he has shaped himself anew, most recently in a transition from Director of the Angkor Hospital for Children (AHC) to Director of the start-up NGO The Lake Clinic Cambodia (TLCC). The Lake Clinic will use a shallow draft boat to provide medical care and education to remote communities on the Tonle Sap lake, a body of water which grows four times its size in the wet season. (at right: a child runs over a bridge in the town of Kampong Chleang. in the rainy season this bridge is under 15-25 feet of water.)

During his tenure at AHC, Morgan saw a need for capacity building in outlying community health centers. If illnesses were caught early, they wouldn’t be as acute as the cases he was seeing in AHC. Once, when he was speaking on behalf of the hospital at a meeting of NGO and community leaders, the Moat Clas village leader looked at Morgan and said “This is what my village needs. I want you to help me.” Morgan replied he would and, years later, he is nearly there.

A floating village, in the dry season Moat Clas is three hours by boat to the nearest health center. It’s another hour by vehicle to a hospital in Siem Reap. It can cost $30 dollars (US) for a local just to get ot the city. With the daily wage in these fishing communities averaging less than $1 dollar, that is a fortune. Simple health conditions are allowed to languish until they become acute. But compounding the poverty is a lack of simple health education.

For instance, some locals know clean water is better for them but they wash their dishes in the same lake into which they urinate, defecate, do their laundry, dispose of their garbage, the list goes on. It is hardly hygienic. (at left: a coffee glass is washed in the lake with water that is filled with fecal bacteria.)

The village chief has three water filters donated by various NGO’s and yet I saw him brushing his teeth with lake water. It was where I’d peed. His wife washed the dishes in the water as did the visiting boats who served ice coffee and our breakfast the next morning. They know it’s good to brush and wash, and that the lake water may not be healthy, but they don’t know to boil or filter all water they ingest. To compound this, not everyone has filters and most stoves are open flame, wood-fired.

Visiting dentist and board member Hal Kussick ate the cooked fish and rice–because they were cooked–but shunned the tomatoes washed in river water. The next morning he turned down breakfast as well, for the sprouts that went in the soup were likely washed in the lake as were the dishes. He was trying to save himself numerous trips to “the thunder bucket.” I’m not sure what he ate, for I was slightly more adventurous but didn’t eat much. Travel on the lake is almost like desert camping; you must bring everything you will eat or use with you for food and water are suspect and the locals have barely enough for themselves (save for fish, which seems plentiful). We slept on a reed mat beneath a mosquito net, a position which could have benefited from a thermarest. And, surprisingly, it was cold enough by dawn that I was glad to have brought my jacket for I was fully clothed beneath my thin sheet.

Mieko, who does water quality analysis, took samples in our departure town Kampong Chleang and our destination Moat Clas. In Kampong Chleang the fecal contaminants were so profuse her equipment was unable to count the bacteria; she had to dilute it to 10 percent before she could confirm it was a toxic organic soup. In Moat Clas, the river water also exceeded World Health Organization specified healthy levels of fecal bacteria, but not as grossly. She is unable to test for petrochemicals, but other toxic chemicals were negligible. For an anecdote, I watched a naked kid defecate into the water while his friend practiced his flutter kick beside him. Then they both went swimming with the floaters. (at right: Mieko samples water while the village chief watches.)

“We’re going to disappoint them,” Morgan said. “There’s going to be someone who will come in here with something we can’t treat or don’t know how to treat. They know me as Angkor Hospital and are expecting that kind of care.”

But because he is just starting TLCC and lacks the funding and staff to provide extensive hospital services, his ambitions are more modest. He wants to start with basic dental care–largely pulling of teeth–for the nearly immediate relief will build local trust in the organization.


“There is not one person here who is not in need of my services,” Kussick laughed. And yet with each trip to Moat Clas and other outlying communities, patients will be screened to create baseline data and allow the Lake Clinic to bring other specialists out on the lake. (at left: at dawn the breakfast boat arrives with noodles and coffee.)

“It’s all about relationships,” Morgan said. Our visit was primarily fact-finding, photography, and supporting that relationship. In a few weeks Morgan will have his first boat which will sleep five. He is currently buying the engine. Once it is piloted up from Phnom Penh, the shallow draft vessel will be put to immediate use on the Tonle Sap. The Lake Clinic will be a very real entity for the villages on the lake; we could have provided some health care on this trip but as Kussick noted, the amount of equipment we’d have had to carry out there to serve one dental patient, never mind 20, would have been ridiculous.

Morgan is confident things will come together; the donors, the staff, the community and slowly, steadily he will reinvent himself once again. Captain Morgan will undoubtedly sail the Tonle Sap, providing the preventative health care and health education he sought to do years ago through AHC’s capacity building program. He takes his CWA in stride, something I will need to learn to do. (at right: the outskirts of the floating village of Moat Clas on the Tonle Sap Lake four hours from Siem Reap.)

VIEW IMAGE GALLERY OF FLOATING VILLAGE

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