Chom Kabey: Out in the community

Helping the helpless, the least we could do
But what’s the next step, when this is all through?
I’m feeling so useless and so ineffective
The desire to change things is ever infective

KEP, CAMBODIA

June 13, 2008

We woke up this morning really early, because Vic, whom some might recognize as one of the anatomy demonstrators from med school, who is a retired Obs/Gyne doc, was doing clinic out in the village. It was a great opportunity. Vic is spending the month of us June with us, mostly hanging around and relaxing, but also donated time and money to run two days of prenatal clinics in the villages as well as some midwife teaching, to come later.

That's him below (the older one), with JC on the left. Vic's such a great guy, funny as hell. Note the ponchos. Ugh, rain.

Only med students were allowed to go, since we would actually be examining the women patients. This was a source of a lot of contention among the students here, who thought that this wasn’t fair. I was sort of on the fence with this – there’s a pharmacy student here, J, who wanted to go, and I was all for it. I think it would have been really useful for him to at least observe (fine, if you don’t want him to do physical exam manoeuvres on the patient, then that’s fair). But what got me was the masters student S, who has been bugging me for the last couple of days. She’s a little self-centred. Anyways, she spent a good 15 minutes complaining to me that she’s not allowed to go on the clinics, and she’s doing a project on maternal health so it would really be useful for her, and why is it that only med students can go. I replied that there are other people who have also asked and weren’t allowed, one a pharmacy student, and Peon 2, who is working on my maternal health project, so she’s not the only one. And if she has a problem, she should take it up with Doc R or Vic, since it’s them that are in charge. She responded that she’s waaaaay more mature than Peon 2, and that she deserves to go.

Fast forward 15 minutes.

Blah blah blah. She has a pregnant sister. She should go.

Fast forward another 5.

Sorry she just took that out on me, but she was going to apply to law school. But she thought she could just have way more impact by doing a masters in global health.

Anyways. I digress, that wasn’t the point of this post.

It started raining, and pretty hard. We grabbed a tuk tuk, and headed out to the village of Chhom Kbey, which I think is in nearby Kampot (as opposed to being part of Kep). When we arrived at the specified house, a little wet (I did wear rainboots though), the women were super welcoming. We saw three women, all who thought they might be pregnant, and all who, if pregnant, were too early in their pregnancies for us to verify by external palpation (can't do pelvic exams here).

It was really funny because as we're examining each of the patients, their mothers, friends, sisters, all sorts of other women in the area, are gathered around to watch the foreigners work. It was really interesting. Everyone was completely open about their medical history and very comfortable describing their problems (like burning urination, or not being able to get pregnant for several years, or a missed period, or birth control use) in front of everyone, including their children, who were also present. I think that's what struck me, the openness.

I got to do a few things too, like take blood pressure, test urine, weight the patients. But I think what really hit me about this whole experience was that I felt like I wasn't really doing anything useful. If the women were further along, we could check things to make sure that the babies were well. But the way things were, we couldn't do anything. One women had had painful urination for the last year or so -- so we have her some amoxicillin and sent her on her merry way. Vic suspected that she had had a miscarriage at some point, but as he couldn't be sure and she didn't have any tests, nothing could be done. Another woman in her early 40s had a systolic blood pressure of 138 mmHg (140 is considered elevated), but we couldn't do anything for her except tell her she was fine -- and it's well known that South East Asians develop cardiovascular problems (and diabetes) at lower thresholds (in terms of weight, BP, age) that Caucasians. And the list goes on.

So it left me feeling very helpless. What's the point of us being here? And as a student, what help am I? I felt that in taking BP and the like, I was actually taking away more from these people than giving them -- and that strikes me as ethically wrong. Not to mention it makes me feel pretty useless, that I can't do anything to effect any change here.

Unfortunately, our next three clinics were canceled. The women we were supposed to see had left, because they had other things they needed to do, like cook and farm and clean their houses. And that's the story here. The people don't have time to go to health clinics because they have other priorities, leading to a grave underutilisation of the public health system.

Helpless again.

There was a silver lining, though. Since we now had the entire day freed up, our guide, Hing Sre who works for Bridges Across Borders (I think I mentioned them in a previous post) took us to visit a couple of the BAB initiative sites. These guys are great. We visited a school that had recently been built by a group of Canadians (EWB-types...but I don't know which NGO they were with), and the vocational training building in which BAB teaches trades to promote sustainability and independence.


One of the classrooms was filled with 16 foot-powered sewing machines where they teach women to sew textiles.


I guess there will always be ways of doing things, of making change. I just wish, sometimes, that the things I can do are more effective.