Health education in practice

Teaching to fish is the best strategy
And worthwhile of my time and my energy
We push them to question, demand, and to learn
That health is a right, not something to earn

KEP, CAMBODIA

July 22, 2008

Tuesday was a great day. It's really starting to wind down around here, and I'm having trouble believing it, to be entirely honest. It's a little strange because when I arrived here eight weeks ago, I remember thinking that August was so far away, and it would feel like forever, just getting to the "fun" part of this trip.

And in many ways it has been long, and arduous, and tiring, and frustrating. But there are things that I have really loved about being in Kep, even though the last week has been fairly boring since I'm stuck doing the worst part of research: analysis and writing. I finished the analysis yesterday, so it's all writing right now, but still...bored.

However, Tuesday was great. TH and I followed Kunthy into the field to watch her do some health promotion. I hadn't originally planned to go, but TH was going, and since my plan is to return next summer and do a project on health education methods, I thought this would probably be a really good opportunity for me, and...there was space in the tuk tuk, so I decided to tag along.

Kunthy was teaching in Aompeng village (one of the poorer villages) about breastfeeding. There was a great turnout, 38 people, and many of them were children and men as well. That's the cool thing about rural Cambodia, I've found: children and men are just as involved in child-rearing as the women are. It's not uncommon to see a small child running around with a baby on his hip, or a man cleaning up a baby's poop.


It was really fun. Kunthy showed a few videos on breastfeeding -- my favourite was definitely "The Breastfeeding Song" where this kid sings about how it's important for her little baby brother to drink breastmilk exclusively until he's six months old. Hilariousity. And I don't think the kids in the village get to watch that much TV, so as soon as they saw that there was a video going on, they ran to the front of the shack to get seats right in front of the TV. It was really cute.


It was also really nice to see how much fun people were having. That's another thing about Cambodia -- people are always laughing and smiling and looking like they're having a good time. People get along and enjoy each other's company, and there is quite a lot of hospitality. As an aside...several of the villagers I visited while in the field were extremely hospitable, offering me guava or bananas...people are very generous.

Part of the health education program involved asking villagers to come up to the front and pick a question out of a jar. They would have to answer the question, and then Kunthy would give them a prize. This was really fun -- a few of the people didn't know the answers to the questions, and all of their neighbours would laugh at them, but it was all in good fun, and they all seemed to be enjoying themselves.

Lots of kids, around, as usual, seeing as we're in the villages. And there was this really cute, really bratty little girl sitting under a table just minding her own business, and I thought it would make a really great shot (I really need to take a photography course when I get back home). So, since I've been working on my photog, I was taking my time setting up the shot, trying out some of the function on my camera, and then, as I was just about ready to take the photo, I got the girl's attention and finally! she's looking straight at the camera. And I depress the shutter halfway to focus and am mid full-shutter-push, when one of the health workers backs-that-thang-up right into my shot. Hence the butt shot below. And then the little girl wandered off. Impermanence is right -- the Buddhists know what they're talking about.


Another great highlight of the villages is the fact that the roads are RIDONKULOUS. There are potholes everywhere, and definitely not potholes like you'd imagine at home. Potholes so that only a moto can get through -- and unfortunately for us, we were in a tuk tuk. We were also carrying a big CRT television and a DVD player, and the TV was heavy, so our driver had Kunthy stay in the tuk tuk and hold on to the TV while TH and pushed the tuk tuk out of potholes from behind.

Kunthy was squealing the whole time -- she thought that the tuk tuk would overturn. It was hilarious.


However, the most interesting thing that happened (and was a bit of a lesson in futility, I think) was when I was watching the kids after the health education had finished. A couple of little kids were playing, and I was watching them, trying to get some photos, when I noticed a little boy, probably less than two years old, heaving as he was breathing.

Now, I've learned about respiratory distress in school, but I've never seen it. You always wonder if the thing you learn will actually kick in when you see them -- and it did. For all you med-types out there: resp rate was up and he was using accessory muscles to breathe (sternocleidomastoids and intercostals were all contracting, giving him a pectus excavatum look on inspiration). It was really scary looking. I told Kunthy what I'd noticed and she spoke to the boy's father and mother.

This family is a Category 1 family on CIH Most Vulnerable Families List -- they're extremely poor, and if memory serves, this means they earn less thatn $0.25 per day. Unfortunately, when we suggested they go to the hospital, and right away (the health worker said it was most likely pneumonia, but the nearby health centres don't have the right antibiotics), they sort of shrugged and said they didn't have the money for transportation.

Now, I don't like most of the tuk tuk and moto drivers in Cambodia, but this time I made an exception. Our tuk tuk driver, whom we were to pay at the end of our trip for transportation to the village, offered for us to dock his pay by a few dollars to give the boy and his mother enough money to get back from the hospital to home -- and we would drive them in our tuk tuk to the hospital right away. It's nice to find that there are good people who still exist among the bad.

We did bring him to the hospital, and Dr. Deena, my new medical hero (more on that in next post), gave him antibiotics and advised that he and the mother stay the night for observation and follow up tomorrow. (Doc R, whom we'd also contacted, advised this as well -- that way if things went downhill they could give the boy O2 or an IV as necessary).

Anyways, she refused, saying she had 5 other children at home, all under 12, who needed looking after. And she took the money from the tuk tuk driver and left.

And there's the frustration again. And that's the problem with health NGOs. The fact is that while health does affect the poverty-health-poverty cycle, it's not the independent variable. Fixing health (if indeed that were possible) doesn't fix the problem of poverty, and all health interventions that are short-sighted enough to focus only on health are merely band-aid solutions. It's poverty and education (through international development work, true, solid, SUSTAINABLE ID work) that need to be addressed to truly start fixing any of the problems.

Which is why I think health education and -- there's that word again -- empowerment of individuals is so important.