Closing Time

I still have 2 months in Cambodia, but with all the pressure to wrap things up, I feel like singing this 1998 classic by Semisonic. Not really pressure, just a sense of approaching finality. Mainly since our close of service (COS) conference (although PC likes to call it the "continuation" of service conference since we are expected to bring our country of service back with us, figuratively, and share) was last month...

The ones still standing. For more info/cool stats check out my friend Evan's blog post "By the numbers - Peace Corps Cambodia K6 Volunteers."

And then there's me.

...and the vast majority of the education volunteers (refresher: there are two programs here in Cambodia, English teaching and health) will be flying out in just one month's time. See Kelly's "The End is Near" post that explains a lot of the conflicting emotions and expectations that come with "coming home." (I will be sure to write a similar post sooner to departure.) But don't let me get ahead of myself. There is still much to be done. And since I didn't post about the last month's happening, allow me to entertain you.

TRAVEL

I did a bit of vacationing and was away from site for a good chunk of May, between a yoga & meditation retreat, COS conference, a SCUBA trip on the Gulf of Thailand, visiting my training host family, a final GenEq committee meeting, an Ultimate tournament, and a trip to visit a nearby "mountain," Phnom Kulen.

Bohitree Yoga Center gang

Morning meditation

bat sunset exodus - Phnom Sampeau, Batambang

Ochres 2 Beach, Kampong Som

Where there be monsters...

Koh Tang bound!

SCUBA fun!

Phnom Kulen with Voleak

Diamond Island Warriors Team hundle

Warriors come out to play!

Cramming a bunch of unused Annual Leave (AL) days before it was too late to use them.
As much as it was nice to have a break from site and recharge before gearing up for the final months, the travel itself was quite exhausting. It is nice to be back and to see how the nutrition project is progressing...

It is good to be home with these hoodlums!

Being oh so PC at the HC.

Vitamin A Vaccination runs with Heang.

Enriched bobor feeding session.

ENRICHING THE FUTURE PROJECT

As with any adventure into the unknown there are bound to be some ups and downs. This is just the case with the nutrition project. One of the vendors, the wonderful Bong Samy has been selling the enriched bobor alongside the other rice porridge for over 45 days! On the best day, she had 12 buyers on the worst there were 3. It is still gaining traction and I am hopefully that it will continue to be (what I think is successful) for the next 2 months and then that she will decide that it is worth it to continue. Only time will tell. Right now is a hard time to be selling anything in our area because of an uptick in the number of people (including parents with children under 2 - the target population) who have migrated to Thailand for work. While the financial benefit can be seen by the increase in large homes being built (many of which then become vacant for the better half of the year, but alas is a symbol of wealth and status...), it is hard to see such a toil on the community at large. Many children are left behind under the care of lovely (yet set in their ways) grandparents. Additionally, rice planting and soon transplanting season is upon us, which means that many people are busy in the fields. In sum, business can be slow these days. And because of that, one of my vendors has pulled out of the project completely. It was a disappointment especially since there is such need in the area in which she was selling, but if you don't have the seller buy-in what can you do? On the flipside, the one VHV involved, Om Ruin (the 3rd and final seller who has a stand across the street from the health center) began selling finally on Friday! It is too soon to tell how that will go, but we are optimistic.

ONWARD!

Three Americans in Cambodia: from the 'bier to the 'bode

(This post is by the marvelous Maggie who made the trip to Kampuchea to visit with the elegant Ellen as was mentioned in my last post...enjoy her musings on the adventure!)

April 10 – April 20, 2014

It's hard to believe now, but just over a month ago Ellen and I arrived in Cambodia after 60+ hours of travel (only slightly disheveled from our experiences with the labyrinth of Bangkok's public transit system and navigating the border crossing from Thailand) and happily fell into Meghan's waiting arms. As we expected, though I remained somehow unprepared for it, the hot climate overshadowed most of our other immediate impressions including the new smells, competing sounds, and bustling crowds of Poipet, our first stop in-country. From Poipet we traveled south, directly to Battambang (where we spent two nights), then on to Meghan's site (one night), and finally landed in Siem Reap (three nights). Despite the climate culture shock (temps in the range of 90 degrees with high humidity), we managed to pack our days with a balanced combination of the must-see tourist destinations and some off-the-beaten-path excursions thanks to our all-knowing local Khmer guide, the habitual author of this wonderful blog. Note: although Meghan claims to not [yet] be fluent in Khmer, the official language of Cambodia, we witnessed her engage in friendly banter and flawlessly execute necessary transactions on a daily basis with the grace and effortlessness that she constantly emotes. Color me impressed.

The morning after our first night in Cambodia found us embarking upon an adventure outside the city limits of Battambang, a mid-sized township in the northwestern part of the country: a ride on the bamboo train. These rickety cars proved little more than bamboo platforms on steel wheels (with pillows to slightly cushion our weak American tushes, thankfully). The unique experience of seeing the Cambodian countryside via bamboo train, as profiled by the Wall Street Journal in this article from earlier in the year, is a thrilling ride of about 30 minutes and offers an open-air view of the surrounding province, including rice fields, grazing cattle, and rural homes nestled in densely wooded areas. From there we set off for a wine tasting at Cambodia's only (yes, that's right – the only one in the country) vineyard, and tuk-tuk'd out to the wat (temple), Wat Banan – 358 steps to the top!

Now, full disclosure: prior to the impressive and informative mini-history lessons we periodically received from Meghan about the country she's come to know and respect over the past 22 months, I possessed an extremely limited knowledge of Cambodia; i.e. only that which I found through a perusal of the Wikipedia page on Angkor Wat, the Lonely Planet's guide to Southeast Asia, and the scenes of the Khmer Rouge occupation in the 1970's as recounted by Vaddey Ratner in her true-to-life novel, In the Shadow of the Banyan. (A highly engrossing and beautiful read, for anyone interested. See the New York Times' review of Ratner's book here.) But even our very brief visit to Cambodia gave us a hefty taste of the rich history and culture that the country has to offer. The complex and varied social and political evolutions that Cambodians have endured are truly mind boggling. And although the tendency of outsiders is to fixate on the country's painful past, Meghan rightfully reminded us that the endurance and fortitude of the Khmer people should not be overlooked. Despite the tragedies of the Khmer Rouge regime in Cambodia in the 1970s (an era well within living memory), it is essential to acknowledge the strength of the country's citizens and recognize their resilience through a particularly horrific moment in history as a building block with which the country can continue to improve and heal.

As a Peace Corps Volunteer, Meghan is working to capitalize on the skills and strengths of the Khmer people in her community to create sustainable programs and systems that seek to provide an improved infrastructure which the community will maintain after she has left the country. Many of this blog's readers are probably familiar with Meghan's most recent project which deals with nutrition (the plague of malnutrition which commonly cripples Cambodians, especially factory workers, is also explored in this piece for the Washington Post, authored by a former Cambodian PCV). Ellen and I stayed with Meghan at her site for one night during our travels, and though we spent the least amount of time there of any of the places we visited, the village ultimately provided the most interesting and affecting experiences of our trip. Our time spent with Meghan's host family included preparations for her cousin's twelfth birthday party, sipping iced tea with her neighbor (a single mother who runs her own breakfast shop; a traditional Khmer breakfast usually includes noddles with a fish-paste sauce...not quite what the American palate is used to first thing in the morning!), and a short bike ride to visit with friends. We also toured the health center where Meghan works most days, and the school where her fellow PCV and site-mate, Emily, is a teacher. Frequently during our wanderings in the village we paused to socialize and exchange pleasantries with the locals through Meghan (our translator!); few of the townies we met spoke English. This practice is what we Kenyonites refer to as “Middle Path Syndrome” - a stroll down the village's main drag guarantees multiple encounters with friends, resulting in many leisurely chit-chats. Community building isn't a major offered a Kenyon (or any college that I know of), but it's a necessary skill that many students pick up during their tenure on the close-knit campus, and its staying power is tested as soon as graduates leave the classroom. Witnessing the enthusiasm with which Meghan greeted each of these encounters served as an impressive reminder of the work she's done to establish a bond with the Khmer community in her village, just as she did in Gambier – much to the joy of everyone around her.

After one last stop on the village tour - the crocodile farm next door to Meghan's host family's house (yipes!) - we hailed a taxi to Siem Reap, our final destination before heading back to the States. Perhaps the most tourist-oriented city we visited, Siem Reap offered plenty to do and see in three days. Highlights of the city included a rice wine tasting at Sombai (http://www.sombai.com/presentation/), wandering through the daily markets and the popular night market, attending a performance of the Phare Ponleu Selpak Night Circus (originally from Battambang), and getting dolled up for a traditional Khmer wedding photo shoot (just for fun – none of us is getting married quite yet!). We dedicated our final day in Siem Reap to an exploration of the ruins of Angkor, a highly impressive historic site which once encompassed the Khmer kingdom in the 12th century. Today all that's left are the temples, or wats, the most famous of which is Angkor Wat (Khmer for “City of Temples”), looming over the surrounding land by 213 feet at its highest point. One of the most popular wats in the temple complex, established as an UNESCO World Heritage Site in 1992, is Ta Prohm, a colossus stone construction in the depths of the jungle which has slowly been reclaimed by the forest's growth in the years since the decline of the Khmer empire. This particular temple is famous for its appearance in Paramount Picture's box-office hit, Tomb Raider, starring Angelina Jolie. Giant vines and impressive root structures strangle the stones of the temple, adding an intriguing atmosphere of destruction and a chilling sense of inevitable decline. The massive trees that grow in and around the temple are mostly silk-cotton trees and banyans, commonly known as “strangler figs.” The banyan is famously found in religious myths and other cultural creations, including a mention in the recent Young Adult hit series, The Hunger Games by Suzanne Collins; for those who have read the series, the lightning tree in the middle of the arena of the 75th Games is a banyan. (As a side note, this only serves to further my suspicions that Meghan – living among the banyans – is, in fact, Katniss Everdeen.)

Nearly 9,000 miles lie between Washington, D.C. and Phom Penh, the capital of Cambodia. As such, it's hard to visualize exactly why a country so far from our own, both physically and culturally, is of importance to a U.S. citizen. However, not long ago the fate of Cambodia was deeply connected to our own: consider this 2012 article from the Guardian (UK) on the importance of civil disobedience as a means towards social and political justice. The piece remains poignant in light of the recent 44th anniversary of the Kent State shootings (May 4, 1970) and its authors, Bill Ayers and Bernadine Dohrn, remind us why the students who lost their lives that day chose to exercise their right to protest: four days earlier, President Richard Nixon announced U.S. plans to invade Cambodia as part of the bloody and largely futile struggle against communism in Southeast Asia. Although Vietnam, Laos, Thailand, and Cambodia have become popular tourist destinations for Americans in recent years, many of those who lived through the Vietnam War still feel its resonance too closely to brave a visit to these war-ravaged countries, largely due to an overwhelming sense of war guilt. The struggles of developing nations like Cambodia must not be overlooked by those who have played a part in their creation. We are citizens of the world before we are citizens of our countries, as volunteers and foreign aid workers like Meghan have admirably proven through their work with Khmer communities.

One of the greatest challenges that these outside volunteers and workers face is establishing programs and systems that are sustainable beyond their stay in the country, or even beyond their lifetime. They must seek to do as the familiar fish proverb asserts: “give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime.” Two years ago, the National Geographic profiled Aki Ra, founder of the Cambodian Landmine Museum outside Siem Reap (find the profile here). Ra's work is one of many projects currently established to help Cambodia recover from the on-going effects of the country's tragic past. It is programs like this one and Meghan's nutrition project with Peace Corps, which offer both employment and education to the Khmer, that give the country hope for reconciliation with the past and inspiration for the future.

For anyone itching to read more about traveling in and around Cambodia, Naomi Lindt of the New York Times does a much more eloquent job than I of describing the sights and scenes of Siem Reap in this article from the Times' travel section on 36 hours well-spent in the city.

Finally, if ever you find yourself considering a visit to Cambodia, my emphatic advice is this: do it.

mh#2

Wanderings & Wonderings

WHAT IN THE WORLD HAS MEGHAN BEEN DOING???! I know that is exactly what you all are thinking. Never fear, updates on my life are here!! Just as it has been super sgnat (quiet) on this blog it has been similarly ghost-town-like around my community as school petered out as Khmer New Year vacation approached, more people migrated for work in Thailand, the imposing heat rolled in hot and heavy, and traffic to the health center slowed. That being said here is what has been up in the world of Meghan...

PEOPLE LOVE VISITING ME.

• My assistant program manager, Saeed (a K4 who has stuck around with PC Cambodia extending 2 years now), stopped by for coffee on his travels up north determining and developing new sites. Unfortunately my site will most likely not be receiving another CHE volunteer so I am the end of the line. The program is looking to go more rural, to get volunteers off the main roads and in areas will little to no NGO presence - areas of higher need and less access. A decision I agree with although it is too bad that my health center will not have another volunteer since this is a great staff with whom to work, especially our newly promoted director, Ee! 

Boo Phally, Om Phanna, Ee Chhat, Chea, Chantee

• Our country director, Penny kicked off town hall meetings (now an annual occurrence) to get news and updates straight from the horse's mouth (so to speak) in Siem Reap town mid-March, which is just a short bike ride away - so basically visiting me... 
• A few RPCVs (not from Cambodia) have made the trip out for lunch of rice and pork at Bong Keya's and to see a site here and exchange stories... it is an exclusive club/family for sure. 

Riding the bamboo train in Battambang (Ellen, Me, Maggie)

• Maggie and Ellen (if you don't know them, you should! #KenyonCollegeClassof2012) made the mind-numbingly-exhausting 50+ hour total travel time one-way trip to see me mid-April. They feel into my arms at the border at Poipet and we proceeded to Battambang, my site, and ended in Siem Reap. They were with me for a short whirlwind of an adventure (about 139 hours!). They have said that they will write about the trip, so here is just a teaser... or two... 

As Ellen said, "Casual laughter in front of Angkor Wat."

PROJECTS ARE HAPPENING. 

• THE WORLD MAP IS DONE! Labeling and everything. All we need now is to have a little party for the kick-butt students who did all the work. 

Labeling (in Khmer), flags, compass rose, and scale HOWIE HOWIE!

• ENRICHED BOBOR is being sold for the first time in my communities history! After finally getting the funding and a bit of a struggle scheduling, Ee and I held the workshop with the vendors early April and then 6 days later the first stall started selling the enriched rice porridge along side the regular. Bong Samy has been selling out consistently. It is our hope that the other two women will begin soon as they were too busy to commit to it only after the Khmer New Year (April 14-16). 

Workshop! (Ee Chhat, Bong Samy, Om Ruin, Ming Dowun)

Promoting the enriched bobor stalls.

Bong Samy with the sign across from her stall in the market.

• HEALTH & GENDER EQUALITY LESSONS. I have been working with Emily to teach little mini health lessons in conjunction with the terrible English book which she has to use when co-teaching. One such recent lesson was about smoking. On another occasion I discussed gender roles and expectations with 7th grade students. 

IN OTHER ADVENTURES...

• ULTIMATE FRISBEE. At the beginning of March, I made the trek down to the capital for the Olympics themed 5th Annual Phnom Penh Hat Tourney. As a member of Team Cyprus we came in 9th after two full days of lay-outs, winning all of our ladies points (in honor of International Women's Day), and plenty of good times. We did make it up on the metals podium for wins in Chicken Wing Throwing, Huck Competition, Boat Racing, and other such ridiculous events. Met and played with Ultimate enthusiasts from all over the globe and from new-comers across Cambodia. So great to spread the Ultimate love!

Team Cyrus United.

• PUBLIC TRANSPORTATION. The first public bus system started with funding help from JOICA (a Peace Corps esque volunteer program of the Japanese government) on a trial basis in February. The pilot was so successful (after initially flopping 10 years prior) that it is going to be rolled out on 5 different routes later this year. Currently there are a bunch of these buses going up and down a central, main artery of the city. For about $0.37 you can get on and off anywhere along this street. I rode it for the first time this past weekend, smiling the whole time like an idiot. Functional public transportation is a beautiful thing. 
• MOVIES. I hit the big city as a devoted Veronica Mars and Divergent fan. Enough said. 

On our way to see Divergent. Riding an escalator. So Dauntless.

• SANS SASSY SITE-MATE. This month I was without my site-mate, but I got a chance to send her off and pick her up. Being without Em, made me realize how much I enjoy working with her and how much I miss having her around. She is the best of the government-issued friends I could have asked for. 

At the airport with Em.

THE FUTURE. 

• Just kidding. No updates for you on that just yet. Except... in a week and a half the remaining 42 K6s will have our close of service (COS) conference and I have picked my COS date... August 7th. The time will just be flying now... 

Traditions and Change

A few quick updates before I dive in: 

- THE ENRICHING THE FUTURE PROJECT IS FULLY FUNDED! - Thanks to all who donated! The project was actually OVERfunded and I had to resubmit an updated budget with the generous new amount to include a beefed up (pun intended) marketing campaign. Because of that, the money did not hit until today so now I am diving in and will have more updates as to the progress soon.

- COLD SEASON IS OVER. - Luckily it is still dry and I can have my 53 articles of clothing line-dry in one day without molding (I get lazy with the laundry and it piles up...). But that also means that it is back into the 90s. Sweat, sweat, sweat, sweat, sweat.

a quick trip to Tatai, Koh Kong to beat the heat

waterfalls, hiking, kayaking, swimming?! = heaven.

- THE WORLD MAP IS PAINTED. - I don't know if I mentioned it, but site-mate Emily and I have been working since mid-December with students to create a world map mural at the high school. Now we are just doing touch-ups and will start labeling (in Khmer) soon!

last week

TRADITIONS

A few weeks back, my host grandmother (yeay) told me to clear my schedule Sunday because we would be going to the wat. I didn't think much of it since the wat is literally across the road, 50 paces slightly south-west of my house. I was told that 8am sharp we would be leaving. I interpreted that as "wear your Sunday best we will be going at 9" as Khmer time allows for some ang-kwe-laynging (hanging out). As all good stories of my PC service tend to go, I was wrong. Sunday arrived and I got out of bed, had breakfast, got dressed, and was brushing my teeth when yeay rounded the corner of the house and started hurumphing (a weird mix of a guttural bark and a scooby-doo question sound) and yelling in Khmer that I needed to change into a long-sleeve (not more layers!), wear a hat, pack a snack, and hurry my butt up! It turns out that the cattle-cart packed with wat grannies was sitting out front. I did as I was told and climbed aboard with 24 yeays, 3 daas (grandpas), 1 small boy, and 2 middle-aged women. Twenty-six of us sat crammed on the planks in the bed of the truck, while the others stood in the front leaning against the cab and chanting prayers. Needless to say there were no seat-belts.

That day I will forever refer to as "wat hunting day." We hit 4 different wats across the district, bumping along on the dustiest and worst roads possible. At each wat (Yeang, Koal, Tippadie, and Prasat) we listened to monks chant and give "sermons;" watched kids playing and wreaking havoc with sparklers and low-grade fireworks; gave money on offering plates; ate communal meals; and shopped around among the food and trinket peddlers. While the activities were pretty much the same, each wat had its own distinct flavor or feel. There was the wat that had electrical outlets and 3D wall paintings/sculptures, another with the gathering hall in a circular pavilion in center entrance, one that was falling apart and getting built back up again, and the final one that was more of a carnival than a religious ceremony (but who says they can't mix!). As we made the long haul back home around 5pm, I felt a true sense of contentment and bliss wash over me. Here I was crammed into a cattle cart after a long day, smelling the sweet, musky tobacco chew that all the yeays spit, and feeling as though I was part of something unique and magical. It's not everyday that you have the opportunity to go (and take advantage of) "wat hunting."

CHANGE

In June of last year, Peace Corps Headquarters (Washington) announced that they would be inviting same-sex couples to serve. The Same-Sex Couples Initiative (SSxCI), as it is known, has been a long time in the making and was rolled out with the "pilot couple" in Ecuador right around the same time as the announcement. PC Cambodia was identified as one of a handful countries that would follow suit. So two weeks ago, I headed down to Phnom Penh as a member of the Gender Equality (GenEq) committee to participate in our post's SSxCI Workshop (although it is unlikely PC Cambodia will get a couple this fiscal year). It was a 4-day intensive strategic planning workshop/training that brought up a lot of questions. We were lucky enough to hear from Khmer panelists who are identify as and/or are active in the LGBTQ community in Cambodia, to hear their views on the acceptance of LGBTQ people and how receptive communities would be if a foreign same-sex couple was placed in a village/town. Two main things that I got out of the week were: 1) this initiative is just another aspect of diversity and a great way to further cross-cultural understanding, and 2) the way that Transgender is defined is not universal. Let me explain. The SSxCI is really exciting! It means a lot to me as an ally and I believe that being able to serve in Peace Corps with your significant other would be a powerful experience. (Maybe I will bully my future husband into another tour with me... jokes.) As for the definition of Transgender, I learned as an undergraduate Gender Studies major the importance of self-identification and the feeling of being born into the wrong body. I can say for a fact that my studies were limited and America-centric. In conversations that week it became clear that pronouns when speaking about lesbians and gay men were tied to the gender identity that the person presented. For example, while in the U.S. a lesbian may be butch or dress more traditionally masculine, she is still called a she. In Cambodia, that same person would be called a he and would be labeled transgender, even if she (my use) did not believe herself (my use again) a man. So while gender identity and transgender identity in America can be separate from sexual orientation or sexuality, in Cambodia this is not so much the case. MY MIND WAS BLOWN. While everyday I am confronted by difference in cultures, it is this one in particular that still has me reeling. And I can not profess to be an expert. I have just scratched the surface. And like that Intro to Women's & Gender Studies my second semester first-year, I am hooked and want to learn more.

Enriching the Future & Food Access

(I need your help funding my nutrition project: https://donate.peacecorps.gov/index.cfm?shell=donate.contribute.projDetail&projdesc=14-303-007. Explained more below...)

When I found out I was coming to Cambodia, one of my first thoughts was about the food. My line of thinking went something like this, "French-Thai-Vietnamese fusion food!" and I began to salivate. In reality, I quickly learned that while there is some influence from outside the country's borders, Khmer food has a unique culinary tradition all to itself that is deeply entrenched. 

So when it comes to talking about and tackling the issues of malnutrition - under nutrition, stunting, wasting, mild and severe malnutrition, and anemia - there are many beliefs and misconceptions. This is not surprising as there is plenty of confusion and changing trends in nutritional science around the world. So much so that the occasional naysayer will throw up their hands and give up with a "let them eat food!" And a times I feel like doing that myself, especially when the over-salted dried fish and the fermented fish paste (prahock) are placed in front of me for a meal. But then I look at the numbers "malnutrition rates in Cambodia remain stubbornly high; almost 40 percent of children are chronically malnourished and micronutrient deficiencies, especially iron, vitamin A and iodine, are high among children under 5 and pregnant and lactating women. " (World Food Program and Cambodian Demographic Health Survey 2010) And these stats are what I see around me. Kids with stunted growth and development. Seeing is believing... and believing that good nutrition can become the norm. 

This year, the Ministry of Health and other health international NGOs have been teaming up to push for better nutrition for infants. Currently on TV there is a campaign running about the nutritional benefits and deliciousness of something called "bobor kap krope kreoung" or enriched rice porridge, targeting mothers with children under 2 years of age (there is even a little catchy jingle to go with it). Bobor (rice porridge - rice, water, salt, and sometimes sugar, chili, crushed peanuts, sprouts and fish or pork bits) is a traditional Khmer breakfast food and in its most basic form, THE thing to eat when you are sick people say, despite its lack of nutrients. In my market alone there are over 15 bobor vendors. All ages eat it. But NO ONE sells the enriched bobor that fortifies the traditional meal with enough vitamins and minerals for proper growth and development during those most crucial months (6-24) of a person's life. 

I have done feeding session and educational talks about proper nutrition which have been successful in that the pregnant women and new mothers I worked with learned how to make the enriched bobor and the infants got a meal of good nutrition. But those sessions proved to not have much of a lasting impact. The skills and knowledge were not put into practice, because of a number of perceived barriers - "the ingredients are too expensive to make it regularly," "my kid doesn't eat a lot so I know s/he doesn't like it," "no one sells it," "I don't have time," etc.  After talking with my counterpart and the HC's super midwife (Ee Chhat) we came up with a plan to try to eliminate some of the barriers. And thus the Enriching the Future: Supplying Communities with Improved Access to Proper Childhood Nutrition was born. In early January, I applied for a Peace Corps Partnership Project (PCPP) grant to help three existing bobor vendors, in three different villages, expand their businesses to include enriched bobor and offer a better option for nutritional meals for parents of children 6 months to 2 years old. With the community's support and assistance from you all back home, together we can enrich the future! Please consider donating to this project: https://donate.peacecorps.gov/index.cfm?shell=donate.contribute.projDetail&projdesc=14-303-007. 

an enriched bobor feeding session

help out this little guy!

Coming into the World

The Birthing Room

Way back when, I wrote an explanation of the work I do in Cambodia. The big picture. The assignment that I was given by Peace Corps. "As a Community Health Education Volunteer in Cambodia, I have five target areas to focus on: 1) Antenatal Care (ANC) and Delivery; 2) Nutrition; 3) Water, Sanitation & Hygiene (WASH); 4) Sexual and Reproductive Health; and 5) Non-communicable Diseases (NCDs)."

Or at least I thought that I did... now looking back I seem to have missed that and have been trying to describe my work without acknowledge the framework that I operate within... whoops. So now I will. Let's start with 1) ANC and Delivery.

When I first arrived (September 2012) my health center was re-evaluating day-to-day patient flow. A newly built delivery and post-delivery recovery two-room building set just slightly off the side and back in a perpendicular L-shape from the main section was being used, but yes not fully functioning. The wing was funded entirely by the Reproductive and Child Health Alliance (RACHA) and the United States Agency for International Development (USAID). (Unfortunately recently RACHA was audited by USAID and accused of corruption in the higher management...) In October 2012 the midwives began regular use of the wing and since then I have been on hand for 11 births. While many CHE volunteers I talk to steer clear of the birthing room, when I see the midwives (Ee Chhat, Kim Heang, Chantee, or Nu) heading to the wing, I always follow. At first I thought it would be awkward, weird, and/or an invasion of privacy to have me observing the deliveries, but as is common in Cambodia, especially in regards to healthcare, confidentiality and privacy do not exist, at least in the way that I define them.

In 2013 there were a total of 63 deliveries in my health center, 2 delivered at home by traditional midwives (a practice that is highly discouraged in my area as this typical does not denote any level of training), and an unknown (but significant) number of deliveries at the referral hospital in Siem Reap. A lot of the deliveries happen at night or early in the morning when I am not at the health center (there is a 24-hour rotating duty schedule for the staff of which I am not a part...). Over the course of a year and a half, 11 births does not seem like a lot, but they each have been powerful and memorable in their own way.

If you came across a Khmer woman in labor, you may not know it. (This is a gross generalization, but hear me out.) I have missed a fair number of births even while I am at the health center, because I just didn't know they were happening... 10 feet away from me. And no the walls are not soundproof. The Khmer women I have seen give birth, are extremely composed and stoic. When I used to think of birth, I would picture Katherine Higel's character screaming profanities in Knocked Up. (I have never seen a live birth in the States, so I don't know if that is a realistic depiction...) Since being in Cambodia, I associate deliveries with midwives chatting about the changing market prices of fruits, an encouraging (maybe strict or vicious) grandmother/mother/mother-in-law/sister/aunt, and a screaming (maybe, most are pretty quiet too) infant. Maybe a grimace, grunt or one tear from the woman in labor. One time, a woman named Srey Rath asked politely if she could please take a few seconds to rest after her aunt told her to push harder, and then apologized(!). The one time I saw a woman make an unusual scene, (she was getting up, yelling, laying on the floor, crying, and generally being disobedient) Thea produced the largest baby I have seen yet at 3.6kg (7.9lbs) with an elongated head because he had been stuck in the birth canal for a long time. I have seen 2 sets of twins be born, 3 breach (feet first exit - this is not a water slide babies go head first please!) deliveries, 1 with unbelievably excessive bleeding, 1 birth with a husband present in the room (very unusual to have men in the room... little boys is okay... oh and husbands clean up after...) and 2 women in labor for under 30 minutes. I have only been on the verge of fainting once (a breach delivery of twins) and the overwhelming warmth I feel inside watching a being enter the world and take he/r first breath, hiccuping or screaming or silently observing, makes me think that I could be a midwife. Truly a miracle of life.

There is a combined 32 years of birthing experience in my health center between the 4 midwives. I have seen them perform complicated deliveries and deal with post-delivery issues and babies not breathing. Infants are put to the breast within the first hour and skin to skin contact is initiated immediately. I have heard horror stories of energy drinks (think RedBull) being put into IV bags (always on hand) and pumped into the woman in labor at other health centers where PCVs work. I am lucky to be at a health center where there are extremely competent and experienced professionals and where I just worry that nobody watches the newborn swaddled in a sarong on the tabletop post-delivery (typically for no more than a few minutes... I have become the baby-watcher.).

I am not birthing children. I observe. I ask questions. I throw in some education prenatal and postnatal. I talk with the parents about breastfeeding and nutrition. And that is great. The general care is improving. A lot of money is pumped into maternal and newborn health around the world, because who wouldn't want to save the babies and women?? What I see that needs to be addressed is what I scientifically call "Baby Mamas" - the women under 22 years of age giving birth. Normal development for women is said to continue until 22-24 years of age. This means that the pelvis is not ready to accommodate for the head of a normal sized newborn. So while the birthing room is an important piece of the Peace Corps target area of ANC & Delivery (I mean delivery is in the name...) my work remains crucial to the stages before those women arrive- that and baby-watching of course.

My 24th Birthday

So I was a newborn once. I know. Hard to believe that I didn't come out of the womb as the sophisticated Meghan that you all know and love. Jokes. Every year on my birthday (1/20 - this year MLK Jr. Day was the same day) my mom likes to retell the story of my "quick" labor and how I "was born ready." Which sounds a bit ridiculous now that I have seen 30 minute labors... 2 hours is a long one. Anywho, this year I turned 24 or started the 25th year of my life and in Cambodia since people count the day 1 as 1 year old, here I would be 25 (so you were right Mom!) or turning 26 in April since many people count from Khmer New Year... no wonder age is confusing and people born in 1992 and 1993 say they are older than me. I have stopped arguing that point. The hardest part about turning older is... remembering to say the new age. It usually takes me about a month to get it down packed and in a different language (!) gosh life is hard. 

I had the chance to celebrate with some other PCVs with January birthdays and some more friends in Phnom Penh. Plans to go swimming or to the water park were cancelled on account of the cold weather (75 degrees), but I can say that it was quite a better birthday than my last one when I celebrated with amoebic dysentery in the hospital... Let's see what this 25th year of life brings me!

Photos to follow next time I have internet. 

A Look Back. A Look Forward. A Bit Belated.

I made New Years resolutions like the average sucker, but one of those did NOT include being better about blogging about relevant things as they occur. Sorry I am not sorry. Can't snap your fingers at 12:01 AM January 1st and make magic happen. Instead I will try and be better - a more realistic goal I think. So here I am attempting to summarize all that has happened recently. I am backtracking and this is quite belated so apologies for absurd length and for inevitably leaving things out. 

NATION WIDE VACCINATION CAMPAIGN - December 1st - 18th

Back in October, the Ministry of Health announced a nationwide measles-rubella vaccination campaign that would vaccinate 4 million children between the ages of 9 months to 15 years, by the end of 2013. To accomplish this goal, "local staff of the provincial health departments had to vaccinate hundreds to thousands of children per day in each commune." What did this look like on the ground? When I arrived back to site from my parents' visit I was thrust into the middle of this campaign, tagging along with two of my HC staff (Om Phanna and Ee Chaat) for two full days of vaccinations in remote villages across the Pouk operational district. Each of the 23 HC's across the district sent 2 of their staff out each day to that day's designated target commune. Everyone would meet at 7:30am at the district hospital to gather the necessary vaccinations, syringes, syringe disposal boxes, coolers, etc. and they set off on their way. The first day I went, we only ended up vaccinating  96 children and had plenty of time for other things like learning to make oam bok (flattened rice) and go to a local palm reader. 

getting a lesson in the foot pedal to flatten rice

the palm reader told me... married by 27. dead by 74. get livin'!

The following day however we vaccinated 234 kids (whew!). No time for pictures of screaming children held down by willing mothers, aunts, grandmothers, and village health volunteers (VHVs). This campaign went on for 18 days in my district. So was it successful? For all account yes. The last reported case of measles (a serious infectious disease that can cause severe illness and complications like pneumonia and blindness especially in infants and children) was in November of 2011. But Cambodia is not certified by the World Health Organization (WHO) as measles free until the country can prove no more cases in the next 2 years. However, Cambodia is well on its way thanks to this large scale vaccination campaign (modeled after the polio eradication campaign in 1996), initiative to give two doses for every child before 2 years of age, and targeting rural areas. This is a recent article about the campaign's success. 

Something that this widespread public health effort brought up for me was what I see day-in and day-out at the health center and in my community: lack of informed consent and decision-making. Doctors and health professionals are seen as having the knowledge and you do as they say, whether you know why you are prescribed something, what it's side effects could be, what your alternatives are or not. More likely patients are not provided this information and their only power is in the decision to take and when to take the meds or not at all. The focus of this vaccination campaign was not to educate the general public about the horrors of measles or rubella or the benefits of vaccines. It was more of a production line operation. "Right arm. No your other right. Open your mouth. Hold still. Now you are protected." In essence: this is for your own good. I am not saying that this type of campaign should not be done. On the contrary, I am thrilled that Cambodia is taking big steps to improve public health. However, I think this raises questions of patient rights and power to make informed decisions about one's own body and health. Discussions that are rare here in my experience. 

CELEBRATING MY HOLIDAY TRADITIONS... KHMER STYLE. 

I got really into X-mas this year. I celebrated 2 times. Once with my host family and once in Siem Reap with a bunch of volunteers. With all the little munchkins around the house we spent evenings leading up to X-mas day making paper snowflakes and setting up "presents" (empty product boxes tied with ribbon) under a "tree" (a branch pulled off a mango tree in the front yard) and making paper ornaments. On the actual day I was able to skype home to the states and in the afternoon I found eager little kids sitting around our tree excited to open actual presents that I had placed there the night before. X-mas with the host family meant that I got a present from each person I gave a present to - none of them exchanged gifts with each other. 

my presents :)

our tree :)

In Siem Reap, the celebrating was a bit different. The weekend after X-mas was spent eating Western food and chocolate drinks of all kinds, playing group games and doing a hilarious "white elephant" gift exchange (everyone makes a gift, wraps it, puts it in the present pile, everyone picks a number, then goes around picking a gift from the pile and deciding to keep it or steal from a previous picker). I made a candle holder from my old bike parts (which I had to get replaced because of wear and tear the result of 2,206km logged on for 11 months!), and I ended up with a lot of chocolate. Before heading back to site, I strapped on some rollerblades with 2 other PCVs at a skatepark and completely Khmer teenager hangout hotspot. A couple of swollen and bruised sitbones and elbows are still with me weeks later. 

just like the 90's :)

swollen elbows :(

Compared to the way I rang in the New Year last year (with Cori at a monk blessing ceremony and dancing in the streets of Siem Reap) this year was quite calm. My host family went to Siem Reap and left me behind so I spent the evening watching the sunset and darkness roll in while reflecting on 2013 and looking ahead to 2014. I made a wish, lit it with a match and watched the wish float heavenward. It would have been nice to have toasted the new year with a flute of champagne in hand and hearing it clink against another, but there will be such occasions in the future I am sure. I don't really like New Years resolutions as I think that each new day should be a time to improve self and strive toward goals, but I found myself making some anyway. But this time around they have taken a different focus. I wrote weekly and monthly goals relevant to my life in Cambodia: go to the market, do laundry, go for a run, finish a book, etc. Realistic and achievable. Small steps. But all for Cambodia. The year 2014 brings with it my close of service (COS) only a few months off. And with that is a major transition that will call for new resolutions. Before I know it I will be writing entirely different expectations for life post-Peace Corps which is something that 2014 will bring, for better or for worse. Here's to new adventures, smooth transitions and staying in touch throughout it all. Happy 2014.  

sending a wish on the wind.