A Tour of the Health Center

31 10 2011

Now that you’ve read a little about what I’ve been up to, let me introduce you to the health center where I work. The facilities aren’t much, but this health center is much bigger than the two others I have visited. And despite the humble setting, the health center employs a relatively large staff—12 people, including two doctors and two highly-trained secondary nurses. This is quite impressive when compared with other centers.

Anyway, let the tour begin!

This building, along the national highway, is where patients drop in for consultations and to pick up medications. I have been spending most of my time here.

The consultation and administrative building

Inside the building, there are two consultation rooms, an administrative office, and a small pharmacy. Generally patients speak with a doctor in one of the rooms and then pay for their medications (if needed) in the other.

One of two consultation rooms

Behind this building is what I’ll dub the “maternity ward,” although, as you can see, it does not resemble a maternity ward in the US. This is where women come in for check-ups throughout their pregnancy and also where babies are delivered. The TV is off in the picture, but it’s almost always showing Cartoon Network.

Waiting Room - Maternity

Where husbands nervously wait for their wives to deliver a baby

Where the magic happens: The delivery room

Perpendicular to the consultation building and the maternity ward is another building used for trainings and other administrative tasks. This is where the NGO held the week-long training I mentioned in my last post. All of the participants pulled up rice mats and sat on the floor while the NGO staff led the meetings.

Training building

Then past the hammocks– where I often find the director resting during lunch– is the itty bitty laboratory and some rooms where patients can stay overnight.

Hammock area

Laboratory and TB building

And, finally, in the middle of the health center grounds is a small building that I’ve never seen used. Thought I’d post the picture anyway because it’s so lush and green.

Mystery building

Not sure what it is, but it is pretty

There you have it! That’s the health center where I work. Look for a post from Tim later this week on life at the high school.


Observing at the Health Center

28 10 2011

I have spent the past few weeks doing little more than observing at my health center; however, I have gotten to see quite a few things already. For example, a couple of days after I arrived, a Cambodian NGO—sponsored by the US government—came to the health center and led a one-week training on birth spacing practices (ie, birth control/family planning) for all of the village health volunteers (VHVs). So I got to witness the training techniques, soak in the new technical vocabulary in Khmer, meet NGO professionals and get acquainted with all 16 of the VHVs.

One of my favorite Village Health Volunteers

The health center where I work serves 16 villages, and each village appoints a health volunteer who serves as the liaison between the health center and the community. The VHV is trained in topics from general hygiene to malaria prevention to nutrition and more. In my district, each volunteer also has basic medications that (s)he can sell to the community. This would include things like ibuprofen, birth control pills, oral rehydration salts, etc.

So I met all the VHVs at this week-long training at the health center, which was great. I got to introduce myself and my role with the health center, and informally ask them about the health problems in their communities. But then, it got better! The midwife asked me to join her on village outreach events—two a day, for eight days. That meant that I could potentially see all 16 villages that are served by the Kampong Kdey Health Center.

Women and children at one of the outreach events

I didn’t make it to sixteen, but I did go to ten. The midwife would come get me at the health center and off we would ride, her on her motorcycle, me on my bike. Although riding a bike on bumpy dirt roads in the Cambodian heat was not my favorite part of the day—especially because I was trying desperately to 1.) keep up with the midwife’s moto, 2.) smile at everyone I passed and 3.) not get too sweaty since I was about to meet new people—the village visits have been a highlight for me.

In each village, we met up with the VHV. (S)he and the midwife would then give a short presentation on birth spacing methods. An interesting aspect of Cambodian culture is that pre-marital sex is not very common, particularly in the villages. So these talks were generally aimed at women who were already mothers, but did not want or could not afford to have more children.

For those of you health people out there, the seven methods that were taught include the pill, condoms, IUDs, implants, the shot, tubal ligation, and vasectomies. And just to put things in perspective, 12 condoms here cost 13 US cents and the 10-year IUD costs US$2.50.

I took pictures in each village as a way of remembering each volunteer and meeting place. To check them out, go here:


Sometimes men attend, too!

In addition to the village visits, I have spent many mornings at the center, talking with patients and observing the system. I finally feel like I have enough information to start an assessment, so next week I will dive into that. In a few more weeks I hope to update with some conclusions and, hopefully, some initial project ideas.

Other than the work at the health center, I have been helping Tim with a few private classes that we co-teach at our house. We’ve also been doing our very best to meet with every NGO in and around our town, but you’d be surprised how elusive the staff can be. We’re also taking one short hour of Khmer classes each week, which provides an opportunity to ask about things we’ve heard throughout the week, but is not enough time for any real instruction. We are still searching for a more formal tutor, and, ideally, we would each have our own since we have different schedules and different interests.


It’s not about the money, money, money

25 10 2011

There has been a lot of talk about money lately among the Peace Corps Volunteers and staff here in Cambodia. Two main conversations, which have been discussed continuously since the Peace Corps’ inception in the 1960s, seem to be going on. First, are we volunteers being paid enough to live—and “live well”—at permanent site? And second, are we living at the level of the local people?

In my limited experience, the answers to these two questions are straightforward. “Yes,” the first question, and “no” to the second.

Are we being paid enough to live at permanent site? This question is quite complicated and very controversial right now. All I will say is yes, Tim and I have been able to live extremely well on the money that we’ve received through Peace Corps. We’ve been able to save several hundred dollars in the short months we’ve been here. And we certainly have not been skimping. In fact, we hardly ever think about money. If I want an expensive tea, I buy it. If Tim wants to print 300 pages for his English club, he prints them. We have recently bought a hammock, a chair, speakers, a countertop stove and several DVDs. Plus, I’ve talked before about the clothes I’ve gotten custom made here. Not to mention that last weekend we took an air conditioned bus to Siem Reap, where I did all of my Christmas shopping (in October… pretty good right?). And in Phnom Penh last month, I’m pretty sure Tim and I ate everything in sight. And we still have money left. Plenty of it. This might not be the case for all volunteers, and I understand that. Some might be placed in more expensive sites than ours. Tim and I might be saving money as a couple. And, of course, people have very different standards for “living well.” But for us, the answer is easy: A resounding “yes.” Yes, in the months that we’ve been here, we have found that our stipend has been more than sufficient to cover our costs.

Our loot from Siem Reap - plus a huge pile of herbs and spices not pictured

On to the second question: Are we living at the level of the local people? Absolutely not. As volunteers, we each make $269 a month. This might not sound like much, but consider this: A primary school teacher in our town makes $60 a month. A secondary school teacher might make $100, while an administrator might come in around $150 or $170. Sixty percent of Cambodians live on less than $2 a day. We make 4.5 times that amount. And we make it on a regular basis. We are not affected by the fluctuations of the local market. Nor do we make all of our money in one or two lump sums a year and then have to ration it for months at a time, as do many. We make $269 a month. Every month.

Except the months when we make more. Like this month, for example, when we were given a hefty “settling in allowance.” Or any of the many months when we’ll have to travel to Phnom Penh for meetings or trainings.

And I haven’t even begun to describe the resources afforded to us by Peace Corps. Upon arrival, we were all given water filters worth several hundred dollars. We have brand new mosquito nets. New bedding, mattresses and pillows. A top of the line cell phone. Peace Corps gave us all bikes—some of us even got shiny new mountain bikes imported especially for us. Do my Cambodian neighbors have these things? Of course not.

Do my neighbors have a safe place to go in case of a national emergency or natural disaster? Do they have someone who arranges transportation for them if they fall ill or get injured? Are their medical costs covered? Do they own iPods and laptops and Kindles and digital cameras?

No, no, no, and no. We are truly kidding ourselves if we think we are living at the local level. I do not mean to paint all Cambodians as poor helpless villagers without access to any resources because that certainly is not the case. And there are undoubtedly Cambodians with obscene amounts of wealth. But I think volunteers are living in oblivion if they think that they are living like the average Cambodian.

We spend a fair amount of our money here too

I have heard Tim say it several times, and I could not agree more: “The idea of a living stipend in Cambodia is ludicrous.” It truly is. Seemingly all of the Cambodians in our community are working to live. They are not taking wild vacations or playing the stock market. They are working to cover the costs of food, shelter, medicine and, hopefully, an indulgence or two. Trying to explain the concept of a living stipend to our Cambodian counterparts has been met with blank stares. And if they knew that our living stipend was significantly more than their government salaries, I can imagine we’d be met with a different reaction.

We are an already privileged group of people in Cambodia, supported by a fiscally and organizationally strong agency of the United States Government. Yes, our title is “volunteer,” but we make a substantial salary when compared with those around us. So, as I see it, our title does not entitle us to lower prices in the market or being exempt from paying the full amount at a wedding. And we certainly are not in such a dire position that we need to rely on our Cambodian friends, coworkers or family members to purchase things for us. I know some volunteers do not feel like they are living well, but I can’t say it enough: Given the funds and the resources we have access to, we are living above the local level, regardless of whether we define that as “living well” or not.

We came to Cambodia as volunteers. And while we’re making a respectable amount of money as volunteers, hopefully the spirit of volunteerism isn’t lost. Being a volunteer isn’t about the money— it’s about a willingness to serve, a willingness to put others before ourselves, and a willingness to help those around us. If the amount of money we are bringing in isn’t enough for us, let’s not forget about the Cambodians we are here to serve, who are making, on average, substantially less.

I hope we can all remember why we’re here.

I’m guessing none of us joined Peace Corps for the money.


All Smiles in Cambodia

21 10 2011

Last night, as I was closing the shutters and turning off the lights before heading to bed, I realized something unusual. My face hurt. (Yes, yes, I know.. Insert lame joke here.) But really, my face literally hurt. And it hurt from smiling so much. I have made it pretty clear that I’m happy here, right? Well, I am. Very, very happy… but happy enough that my face hurt from smiling so much? That seemed like overkill to me– until I thought about all of the different kinds of smiles that come over my face in the course of a day. When I thought about the different reasons I smile here, it started to make more sense.

Allow me to explain.

The most common smile of all is probably the “I know you’re talking about me, but have no idea what you’re saying” smile. I find myself with this smile everywhere– in the market, at the health center, while I’m going for a run. For some reason unbeknownst to me, Cambodians in our town love to talk about us, especially in front of us. And it’s nearly certain they are either saying something sweet or making fun of me. Both warrant a smile so this one reaction covers all of my bases.

Similarly, there is the plain ol’ “I have no idea what you’re saying” smile, when the speaker is talking about something other than how pretty my nose is or the fact that I speak Khmer.

One of my favorites is the “I desperately want friends” smile. When walking or riding my bike around town, I always have a huge smile plastered on my face. I want people to think that I’m friendly, approachable and happy. I want them to want to talk to me. And I want them to think highly of me. So I grin so big that I end up swallowing big gulps of dust from the road and have to stop my bike while I try to survive my mini-coughing fit. I really know how to impress, huh?

At least once a day, I find myself in a situation where I just don’t have the vocabulary to adequately express my gratitude toward someone. In these cases, I flash my “I wish I could properly thank you but I only speak Khmer tech tech (a little)” smile. Lately, the midwife at the health center has been the one receiving this smile but our host mom, Khmer tutor and random ladies in the market have also seen this smile on occasion.

Last, but certainly not least, is the “I’m so happy here I could burst” smile. This one comes over me when exploring a new village, ending a successful conversation with a stranger, spotting a cute little kid, finding my favorite bag of spicy chips, learning a new word in Khmer or simply relaxing on our porch watching the sun set over the palm trees. This is the only smile on the list that’s a result of feeling truly joyful, but it is powerful in a way that the others simply are not.

So Cambodia brings a lot of different kind of smiles that all mean different things. Maybe only one of them is a “real” smile, but heck, I’m happy to smiling at all.


The Floods

12 10 2011

Since mentioning the flooding in Siem Reap in the post about or site visit, the flooding in Siem Reap (and much of Southeast Asia) has gotten worse. Siem Reap town has been flooded three times, forcing Peace Corps to evacuate its volunteers there. On our way to site from Phnom Penh, the Tonle Sap appeared even more swollen than during our previous trip. Houses that had before been islands in the water were now up to their windows and roofs. At site, things have been pretty quiet – despite the swollen rivers, the town has not flooded since we’ve been here. Teachers at my school told me a day or two after our site visit, the national highway was flooded over, temporarily closing the route between Phnom Penh and Siem Reap. Since arriving here, the monsoon rains have generally followed their usual pattern: clouds rolling in at two or three in the afternoon with no more than a couple hours worth of rain. Last night and this morning have been an exception to that usually predictable rule. It stormed all night with harder than usual rains, and it continues to rain off and on this morning. With all this additional rain, I can only assume that the flooding in Siem Reap town will get even worse.

Thus far the floods have killed 207 people and caused an estimated $100 million in damages in Cambodia alone. Today the government lowered its forecast of GDP growth from 7 % to 6%, citing the agricultural damage done by the flooding. Although the international news has been reporting on some of the flooding (primarily in Thailand), it seems like most of it is being overlooked. The Prime Minister of Cambodia has not yet asked for international support, but is being pressured to do so by lawmakers and NGOs in-country. It is unclear exactly what the government will do but many NGOs are already working in the flood-affected areas.


Serving in the Peace Corps as a Married Couple: Part One

11 10 2011

I thought it was only fitting today (our two year wedding anniversary) to write about how it has been to serve in the Peace Corps as a couple so far.

One of the clearest memories I have from staging in San Francisco is the swarms of people gushing about how lucky I was to be serving with my husband. “That’s so great. It will be so much easier for you two,” they said. At the time, I resented this a little. Having lived abroad before (with Tim and alone), I felt like they were missing a big part of the story. Yes, in some ways it will be easier, I thought, but in many ways it will be much more difficult.

With Hal and Sam, Another PC Cambodia Couple

However, more than two months in, it looks like they were more right than I was. Serving together has been extremely easy so far.

In many countries where the Peace Corps serves, couples are split up for training. This means that couples spend their first two or three months in country—the most difficult months for many— apart from one another. In Cambodia, however, Tim and I got to live and study together during training. Although I imagine that being separated would have helped us feel more independent and to get to know more of our fellow volunteers, being together in Takeo worked well for us. We were able to come to permanent site with a similar foundation that made us feel unified in our knowledge, goals and expectations. It was also great to have a built-in study partner during training, and it was incredibly useful to have two people trying to decipher Khmer instead of going it alone.

I think the biggest advantage though has been the comfort and ease with which we have been able to face transitions. Initially moving to Cambodia, visiting our new site, and then eventually moving in were all much easier for me with my partner at my side. I don’t think either of us felt the isolation or panic that some volunteers felt when being faced with these completely new situations. While I think our personalities certainly play a role in the smooth transition, being with my best friend was a critical part of it too.

The biggest difference in our relationship since we’ve arrived in Cambodia has been the amount of time we spend together. We both have histories of being workaholics in the States, which limited the time we were together each day, but right now we are spending around 20-22 hours a day together. It’s been so much fun to share and process all of these new experiences with one another. We’ve had plenty of time to discuss Cambodian politics, play cribbage, ride our bikes through the countryside, sip on coffees, invent catchy songs about the heat, conduct impromptu puppet shows, and then get bored of each other. And during those times, we just do the housework, catch up on our reading or write more blog entries.

We've gotten so close we even ride the same bike!

The one challenge I think that couples face that is unique to them is that it can be easy to take out any negative feelings on your partner—and this holds true, not only in Peace Corps, but in all stages of life. All volunteers feel frustrated, exhausted, confused or overwhelmed. And all volunteers will feel these feelings on a very regular basis, even if they are only fleeting feelings that dissolve quickly. Presumably, if you are a single volunteer you will take a nap, go on a run, have a good cry or call your family and the feelings will pass, no harm done. However, as a couple—and particularly a couple that is together as often as we have been here—it can be easy to take these feelings out on your partner without realizing it. And, depending on the day and the mood of your partner, this can easily escalate from a momentary feeling of frustration to an all-out argument or, even worse in my opinion, a silent wall of tension. Luckily, I am married to a man who is able to keep perspective and maintain a positive attitude so this does not happen too often, but the heat, bugs, language struggles and cultural differences can wear on anybody so it happens—even to us!—from time to time.

Serving with Tim has been a blast up until now, and I can’t wait to see where we are at the end of our time here. We will undoubtedly face a lot of challenges here as we develop, learn and integrate at different speeds and in different ways; however, I feel privileged that I get to celebrate two sets of victories, learn about two different sectors and gain insight from two people’s separate experiences.

I hate to admit it, but I guess everyone at staging was right…


Your First Khmer Lesson

10 10 2011

After two months of intensive language classes, I’ve started to miss studying Khmer now that we’re at permanent site. Virtually every class had one or two hilarious (or at least intriguing) moments when we were able to connect the meaning of one word with other. Khmer is largely made up of compound words, so we’d often learn three or four short words from one longer word or phrase. For instance, the word gah = neck and wain = long. Put them together and you get gah wain = giraffe. Easy, right? Here are more:

bii = rice / patea = house / bii patea = kitchen (lit. rice house)

smau = shoulder / ow = shirt / smau ow = hanger

dteuk = water / trii = fish / dteuk trii = fish sauce

                             / crowit = orange / dteuk crowit = orange juice

                             / bantoupe = room / bantoupe dteuk = bathroom

Avocado = butter fruit.

Diabetes = sweet urine.

Cake = French snack.

Air conditioning = cold machine.

Pretty fun, right? The next thing to know about Khmer is that there are no tenses and no verb conjugation. Remember those countless hours studying Spanish, French, German, or Arabic verb forms? Not here! Just throw a subject with a verb and call it a day.

Knyum nam bii howiee. (I ate rice already)

Gwat nam bii howiee.(He/she ate rice already)

Jung nam bii howiee. (We ate rice already)

Just use the same verb (nam) throughout. If you’re feeling particularly precise you can add “tomorrow”, “yesterday”, or “later” to indicate time, but people here seem generally confident that I will somehow manage to figure out the time through context clues. I think this is an advantage to learning the language now since it cuts way down on how much you need to memorize, but will probably be frustrating in the future when we don’t know if something is going to happen, happened already or is happening now.

Our next Khmer hurdle is to learn the alphabet. During training, we made our own transliterations from how we interpreted our LCFs (Language and Cultural Facilitators), instead of learning the Khmer alphabet. This was a great way of getting us to speak , but made it next to impossible to share each others’ notes without yelling, “Why would you write it like that?!?!” This just solidified the fact that we hear sounds differently and find lots of creative ways to remember words. Mnemonic devices ran rampant during language training. Some students wrote down words to look more like English to better remember them. Personally, I tried to think of Khmer words as if they were said with a thick Brooklyn accent whenever possible. For example, watch or clock is nea la kaa, which to me sounds a lot like a Brooklyner saying, “near the car.” This helped me remember, but probably destroyed my pronunciation (and made it impossible not to giggle whenever someone said clock).

I hope this was interesting to anyone outside of Cambodia. We are having a great time deciphering Khmer and can’t wait to be a bit more conversational.