A Tale of Two Cities…er, Villages

24 10 2012

After a full week of no rain, I woke up this morning and realized the streak was over. I got out of bed immediately to call the village health volunteer who works on the nutrition project with me. I knew from previous experience that when it rains, it’s best to cancel project activities. More often than not, paid government employees like teachers or health center staff won’t go to work if it’s raining, so it’s even less probable that community members will volunteer to come to projects when it’s wet outside.

I called the volunteer and asked if we should still have the planned feeding session, the second in a series of ten. Yes, she assured me. Yes, the mothers will come. Let’s still have the session. I was skeptical, but trusted this volunteer. She told me that the mothers would come so I believed her.

Volunteers mapping where the underweight children live

At least, that’s what I thought she had told me. But when I arrived in the village a half an hour later, I realized I had misunderstood. Since the Khmer language doesn’t have tenses, I hadn’t realized when we were talking that the volunteer had told me, “Yes, the mothers came” and not, “Yes, the mothers will come.”

So I showed up on my bike, a little wet, and was greeted by more than 30 smiling faces who were sitting underneath the stilted house eating their nutritious weaning porridge while a light rain fell around them. Everything about this situation was surprising to me. First, it was only seven in the morning, and they had already made and started to eat the porridge. In the other village where we did the project, it was a battle to get the porridge finished in time for my 11am class. Second, there were 30 people there, including every single child on the list of underweight kids. Again, this was nothing like in the other village, where we were happy to get half of the participants to show up. And, finally, the volunteers were enthusiastically teaching about nutrition to the mothers, using the education tools they had been trained on. In the other village, I had to do a large portion of the education because the volunteers refused to do it. And when they did teach, they certainly didn’t use as effective of methods. All of this, and it was raining to boot! I sat and watched the whole thing unfold, almost feeling unneeded. A bittersweet feeling, indeed.

Volunteers learning about behavior change communication

Consider this is another situation to file under “things that baffle me.” (Although, to be fair, it would be unusual if more than a couple of days went by without having something to add to that list.) Volunteers from both villages received the same training. The villages are a mere 500 meters from one another. As far as I can tell, they have approximately the same level of income and resources available. Yet, I’ve seen drastically different results in the two places. It’s been like night and day since the beginning of the project, but this morning was the perfect illustration of the competence – and confidence – found within the second village.

This morning, one of the project volunteers from the second village excitedly approached me saying, “I think the mothers trust us already. I think they have confidence in us and understand that our method will help their children. Mothers won’t change their behaviors unless they trust us – and trust this project – but they do! All of the mothers in the village want to come participate now. They all want to learn how to help their kids grow up to be healthy and strong.” And then, after a pause, “This many women didn’t want to participate in [village one], did they? In our village, the mothers want to learn, they want to be healthy. Today, every single mother brought money to contribute. All of the mothers made time for their children. They want to be lazy, but they are not because they know that health is important. I think our two villages are different.” Truer words were never spoken.

Letting the porridge thicken

This whole thing leads me to a perennial question for Peace Corps Volunteers: Who should we be working with? People or groups who, like the second village, have the desire and a foundation of skills to help themselves? It certainly seems as though that’s where we can be most effective. Connecting willing and able communities with resources and knowledge seems like a great role for PCVs. But then what about those other communities? Why are they more difficult to work with? Do they really not want to help themselves? Are they “lazy,” as the other villages will quickly label them? Or do they lack the capacity? Should we be focusing on building the abilities of these villages to self-organize and manage projects instead of putting resources into villages who already have these skills?

It’s a tough question. Maybe in the long-run, it is best to focus on villages like the first who can’t do it themselves yet, even if it is more difficult. However, when it comes down to it, when I plan my next project, it’s much more likely that I’ll continue to work with the volunteers in the second village. If nothing else, they show up when it rains.

Katie

 





A Day in the Life

26 09 2012

Most Peace Corps Volunteers write a “day in the life” post. This is mine. I thought now would be a good time to write one, as it’s the first stretch of time where I’ve felt like I’ve had something resembling a routine. It won’t last long, but here’s a look at my daily life in Cambodia looks like for now.

Tuesday, September 25, 2012

6:20 – My alarm goes off. Normally, I’m quick to wake up, but I did not sleep well last night. It seemed as though there was a finely orchestrated, night-long chorus of alternating claps of thunders and mice squeals. When I was sleeping, I had weird dreams. Not ready to get up yet, I decide for the third day in a row that I’ll forgo breakfast.

6:45 – I drag myself out of bed, leering enviously at Tim, who gets to sleep for another hour today. I stumble to the bathroom, where I take a shower, which entails drawing water from a large basin and dumping it over my body a few times. I quickly try to find some clothes. The 10 straight days of rain we’ve had means I haven’t been able to do laundry. I grab a pair of wool pants and an ill-fitting button down top because they’re all I have.

7:00 – I hop on my bike. It’s got a flat, but no time to fill up the tires, as I’m running behind already. I, instead, head to the market to pick up bananas, which are my contribution to the feeding session I’m about to attend. From the market, I head to the session.

7:30 – I arrive at the house of one of the village health volunteers, Ibe. Ibe is there, cutting up the pumpkin that will go in the nutritious weaning porridge we’re making for the malnourished kids in the community. After twenty minutes or so, none of the other mothers show up with their contribution so Ibe sends me back to the market, which is about 2 kilometers away.

8:00 – I head to the market, wondering why no one has shown up yet. Today is the fifth feeding session, and usually by this time a handful of mothers have arrived with food or money in hand. “Oh well,” I think, pedaling through the slippery mud, “They’ve given so much more than I expected the past few days. I’m happy to help out today.” I buy 75 cents worth of pork, two carrots, a couple of duck eggs and some rice at the market and head back. When I get back to Ibe’s house, four mothers are there, chopping greens and chatting. I’m relieved.

8:30 – I sit with the women while they prepare the porridge. They won’t let me help make the food, so I instead try to keep the children happy and occupied. I feed each of them at least two or three small bananas while we wait. I play ball with the bigger kids. The mothers discuss everything including what foods make their kids sick, the man in the community who’s cheating on his wife, why learning English is so difficult, and how to get more women to attend the feeding sessions.

9:30 – The porridge is finally ready. I nervously get out my list of names. There are fourteen mothers who are supposed to come with their young children. Attendance was low the first few days, but yesterday we went house-to-house to talk with all the families about their reasons for not coming. I thought we had broken some ground with them, but only five of the target women are here, plus a few others who always come help even though their kids are healthy.

10:00 – The number is up to ten, but we’re still missing some so I scoop some porridge into a container and go to the kids’ houses to deliver the porridge and talk with their families again. I really enjoy this part. After listening to their reasons for not coming – some of which seem more legitimate than others –  I try to negotiate with them, and leave feeling positive about our conversations.

10:45 – I finish the home visits and ride back to my house, hoping to arrive before “the monsters” do. I beat them home, great news. As I enter the house and plop down on our rattan couch, I’m thankful that Tim’s mom recently sent us a package. I dig around in the box, and pull out a bag of almonds. As I throw a handful in my mouth and begin to open my laptop, the kids arrive, ready to study English. I’m hot and tired from the running around, but the kids are full of energy and need immediate supervision.

11:00 – Only six kids show up, so it’s an easier class to teach. We spend 15 minutes coloring in our health coloring books, then talk about words related to family, wash our hands and eat some fruit. By the time they leave, I’m happy for a break.

11:15 – Tim comes home from teaching his hospitality class. We sit on the couch for a few minutes, zoning out as we check our email, Facebook and the news. Then, I head to the small balcony attached to our kitchen. This is where I do dishes.

11:45 – Tim begins to make lunch. Today, we’re having scrambled egg sandwiches, a quick lunch option with a lot of protein.

12:30 – We sit down on the couch again, this time to eat. We stream the new episode of The Office, and relax for the next twenty minutes.

1:00 – Laundry time. I head back to the balcony with a large armful of dirty clothes covered in mud and dust. I hand wash each garment, wring it out, and hang it on a clothes line that’s strewn in front of a patch of fruit trees.

 

2:00 – Emails. Boring.

2:30 – I spend a few minutes lesson planning for the daily English class I teach at the health center. I write out a list of words for a dictation exercise and decide on a conversation activity so the students can practice speaking some more.

3:00 – I arrive at the health center to teach. The usual crew is seated, waiting for me to arrive. There are five students, all staff members at the health center. I’ve been teaching this class since last November, so it’s my longest lasting project. It’s a fun class to teach, and I feel close to this group. Today, the students ask me about “vacation,” “light” and “faded,” words they had seen earlier in the week.

4:00 – I go back home, stopping at a friend’s house for a few minutes to “neeyay lang” (chat). She apologizes for not coming to study with me today and tells me that a patient came to her house, looking for help. The patient has low blood sugar and was dizzy, according to my friend. I am supposed to have a Skype meeting with an NGO staff member in Siem Reap at 4 o’clock, but when I get home I see an email postponing it.

5:00 – It’s time to exercise, but it’s raining. I stare at the sky a while, but decide I need to go out anyway. By the time I leave, the rain has died down to a sprinkle, but there’s a cool breeze. It’s the perfect time for a run. When I head toward the south, I’m greeted with a clear, bright rainbow. On my way back, the fiery orange sun is setting over the palm trees. It’s an idyllic view I never get sick of.

6:00 – I take another bucket shower, just as Tim is finishing up the private class he teaches on our porch each night. I quickly wash the dishes for dinner, and head off to get some work done while he cooks. I work on a document about proposal writing that I plan to post on Peace Corps’ information sharing website. I don’t get much done before Tim brings out the food.

7:00 – It’s pasta! A treat purchased in Siem Reap last week when Tim was there for work. We watch The Daily Show and catch up on each other’s days. We spend some time talking about our own projects and schedules, then decide to start planning our upcoming vacation to the southern part of the country. We poke around on a few websites looking at guesthouses and restaurants.

8:30 – I am exhausted since I didn’t sleep well the night before. I spend a few minutes stretching, brush my teeth and head to bed. Lying in bed, I think about everything I need to do for tomorrow. I’m asleep before 9:30.

Katie





Nutrition Project: Weighing Sessions and Community Research

14 09 2012

The past two weeks have been filled with activities for my childhood nutrition project. After organizing the training for the project volunteers last month, the next steps included (a) weighing all the children under the age of five in the two target communities and (b) conducting community research to figure out what positive nutrition practices exist in the communities already.

In both villages, we found that less than half of the children were considered to be at a healthy weight. That’s the bad news. The good news is that only a few children in each community were severely underweight, leaving the majority to be either moderately underweight or in danger of falling underweight. Hopefully, this will make it easier for us to pull the kids into the healthy category. To help accelerate that process, we also provided vaccinations, Vitamin A droplets and de-worming medication so that all of the children would be better positioned to gain weight.

All of the children who are  not considered to have a healthy weight have now been invited to a series of sessions where we will provide a healthy variety of a local weaning porridge along with some basic nutrition education. The education provided won’t come from textbooks or the internet though. No, the information will come from the community itself. We want to share with the families what their neighbors are already doing to promote nutrition in their households, with the idea that if an average caretaker is already doing this, the others in the community should be able to do it too.

In order to find out these practices, we conducted surveys in each community. The project volunteers and I went to several homes in each village to learn about how the families are currently helping their children to be healthy. Many of the results to the survey are changes that caretakers can implement without spending any additional money: breastfeeding for the entire first two years after birth, rinsing rice only one time while cooking, washing your hands before cooking and after using the bathroom (lowering the chance of illness), helping young children eat. Others might not be possible for everyone, but are attainable for most: feeding young children four or more times a day, avoiding junk food, adding nutrient-dense foods to porridge, continuing to feed young children while they are sick.

Next week, these feeding/education sessions will begin in one of the villages. We will have ten sessions over the course of 14 days. It can be difficult for families with limited resources to help their children gain enough weight to move into the healthy category so we want to help them out with that. Then, by hopefully implementing some of these simple and low-cost practices we’ll share with them, they will be able to maintain their children at a healthy weight over time.

Let’s hope this works! (More pictures here.)

Katie





Reflections on Cambodia: Year One

17 07 2012

 As we near the one year mark of service in Cambodia, I’ve spent a fair amount of time processing the experience. As the days and months pass, I simultaneously seem to understand more and less about the complexities of this country and its fragile future. Although I could never speak with any authority on what Cambodia truly is, I’ve put together the following list of things Cambodia has become to me. I hope it provides insight into this place and the twelve life-changing months I’ve spent here.

******

Cambodia is a friendly smile and a nervous laugh. A “hello,” shouted from the rice paddies. It’s the hushed murmur of “barang” as you pass by, and the demanding “Moak bee na?” from a stranger. Cambodia is a string of small children chasing your bike. And a moto driver who stops to stare.

Cambodia is the smell of urine. Of fermented fish and rotting meat. It’s vomit on a long bus ride or the oniony scent of the country’s most beloved fruit. It’s incense burning near a spirit house.

Cambodia is pork with rice. Soup with rice. Noodles with rice. Cambodia is rice with rice.

Cambodia is the sound of roosters in the mornings and dogs at night. The monks’ rhythmic chanting drifting from the wat. It’s the discordant sounds of a wedding or a funeral. Dishes clinking next door or a baby crying. Cambodia is Pitbull and K*Pop, Karaoke and Prom Manh. It’s that same female voice, shrill and submissive, blaring from the TV. Cambodia is the deafening sound of a monsoon falling on the roof. And it’s a silence, a devastating silence, when voices should be heard.

Cambodia is the one glass eye watching everything you do.

Cambodia is emerald fields and killing fields. Disappearing forests and lakes filled with dirt. It’s a flood that ruins the crops. Cambodia is border wars and broken promises. It’s a billion dollars of aid and discouraging results.

Cambodia is 3,000 NGOs. It’s expats in coffee shops and sexpats in brothels. It’s bodyguards in the most exclusive of night clubs. It’s flocks of tourists, “Tuk tuk, lady,” and markets filled with cheap souvenirs. Cambodia is children begging on the streets. Amputees and orphans. It’s mediocre Western food.

Cambodia is its history. Cambodia is Angkor Wat.

Cambodia is a delicate balance of optimism and fatalism. It’s stories of the Khmer Rouge told in a whisper. It’s cheap beer and men who can’t hold their liquor. Cambodia is rovul taking afternoon naps in hammocks and sipping iced coffee on red plastic stools.

Cambodia is whitening creams and painted nails. Bright colored shirts adorned with lace and beads. It’s flexible fingers stretching backward, feet shuffling as music plays. It’s orange robes or bare bellies. Sampots and collared shirts, or tight tops and miniskirts.

It’s traffic and trafficking. Five on a moto and a truck piled high. It’s tai chi as you cross the street. It’s hanging on for dear life.

Cambodia is bats and spiders, snakes and mice. So many damn mice. It’s monkeys and elephants, lizards and butterflies. It’s plankton that glow in the dark.

It’s protractors and white out. Perfectly straight lines and meticulously taken notes. A sea of blue and white as children parade to school. Cambodia is a head ducked with respect, a face that’s been saved. Cambodia is so many vowels that all sound the same.

It’s squat toilets and no toilet paper. Stilted houses and burning trash. It’s life in a garbage dump, in its most literal sense. Cambodia is open defecation. It’s polluted rivers and a toxic lake.

Cambodia is rice farmers. Factory workers. Small business owners. Cambodia is a yay with a checkered kroma tied on her hairless head. A grandfather speaking French under his breath. It’s a teacher trying to do the right thing. A mother standing up for her community. Cambodia is a seller in the market, giving a discount and a smile. It’s a tour guide, beaming with pride.

Cambodia is exhilarating, inspiring and exhausting.

And, for now, Cambodia is my home.

******

Katie





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:

https://www.facebook.com/media/set/?set=a.2595964142447.145329.1355022833&type=1&l=83207bdac0

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.

Katie