I was delusional in Siem Reap. My self-medication story.

The year was 2015 and I had come down with a terrible stomach bug or sickness. Probably triggered by dehydration. I was staying in a small guest house. On the tuesday night I went to bed at 9:00pm and I never woke up until 9:00 am, not 12 hours later: a full 36 hours later.  I still felt groggy, and I needed some kind of suitable medication, so I got dressed, went downstairs on wobbly legs, and found a tuk-tuk to take me to a Pharmacy.

I didn’t speak Khmer and the staff were having trouble with my Kiwi accent. The answer was to let me make my own selection. I never expected the results.

When I went in the three staff were stocking the shelves and chatting lightly.  One of the young women came to the counter and asked if she could help.  I tried explaining about my upset stomach but also my headaches and the alarming 36 hour blackout.  In my rambling kiwi accent however, I probably sounded drunk, I couldn’t convey what sort of medication might help.  What did she suggest?

The assistant kindly invited me around to her side of the counter and gave me the freedom to find the medication that I needed. There was a whole wall of unfamiliar bottles and creams and boxes.  here’s where my problems multiplied.  I’d forgotten to bring my glasses.  The labels all looked like a blur.  I tried my best to make words from the fuzzy shapes.  I could see from the names that many prescription drugs were made in India, and reasoned that these were probably knock-offs of well proven western medicines.

I looked for anything that might relate to stomach, or head-aches or fever.  If you use Dr Google you’ll know the same feeling.  You start by typing in a brief symptom, a sniffle, and before you know it you’re scrolling through the awful possibility of leprosy or gangrene.

My fuzzy-eyesight obviously took me to these same uncertain places, right here in the pharmacy.  Still, after 20 minutes I felt I’d found two bottles of pills that would do the trick.  I paid the shop assistant and went by tuk-tuk back to the guest house.  I was dying for sleep once more so I took two of each type of tablet and drifted off.

Well 12 hours later I woke feeling very weird.  My stomach was settled but I felt, well, just out of sorts.  I felt – I can’t describe it – but somehow strange. An out-of-body feeling. What were those tablets I’d taken?

This time I put on my glasses. Bingo – one of the bottles contained tablets for the relief of upset stomachs.  Smart choice.  But the other bottle? Well it wasn’t what I expected and may well have caused my disorientation.  It was a bottle of female hormone tablets.

PS. Incidentally in 2017 the Cambodian Ministry of Health placed a ban on selling anti-biotics without a prescription.  It seems I was not the only one rocking up to a pharmacy and buying stuff without a prescription. The concern was raised by doctors that if the population kept using enough antibiotics, then the population would lose their resistance to serious infection: a case where less is better than too much.

For another true story from my Brush with Medicine files: click here.

For a local health issue see a report on Cambodia’s fight against smoking: click here .

 

 

 

 

 

Cambodia needs more than wells to achieve universal clean water access

UNICEF reports that 6 million Cambodians do not have access to safe, clean, drinkable water.  The problem is not just lack of wells.

The latest drought across Cambodia has shone the spotlight on the need for clean fresh water.  State initiatives to bring clean bottled water to drought-stricken villages has been useful, but only for the short term. What every Cambodian needs is steady, reliable access to clean fresh water. A recent UNICEF report, dated 2014, calculated that 6.3 million out of Cambodia’s 14.9 million population lacked access to clean drinking water. The problem is, in particular, a rural problem (80% of Phnom Penh’s population has access to clean drinking water,) and the main reason for the problem – the report stated – was that the Government has simply made other developments a higher priority. New roads have higher priority than access to water.

• Some 40 percent of primary schools and 35 percent of health centers in the country do not have access to safe water and sanitation.
• The lack of access to clean water leaves Cambodian children vulnerable to diseases such as diarrhea, which is the second leading cause of death among children under five, according to UNICEF.
• According to WaterAid at least 380 children die each year from diarrhoeal diseases caused by unsafe water and poor sanitation.

Since 2014, according to international aid agency WaterAid there is now a national strategy, outlined by the Government, of reaching universal access to clean water by 2025: an objective that will not only play catch-up with the 6 million who lack adequate water supplies today, but will need to also reach the expanding population projected to reach at least 17.5 million by 2025.  Can they achieve this?

The digging of wells is the main solution in the rural villages though for the cities the provision of mains supply water is the main emphasis: treating lake, river sourced or well-sourced waters with full filtration systems as well as chemical treatment such as flouridation or chlorination.

Compounding the problem is the presence of two hazards in the ground and surface waters usually drawn upon by villages.  One hazard is naturally occurring arsenic: an issue that affects the whole Mekong delta region.  On this front Cambodia’s official ‘acceptable’ limit is 50 parts per million – in contrast to 30ppm in most Western countries.

An even more significant hazard is the presence of TTCs (thermo-tolerant coliform bacteria). For these bacteria, water treatment is needed.

Today in the face of drought, now and in the future, the provision of wells is a laudable initiative, and their are many agencies engaged with this – and worth supporting. My friend Savong has helped many well-building projects in rural Siem Reap.

But Cambodia also needs more reservoirs to effectively store water gathered during peak rainy periods and create a top-up for groundwater which, many experts believe, is sinking significantly.

The more wells or holes dug into the groundwater, the more pressure it loses causing well water levels to drop. That’s according to Mekong River Commission technical adviser Ian Thomas as reported in the Phnom Penh Post, last March 4th. A February Stanford University study found the more wells Cambodians dig, the harder it will be to extract water.

The building of reservoirs, (Angkor’s  East and West Baray are good examples from 1,000 years ago,)  would provide greater eco-stability for farming, fishing, and general water supply.

But for now, reservoirs and wells are just the start. Treating the water is also necessary. Water filters are a big part of the story. If you are supporting a water project, ask about the need for water filtration and treatment.

• Sixty dollars will by a good basic bio-sand filter via Water for Cambodia.
• Or Ceramic Filters, (they look like clay pots,) which are also recommended, are available through Resource Development International – who also supply water testing kits if you are worried about arsenic levels.

Further reading in this blog:

For more on the politics of water in Cambodia Who owns the Mekong? The intricate politics of water.

Also about the 2016 Drought

For other Facts and Figures about Cambodia

 

 

 

Teen sex in Cambodia – a challenge to local standards

Nightclub – Phnom Penh.

Cambodia is a very conservative nation when it comes to teen-sex; and that is quite amazing when you consider the sheer youth of the nation. In the West a series of sexual revolutions took place when the post-war generation hit their teenage years around a time we conveniently refer to as Woodstock. Teen-sex, or extra-marital sex became normalised, and one usually explains that in terms of demographics, the boom in numbers of teenagers, the media and increasing media freedom – as well as a drift away from formal religion. Economic and transport freedom – teenage ownership of cars – further loosened the strict standards that may have been laid down by a previous generation.

In Cambodia the underlying recipe is the same, but on steroids. An exploding population of teenagers, a conspicuous rise in transport freedom and nightclub venues aimed at young singles, the rise of western-styled media – all must be straining the Buddhist standards that remained intact despite the experiment conducted by Pol Pot to shut down the influence of family and of religion.

I first considered this dynamic when I visited, strangely enough, a crematorium in Bakong, back in 2007.  The pillars of the main structure were painted by monks who had depicted in their mural the cycle of life: on one pillar, infancy. On the next, childhood and the school years. And so on, until the last pillar which depicted old age. It was a piquant elegy about life and death, as poetic as any scripture.

But what caught my eye was a piece of graffiti, written in English on the pillar depicting a young man and woman in love. “I miss you,” it said. “I miss you so much.”

Who had written this? Surely this was the message from a young person: who else would write in English, a private language in the traditional Bakong village neighbourhood? A boyfriend, perhaps, had died. Or a girlfriend. The ache of that graffiti message was palpable. A last farewell at a crematorium. A plea through the gates to eternity.

Is teenage love common I wondered.  Are there millions of Romeo & Juliet stories being played out in towns and villages throughout Cambodia?  Does society frown on teenage love?

Recently I saw some figures from the official, Government sanctioned Demographic & Health Survey which is an amazingly comprehensive public health document. In it are the figures for median age for first intercourse – for females and for males.

The median is the age by which 50% have had sex, and for women age 25-29 their median age of first intercourse was 21.4 years. It is almost 21 in the rural areas, and closer to 24 in the big cities.

This age is more or less steady compared to the median age reported by women 30-34 (20.9)  or 35-39 (20.3) or 40-44 (19.9) or 45-49 (20.6 years.)  It varies slightly with regard to educational attainment or wealth level.  Those with a low education for example, report having has first sex around 2.6 years earlier.

For men the figues are more or less the same though generally 6 months later than females. Age 22 is the median age for first sex.

Another measure: at age 19, some 83% of females have never had intercourse and at that age 93% of males have not had sex.

In the USA, by contrast; and here I lift directly from Wikipedia:

According to the US Centers for Disease Control and Prevention (CDC), in the year 2007, 35% of US high school students were currently sexually active and 47.8% of US high school students reported having had sexual intercourse. This percentage has decreased slightly since 1991.

My country, New Zealand has an unenviable record for teen pregnancy which is regularly cited has the highest incidence in the world. The NZ online Encyclopaedia Te Ara reports figures from 2001 and seems quite pleased that ‘less than 20% of 13-year-olds’ have had sex.  That’s a figure that would make Cambodians shake their heads in dismay.

Since the late 1960s most New Zealanders have had their first sexual experience during their teens and outside marriage.

Perceptions that teenagers are having sex earlier and earlier, and that more of them are doing so, are unfounded. In 2001 less than 20% of 13-year-olds reported that they had had sex. The likelihood of sex rose with age, and about 50% of those aged 17 and over reported having sex.

Compared to Western figures, young Cambodians are relatively chaste. However there is concern that this picture is volatile, and with more blatant sexualised media, and more teen freedom (money and motorbikes) not to mention the changing social architecture thanks to mobile phones and social media: these are the seeds of a big change ahead.

These issues are of concern to directors of NGOs that educate and care for students. My friend Savong has recently published an updated ‘rules of behaviour’ for students under the care of his organization. Savong makes it quite clear that students need to refrain from forming girlfriend/boyfriend relationships that derail the students’ progress through to higher education.

If you find my articles interesting, please feel welcome to Follow this blog by pressing the blue button up near the top left.

For an article on child labour in Cambodia, click here

 

 

 

 

 

 

The intricate politics of water

Rivers are commonly referred to as the lifeblood of nations. Rivers provide water but also sustain plant and animal life both on the banks and beneath the surface. Fish travel up rivers to spawn. Rivers feed the ground-water supply and help farmers keep an equilibrium between wet seasons and dry.

But who controls the river? What rights do various nations have when the river flows through their territory? One only has to look at the fate of the Colorado river in North America to see the downstream impact of up-stream actions. Thanks to the water consumption of California, the mighty Colorado no longer even makes it to Mexico where it flowed for thousands of years.

What if China did the same to the Mekong that flows through Cambodia, Laos, Thailand, and Vietnam?  Pictured above is the awesome Jinghong dam in China, built to generate much needed electricity. But this dam can effectively turn-off the Mekong tap, and limit the river flow – affecting water supply and fishing.

China is not alone here. Since 2006 some 11 dam sites have been nominated for hydro dam construction in Thailand, in Cambodia and – with 7 slated projects – in Laos. Everybody wants a slice of the resource.

In attempt to co-ordinate management of the Mekong resource, Cambodia, Laos, Vietnam and Thailand governments formed the Mekong River Commission with which Myanmar and China also confer. The MRC was formed in 1995, but this last year has faced serious internal problems through lack of funding and very divisive disagreements between the member nations. In particular, the dam projects planned by Laos threaten to seriously impact the fishing on the river – estimated by the MRC to be an annual 4.4 million tonne catch worth almost $17 billion. That represents around one eighth of the value of the world’s total freshwater fish catch.

Make no mistake, as China flexes its economic muscle in the region, downstream nations namely Cambodia and Vietnam have a lot to lose.  Decreased flows from the Mekong have already led to increasing salination – from salty sea water – of delta flats in Vietnam, rendering farms and local freshwater fisheries unsustainable.

This year, in the face of the SE Asian drought experienced by the Mekong nations, China scored a diplomatic coup by announcing to the MRC that the Jinghong dam would release a substantial flow of water to alleviate the drought situation downstream for one month to mid-April 2016.

It was a generous gesture, but it was also a reminder that what can be turned on can equally be turned off.  The Mekong River, more than ever before, is up for grabs.

• For more about the 2016 drought in Cambodia click here
• For more about the shortage of safe drinking water in Cambodia – Cambodia needs more than wells to achieve universal clean water access.

If you find my blog entries informative and interesting, please click the FOLLOW button. You are welcome to join me in my discovery of this complex nation.

 

 

 

Drought Conditions hit Cambodia

In dealing with Cambodia since 2004 I’ve witnessed some extreme weather – notably flooding during monsoon season when roads, and our school grounds, turned briefly into lakes.  But in 12 years I’ve never seen anything as extreme, climate-wise, as the current drought which has taken parts of Cambodia to an emergency situation.

The drought is affecting Vietnam, Thailand and India also and has signs of turning into one of greatest weather-induced catastrophes of our times. Cambodia authorities declared drought conditions on March 29th, and since then 7 weeks have passed by with scant rain and scorching 40 degree temperatures.

Areas as disparate as Battambang in the west to Kandal Province, just South of Phnom Penh, where lakes and small rivers have dried up, to Stung Treng Province in the North, bordering Laos, have suffered.  Effects of the drought have included:

• More than 300 farming buffalo have died
• Tonnes of fish are dying in rivers and lakes – more than 60 tonnes of fish in the last week of April
• Ground-water levels at unusually low levels after three relatively dry years
• Wells drying up – an estimated 2.5 million people facing acute water shortages
• Regions where schools are closing due to lack of water
• Rising risk of disease due to increasingly poor water quality – including risks of cholera.

What is causing the drought? Meteorological conditions, namely a large El Nino weather system are directly to blame, but compounding the problem have been extremely poor environmental choices throughout S.E Asia including Cambodia. Massive losses of forestry have hurt normal rainfall patterns while dams have altered the normal aquatic patterns affecting fish life.

I’ve noted in previous blogs that Cambodia is particularly vulnerable to disasters – not just because of the disasters themselves, but also due to the poor disaster relief infrastructure. Farmers are currently losing everything – their crops, their animals and their meagre cash reserves, while there is little or no official welfare system established to assist them. According to the Guardian newspaper, some 19 provinces have been classified as in a serious condition requiring “immediate intervention” from the government which claims that “ministries, military units, NGOs, and everyone capable of helping” have been asked to step up. There has been publicity around delivery of bottled water to drought-hit villages, but little in the way of long-term solutions. And so far authorities have held off on making an appeal for international aid.

Right now everyone is praying for rain. May is supposed to be the commencement of the 3-month rainy season during which 75% of the annual rainfall normally occurs, but according to the Xin Hua news service the present conditions are forecast to last at least until July.

• For more about the shortage of safe, clean drinking water in Cambodia – Cambodia needs more than wells to achieve universal clean water access.
• For insight about the politics of water in Cambodia – Who owns the Mekong?
• For more about Cambodia’s lack of resilience – click here.

 If you find these blog entries about Cambodia useful and informative please click the FOLLOW button.  You are welcome to join me!

A teenage tragedy – a sad loss of life

This week the children at our school were rocked by the sudden death of one of their fellow students, a teenager who took his own life one evening. Nobody saw it coming. Today as I write this, there is a full-scale funeral for the boy and those attending include fellow students, teachers and other staff who have been involved in the care and teaching of this young man.

The event may have been triggered by another suicide, also involving a teenager from the same village one month earlier: I can’t be certain of this.

The sad news prompted me to research the incidence of suicide in Cambodia, and to examine some of the attitudes surrounding this.

Ten years ago when I first came to Cambodia I asked about attitudes to suicide, thinking that perhaps Buddhist attitudes might be more accepting of this, compared to Western religions. Not so: it appears all major religions in the world are agreed that taking one’s own life is a tragedy best avoided.

But avoiding suicide amongst teenagers is a difficult thing. My own country, New Zealand, holds one of the worst teenage suicide rates in the world, and in 20 years I’ve not seen any convincing program to deal with this problem. More likely, the story is more granular and complex – with many many good interventions effectively saving lives but going unreported while meanwhile a bigger avalanche is still occurring.

In Cambodia psychologists have in recent years turned their attention away from the stress disorders resulting from the Pol Pot years, and started to focus on the issues faced by the burgeoning young generation aged under 30.

Here the figures get murky. According to government reports, for example in 2013, there were some 600 suicides in Cambodia, up by 13% over 2012.

But these figures are hotly disputed by university psychologists who have studied the issue in depth. They say 600 is a mere fraction of the real numbers. One issue is the lack of autopsy and official record-keeping associated with deaths in highly rural Cambodia.

And as a researcher I know how hard it is to otherwise calculate these things. You can’t just conduct a survey and ask people on a scale of 10, how close they have come to taking their own lives. Ms Sek Sisokhom, head of the Royal University of Phnom Penh’s psychology department suggests that the government figures woefully under-report the true state of affairs. Using rigorous research, and representative sampling, her research calculates that among adults the rate is more likely in excess of 40 individuals per hundred thousand (42.35 reported suicides per 100,000 of the population in 2011.)  This puts Cambodia right near the top of the ladder in terms of global figures, unfortunately. See Phnom Penh Post.

The under-reporting, which is clearly happening, reveals something of the attitudes towards suicide – and a lack of concerted effort to do something to prevent young people taking their own lives. If society was committed to solving the problem, then it would begin by measuring it and looking for patterns.

As it stands, the existing research reveals the following:

• Young people under the age of 25 are the most susceptible to thoughts of suicide.
• There is a clear gender split – young men much more likely to contemplate suicide compared to young women.
• There are societal causes implicated including unemployment and poverty.

Psychology studies in Cambodia (see also) conclude that young people are poorly equipped when it comes to discussing the problems, or knowing where to go should they need help. Like young people in many places, the young adults of Cambodia tend to bottle-up their feelings, often hiding their true state of mind.

As social workers worldwide recognise, suicides can occur in contagions – with one event at a high school triggering others. Whereas western schools are, more and more, putting grief counselling processes in place – or having access to these – the same is not true in Cambodia. Yesterday I spoke about this with a friend of mine, Royce, who actually comes from the same village as the boy took his own life. He recommended that we get in contact with an organisation, an NGO, that specialises in social counselling: TPO is the organisation, and while their main focus was historically on postwar stress disorders, their services now include grief counselling.

This week is very sad, but we should use the opportunity to increase our understanding of the issues, and raise the level of grief counselling intervention to help prevent another contagion.

• See also the program of a recent Suicide Prevention Conference in Cambodia.