On Friday July 20th 2007 Margaret Blackshere and
I learned two important realities of Cambodian
rural life in the village of Lvea Choum. The first
lesson: minor injuries can turn fatal very quickly
in the Cambodian countryside; and the second: aid
provided to alleviate these situations doesn't help
if it is inaccessible to those who need it.
We visited a tiny one room thatched hut where a woman lived with her 19 year-old daughter. This daughter was ill from a cut on her hand she had gotten while planting rice the week previously. Following the mother's gaze, we saw a young woman lying in a hammock under the shade of a larger house on stilts.
Margaret made a beeline for the young woman in the hammock. From a distance I could tell the young woman's situation was serious by the way she limply held her blackened, swollen hand. I approached her and was able to take a closer look. Her middle finger had almost tripled in size and there was puss oozing from the wound between her fingers.
Her name was Chenla. Her mother had spent all their money on a traditional healer. The healer had applied a blackened paste of herbs over the entirety of her hand. It had failed in preventing the wound from turning septic. It was clear to us that if she did not get medical attention Chenla would lose her hand or quite possibly her life. It took some convincing to persuade her mother to let us take her into the provincial town 15 minutes away and go to the hospital. We would pay for it, Margaret assured her. They could make her better, she said. We could go right now.
Agreeing, her mother quickly got their belongings together: a pillow, their insurance card. An insurance card? Yes. They had an insurance card from a non-governmental organization, but hadn't used it. It claimed to provide the cost of medical care as well as transportation to get to the hospital and food during a hospital stay. However, the mother and daughter did not have money for transportation to the hospital, no phone to communicate their situation to any organization, no knowledge of the services the hospital provided and a fear of being ill-treated in a hospital after having used traditional remedies.
It was clear the obstacles they were up against as we guided the young woman into our van, her arm in a sling. Her mother was rushed and nervous from being pulled unexpectedly into an unknown situation. Margaret sat close to Chenla, reassuring her with smiles and attention, repositioning the large barrette clasping Chenla's braid so she could comfortably lean her head against the seat to rest. Chenla said nothing. She was stoic. She was in a lot of pain.
We arrived at the referral hospital, which looked deserted and sad. I worried whether the hospital had the medicine to treat her or a competent doctor to attend to her. We were guided to a room in the back of the hospital labeled "Wound Dressing Room." Chenla was given a bucket of antiseptic water and some gauze and was instructed to clean her hand herself. She winced as she rubbed the black tar off her submerged hand.
The vice director of the hospital came to check on her. He only spoke French and Khmer so we patched together a conversation with the help of our translator via mobile phone. The conversation we had with the doctor was a scary one. He said he had not seen an infection as bad as this one. He did not know how long it would take to treat. If the medicine did not help the infection her whole hand would have to be amputated. But first they would try the medicine.
Chenla was given pills to take. Naked pills: no printed instructions, no indication of what they were. She was given pills but no water with which to take them. I ran out to our van to get her some water. We realized that we could not stay with them all night. We tried to figure out what the two women needed for their indefinite stay. I went with the mother across the street to a stall to purchase the provisions she would need for her stay.
By the time we returned, Chenla had been moved to a vacant space in a room with 10 beds. The eyes of all the patients and their caregivers where fixed on this new arrival trying to puzzle out the relationship that existed between her and Margaret. Chenla's mom went to work setting up their new supplies and going about the business of caring for her daughter. Margaret reported that during our excursion across the street, Chenla's hand had been lanced to drain some of the puss, which seemed to relieve some of the horrible pressure. Chenla's hand was now wrapped in gauze and her mother placed a wool blanket over her sweat-drenched daughter. Chenla and her mother remained in the hospital for a week and a half of treatment until her hand healed and they returned to their village.
The tragedy of this story is that although aid was provided, it was inaccessible to this mother. She had spent all her money on a traditional healer rather than being able to access the existing opportunities for the care she needed to save her daughter's life. This story stands to remind us that how aid is implemented is just as important as the aid itself.