The extent of Cambodia's poverty

The past two days, I have been back at the guesthouse working on the Most Vulnerable Families List project. Sadly, I do not miss going into the field to administer surveys about water safety. It pains me to see so many families in one day who lack the most basic necessities, and even though I have been a pretty positive person all year, I think that meeting some of the poorest families in Cambodia has forced me to confront reality, and it is not pretty. It is tempting to glorify poverty - to admire the fact that community bonds are stronger here (people have to rely on each other to survive, and when there are few opportunities to make money, it makes for a lot of down-time). Poverty is like a trap that no matter how badly you want to escape it, you cannot.

Yesterday, while a fellow volunteer, Marlene, and her translator Sray Tal were in the field collecting data on water safety behaviour, they came across a mother and her young 5 year old child. The young boy was wimpering and crying because of a large infection that he had on his buttocks. It had been there for about a week, and was apparently a recurrent infection. But because the mother was extremely poor, she could not take the child to the health centre. What parents usually do in this case is try to get a willing neighbour who owns a motorcycle to take the child to the health centre, located usually about 4km away (but can be as far as 10km away). But because everyone is poor, the mother would end up having to pay for it some way or other, and category 1 (extremely poor, vs. Category 2, which are very poor) families on the Most Vulnerable Families List have less than 13 cents US to spend per person per day. A moto ride to the health centre costs on average 1 USD. You can imagine the giant dilemma this mother is facing.

In the end the mother probably consulted a traditional healer who told her to put flowers and herbs directly ont the wound. If they were smart, they would try to at least clean the water first by filtering or boiling, but because many of the families are very poor and uneducated, many of them do not know how to make their water safe to drink and safe to put on open wounds. The water here has E. Coli and dozens of other very harmful bacteria. Marlene and Sray Tal were faced with a huge ethical dilemma, too. Should they just offer a dollar for the family so that they cojuld take the suffering child to the doctor, or should they call the doctor at the referral hospital to send the ambulance (in which case the family would be charged)? On the advice of the supervisor of our program, Rebecca, Marlene and Sray Tal decided to let the family be, on the basis that Marlene and Sray Tal could not be handing out money to all the families they came across that required medical attention - that would be nearly ALL of them.

Another reason why the mother had chosen not to take her child to the hospital was because the child was afraid of the hospital. This is not surprising considering that healthcare at the public hospital and other public health centres here is quite dismal (poorly staffed, poorly equipped, lacking drugs, and no sense of patient care or patient advocacy). Things are changing, gradually, for the better now that the government has a better financing strategy for its public healthcare system.

One of the biggest barriers to care for the poor is, very simply, poverty. When you are poor, you cannot just take your kid to the health centre. You have to take time out of your work day to look for someone who owns a motorcycle to take you there. You have to pay for gas for the motorcyclist. And when you get to the health centre, they may refer you to the referral hospital because they aren't adequately equipped to take care of your problem. Then you have to pay again to get to the referral hospital. And all the money that you spend may be two or three times the amount of money you need to spend on the family for food for one day. You then either have to pay back your debt through labour, or by selling some of your property.

It is so difficult to get out of this cycle of poverty. And the sad thing is that there are many bright young men and women in this country who are trying to get out of it, like the talented translators that we work with to get our research done in Kep province. But unless you win a scholarship or want to work for NGOs the rest of your life, in Kep province, there are very few avenues for you to make a decent amount of money. It is difficult for me to be optimistic when I am reminded of this every day.

There is so much need in the world. We need more people to put their heads together to figure out how we are going to solve this problem of worldwide rural poverty. I hope that my MVFL documentation project will help alleviate some of it by encouraging the government to invest more in the poor, and to encourage more governmental sectors and NGOs to specifically target the poor with their programs and services as a way of improving the quality of life of everyone in the country.