Dr. Kantha was tossing and turning in bed. She was anxiously anticipating the first morning of medical volunteering in the Cambodian seaside town of Kep. She had awakened too early due to jetlag and the uncomfortable sleep in a strange bed of a modest hotel. As she reached to cancel the alarm clock, she thought about whether she had packed enough medical supplies. She also considered the interesting clinical cases she might see, and what might be happening back home in faraway rainy Vancouver. It must be early afternoon there, of the previous day. She decided to put a stop to her wandering mind by getting out of bed, having an early breakfast, and getting ready for the day. She walked outside with a strong desire to breathe the dawn’s fresh tropical air, to get a feel of the town, and to see the places where locals lived before heading to the provincial hospital.
Upon meeting the blowing sea breezes, she paused to tie her thick black hair into a ponytail. The cool freshness of the air made her realize how differently she was feeling now compared to just a year ago. At that time, she was planning this first volunteering trip. She had to save enough vacation time, find an appropriate traveling medical group, receive permission from her work to travel, and allot enough time to read up on the clinical cases that she was likely to see. Older colleagues warned her that she might see some complex cases, many of which she would not be able to treat. The warning did not faze her. Being young and idealistic, she also wanted to dedicate her clinical skills to help people in dire need, beginning at the place where her parents were born. Her life was so much more secure as a newly trained physician compared to that of her parents, who had come as new refugees to Canada when they were of her age. It was such a joy for Dr. Kantha to step foot on the land of her family roots.
On her walk, the pavement by the hotel soon gave way to dirt alleys, where thatched huts lined up on bamboo stilts, some atilt from settling in the shifting ground. Roosters began their crowing as the chirping of the crickets subsided. People were up and chatting away. Some dogs joined in with barking. The sounds of pots and pans and utensils clanging against plates spilled over into the alleys. Occasional whiffs of hot coffee permeated the air. The splashing sounds of people bathing behind the huts could also be heard. Soon she saw people rushing out of their homes. Some were loading their motorcycles with produce, housewares, and trinkets, while others were hauling things in used rice bags on their shoulders. Dr. Kantha was surprised to see that many bleary-eyed children were doing the same. She approached a smiling local woman, who was walking with her two young children, all weighed down by supplies.
“Good morning, where is everyone going so early?” Dr. Kantha asked.
“Ah, it’s the story of our mornings,” the woman answered, her sunbeaten face darker than the early dawn. “We’re not so lucky to have an assigned stall at the town’s market, and so we must go early to claim a place nearby for the day, in order to sell our produce. If we’re too far out from the market, customers are not likely to buy our stuff.”
“And aren’t your children going to school?”
“My kids are helping, because their turn to attend school is only in the afternoon…as is the schedule. Are you from out of town? Your Khmer accent is different.”
“Yes, I’m here to volunteer at the provincial hospital.”
“Ah, you must be from America. We’ve been hearing announcements on the radio about foreign doctors coming to help at the hospital for the next two weeks. In fact, my sister has already taken her kids to wait in line to see you later today.”
“I’m from Canada but the group I’m traveling with was founded in the United States. I’m sorry but I’m not a children’s doctor, and I don’t know very much about them. I only treat women’s problems.”
“I bet you know more about kids than that. Please take some of these bananas and mangoes for lunch,” the woman offered.
“That’s very kind! Thank you very much for the offer. I’ll help myself to just a banana. I don’t have a knife to cut a mango,” Dr. Kantha replied, not wanting to seem ungrateful.
“Then take some more bananas and share them with your colleagues,” the woman responded and handed the doctor a bag containing about a dozen ripe ones.
“Let me give you some money for these,” the doctor insisted.
“There’s no need! It’s enough that you take time to volunteer here…and thank you,” the woman said, as she turned toward a different road with her children.
The doctor continued her walk and soon it seemed quieter, with sparser settlement. She came by a little hut surrounded by thinly planted bushes and heard someone moaning in pain intermittently. Through the trees she could see a girl alone, crouching by the hut with her hands holding her stomach. She looked about twelve years old and had disheveled hair. The edges of her red nightgown dragged on the dirt and kept her well covered. The doctor thought that the girl must be needing to purge parasites, so common in the tropics, as she had read. She walked quietly on to leave the girl in peace.
Approaching the hospital, the doctor noticed a long line of patients already waiting at the entry for triage. The line wrapped around the hospital, at least three blocks long. Many of those waiting were women, children, and older folks. They stood proudly despite wearing weary faces from endless struggle with poverty. A few people with missing limbs—perhaps from landmines—were sitting in makeshift wheelchairs. One man in his prime had shriveled and lame legs from polio, which Dr. Kantha knew to be an easily preventable infection. The sights stirred in her a sharp sense of helpless anger and sadness at the consequences of decades of senseless war. She learned from those at the front of the line that they had been waiting since the night before for the free medical care. They were fortunate that it was the dry season, as there was no roof above their heads.
On entering the hospital grounds, the doctor was impressed that other volunteers had come a day earlier to set up the clinic. There were tents and plastic chairs for different areas for patient waiting, triage, and teaching. They put up clear signage for different clinics in subdivided parts in the nearby buildings. She entered her assigned “Women’s Clinic” and was welcomed warmly by the local doctors and nurses. Everyone was dressed formally. She was happy to see the box of medical equipment and supplies that she had packed for the flight arrived undamaged. She inspected the contents and set up her own working nook. Upon finishing, she began to see other volunteers streaming in.
A short while later, each medical team huddled to discuss the running of the clinic: workflow, requests for resupply, support by local doctors, patient admission, and referral to other clinics. Non-medical staff, called “runners”, would help to direct patients from one clinic to another. Lastly, the team arranged to take staggered breaks. They were glad to hear that the catered lunch would be well cooked to prevent food-borne illnesses. Dr. Kantha offered to her colleagues the bananas that she had received from a local family.
Soon after the huddle, television cameras and interviewers suddenly appeared in the clinics, along with local dignitaries and hospital administrators. Cameramen appeared rather rushed. They were filming many short takes to highlight expressions of mutual respect and gratitude between the locals and the medical volunteers for airing on the day’s news. Afterward, all the volunteers and local healthcare staff had to gather on a stage in the open air in front of the waiting patients for a welcome ceremony. The dignitaries, all dressed in angelic white, took turns delivering illustrious speeches, as the cameras were rolling and the morning was aging rapidly in the hot air. Finally, there was a blessing and reciting of prayers by the local Buddhist monks.
The monks could barely finish uttering the sacred words when a nurse from the triage area called for a doctor to help a child in distress. Two pediatricians and an emergency physician hurried out from the ceremony to see the patient. Their leaving was a cue for organizers to hasten the ceremony to an end, given the urgent needs of the patients. The attendees soon dispersed, and the medical volunteers gathered at their clinics. Dr. Kantha changed into her scrubs and noticed that it was already past eleven o’clock. She fortified herself by snacking on a banana, while waiting for a patient. As she looked out a window, the stage where volunteers had stood was now filled with young children, playing and pretending to make speeches of their own.
Suddenly, the two pediatricians rushed into the Women’s Clinic, carrying a girl in a faded red dress. It was the same child whom Dr. Kantha had noticed earlier crouching by a hut on her walk to the clinic. The girl was still moaning but now looked more tired and ashen. The pediatricians quickly stated that the girl’s illness needed gynecological expertise, and one began to brief her on the patient’s history: “We have an autistic and non-verbal fifteen-year-old who has had vaginal bleeding, thought to have begun this morning, associated with diffuse abdominal pain. The amount of bleeding could not be ascertained. Her menstruation started nine months ago and has been irregular. Her last period was four months ago. She’s had no recent fever, illness, or trauma. She’s not taking any medication and has no known allergies. Both of her parents had died from AIDS, but she herself was reported to be HIV-negative. She’s under the care of her maternal grandparents. Her blood count, infectious serologies, electrolytes, liver enzymes, and serum pregnancy test are all pending.” They added that the grandmother had brought the patient to the hospital. She was asked to wait outside.
Dr. Kantha graciously assumed the care of the patient and began by placing her onto a gurney with stirrups for an examination. The girl looked quite younger than fifteen and her hair had a reddish-brown hue, likely from malnutrition. Her red dress masked the extent of the fresh bleeding and smelled of old urine. Dr. Kantha was about to ask the grandmother to come in to share more detailed medical history, but the girl continued to wince and writhe with increased intensity. With rhythmic grunting, the patient appeared to bear down on her abdomen from time to time. A nurse tried to calm her with soothing words, but the child’s face seemed lost in her own world of pain.
Because the patient was worsening before her eyes, Dr. Kantha palpated the patient’s abdomen and then proceeded to an internal inspection below. As the doctor stooped down to lift the gown, the girl screamed her loudest since arriving in the clinic. With that, her small body forcefully rejected what had been hurting her—the delivery was claret, misshapen, and lifeless. The oval head with fused eyes appeared crunched to the torso with only a discernible line for the neck, the arms were spindly and wrapped sinuously on the torso, and the legs were mere stumpy growths. The doctor had seen such a deformed entity before, too marred with genetic abnormalities to survive—many arisen by cruel random chance and some stoked by consanguinity. She caught the extruded conceptus in time, placed it on the nearby metal tray, and quickly covered it with gauze. But her move was not quick enough. The girl caught a glimpse and shrieked in fright. The overall appearance reminded her of a swollen organ that had forced itself in and out of her…from time to time and without her understanding or say.
* * *
When the patient had stabilized, Dr. Kantha spoke with the grandmother and informed her about the miscarriage.
“What a relief, doctor!” cried the grandmother. “She is not cut out to be a mother, not like the way she is.”
“Do you know what happened?”
“It must be the boys of the neighborhood who took advantage of my girl. They take every chance to tease her and curse her misfortune, because she can’t talk back. Since the start of her period, I’ve tried to keep her safe by making her appear dirty, so that they won’t even think to touch her. Each day before leaving for work, I’d mess up her hair, smudge her face with dirt, and dress her in drab smelly clothes. And yet, the desperate animals stole her innocence!”
“I’m sorry about the situation. I’ll speak with my local colleagues for help to protect her in the future.”
“I do hope they can help, but I’ve learned not to expect much from anyone for my girl. Even the school refused to teach her, with officials calling her ‘uneducable’, to mask their unwillingness to even try.”
“Who takes care of her during the day?”
“It’s just me and her grandfather. But I work most days at the market. He’s been taking care of her at home for the past two years ever since his stroke. He can’t move much on his right side and can only mumble to ask for simple things. He’s often confused and tends to sleep a lot, but he’s able to feed her. She probably wanders off when he falls asleep.”
“Is there anyone else who can help to take care of her?”
“I have extended family, but they all moved away to eke out a living in the capital city. I’m sure they don’t have time for her, not like the way she is.”
“I can tell you that for now your granddaughter seems OK, but I’m afraid that she might be in danger of having the same thing happen again. I don’t know how it would affect her next time. To help her now, I can place her on birth control and make sure the local doctors know to check up on her and to give refills. But the pills won’t prevent her from getting diseases that spread by sexual activities. I’ll let you know about the test results of these diseases when they’re available.” After that, Dr. Kantha continued to counsel the grandmother and introduced her to a local doctor for follow-up.
* * *
Later that afternoon, the grandmother showed up again, this time to drop off some large bags of purplish-greenish milk fruit for Dr. Kantha as a gesture of thanks. Each was the size of an apple but rounder. Because she received so many, she only kept a few in her bag of leftover bananas and shared the rest with her curious colleagues and other patients. As she was handling each wholesome fruit, she saw in its colors the fragility of life of the girl she had helped earlier: the green for her youth and lasting innocence and the purple for her bruises sustained during life in a war-torn place that could not protect its own most vulnerable. Tears welled up in the doctor’s eyes…was this an example of what her older colleagues back home had warned her about? She dabbed her tears, realizing that she could not take more time to reflect at that moment. The day was very busy caring for many other patients with so much need, consulting with colleagues, and teaching medical and nursing students. There were no other emergency cases that afternoon.
* * *
After the long day of work, Dr. Kantha strolled back to the hotel with a few tired colleagues. On a whim, they decided to make a side trip to view the colorful giant crab statue that was erected above the sea. It was a symbol of the traditional cuisine of the town. They were famished and looking forward to a hearty dinner. But instead of speaking about food, the doctors and nurses shared with one another moments of their first day at the different clinics, from happiness to heartache to hope.
A few blocks away from the sea, they came across some barefoot kids, who were reaching high for overhanging milk fruit at a neighbor’s house. The volunteers stopped to watch the attempt. An older girl, about ten years of age and carrying a toddler on her hip, was yelling orders to two younger boys. She told them to climb the fence and to use a curved stick to hook onto the high branches with dangling fruit. The boys tried several times but kept losing their balance and falling off the fence. As they fell, they stirred up the dust on the road, making everyone cough and laugh. Dr. Kantha noticed the failed attempts and offered the youngsters her whole bag of fruit. The kids looked at her in amazement and thanked her. Right away the older girl rubbed a milk fruit on her shirt, bit into it, and offered the soft gelatinous core first to the little boy she was carrying. The thick white sap of the milk fruit flowed, covered his mouth, and dripped down to his bare chest. While they were eating, the kids burst into more laughter at their good fortune.
As she walked on farther, Dr. Kantha turned to glance at the youngsters. The older kids were now sitting down and continuing to eat with laughter and abandon on a side of the dusty road. Only the toddler was standing and not eating any longer. He was looking back at her, his hair tousling in the sea breezes and his arms akimbo, as if to show his newfound vigor from having a full belly that day.
Callen S. Sor is an American-Canadian physician of Cambodian origin. He and his family lived through the Khmer Rouge genocidal regime (1975-1979), after which they immigrated as refugees to the US and Canada. His background as a refugee and in medicine informs his writing. His aim is to explore the hidden layers of human existence in society.
Andrew Szeri paints in watercolour when it rains, in Vancouver.