One of the cultural differences that arises quite regularly is the accusation from Cambodians that Barangs/I don't care about their/my family. This can be due to various observations;
a) I am single - a good daughter who respected her parents would have been married & produced grandchildren a long time ago
b) I am living 7000 miles away from all my family
c) We put all our elderly people into nursing homes
d) Being a "strong" western women must mean that you can not care for your children & husband
e) Being educated, capable or having an opinion is unladylike & hence makes you a bad daughter (see a))
In an interesting paradox, often with my western paediatric emergency physician head, I see many Cambodian children who would be on the at risk register in the UK. Not always or even solely because of poverty but more specifically because of parenting practices that seem as strange & neglectful to me as me putting my Grandmother into a nursing home would seem to a Cambodian. For example 6 year old looking after their baby siblings with no adult supervision all day, a 3 year old going alone to the shops to buy food, slapping babies until their skin marks red & they cry - as a sign of affection, letting your 5 year old boy watch violent pornography on your phone (this child went on to sexually assault a 2 year old girl in his village), pulling & pinching young boys penises, traditional medical practices that burn, scar & hurt children with no evidence of cure...to name just a few.
This cultural skew of children at risk has got me thinking about changing the topic for my MA dissertation. Previously I had planned a literature review on whether a Parent deliberately self harming means that their children are automatically at risk (No - as it turns out. Substance abuse & mental health problems with thought disorder - yes). Now I am thinking more about how culture effects society's & individual's views of what is abusive & neglectful and how this impacts cultures that are imbedded in other cultures such as immigrants but also what this means for development & international NGOs working with children.
This was brought home to me this week when I saw an 18 month old child on the Paediatric ward with Severe Acute Malnutrition (SAM). His mother had left him when he was 1-month-old to work in Thailand, after an argument with a money lender she was now in prison. The father had left the family for another woman. The grandmother - with a right sided paralysis from a previous stroke - was left to look after 4 of her grandchildren from her 2 daughters, one in prison & the other working as a sex worker in Bangkok. She couldn't afford formula so had fed him with tins of condensed & sterilised milk. She'd brought him & his cousin in with cough & diarrhoea. C - the youngest of the family - had all the signs of SAM & was so stunned that a 6 month old breast fed baby, a patient on the same ward, was bigger than him. His 10 year old brother was also stunned & malnourished - the whole family was.
He was left to feed himself from a bottle with F-75 - the high calorific formula designed for acute malnutrition. If he sat up or showed any interest he was pushed back into a laying position. He was never held, cuddled, played with or shown any affection. I think even by Cambodian standards we could say this was neglect. A combination of various factors had resulted in this - poverty, poor education, no access to good healthcare, poor livelihood opportunities & PTSD/mental health problems would be in the mix, no doubt.
As we have recently trained on SAM treatment I thought this would be a good opportunity to discuss this case with the staff - but as it turned out this revealed a different kind of neglect. They said that the grandmother was "dirty, stupid & poor" so they could not help her.
However one point that came out from our discussion with staff was that the ward always ran out of BP-100 (a high energy-protein bar) because the MoH don't provide enough. This enabled me to show the staff a photo I had taken of the cleaners son tucking into a BP-100 bar just the week before. There was much shouting & consternation, mainly from a senior nurse who feeds the stuff to her niece also! I do enjoy a bit of lively debate in the work place.
The little boy in question then came in & unprovoked, slapped J really hard on the bum - I wonder where he had learnt that kind of behaviour?! I tried to tell him in my limited khmer to respect J & not to hit as this was bad but he just screamed at me & then ran into a store cupboard. Now I'm not sure what came over me but I thought it would be a good idea to pretend to lock him in the cupboard. This back fired slightly because instead of understanding that I would never lock a child in a windowless, pitch black storeroom, he just appeared completely resigned & begged me to turn the light on. Clearly being locked up in this cupboard was a regular punishment for him, which left me cold.
Ironically the staff on the ward responded very well to me after my exhibition of feigned child cruelty & fully co-operated with the TB follow up I did the next day.
That evening after work during my khmer lesson, I was distracted by thoughts of the neglected, vulnerable SAM child & the overfed, spoilt but locked in cupboards cleaners son.
"បើកពន្លឺ" I muttered, parroting the cleaner's son's plea. S - my khmer teacher - leapt up & turned on the light. My Cambodian mother never neglects me...
a) I am single - a good daughter who respected her parents would have been married & produced grandchildren a long time ago
b) I am living 7000 miles away from all my family
c) We put all our elderly people into nursing homes
d) Being a "strong" western women must mean that you can not care for your children & husband
e) Being educated, capable or having an opinion is unladylike & hence makes you a bad daughter (see a))
In an interesting paradox, often with my western paediatric emergency physician head, I see many Cambodian children who would be on the at risk register in the UK. Not always or even solely because of poverty but more specifically because of parenting practices that seem as strange & neglectful to me as me putting my Grandmother into a nursing home would seem to a Cambodian. For example 6 year old looking after their baby siblings with no adult supervision all day, a 3 year old going alone to the shops to buy food, slapping babies until their skin marks red & they cry - as a sign of affection, letting your 5 year old boy watch violent pornography on your phone (this child went on to sexually assault a 2 year old girl in his village), pulling & pinching young boys penises, traditional medical practices that burn, scar & hurt children with no evidence of cure...to name just a few.
This cultural skew of children at risk has got me thinking about changing the topic for my MA dissertation. Previously I had planned a literature review on whether a Parent deliberately self harming means that their children are automatically at risk (No - as it turns out. Substance abuse & mental health problems with thought disorder - yes). Now I am thinking more about how culture effects society's & individual's views of what is abusive & neglectful and how this impacts cultures that are imbedded in other cultures such as immigrants but also what this means for development & international NGOs working with children.
This was brought home to me this week when I saw an 18 month old child on the Paediatric ward with Severe Acute Malnutrition (SAM). His mother had left him when he was 1-month-old to work in Thailand, after an argument with a money lender she was now in prison. The father had left the family for another woman. The grandmother - with a right sided paralysis from a previous stroke - was left to look after 4 of her grandchildren from her 2 daughters, one in prison & the other working as a sex worker in Bangkok. She couldn't afford formula so had fed him with tins of condensed & sterilised milk. She'd brought him & his cousin in with cough & diarrhoea. C - the youngest of the family - had all the signs of SAM & was so stunned that a 6 month old breast fed baby, a patient on the same ward, was bigger than him. His 10 year old brother was also stunned & malnourished - the whole family was.
He was left to feed himself from a bottle with F-75 - the high calorific formula designed for acute malnutrition. If he sat up or showed any interest he was pushed back into a laying position. He was never held, cuddled, played with or shown any affection. I think even by Cambodian standards we could say this was neglect. A combination of various factors had resulted in this - poverty, poor education, no access to good healthcare, poor livelihood opportunities & PTSD/mental health problems would be in the mix, no doubt.
As we have recently trained on SAM treatment I thought this would be a good opportunity to discuss this case with the staff - but as it turned out this revealed a different kind of neglect. They said that the grandmother was "dirty, stupid & poor" so they could not help her.
 |
| I love this photo as its a shining example of 'best bad practice' - please note 1) Bottle with teat - banned for SAM children as it's difficult to clean, increases the risk of diarrhoea & death as well as interfering with breast feeding. 2) Salt - no salt should be added to the food of children with SAM, even the oral rehydration solution (ORS) is specially formulated to be low in sodium & high in potassium to accommodate the SAM child's electrolyte imbalance. 3) Water - the only fluids a SAM child should have are F-75 & breast milk and ReSomal (special ORS) if they have diarrhoea. 4) F-75 in a cup (GOOD), left out for more than an hour to breed bacteria & increase mortality rates (BAD) |
The little boy in question then came in & unprovoked, slapped J really hard on the bum - I wonder where he had learnt that kind of behaviour?! I tried to tell him in my limited khmer to respect J & not to hit as this was bad but he just screamed at me & then ran into a store cupboard. Now I'm not sure what came over me but I thought it would be a good idea to pretend to lock him in the cupboard. This back fired slightly because instead of understanding that I would never lock a child in a windowless, pitch black storeroom, he just appeared completely resigned & begged me to turn the light on. Clearly being locked up in this cupboard was a regular punishment for him, which left me cold.
Ironically the staff on the ward responded very well to me after my exhibition of feigned child cruelty & fully co-operated with the TB follow up I did the next day.
That evening after work during my khmer lesson, I was distracted by thoughts of the neglected, vulnerable SAM child & the overfed, spoilt but locked in cupboards cleaners son.
"បើកពន្លឺ" I muttered, parroting the cleaner's son's plea. S - my khmer teacher - leapt up & turned on the light. My Cambodian mother never neglects me...
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