Kathen - កឋិន

I scratched up another Buddhist ceremony last week as part of S - my khmer teacher - one woman attempt to convert me to Buddhism.

This one Kathen - កឋិន is a monk robe giving ceremony which happens once a year & gives the donor a better chance of a good life when reincarnated. The robes were $45 which is significantly more than any items of clothing I currently possess. The date was set for Wednesday so I agreed to meet S at 3 pm for an hour to do the ceremony.

On the day at 2 45 pm I received a frantic call from S to tell me that the ceremony was starting sooner than expected & I must come immediately. I started to pack my things up before cycling the 5 minutes to her Pagoda when I received a second even more frantic call from S telling me it had started already & she was going on with out me. It was 2 46 pm. This is Cambodia.

By the time I arrived at the Pagoda they were on the third & final lap of the pagoda. S was carrying the box of monk robes on her head & beaming like a happy buddhist, safe in the knowledge that a good next life was in the bag.

The thing that struck me about the large procession of people all looking for  better reincarnation was that they were predominantly women. Perhaps Cambodian women have, I mused, more reasons than men to improve their next life.

S found us a spot by the door where everyone coming in & out, as well as all around could stare & gawp at the only barang in the crowded Pagoda. A woman gave me a flier for something which I took smiling & then immediately gave to S. S started rooting around in her bag for Riel. The woman was asking for money for another Pagoda & spent the next 2 hours milking the crowd. "Give only a little" S hissed at me as she slipped a 500 Riel note into the flier & passed it back to me. Apparently you can't reach enlightenment in Cambodia without a lot of money being forked out first.

The master of ceremonies started to call out names & pairs of people picked their way through the packed Pagoda to offer the robes to the monks sat at the front beneath the huge gold Buddha.

Concerned I asked S - I won't have to go up there will I?

S smiled reassuringly back at me & shook her head & told me to wait.

I got given a bottle of water.

I made friends with a 2 year old boy eating dried banana who had a similar vocabulary to me. He enjoyed showing me his half masticated banana.

My legs went numb.

My back went in to spasm.

I marvelled at the callouses on the ankles of the old khmer women who have spent a life time sitting on hard floors with out the soles of their feet showing.

I admired the variation of the traditional Pagoda dress of sampot & white shirt. Some women had intricate sequinned lace tops, other beautiful embroidered cotton blouses. Some Sampots were traditional khmer silk, other Laos or burmese pattern. All were in their Sunday best.

Out side the Yays gathered, drank tea, chewed betel nut & the fat.

I felt the familiar feeling of inner peace wash over me as I stared up at the intricate paintings of Buddha's life story on the ceiling, felt the cold tiles under my numb legs & inhaled the incense & talc ladened air.

"ESTHER WILSON" the man with the microphone shouted.

I snapped back to reality. S had already leapt up & was nimbly tip toeing toward the front of the Pagoda. I sat literally paralysed as it would take at least 5 minutes to get my legs working again.

"ESTHER WILSON" was called again.

The Yays all sat around me started to mutter - go Esther Wilson, go!

I looked imploringly at S - You said I didn't have to go up?

She smiled serenely & told me it didn't matter.

"ESTHER WILSON???"

The Yays all looked at me accusingly. "Tow - Go!"

"I am shy" - I replied

Ohhhhhh - they all nodded in agreement - Ean - they murmured. The barang is shy.

Meanwhile S got to give her monk robes & buy a few more future life credits.

There then was a long session of buddhist chanting which at one point sounded like an ambient track I once owned when I was at university. I felt awkward about recording it until I saw one of the monks get out his smart phone & film the proceedings.

The lab lady from the hospital saw me on the way out & amused asked S what I was doing there. Every one looked very happy, it must be nice to believe that you have secured yourself some good karma for the next reincarnation.

Why didn't you come up with me to give the robe? S asked me crossly when we got back to her house.

You said it was ok for me not to! I replied defensively, bewildered by her sudden change in mood.

I wanted to do it with you, next year you come back & we will feed the monks AND do monk robe ceremony together, both. Every year in this life so we will be together in the next life.

But I don't believe in any other life but this one, I deferred.

The sharp intake of breath from S was adequate reproach.

I gave her a kiss & apologised for being a constant source of disappointment & worry to her, she is after all my Cambodian mother.

Then I went back to work, safe in the knowledge that I would need an awful lot of ceremonies or Bon to ever be any where near a good person.

Very Superstitious, one more thing to say...

Just a post script about superstition & health in Cambodia. Follow the link…...

After the Flood

There has been bad flooding in Cambodia this rainy season which a couple of weeks ago resulted in a Dam near my home being breached to stop the reservoir bursting its banks. 

A Khmer blog said that the villagers that had lost their homes had said that "the authority told them that their houses are deliberately flooded because the land in this area has already given as a concession to the company and they company tried to evict them along time ago but the people refused to leave. Now they deliberately flooded their houses in order to evict them from the land." 

My friend went last week with a group of people to hand out tarpaulins & rice to the displaced villagers & help make temporary shelters for them. This weekend my assistant wanted to go to see the lake - it felt a little like disaster tourism but as we had lunch at an exorbitant price at least we gave back a little to the local economy. I have never visited the lake before - it is a 1 hour moto journey from my house - therefore I have nothing previous to compare what I saw to but suffice to say you don't need to have visited a place before to recognise devastation.

 Flooding all the way to the road we travel on once a month to the border hospital

Deep enough to necessitate the white 4 x 4 car we go in.

The lake still beautiful despite a UK-like grey overcast day & no longer threatening to burst its banks

The path the breached water flow took through a village taking with it over 50 dwellings

Life after the flood

The expensive lake monster we had for lunch - looking at the teeth on it we didn't really fancy a  post prandial swim 

Historian

At medical school we were always told that there is no such thing as a patient who is a poor historian just a poor history taker. With this doctrine still ringing in my ears in Cambodia I thought that it was just my extremely poor language skills & things getting lost in translation, which gave me the impression that Cambodian patients are really dreadful historians. I have recently had to revise this opinion.

My khmer teacher, S, who speaks reasonably good english & is an educated woman asked me for some medical advice. In khmer she told me she had a sore throat.

How long for? I enquired.

Since you left for Sampov Luon - came the reply. So this was about 6 days.

Where is it sore exactly?

THROAT! she shouted as me in khmer.

All over, one side, upper, lower???? Could she maybe point to the place? I persisted

Silence & a very blank stare. So I asked again but this time in khmer. Still a blank stare. So I demonstrated pointing to either side of the throat on the outside, then opened my mouth & pointed to my tonsils & finally pointing outside but lower down, by my sternal notch.

THROAT! she yelled at me in khmer again. It is not uncommon for patients to present with unspecified character of pain "choo" all over their entire body so I should perhaps have been grateful we had an area.

What brought the pain on? I asked her, changing tack slightly. Have you had a cough or fever with it? Can you swallow ok?

NO NO NO! she shouted back at me & then disappeared into my bathroom.

She came out a few minutes later & flipped her head back like a cartoon character, opening her mouth in such a way that all could I see was the roof of her mouth & her false teeth.

THROAT - she yelled in khmer at me whilst performing a semi-limbo for me to inspect her dentures. Well at least I could surmise she had an airway, was not hoarse & at 63 years of age was still very nibble.

I felt for swelling or lymph nodes in her neck - she shrugged me off - THROAT! she screamed at me.

Using another favourite history taking trick of mine & the very last of my patience I asked her what she thought the problem was?

"I ate some fish & the next day I had a sore throat, maybe I scratched my throat" she responded in perfect english.

Which side? I asked

She stared at me impassively.

Normally when you get a fish bone stuck or scratch the throat it will be sore in one particular place that people can point to from either in or out side.

THROAT! - she replied......

I have a theory that because in the UK even child birth is medicalised any woman having a baby will have some access to antenatal & prenatal clinics & medical care. Most children are immunised & there are scheduled follow ups for children with community health. Doctors used to go into schools. Dental & optician services used to be provided for free. All of this meant that even if you were a perfectly healthy individual you would still have some contact with free health care services & health surveillance programmes. This meant you became practiced in the questions health workers usually asked. There is health promotion & education in the media, medical dramas & documentaries on the TV all of which provide the language to communicate with health workers. Parents teach their offspring.

Doctors & nurses in the UK talk to patients & depend on their answers to help them make a diagnosis. If you speak to a doctor in my country or ask them a question generally they don't yell at you, tell you to leave there clinic & refuse to treat you again, generally not......

So although I do agree that it is up to a doctor to get a history from their patient there is also something within certain cultures that trains patients to be better historians. Mainly I believe that this is as a result of a decent & robust public health system & professional health workers.

S went to get coined the following day & now feels much better. She is still unable to pin point for me where exactly her pain was but since it has disappeared I thought it was best just to let that one drop.

Saving face

In Asia saving face is culturally pretty big. I am told that it is a form of respect towards others & helps keep the peace. Personally I have only ever experienced it as a method to lie, cheat & avoid responsibility and my face has certainly never been saved as a result of it. It seems the phrases "I do not know", "I am wrong", "I did not do", "That was my fault" & "I am sorry" are not synonymous in cultures that 'save face'. I will give you a very small, non-medical example of this phenomena. 7 am - I call the water man to deliver a new container of water. 9 am - My khmer teacher is concerned that maybe the water man did not understand my request (it has after all only been 30 months that he has been receiving calls from me), so she calls him to check that he is coming - 'in a minute' she is told. 5 pm - I call my teacher to ask her how long is "in a minute" and she says she will call the water man to see if he has forgotten about me. 5 05pm - She calls me back to say that he delivered the water this morning. I tell her maybe he is confusing me with another house as I still have an empty container of water with the money waiting for replacement. She seems pretty certain that he has delivered to my address. I am also pretty certain, being that I am actually AT my address that he hasn't. She says she will re-check with him. I tell her it is not a problem if he has forgotten but it would be good if he could deliver this evening as I have no water in my house. 5 10pm - Second call from my khmer teacher telling me I am mistaken as he has told her he has definitely been to my house & delivered a new container of water already. HE DID IT HIMSELF. She is quite insistent that I must be wrong as he has said he has definitely done it already earlier today. Slowly & patiently I explain that I am at my house with an empty water container & the money for a replacement one. It is sitting in the same spot that I left it over 10 hours ago. It is fine if he has forgotten to deliver it but if he is insisting on 2 separate phone calls that he has done it already then he is just a liar. Please wait until 6pm & I will call again my khmer teacher urges. 5 15pm - silently the water man furtively comes up the steps to my house & replaces my empty water container with a new one. I watch through my screen door as he creeps away trying to mute the rustling plastic of the empty container.  I think he is a lying, incompetent idiot who can't even admit to forgetting my delivery & have the decency to admit it or say sorry. Not really sure how this saving face thing is meant to work but it is really not working for me.

The quest to sleep

In an attempt to get some sleep - dogs, monks, karaoke, night time storms, mice have all been conspiring to rob me of my 6 hours recently - I have taken to some desperate measures. These have included moving out of my house - the noise unfortunately just followed me. And purchasing some strong sedatives to see if I could sleep for more than a couple of hours in one night.

The result is that I have slept well enough but I am now externally blunted. By this I mean I am still, expressionless, muted, move slowly, forget what I was going to say, don't express any anger or irritation. From the outside I look calm if still a little tired - I have dark circles under my eyes as well as multiple bags & wrinkles.

Inside however is a different story - I am beside myself with sleep deprivation, frustration  & agitatation, anxious & negative about my future. My heart feels like it is physically breaking into tiny little pieces every time I think about leaving Cambodia. This internal turmoil causes chest pains, hyperventilation & water to leak out of my disconnected eyes.

Lorazepam would not be my first drug of choice for agitation perhaps NICE should look into the evidence base for a nice cup of tea, a big hug & some sympathy. Can't seem to get any of these in Cambodia however. So I will to find a way to get some sleep via an alternative method which doesn't leave me so brain dead whilst my heart tries to escape from my chest, unrestrained by reason because it's in the hot tub with the lorazepam. 

More by accident than design

J & I have got into rather a bad habit of having to have ice cream after going to the Chinese noodle shop.

Today whilst I tucked into my newly discovered delight of a $2 banana split, which as it is with fruit you can count as one of your 5 a day - I noticed something that made me look twice.

There was a man walking towards us, the khmer restaurant that we go to is a hot spot for glue sniffing street kids & beggars to harass tourists, but the ice cream is great so its worth it! The man walking towards me had an above knee amputation with an artificial leg, which in these parts is not so unusual what with all the mines still being cleared here, but what was notable was his use of a single crutch.

In between mouthfuls of melting ice cream I mentioned to J that it was unusal to see anyone, let alone a Cambodian, using a single stick or crutch correctly but this man actually was - he was holding the single crutch for support in his left arm. Normally people, despite being told by health workers, will hold the stick the same side as the leg with the problem, when in actual fact they should hold it the opposite side for better stability when walking.

I was really impressed by this. My physio friend would also be I thought to myself.

As he walked past our table he then came into view for J to observe his gait.

"Esther" - J dead panned - "He doesn't have a right arm to hold a stick with."

And that is pretty much how it goes here, if you see something that is right it will often be quite literally more by accident than design.