by Tara Winkler
The kids sat grimly with their heads down, and we waited and waited. My level of unease with the place—and the effect it was having on the kids—grew until it was intolerable.
‘Jedtha, I think we should come back another time,’ I said, my eyes pleading for him to agree. ‘Let’s come back on our own without the kids, just to ask questions.’
The kids couldn’t get out of there fast enough.
At dinnertime that evening, I noticed that Sinet looked much brighter, but her sister Sineit was sitting alone. She was playing with her food distractedly.
I assumed the sex education class earlier in the day had upset her. I went and sat next to her to find out. She smiled at me warmly—she was a very kind, gentle girl. But she went back to toying with her food.
‘Not hungry?’ I asked in Khmer.
She smiled but said nothing. Not being able to speak to her properly was maddening. I got up to find Reaksmey. I had to know what the matter was.
Reaksmey was always happy to help. We sat down next to her, and Reaksmey started chatting away.
‘She not feeling well,’ Reaksmey relayed to me.
‘Is she upset about anything she heard today at RHAC?’ I asked.
Reaksmey translated her answer. ‘No,’ he said. ‘She know already she have HIV, she just feel a bit sick today.’
I pressed my hand to her forehead, feeling worried. She laughed off my concern and gave me a big, genuine smile.
‘Ot ay day!’ she assured me. No worries.
‘Okay, I need to go home now before it gets dark.’ Everyone in Battambang seemed to panic if they heard I drove after sunset, warning me that only drunks and hoodlums, thieves, gangsters and ghosts were out after dark. I gave Sineit a big hug and said to her in Khmer: ‘See you tomorrow.’ I hated seeing her suffer and was now determined to find out more information about her condition.
The next morning, Jedtha, Lauren and I went straight to the hospital. As well as talking to a doctor about getting treatment for the kids with hep B, I hoped we could meet with Sineit’s doctor to ask some questions.
We followed Jedtha down the dirty, poorly lit hospital corridors. It took a moment for my eyes to adjust enough to the gloom to catch glimpses of patients lying in their rooms on grass mats over bare wooden slabs. The intravenous drip hangers, holding up bags of bright yellow fluid, were rusted. Some were held high by family members, who sat around the patients, fanning themselves against the heat. Various wretched smells wafted out of each room. I longed for the antiseptic smells of the hospitals in Australia.
In the doctor’s office, a bunch of nurses were hanging around chatting. They pulled up a few chairs, invited us to sit down and asked Jedtha endless questions—presumably about Lauren and me, judging by the way they stared at us as they talked. After an uncomfortable half-hour wait, a thin, tired-looking man in long white scrubs arrived. The doctor.
We showed him the blood test results. He stared at them for a long while, saying nothing.
‘Do you speak English?’ I asked finally.
He smiled and shook his head.
I handed Jedtha the list of questions about hepatitis B that we had prepared for him. They were about further testing, disease management, medication and prognosis. Jedtha kept looking at the list as they talked, but the doctor didn’t seem to have much to say.
Finally, Jedtha translated for us. ‘He say the children need to take more vitamins.’
‘Really?’ I was surprised. ‘And what about all our questions?’
‘I think it’s better we check a different hospital,’ Jedtha muttered under his breath. ‘I think he doesn’t know much about this problem.’
Lauren and I exchanged looks of confusion and disbelief as Jedtha stood up. We thanked the doctor in Khmer for his help, then followed Jedtha out.
We didn’t know what to think. Was this incompetence? Corruption? Maybe he was expecting a payment from us. Or did he just not care?
Before we left the hospital, we had a meeting with the doctor who was in charge of Battambang’s HIV program. This meant walking through the hot, wretched AIDS ward, where four skeletal patients languished on mats, three of them with a single listless, despondent-looking female family member slumped beside them.
The doctor was a grumpy-looking man who seemed unable or unwilling to help. But he did do one surprising thing for us: he gave us a copy of Sineit’s medical file. This would later prove to be a lifesaver.
I left the hospital feeling shell-shocked and hoping we wouldn’t ever have to bring the kids back there again.
We went back to the polyclinic near the markets. They were much more helpful. They set up a vaccination regime for all the kids, and put the seven kids with hep B on a complex multi-drug treatment.
The seven kids were prescribed a ‘party mix’ of pills to take three times a day, so we showed Reaksmey how to administer the drugs and put him in charge of making sure the kids didn’t miss any doses. Jedtha said he’d keep a close eye on Reaksmey to make sure he followed the doctor’s orders. Reaksmey was a nice boy, but it was clear that sometimes his head was somewhere else. Hopefully we’d made the job simple enough for him to manage.
I was still concerned about Sineit, and I couldn’t seem to get any decent information about HIV from the polyclinic. Jedtha and the staff didn’t know what else to do either. But Jedtha agreed that, as the kids’ caregivers, they needed to understand more about how to manage their chronic diseases. We decided I should take the copy of Sineit’s medical file with me to Siem Reap and see if I could track down an HIV specialist to get some clear information.
6
It was nearly Christmas 2006, and my twenty-first birthday was on 27 December, so I had planned a short, refreshing break to Siem Reap. Lauren, Chloe, Emma and Elise were all heading home before then, but Fern was keen to stay on and celebrate my birthday in Siem Reap with me.
It was sad to see the Aussie girls go. Lauren assured me that she was only an email away, and that she would be happy to help out with administering any extra donations in Australia.
After the farewells at Siem Reap airport, Fern and I caught a tuktuk into town. The next few days were fun—eating at cafes and pubs that served familiar western food, hanging out with interesting travellers, and catching up with some of the kids from Akira’s, where my journey had begun.
The night before my birthday, Fern and I went for dinner at the Dead Fish Tower—a multi-level, labyrinthine restaurant with stairs randomly connecting floating wooden platforms, each furnished with cushions and rubber-tyre seats set around low tables. Visiting the toilets involved negotiating a narrow platform built over a crocodile pit. Patrons threw chunks of raw meat to the hungry, bored animals that were kept in a space so small they couldn’t move. I felt bad for those poor crocs, but the rest of the place was pretty fun, even if it was an OH&S nightmare.
The food from the kitchen was sent up to our platform on a rope pulley. We watched traditional Khmer Apsara dancers, draped in gold silk, floating hypnotically on a platform in the middle of the restaurant, their long-nailed fingers drawing graceful, double-jointed shapes in the air.
The food wasn’t much to write home about. My stir-fried vegetables with cashew nuts was actually just a bowl of fried cashews, with a couple of chunks of onion and pineapple. But the atmosphere was exotic enough to make up for it.
On the way back to the hotel I started feeling a little unwell, but brushed it off as an overdose of cashew nuts.
‘I’m such a party animal,’ I said to myself as I crawled into bed early—far too early for an (almost) freshly minted twenty-one-year-old. I fell asleep straight away.
About an hour later I woke and sat bolt upright. My dinner really hadn’t agreed with me. I made it to the toilet bowl just in time. After an intense bout of vomiting, I realised it wasn’t just my dinner. My insides were trying to get out as quickly and violently as possible. I spent the next few hours in various configurations around the toilet bowl, feeling ver
y sorry for myself indeed.
Luckily, Fern, who was in the other bed, slept through it all.
At 4 am, after hours of vomiting and dysentery, I desperately needed water. I tried to stagger downstairs to buy some, but when I got to reception, no one was there. I was so weak I couldn’t go any further, so I accepted defeat and headed back to bed. I slept for a few hours and woke shivering into a warm Siem Reap morning. Fern fetched me a bottle of water and, wrapped up in the hotel’s fleece blanket, I stumbled down the stairs and into a tuktuk.
Fern instructed the driver to take us to the nearest clinic, but it wasn’t due to open for another thirty minutes. So we sat outside the gates and waited. Poor Fern did her best to keep my spirits up while I oscillated between shivering and almost passing out. My field of vision shrank to a pinprick aperture, surrounded by a field of white.
I woke up on a slab of padded wood with a drip in my arm. A clinician told me my blood pressure had been dangerously low and a test had revealed I had amoebic dysentery. Amoebas. Ugh. Then he went on reassuringly about how amoebas can enter vital organs. He was quite graphic in his descriptions.
For the next three days, I lay on that slab, completely off my head with fever, obsessing about amoebas. The cook at the clinic was away, so I wasn’t given a thing to eat, but that was okay. Food was the last thing on my mind.
The three days of fever, delirium and no food left me in a very sorry state.
Finally, in the late afternoon, a doctor from my travel insurance company arrived. He immediately arranged for me to be evacuated to Thailand.
The next thing I knew, Fern and I were on a little jet plane staffed by medics. ‘Isn’t this a little excessive?’ I asked. ‘I think I’ll be fine . . .’
I slept the whole flight and barely even woke as I was wheeled into the incredibly fancy Bumrungrad International Hospital in Bangkok.
I spent the next few days in hospital drifting in and out of sleep. When my results came back, the doctor told me the antibiotics given to me at the Siem Reap clinic had cleared up the amoebic dysentery—if I ever had that at all.
What I definitely did have (even though I’d been vaccinated against it) was typhoid fever.
Typhoid fever is entirely treatable in Cambodia with antibiotics. But the Siem Reap clinic had missed the full diagnosis, leaving the typhoid untreated. The whole experience really shook my faith in the Cambodian medical system.
Once I recovered enough to be released from hospital, Fern flew home to Australia and I was sent back to Battambang by the insurance company. I was looking forward to going ‘home’ to my little pink villa, where I could rest without someone waking me in the night to take my temperature, stick needles in my arms and ask about my bowel movements.
My holiday hadn’t gone exactly as planned. Instead of returning full of renewed energy and armed with information on HIV, I was weak and easily fatigued and still as clueless on the subject of HIV as when I left.
But it was great to go back to SKO. The kids ran up to greet me when I pulled up at the gates, seemingly just as happy and excited to see me as I was to see them. I doled out some cheap little dog tag necklaces I’d got for them in Bangkok. The tags were each engraved with their names, spelled phonetically in English. They had the exact effect I was hoping for: those beaming smiles I was getting hooked on.
‘They say it best present they ever get,’ Reaksmey told me with a grin.
There was still one necklace left in the bag. I fished it out and called out the name engraved on it: ‘Sineit?’
The younger girls took my hands and led me into the gloom of the girl’s dorm. Sineit was lying on her sleeping mat—so motionless that I waited for a moment, my heart in my mouth, until I saw her chest rise and fall. I put my hand on her shoulder and softly called her name. No response. Her skin was burning hot. I called her name again and again but I couldn’t get a response.
My blood rushed down from my head to my toes. I’d come to really care about this sweet, quiet girl. I jumped to my feet, my own fatigue swept aside by the surge of adrenaline. I didn’t know much about HIV but I knew she needed urgent medical attention.
I phoned Jedtha, who was running an errand in town. ‘Please—can you come to SKO?’
He arrived on his moto within just a few minutes.
‘How long has Sineit been sick?’ I was practically wringing my hands with worry.
‘Many days. I take her to hospital this morning,’ he told me, his brow furrowed.
‘Did they say what’s causing the fever?’
‘Oh no, they not say, they just give me tablets for her.’
I asked to see the tablets. They were six familiar-looking white pills, loose in a little snap-lock bag.
‘Para,’ said Jedtha.
‘Paracetamol? Has she taken any? Because if she has, they’re not working. Her fever is still very high!’
‘Yes, she take.’ Jedtha shrugged helplessly. It just confirmed my opinion of that horrible public hospital.
‘Loak Khrew, I think she needs to see a good doctor,’ I said. ‘I’m so worried about her. She’s unconscious now. Maybe we should take her to Phnom Penh to see a western doctor?’
‘Okay, if you can take her, that is the best,’ Jedtha agreed. ‘I can get a taxi for you. Maybe you take her sister, Sinet, too. She can help you to take care of Sineit.’
Similar symptoms had just seen me get airlifted to Bumrungrad Hospital. Looking at that sweet girl lying unconscious with fever, I realised I was face to face with the gross inequality between rich and poor that I’d heard people like Nelson Mandela or Kofi Annan going on about when I was a kid. It had been an abstract, theoretical thing for me until this moment.
Jedtha arranged for the taxi to pick us up from SKO at 2 pm, just enough time for me to jump on my bicycle, get home, throw some clothes in a backpack and rush back.
A grey Toyota Camry taxi was waiting when I rocketed through the SKO gates on my bike. Sinet stood beside the car in a blue trucker hat and a fluoro-green scrunchie. She held two plastic bags stuffed with a few spare clothes for herself and Sineit. I felt slightly embarrassed by my overstuffed backpack.
Jedtha and I helped Sineit into the back of the taxi. She didn’t have the strength to sit up, so we put her in the middle so she could lie across Sinet and me. Reaksmey handed me a few plastic bags, in case Sineit was sick on the way down. Jedtha, Reaksmey and the kids all waved solemnly as the taxi reversed out of the gates.
Both girls slept the whole five hours to Phnom Penh. Not me, though. I was quietly freaking out. These two girls had suddenly become entirely my responsibility. It was the biggest responsibility I’d ever been given . . .
Under these dire circumstances, taking Sineit away from SKO was the right thing to have done—she probably would have died if I hadn’t acted. However, and this is a big however, this was only necessary because SKO was so seriously discreditable. Social workers, child protection professionals and anyone who has worked for a reputable children’s organisation will confirm that, in normal circumstances, having a volunteer take children away from an orphanage or any residential care facility is a serious child protection issue. These matters are best dealt with by professional staff who are qualified to manage such emergencies.
We have learned a lot since then.
The trip down to Phnom Penh was wild—like a kamikaze mission. Imagine a single-lane highway, with potholes the size of ponds, with buffalos, cows, people and dogs swarming all over the road. Imagine overtaking with oncoming traffic in plain sight, hurtling towards you, like an insane game of chicken where the rules are that you either swerve back into your own lane just in time, or force the oncoming traffic to make room for three vehicles, even though there are only two lanes. Now imagine doing all that at lightning speeds. Even today, every time I travel from Battambang to the capital on that crazy highway, my heart is in my mouth the whole way.
While both the girls slept, I kept my eyes off the road and my thoughts away from our
impending death by reading through all the information I’d printed out from the most reputable websites I could find about HIV/AIDS. I compared it with the few notes in Sineit’s file from the public hospital.
There wasn’t much in her file, just a few sheets of paper with percentages recorded on them and a medication book with about six entries in it. It did give me the name of the antiretroviral (ARV) she was on. The printouts said that ARV therapy requires strict, near-perfect adherence. The medication needs to be taken at the exact same time, every single day. The implications of poor adherence to ARV regimes were very serious.
I wondered if Sineit had ever been told any of this. I thought back to all the times the kids had looked at my watch to find out the time, because SKO didn’t have a clock. With no clock, how could Sineit possibly have known when she needed to take her medication? I started to worry that her sudden decline was because she had built up a resistance to the drugs.
Lauren had emailed me from Australia to say that one of her Oxfam colleagues had recommended the MSF (Doctors Without Borders) office in Phnom Penh, so I asked the driver to take us there. After a hot and exhausting journey, we pulled up outside a big villa in Phnom Penh with the MSF logo over the door. I rang the bell and a tall Khmer man opened it.
‘I have a young girl with HIV who is very sick,’ I said, feeling terribly out of my depth. ‘We’ve travelled all the way from Battambang—please, can you look at her?’
‘We don’t have a clinic in Phnom Penh—this is just an office,’ he said in perfect English, in a rehearsed kind of way . . . but then he looked past me, to where Sineit leaned heavily on Sinet’s shoulder, and his eyes softened. ‘Bring her in and I’ll check her out.’
Sineit sagged in her seat as he checked her pulse, blood pressure and temperature. He spoke to her kindly in Khmer. He wrote down some addresses and handed them to me, saying in English: ‘She’s running a very high fever and she’s exhausted. The only good clinics in town are closed now, so please check into a hotel, let her get lots of sleep, and then take her to either of these clinics in the morning.’