by Tara Winkler
I swallowed the lump of fear in my throat and nodded. I’d really hoped I could get her into a clinic that night.
I was just grateful that I’d brought Sinet with me. All the little things that make negotiating Cambodia so frustrating for a foreigner—getting around, finding the MSF office and securing food and lodging—was easier with her there. I was impressed with her confidence and general street smarts.
That evening, while Sineit was sleeping, Sinet and I tried our best to communicate via my Khmer–English phonetic dictionary. We started with small talk but eventually the conversation turned to the more serious matters at hand.
‘Will she be okay?’ Sinet asked cautiously.
I didn’t know. And I didn’t want to lie. ‘I hope she okay,’ I said in Khmer, after trawling the dictionary for the word ‘hope’. ‘Sineit have HIV how many year?’
Sinet took the dictionary and flicked through. ‘Long year,’ she replied eventually.
I had to ask. ‘Sinet, Sineit have HIV how?’
Sinet spent a small eternity leafing through the dictionary, head bowed in concentration. Eventually, she made a pencil mark in the dictionary and passed it back to me. The word ‘rape’ was underlined.
Fucking hell, I thought to myself. That information totally floored me. I wanted to cry. I could feel that big ball of emotion rising up from the pit of my stomach, but there was no way I was going to let myself cry in front of Sinet. She had enough worries on her plate without feeling like she had to look after me as well. A million questions were running through my head but I didn’t want to question her further without some professional support around. So I gave her a hug and we said goodnight.
The next morning, Sineit’s fever was still raging and she was nauseous. She was little more than skin and bone, so I was longing to see her eat something. I tried to encourage her to eat a bit of rice porridge, but she was too nauseous to swallow much more than a few mouthfuls.
The three of us set off in a tuktuk to the Naga Clinic, the first of the two clinics MSF had recommended. Poor Sineit vomited over the edge of the tuktuk all the way there. I held back her hair and tried to soothe her as best I could. I was desperately hoping this clinic was going to come through. A French doctor who was standing at the front desk took one look at Sineit and put her straight in a bed. Relief washed over me. At least she was in the hands of a doctor now.
After running a few tests, they told me she had pneumonia and oral candidiasis—both of which, I learned, are opportunistic infections common to HIV patients. They kept her in overnight.
The next day was a school day, so I reluctantly put Sinet in a taxi back to Battambang. I wasn’t looking forward to navigating this situation without her.
I packed up our things and moved to a guesthouse near the Naga Clinic. I was in and out of the clinic constantly over the next few days.
After day three, the doctor, Cecile, told me that Sineit would be okay. Her fever had come down and she was responding to intravenous treatment. ‘But you must get her HIV treatment regime checked by a specialist,’ she cautioned. I told her of our frustrations with the doctors in Battambang. She nodded, empathising. ‘I will get you the address of someone you can talk to here in Phnom Penh.’
She discharged Sineit as an outpatient with a prescription for oral antibiotics, and made an appointment to see her again the following day.
It was such a boost to see Sineit feeling a bit better. I had high hopes that soon I’d be talking to a competent HIV specialist. But the doctor Cecile sent me to turned out not to be an HIV specialist after all—in fact, he didn’t have that much knowledge of HIV. But he knew just the guy to help me. He gave me a name and address, and I made another appointment, still feeling hopeful . . . and it happened again.
Over the next two weeks my hope drained away, and Sineit suffered nausea, vomiting and fevers. As instructed by the doctors at Naga Clinic, I spent long hours through the night covering her in wet towels and feeling utterly desperate. Whenever the fevers got too high, above forty, I’d take her back to the clinic again. The clinic was trying to keep costs down, letting her recover in a hotel, but part of me wished she could have just stayed at the clinic where she was in knowledgeable hands.
She suffered monstrous headaches, and begged me to massage her temples with tiger balm, which seemed to soothe her. By the end of the fortnight we were so closely bonded I was ready to kick down doors for her.
After what felt like an endless stream of false leads, we ended up in the consultation room of one of Cambodia’s most esteemed HIV doctors.
Sineit rested on the examination bed while the doctor looked through her files, his brow furrowed.
‘There are tests missing,’ he grunted. ‘She start this program many year ago, so why there only three pages filled out here?’
Yep. More evidence confirming my misgivings about the Battambang public hospital . . .
He carefully examined Sineit, took some blood samples and asked us to come back in a few days’ time. This was the first time since we’d arrived in Phnom Penh that I felt we were actually making progress.
Thankfully, over the next few days, Sineit picked up a bit and some colour returned to her cheeks. I grabbed the chance to take her somewhere fun to boost her morale. As she was a teenage girl, the Soya Shopping Centre seemed like the smartest option! Even though she was quite frail, she was soon smiling from ear to ear over her first ride on an escalator, all dressed up in a brand-new outfit.
We went back to the clinic the next day to find out the results of Sineit’s blood tests. Dr Sergey’s brow furrowed again when he told me her results were ‘very bad’.
‘Her CD4 count is only forty-nine,’ he said. ‘For a healthy person like you and me the CD4 count is from five hundred to twelve hundred. Under two hundred mean it progress to stage-three infection, which we call AIDS.’
I felt the blood drain from my face. ‘AIDS?’ I squeaked.
‘It’s okay,’ he said. ‘She is looking strong enough now and her other results are not so bad. We can give her treatment. But if patient has CD4 go below two hundred, normally we prescribe prophylactic treatment so they don’t contract opportunistic infection like the pneumonia she had. I don’t understand why they don’t follow correct treatment in Battambang.’ He shook his head.
He prescribed a course of prophylactic treatment for her and told us she had to adhere strictly to her antiretroviral regime. ‘I know some doctors who are working in Battambang hospital,’ he said. ‘They used to be my students. I will call them to follow up for you.’
‘Oh . . . but can’t she be treated by you here, in Phnom Penh?’ I asked, following up quickly with: ‘I don’t mind paying for her treatment.’ We had come so far. I didn’t want to just end up where we started, back in that godforsaken hospital.
‘Oh, no, in Cambodia it’s not so easy,’ he said. ‘The patient must be treated in province that they live. If she lives in Battambang she must be treated in Battambang. But don’t worry, I will ask my old students to follow up this case and make sure they keep better records. It is very important for her to follow the regime and take care of her health. She must take her medication at the same time every day—should not be even ten minutes late. She should be eating a lot of meat and vegetables. You can buy her some Ensure—it is a high-energy milk drink that is very good for patients with HIV.’
I was madly scribbling everything down as he spoke, when something he said suddenly struck me. ‘Several more years?’’ I echoed. ‘What happens then?’
He gave me a sympathetic look. ‘HIV is serious illness,’ he said. ‘The ARV only can work for about ten years and she already in stage three. In Battambang we don’t have any more options for treatment available.’
‘But—’ I glanced at Sineit, relieved for once that she couldn’t speak English ‘—she’s been on it for five or six years already . . . what will happen then?’
The doctor explained, gently and kindly, that HIV patients will i
nevitably become resistant to the treatment, develop AIDS and die of opportunistic infections such as pneumonia, candidiasis, lymphoma or tuberculosis.
‘In Battambang HIV program, not have other options for treatment yet like in your country,’ he explained.
‘Can I bring in the medicine for her from Australia?’ I wondered aloud.
‘It’s possible,’ he agreed. ‘But not easy and very expensive.’
I felt that ball of emotion well up inside me again. It was partly relief that we had found the doctor, partly grief and anger that Sineit’s treatment had been compromised for so long, but mostly just terrible sadness. Because this lovely girl, not much younger than me, only had a life expectancy of about five years . . .
When we arrived back at SKO, Sinet and the other kids greeted us at the gate and admired Sineit’s new outfit and smothered her in hugs. I caught Sinet’s eye and we both exchanged a very happy, relieved smile. At least Sineit was better for now.
I brought Jedtha up to speed on everything the doctor had said. He listened intently, and said: ‘Thank you, Tara! We need to know this—nobody on the staff knows any of this information. Nobody told us.’
We went straight to the markets to buy a good-quality watch for each sister, so Sinet could help Sineit remember to take her medication on time. I set the alarm on the watches for six in the morning and six in the evening, to make it even easier to remember.
I was seething over the incompetence of the Battambang HIV doctors. According to the records the doctor in Phnom Penh had shown me, they knew her CD4 count was below 200 and still didn’t put her on prophylactic treatment.
Jedtha and I decided to talk to them the following day.
I was feeling just a tiny bit obstreperous when we arrived. As soon as we were called into the doctor’s office, I started laying down all the information given to me by the doctor in Phnom Penh.
‘So why wasn’t she on treatment?’ I finished.
The doctor clearly didn’t like my tone. He waved his hand to dismiss us from the office, telling Jedtha: ‘No, we didn’t do anything wrong.’
But I sat tight in my chair, punching the numbers for the Phnom Penh doctor into my phone. When he answered, I handed him the phone.
He gave me a death stare. ‘Hello?’ His voice rose and things got a bit heated, then he calmed down, saying, ‘Bat, bat, bat, ba, ba, bababaaba,’—‘Bat’ being the masculine word for ‘yes’ in Khmer. He handed the phone back to me.
‘It’s okay, Tara,’ said the doctor in Phnom Penh. ‘He understands and will do what I ask now.’
‘Thank you so much!’ I said.
As we spoke, I could hear the Battambang doctor muttering angrily, getting quite worked up.
When I hung up, he said in an icy tone: ‘If you take patient to Phnom Penh again, cannot bring her here again. We not treat her.’
The full meaning was clear in his livid face. It was a death sentence for Sineit.
Jedtha and I took our leave.
I realised that I’d made a cultural blunder by being so overtly angry with him. It’s not the way to do things in Cambodia. But at least Sineit would get the treatment she needed now.
7
By early February 2007—after the stress of the last few weeks—I was worn out and a bit lonely for a familiar face. So it was wonderful to hear that Sally Power was flying over to visit and meet everyone she’d been hearing about by email.
The day she was due to arrive, I waited impatiently in the yard of the pink villa with Chan’s wife, Mina, and their little daughter Chea. Finally, a taxi pulled up outside the front gate and Sally hopped out, petite and elegant in long flowing pants and a headscarf.
I squealed, tumbled out of the hammock I was lying in, and ran to the gate.
‘I can’t believe I’m finally here!’ she said, giving me a big hug.
As soon as she’d had a shower and settled in, we sat on the day bed in the yard eating one of Mina’s delicious curries, catching up on all things CCT.
Sally is a big-picture thinker, and she had all kinds of new ideas for raising funds when we were both back in Australia again. It was important to us to be completely transparent with our donors. We both felt strongly that donors and supporters had a right to know exactly where their funds were going—and they should know about the failures as well as the successes. Sally suggested we start documenting operations at SKO so that, in the future, we could provide detailed reports to prospective donors.
We also thought it would be a good idea to buy the orphanage a vehicle. A moto seemed like the best choice—it would be affordable to buy and run, and it was the most culturally appropriate vehicle for the staff to use.
Talking to Sally gave me an extra surge of energy and optimism. I was so happy to have her there.
The following morning Sally and I cycled out to SKO. I had discovered earlier that there were no case files for the kids, so the first job Sally and I got started on together was helping Jedtha, Reaksmey and Rath put them together. After a hard morning’s work sorting through piles of confusing government documents, we took a break and headed out with Jedtha to buy a reliable moto for SKO.
Sally was all fired up about getting corporate sponsorship, and kept asking Rath if she could see the latest financial reports for SKO. He kept saying, ‘Okay, okay,’ but, once again, the reports never materialised.
Given the lack of financial transparency at SKO, we just didn’t feel comfortable donating the funds directly. We were aware that there were administration costs, but apparently the German NGO was covering most of those already. Jedtha didn’t have access to an SKO bank account, so he couldn’t tell us anything about SKO’s current financial situation. Until we could see some financial documents, we decided to tread very cautiously.
Sally felt that the problems were deeper than just poverty and incompetence. She thought that the bare offices, the lack of any clear systems or policies and Rath’s steadfast refusal to produce financial records was not right. She didn’t trust him. And, though he would never have said this directly, it was clear that Jedtha didn’t either.
We decided to trust Jedtha—we felt we had to trust someone at SKO. In hindsight we should have considered consulting with other NGOs, but Jedtha didn’t seem to have a bad bone in his body. We liked him, the kids adored him, and whenever we gave him money he was scrupulous about keeping detailed documentation and receipts. Between us, Jedtha and I accounted for every cent raised at that first fundraiser.
While Sally was visiting it became apparent that, just as I’d feared, Reaksmey was not coping with the task of keeping on top of the kids’ medication schedules.
‘Yes, it not good,’ Jedtha agreed. ‘SKO need more staff. Usually SKO’s social worker, Savenh, she take care of these kind of job, but now she away. She come back soon but I think one thing SKO really need is a nurse to help take care of the children health. Maybe you can help us pay for salary for one nurse?’
Sally and I agreed that sounded like a great idea, so Jedtha put the word out that SKO was looking for a nurse.
The best application for the role of SKO nurse came from a woman named Davi, who also happened to be the sister of SKO’s social worker, Savenh. She seemed lovely and we were impressed with all her answers in the interview, so we unanimously agreed to give her the job.
Sally fell madly in love with Battambang. I think if she was as free of responsibilities as I was, she’d have moved over immediately. She loved the people, the food, the beauty of the landscape and, of course, the kids.
One day while we were riding down a dirt road on the very edge of town, when the sky was a sharp shining blue and the breeze was making ripples through rice fields, I was rambling whimsically about how often I found myself rapt with awe at the rough, unbridled beauty of Cambodia.
Sally suddenly asked me: ‘Do you think you could live here?’
‘Ah, I dunno,’ I said. I was definitely committed to SKO, and planned to continue supporting the kids into the f
uture. But I hadn’t yet worked out a plan for how I was going to do that. I had been thinking I was going to try to build a career in something that either paid incredibly well, or gave me time to keep fundraising. I wasn’t quite sure . . .
Contemplating the next steps made me feel a bit depressed for a moment. I’d already been away for two of the three months I’d budgeted for this trip and I knew that in just four short weeks I’d be faced with the harsh realities of going back to life in Australia. The last month or so had seen me almost completely forget about the life I’d left behind.
That’s how it often is, though, when moving between such profoundly different places as Australia and Cambodia. ‘Mutually unimaginable’ is the only way I can describe it. Even these days, when I spend time in Australia—the other side of the rabbit hole—Cambodia seems like some kind of crazy dream.
One afternoon, I arrived at SKO to find Sineit sitting on the moto, tears streaming down her face, desperately trying to start the engine. A few of the older kids knew how to ride—but they were forbidden to ride the moto and Sineit knew it.
I raced up to her and yelled in Khmer: ‘Sineit! Stop. What wrong?’ She shook her head, got the moto running and steered it out of the gates.
‘Stop! Stop!’ I cried. Then, giving up, I yelled: ‘I go too!’ and jumped on the back.
We travelled about forty metres before we had to make a left turn onto a bigger dirt road. Sineit, who was upset and shaky and not as experienced as she, or I, had thought, overshot the turn. Sinet and some of the other kids happened to be on their way home from school, heading towards us. They got to enjoy the dignified sight of us careering into the deep water-filled channel running alongside the road.
We were both a bit shocked at first, but by the time we climbed to our feet we were laughing. The kids, relieved, helped pull us and the bike out of the filthy water. We were lucky enough to get away with just a slight fracture in poor Sineit’s ankle, and a whopping great purple bruise on my arse.