by Gail Gutradt
Wayne does his best, but Malis needed a mother, and ironically she is one of the few children at Wat Opot who actually has one. But her mother is away in Phnom Penh with a new husband, and they do not want her daughter living with them.
Miss Malis went to live in the village with her relatives and continued going to school. Wayne gave her an allowance and she took meals at Wat Opot. When I returned there in 2011, I learned that Miss Malis had had a baby by her aunt’s husband.
About a third of the children at Wat Opot are HIV positive. Our oldest children with AIDS are only now reaching puberty. I know that Wayne is concerned about how his children—whether HIV positive or negative—will behave in the outside world, whether they will act responsibly and honestly. Wayne is also acutely sensitive to how Wat Opot is viewed by people beyond the walls.
In an extreme example of what can happen, one woman, an adult AIDS patient on antiretrovirals, had been having sex with an HIV-negative teenager from the village. His parents found out, and discovered that the couple had not used condoms. The woman was blasé, saying that “this was how he wanted it.” Despite all the attempts at AIDS education in the villages, the boy did not understand how the virus was transmitted; as someone with AIDS it was her responsibility to protect him. The boy’s parents were irate, and one night they sent a group of local goons with clubs to break windows and terrorize the campus. The woman was well enough to live and work outside, so Wayne made her leave Wat Opot.
One of the missions of Wat Opot is to encourage acceptance of people living with HIV/AIDS so that they are not feared or ostracized or shunned or even killed. If our children or adult patients are seen as endangering others, then much of the progress that has been made could be destroyed.
KIMCHAN
Kimchan was a pretty, vivacious young woman who had moved to the community with her three children, each by a different father. She was smart and capable and had a better grasp of English than most of the women, but she was also mercurial, quick to anger and, apparently, unwise in love. She found living at Wat Opot more frustrating and confining than did some of the other women, who seemed to relax into life here as a kind of refuge. Still, it would have been hard for Kimchan to leave. Wat Opot provided her children with food and shelter and education, and took care of their medical needs.
Of course, life in the outside world is hard for people with AIDS. Often they do not have the strength to harvest rice under the hot sun. The garment factories of Phnom Penh, faced with tight schedules, avoid hiring workers who might take sick days or need time off to visit a doctor, or who lack the stamina to work overtime when demand is high and deadlines looming. With three children, Kimchan knew that her options were limited. She settled into life at Wat Opot, but her angry outbursts made her unpopular with the other women.
Sok Mean [sok MEE-in], a large woman with a broad open face, came to Wat Opot with her husband. He was very ill with AIDS and she nursed him faithfully in the hospice, feeding him and cleaning him day and night for months. Over time he recovered, but as he regained strength he began to flirt with the other women. This enraged Sok Mean, and on several occasions she berated him for his ingratitude.
A rumor began to circulate that Sok Mean’s husband and Kimchan had been spending time together. Sok Mean attacked Kimchan, leaving savage bite marks on her face and arm. It was an ugly scene, an overflow of frustration and violence. Kimchan retreated to the clinic, where Wayne tended to her wounds. I found her lying on a bed with an IV in her arm, deeply shaken.
Wayne tries to stay clear of what he calls “Khmer business,” such as how parents discipline their children, and the endless back-and-forth among people living in close quarters. At Wat Opot actual violence is rare. I can remember only one other instance when people fought in earnest. Even the small children understand that chee-um, blood, carries AIDS, and that fights are dangerous and forbidden. After the fight between Sok Mean and Kimchan, it was clear that something had to be done. Wayne tried to put the decision off until morning, when he could talk with Vandin.
But around ten o’clock that same night one of the boys, breathless from running, came to fetch Wayne. When Wayne reached Sok Mean’s house he found her naked, chasing her husband around the yard with a kitchen knife. She had managed to slice four long wounds in his back. Wayne walked quietly into the midst of this madness, removed the knife from Sok Mean’s hand and wrapped her in a blanket. I was amazed by his calm presence, but he told me later that in his experience as a psychiatric nurse, people who do such things really want to be stopped. He said he could tell that Sok Mean was not trying to kill her husband, because she was using the length of the blade to cut shallow wounds, rather than plunging it point first into her husband’s back. Wayne believed she wanted to punish her husband, to teach him a lesson, but not to kill him.
The children were quiet, shocked by the violence, and drew close to the adults for reassurance. But that incident decided things. As Wayne put it, “If this were a movie I would pull the video out of the player and destroy it. I would not let my children watch.”
Now there was a hard decision to make: Who would have to leave Wat Opot? Sok Mean had been mightily provoked by her husband’s philandering, but Wayne simply could not allow such violence to continue. Her husband’s flirtations were clearly disruptive to the community, and it was only fair that he too should bear responsibility. Wayne was inclined to allow Kimchan to remain because of her three children, but when he put the question to the other residents they insisted that she leave. They reminded Wayne that this was not the first serious incident Kimchan had been involved in, and they saw it as only fair that she be held responsible as well. With so many conflicting interests and points of view it would have taken the wisdom of Solomon to sort it all out, but Wayne did his best. He told Kimchan that she too had to leave, but offered to keep her children at Wat Opot, and Kimchan agreed. And so three children became motherless that night.
Wayne gave each of the adults 30,000 riel (about $7.50), which is about a week’s wage, for transport and to get started in their new lives. They could all continue to receive medical care through the Partners in Compassion Home Care services. Sok Mean headed for Phnom Penh. She had experience in the garment industry and could find work there. Wayne offered Kimchan a paying job in the Home Care division in another village. It would have been a good opportunity for her to begin to reenter the outside community, but she declined. She and Sok Mean’s husband left together.
Late that night Wayne reflected ruefully on the day’s events. He wondered whether it had been, at least in its endgame, a setup, in which Kimchan got to unburden herself of the responsibility for three children and run off with her lover, and Wayne had to give everyone traveling money.
Kimchan visits her three children now and then. Each time, she tries to pressure them to give her the contents of their savings accounts, and Wayne always refuses. A year or so after the incident Kimchan came back alone and pregnant. She asked Wayne if she could live at Wat Opot. Wayne offered to take care of the new baby, but the other women said Kimchan was too disruptive and they did not want her back in the community.
Kimchan’s two daughters seemed to do pretty well after she left. The youngest adjusted quickly; the older girl missed her mother and lost some of her confidence. Wayne believed that Rajana, her son and eldest child, always held out hope that Kimchan would come back and be his mother again.
Rajana is an insightful boy, a good student, with a quiet dignity. He always held himself a little apart. Two years after Kimchan left, Deb, a volunteer nurse, visited for a month from Maine. She and Rajana grew close, and when she left, Rajana told Deb she had been like a mother to him.
When I returned to Wat Opot in 2010, Rajana was living with the monks. He had dropped out of school and planned to become a monk himself. Often in Cambodia a young man will become a monk for a few years before returning to society. Wayne gave Rajana money to buy his monk’s robes. He thought Rajana would make a good monk.
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NEW PATIENTS
One day a physician from Médecins Sans Frontières phoned to ask whether Wayne might accept a mentally disabled woman with no family to care for her. She was also going blind and needed more personal care than the hospital in Takeo could provide. MSF would not give her antiretroviral drugs unless she had someone to guarantee her care.
Wayne felt he was being blackmailed—that the woman was MSF’s problem, Cambodia’s problem, but not his problem unless he accepted her. On antiretrovirals she was likely to survive for years, and her care would take away a lot of his time and attention from the children. And yet, she was a human being in need of help, and he was being asked to decide whether she would live or die. What sort of life could she have, even if the drugs saved her? “Cambodia needs to provide for its people,” Wayne told me, and if he refused perhaps they would find another solution, one that would help the people who came after this woman. He liked the way Wat Opot was now, with all his energies focused on the kids, but he was having a tough time saying no and letting this woman die. In the end he could not make this choice alone and decided to consult Vandin, Mr. Sary and the other Khmer staff.
Around the same time, a very sick young man of twenty-four was brought in by his family. Once Wayne accepts someone, that is the end of it: he is responsible for them from then on, often for years. There are no halfway measures. Mr. Sary reminded Wayne that he had made a decision not to accept new adults, and definitely not men. Women who recover join the Wat Opot community to re-create something approaching normal life. They help with cooking and are surrogate mothers to the children. Sometimes they remarry and go back to the world. But male patients are usually solitary and depressed and often turn to drink. In the end, Wayne called the hospital in Takeo and arranged for the young man’s care, but while the family was at Wat Opot Wayne never left his office. He knew that once he met the young man he would not be able to say no.
Caring for the dying has always been Wayne’s special calling, and I know it troubles him to turn people away. Each time he is presented with an adult patient it is a new agony. Wayne knows that if he accepts one there will be others and then others, and he will once again be running a hospice.
And yet … and yet. If Wayne rejects these new patients is there another message? What do the children and the rest of us learn about taking in those we are given to love, even if it is inconvenient or troublesome, as it often is, or futile? What does it mean to love unconditionally, even the ones who seem unlovable? And when you can no longer take care of them all, when it is just too hard, when there are too many children and not enough of you to go round? What then?
MR. SAMADHI
Toward the end of 2006, Wayne had a very difficult patient whom everybody had given up on. He was blind, paranoid, depressed, suicidal and at times physically aggressive. One day he took a swing at Serain, the night nurse, with a metal walking stick. He missed, but he hit a cement post with such force that he bent the stick.
As Wayne tells the story, “I had been up all night with a sick child and was exhausted. I lost my temper, took the stick away from him and threw him down on the bed. I then ordered my staff to take him to the hospital and tell them I would not accept him back unless they could give me medications that could control him. The doctors said they understood, but a few days later the hospital truck drove into the yard and pushed the patient out and drove away. He was covered in shit and looked like he had not had a bath since he left us. I walked out to him and said his name. He responded by saying my name, but I could tell he had lost the will to live. We hosed him off and put him to bed and gave him something to eat. Unknown to him he had only seven days of ARV drugs left, and I had to decide what to do when they were finished.
“Making someone comfortable at the end of his life is one thing, but here was a man who could live for several more years. To stop giving him his medicine would hasten his death not by minutes but by years, and nobody wanted to make that decision for me. I didn’t want him dead; I just did not want to be responsible for him anymore, and he evidently sensed that, because his condition deteriorated rapidly, and on the seventh day, as I gave him his last dose of ARV medicine, I realized that he would spare me having to make that decision. He died peacefully later that afternoon with all of us by his bedside.
“I have tried every way to rationalize it in my own mind, but the fact remains that a man willed himself to death, simply to make my life easier. Who am I to deserve that much love?”
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Leaving, Returning
There’s a saying that you cannot wade into the same river twice. Wat Opot is like that. Whenever I talked about returning Wayne would tell me, “Okay, but don’t expect it to be the place you remember.” New children arrive, timorous and shy, and the pecking order shifts just a little. A mother leaves her children and returns to the village to start a small business, and her older son, suddenly serious, takes on the responsibility of a parent. Wayne makes a dorm into an office, a meeting hall into a bedroom, plants a garden or digs a fishpond, following a master plan in his head that no one else has ever glimpsed. Patients take to their beds or grow strong, or go to the hospital and return as corpses to be cremated. Children are adopted, or move back with their extended families in the village. The sense of mission alters naturally over time, from a hospice for the dying to a community of people living with AIDS, from an orphanage to a family. The emphasis shifts again as the children grow older and begin to ponder how they will live in the world.
Daily life is rarely uneventful. Some days start out quietly, all peaceful and routine, and by noon someone is crying or bleeding or sulking, and then quiet returns with the afternoon heat. Yet there is a measured grace to the days here, a rhythm of meals and medicine, of sweeping and cooking, of the children going to school and returning home, of afternoon naps and after-dinner games. Of the old generator coughing up light for two hours every night and the family gathering to watch Korean soap operas on television. The tucking in of mosquito nets and the freshly showered sweetness of children settling down to bed. Of rain on tin roofs in the monsoon, and the children carrying their mats outside to sleep in the dry season. Of planting and harvesting and ducks quacking; of whispered late-night card games; and of groups gathered around tiny fires, roasting taro in the ashes on hot evenings, or warming their hands on January mornings.
Mark the evening flight to Singapore high overhead; you live in a place where a passing airplane is an event to be noticed. Take the time to savor the shift from rice paddies of green to stubble a dozen shades of dun. Cows and dust and whistling wind and singing kites. Children playing, or dying, or going home.
There were some passages I witnessed, some I only heard about from back home in Maine in snippets of emails or the tales of returning volunteers. I tried each time to imagine the textures of the children’s changing lives, yet felt far away, alone, and I knew that no matter how long anyone volunteered at Wat Opot, in some ways they would always be a visitor.
Sometimes I would only find out about a child’s leaving after several months, and realize with a start that the person and place I had been picturing woven together had not been so for some time. It has become a process of constantly reminding myself that Wat Opot is not fixed in amber, but is a living, evolving world.
My time away is a sharp discontinuity. A kind of mourning happens, a yearning for the children that never completely goes away, and floods over me when news comes from Wayne that I have missed some milestone. Sometimes just remembering a moment with a child brings with it a longing to embrace with body and heart. Yet something in me impedes the commitment to set aside my life in Maine and go to live at Wat Opot. There are many reasons, including the sheer exhaustion I feel after three or four months in Cambodia, from heat, dust, lack of sleep and, yes, age, and from the constant needs of children, and from second-guessing and doubting myself. When all these things have ganged up on me to such a degree that even a layabout weekend in an air-conditioned hotel
room in Phnom Penh cannot restore me, then I realize the well has run dry and it is time to leave—to go away for a while.
This rhythm, this leaving and returning, brings its own deepening. At home I have time to write, reflect and share the stories, time to lecture and raise money. When volunteers from Maine venture to Cambodia and return with their own stories, it integrates my existence by making one half of my world real to the other.
Too, there is a sense of what is still to come in the other half of my life, things somehow resonating from my experiences at Wat Opot. What happens to me in Cambodia has a way of diffusing into other lives in ways that are unpredictable and often marvelous, through the permeability of the receptive heart. One is a friend who continued his donations even at a time of personal sorrow and financial distress; another friend, though losing her eyesight in one eye, gave precious time to read and comment on my writing; people who were moved to visit and volunteer and form continuing relationships with the children; and for myself, new, sweet intensities of loving.
The comings and goings feel like the tempering of a blade of Damascus steel: heated, hammered, quenched, then forged in a furnace, folded and hammered again. With many layers it is nearly unbreakable; it can bend but it will not shatter. And I feel myself, after each return, each reworking, more pliable, less demanding. And, I pray, more fiercely loving.
It is April now, a blazing dry-season afternoon, and I am leaving again. I lug my suitcases to the pickup. The whole Wat Opot community clusters around the truck to bid me safe journey. And I simply lose it. I weep, understanding at a stroke that all the transient petty dramas, the hurts and misunderstandings, are nothing but an illusion of separateness, and that this moment, this encompassing love, is all that is real.