Health: Right, Privilege or Responsibility ?

Is health a right, a privilege or a responsibility? That’s a pretty hard question to answer. Even with access to the best available health care and the most vigorous self care we may not be able to control our health status. Should I simply be grateful for the privilege of current good health or am I healthy because I live a life of privilege? Are we responsible for our own health? What about our responsibility towards the well being of others? Is a reasonable level of health care a human right? What’s reasonable when we consider the costs of global public health?

I have been thinking lately about health in terms of justice and here in Cambodia there is simply not enough of it.

The inequalities are stark.

In Cambodia it is common for families to sell land, animals or motorbikes or take out high interest loans from unscrupulous money lenders to pay for a family member to have surgery. All bathing, feeding and general nursing care is done by a relative of the patient so the family is going without two incomes. They will often need a family member to continue to be the full time carer when they leave hospital. Not uncommonly a daughter will be removed from school for that purpose. I’ve been seeing stroke patients in a government hospital and they regularly leave to go home well before they can sit up, let alone walk, because they have run out of money. There are too many stories of patients paying for unnecessary and sometimes dangerous combinations of medications with no understanding of their condition. Many people can’t afford the transport cost to a health centre, let alone the treatment, so they wait and wait until their condition is very serious and then often too difficult to treat.

An illness or accident can spell disaster for the whole family. It’s not surprising that anxiety is such a common problem and a contributing factor to ill health.

If you have money, however, most likely you will leave the country when you have a significant health problem in order to receive quality health care elsewhere. Maybe Vietnam or better yet Thailand or Singapore if you can afford it.

We have just done that. Tennyson went to Bangkok for knee surgery because our organization covers our health costs. We are also citizens of a country that has a well functioning, even if imperfect, public health system. When we were back in Australia recently our family had several doctors’ appointments, lots of health tests and a couple of small procedures and just about all of it was covered by Medicare. While I stood in line at the Medicare office contemplating the beauty of a public health system, others around me seemed very put out by the long queue. I was just so thankful that they were going to give me back all that money. It was wonderful to know that having preventative health checks and effective treatment for problems, before they become life threatening, was not going to financially cripple my family. In fact we would hardly notice it.

Bono wrote in a song ‘Where you live should not decide whether you live or whether you die’. Unfortunately it often does.
I’m very grateful for the quality health care we have received but I could do without the nagging discomfort of being one of the privileged few.

“Traffic that flows like water”

My initial reaction to hearing this assessment of the Phnom Penh traffic was to laugh and add “and goes ‘bump’ very hard”. But over time I must say “flowing like water” is the reality of how it works. The key is learning to merge, give way to the bigger vehicle, and follow the ‘actual’ road rules not the theoretical ones.

The best preparation for taking the plunge into the traffic here was the time I spent on the boys gaming console playing the game “Need for Speed: Most Wanted”. Little did I know that learning to drive on the wrong side of the road facing oncoming traffic would be a useful skill here in Phnom Penh. Dodging other traffic is one of the major skills needed to navigate the roadways.

The “flows like water” bit happens when, for example, turning left to join the traffic (which mostly uses the right side) one never stops, but rather kind of merges and mingles against the oncoming traffic until the “waters part” and a way opens up to make it across the traffic and then requires a similar merge into the stream of traffic heading left.

Confused? Perhaps this will help. There are officially two lanes of traffic with all vehicles driving on the right-hand side as in North America and Europe. So as you are driving looking forward there is the oncoming traffic on your left. Got it so far? Ok, this is where it gets tricky, there is another lane of oncoming traffic further to your right which represents the vehicles, mostly motorbikes but actually all vehicles smaller than trucks, that are trying to merge through your line of traffic to join the traffic to your left. Still with me? It is this right hand lane that does the “need for speed” thing and kind of cuts through your lane to merge with the other stream.

This is the basic ‘level 1’ context of the game and has ‘regular’ traffic – cars (some), motor scooters (lots), trucks and bicycles (lots too).

But lets play level two – this adds tuk-tuks (motor scooters pulling a carriage that comfortably seats 4 and often seats 8-10), tri-shaws (peddle powered single seated three wheeled vehicles), rubbish collectors pushing hand propelled carts around, and bicycles or scooters converted into hot food stalls fueled by hot coals.

Level three adds scooters converted to carry 44-gallon drums of flammable liquid, sheets of glass, pieces of angle iron 4-5 metres long, cupboards, double bed mattresses, and then inserts old people from the country side that are visiting the city for the first time and who randomly cross the road along the way.

Level four is the highest level and is the last test. It adds in teenagers who speed, weave in and out of the traffic, and generally create havoc by riding 3 or 4 abreast while chatting to each other. And then the last challenge - the people with mobile phones held to their ears or texting as they go along at half speed.

So watch out for the game “Need for Speed: Flows like water” at a retail store near you – $69.99. Or go down to the local market and get a pirated version for $2!

Inadequacy

When I think about our years of living in Thailand and now Cambodia, trying to learn language and engage in the lives of the people we are living amongst the word that would most often describe my feelings is ‘inadequacy’.

There is nothing like trying to learn a new language to make you feel small and childlike. Combine that with a totally unfamiliar culture, vastly different worldviews, less than ideal circumstances and a lack of resources and it’s not surprising that there are days we are left wondering about our effectiveness.

In the Mercy Medical Clinic, where I have been doing some physiotherapy, the people that I meet are often in situations that are way beyond my ability to address in any meaningful way.

This week I saw two stroke patients who were both left so disabled and so dependent that I couldn’t imagine how the families where going to cope with their care. The clinic is not a hospital for long term stays and these families couldn’t afford any other form of inpatient treatment. So they go back to their village homes to lie on the floor, being bathed and looked after as best they can by overwrought family members who will now have to give up paid work to become full time carers.

One of the patients could no longer speak and was having great difficulty with swallowing. Apart from rehydrating her in the clinic with a drip, little could be done as there was no tube feeding available. She would just have to be fed at home, very carefully by spoon, at great risk of getting the water or food into her lungs and developing pneumonia. Her devoted son said to me that he didn’t mind if she couldn’t move around or sit up. He would take care of her but he just wanted her to be able to eat and drink as he was afraid she might die. ‘Yes, exactly!’ I thought. It would have been difficult to think of something helpful to say even if I did feel more confident with my language skills..

It’s times like this that I find it hard just to be there witnessing people’s suffering. It’s even harder when I know that in another place, like Australia, there could be so much more done to help the whole family. My expertise and professional opinion don’t seem to be much help at the point where circumstances stack up against people and what is needed is comprehensive change to inadequate and unjust systems.

Although the temptation is to walk away or close my eyes to hard things, I do believe there is real value in simply being present with people in their pain even when we can’t take it away. I still, however, feel very uncomfortable with it. It regularly challenges my sense of professional efficacy, my sense of worth and identity and raises uncomfortable questions about what on earth I’m doing here.

Maybe if I did feel adequate I’d be in even more danger of imposing my insensitive responses and inappropriate ‘solutions’. Inadequacy is often an accurate appraisal of ourselves but it carries the danger of despondency and paralysis. Taken in a spirit of humility, however, the response is a greater dependence on the One who is able to do more than all we can ask or imagine.

Despite my wobbles, these weekly encounters with heartbreaking situations are spurring me on to deeper reflection on the meaning of solidarity, the ministry of presence, and above all else, a profound appreciation of Emmanuel, God with us, especially in our suffering and weakness.

A Godly Protest

Well over a month ago I started writing about Ligar. She was a bright young university student I met, who became horribly disabled and distressed from Tuberculosis in her brain. I was going to tell of the suffering her Christian family endured though her 18 month illness as they were plunged into poverty due to outrageous medical costs and the full time care she required. I was going to share the disturbing thoughts I had about her right to choose, even choose death, as she screamed in fear and disorientation, refusing any physical touch from me. I was going to ask unwelcome questions about her sudden death soon after a change in her medication that was never investigated.

But as I wrestled with my words, my questions about suffering, injustice and God’s place in this particular story where overtaken by news of a greater tragedy unfolding in Japan. And then the conflict, fear and mayhem right across the Middle East was brought to our attention.

This year has brought misery around the world on a scale impossible to comprehend. Does the everyday pain I see here in Cambodia become diminished at all in the big picture of things?

I no longer wanted to write just another sad story. What good could come of that? Does anyone want to hear more miserable tales with messy endings that raise more questions than answers?

But I remembered Ligar’s mother at the funeral and was challenged by her confident faith. She said that she had a dream in the weeks before her daughters’ death in which she felt Jesus was showing her that he would take Ligar to be with him. She said that, although she is very sad, she has peace and trusts God for Ligar. She is still convinced of God’s love and goodness.

Holding resolutely to the belief that God is good and God is loving despite being surrounded by tragedy is in fact a bold protest against the darkness of death and destruction.

We are tempted to despair but by a prayerful refusal to be dragged into hopelessness we can take our stand against all that is evil. Worshiping the God who saves and trusting in his ultimate restoration of all things becomes an act of defiance to the spirit of the age.

In confusing times such as these Peter encourages us to simply ‘commit ourselves to our faithful Creator and continue to do good’ (1Peter 4:19).

A Different Kind of Kindness

I met a man who lost his three middle fingers. Most of his right hand was gone as well leaving just a stump with the thumb and little finger poking out either side. It all started with a simple cut to his hand while doing his daily work as a cane basket and furniture maker. But the cut wouldn’t heal and became infected. (At the time he wasn’t aware that he had diabetes.) So he went to the local traditional healer who made a poultice of mysterious ingredients, most likely one of which was cow dung – a common remedy for wounds. The healer then chanted magic words, blew on his hand and sent him home.

Instead of healing the infection worsened. The hand swelled up like a balloon, all red and inflamed. Eventually he came to see a medical doctor at a government hospital in Phnom Penh. By this stage it was too late to save the hand and the man had surgery to remove the rotten flesh. I think the surgeon hoped the remaining thumb and little finger would be able to oppose and give him at least some function. But it seems they failed to send him for follow up therapy and by the time I saw him, some three months after the operation, the man’s remaining digits, wrist and shoulder where stiff and painful from immobility.

It is hard to understand how a simple cut can lead to a man losing his livelihood and becoming totally dependent on his family. The maddening thing is that a different response at any one of a number of points along his story would have led to a better outcome.

I felt angry, frustrated and quite useless as a physio trying to address this situation, knowing that most likely he would return home to his village the next day and never return for follow up treatment.

The Khmer nurse who was helping me communicate with this patient suggested in the end that we pray for him. I was all for that as I knew what I’d done so far was not likely to make any difference and the man himself was very happy to be prayed for. So that is what we did. There was no miracle cure but the long discussion that then proceeded between this godly nurse and the patient, full of questions and deep seeking, was itself a demonstration of God’s grace and love. The man left encouraged and hopeful.

Despite my exasperation at the number of the serious but preventable health problems I’ve seen I have been constantly amazed at the way the gospel is so openly and naturally shared through the staff at this Christian clinic. It did, however, make a bit more sense after our latest ‘foundation year’ morning.

We’ve been organising monthly seminars for the newer people in our team. On Saturday we heard from some very experienced people sharing their insights on Khmer culture and Buddhism. An interesting point came up about how we talk about spiritual things. Often in Western cultures we feel it is polite to be quite reserved and careful not to impose our beliefs on others until we feel the right opportunity comes along or the relationship is developed sufficiently. It seems that in this culture if you have something good or know some good news it is unkind and uncaring not to share it with others.* In this context faith sharing with people you meet is therefore seen as something very natural. I’m learning a lot from the people I meet and some of my own cultural values and assumptions are certainly being challenged.

* Maybe this is why the temple and the aerobics dancers love to use loud speakers directed outwards. It would be seen as unkind to not share their good experiences with the whole community. This puts a very annoying aspect of life here in a new light.

Sharing Good News

Nearee had a motorbike accident over ten year ago. She lost her memory, her ability to read and write and suffered disabling nerve damage in her right arm. Today Nearee is a passionate evangelist. She believes that through prayer God has restored her ability to read the scriptures and she shares the Good News with whoever she can. She has plenty of opportunity to do this in her work as a cleaner at the Christian clinic where I met her. She does a little mopping of the floor and then stops to chat to the patients finding a way to encourage them and point them to Jesus. She told me how grateful she is for this job. ‘Many other places would never employ someone like me with a disability. But I have been working here for 10 years. Thankyou Lord Jesus.’

Nearee’s lack of inhibition, probably related to the head injury, does make her an unusual person. She chats away with me in Khmer and I don’t yet understand everything she says but she doesn’t seem to notice my faltering questions and vague looks. I did understand that she lives alone in a rented room which is very unusual for people here. She only sees her siblings and parents, out in the country side, about twice a year. It costs too much in travel to see them more often. When she has some spare money to buy milk and snacks she visits sick people because you can’t go empty handed. She follows up people she has met at the clinic, some of them with HIV, and goes to their homes to encourage them and pray.

In this culture it is believed that a disability is caused by bad karma. You live with the consequences of the bad deeds you’ve committed either in this life or in a previous life. But Nearee transcends this labelling. She knows that she is one whom Jesus calls blessed and it is clear she is being used to further His kingdom in and through her life situation.

I wonder what it would be like if more of us, regardless of our limitations and circumstances, lived with gratitude and love, simply seeking each day to share good news with somebody.

Streams of Living Water

“We think its arsenic poisoning.”

This was the conclusion the doctors came to after examining a boy with a strange lumpy skin rash. His parents brought him from their provincial village to the Mercy Medical clinic in the city which is known as a place that cares for the poor. As the boy’s brothers and sisters have also been unwell the best advice they could give was for the family, and in fact the entire village, to stop drinking the well water.

I have since discovered that there are places in Cambodia where the ground water is contaminated with up to 30 times the accepted ‘safe’ level of naturally occurring arsenic. Over the last few decades with a growing population and increasingly scarce and polluted river water there has been an explosion in deep tube well drilling. Well drilling projects by charitable organisations encouraged the widespread use of well water long before testing revealed that in many areas the water contained high arsenic concentrations.

Arsenic has no taste or smell and it takes years of slow build up in the body before symptoms appear. It can cause cancer of the skin and internal organs, respiratory disease, mental slowness, hearing loss in children, low birth weights and impaired skin sensation. Children are at greatest risk and the damage is irreversible.

Improving access to clean and safe water in Cambodia is essential for the people and the country’s future. Seventy four percent of all deaths in Cambodia are due to water borne diseases. It’s tragic, therefore, that well drilling projects aimed at improving the health of villagers by providing the much needed water inadvertently ended up poisoning them.

This fact got me wondering about other ways the things intended to bring life to us and those around us unintentionally carry instead disease and death. What if that which is flowing out from us is not always the ‘living water’ that Jesus promises but something more stagnant? What if the light within us is in fact darkness? Do our particular theologies, our forms of church structure, our organisational culture, our models of leadership, or our acts of service bring the life and freedom Jesus intends? These are concerning questions as we seek to serve, teach and be ambassadors of Christ.

For us here in Cambodia it is becoming clearer that in our own understanding or in our own ambitious plans and programmes we may easily, like those wells, do more harm than good.

In Jeremiah 2:13 the Lord reveals the sins of His people. They have forsaken their dependence on Him, their source of living water, and have instead dug their own cisterns, thinking their own plans will be safer and better. But the Lord declares that their cisterns are broken and they can not hold water. Only He can be for them the life that is truly life.

May we return constantly to a humble reliance on ‘Christ in us’, the Holy Spirit, who is the spring of living water, remembering the promise of Jesus that whoever follows him would never walk in darkness but have the light of life (John 8:12).

Source: www.rdic.org