Monday, October 6, 2008

An angel in Cambodia

Winnipeg nurse helps restore a shattered nation

SIEM REAP, Cambodia -- David Shoemaker, a nurse from Winnipeg, stumbled upon Siem Reap during a volunteer trip to Southeast Asia in January 2000 and decided to return to continue his efforts.

He's still there.

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David Shoemaker in the crowded waiting room at Angkor Children's Hospital in Siem Reap, Cambodia. (Photo By Rick Friedlander )

Siem Reap, site of the architectural wonder of the world, Angkor Wat, shows Cambodia's tentative steps toward economic growth. When I first saw it in 2004, Siem Reap seemed to be another dusty town with a great attraction, slowly emerging in the global tourism market. When I revisited it a year ago, billboards were promoting new shopping malls and cellphones, and hotels were competing with aid groups for real estate.

It has helped that a decade has passed since Pol Pot died quietly in the jungles of northern Cambodia. Brother No. 1 and his radical form of agrarian communism, enforced by the dreaded Khmer Rouge, brought the country to its knees. No one is doing more than Shoemaker to get it back on its feet.

"What has kept me here for so long? Quite simply, it is the people, the doctors, nurses, housekeepers and the rest of the staff at AHC (Angkor Hospital for Children)," Shoemaker said. "I have never experienced a country where the people want so desperately to learn and improve."

Sheila Anzarut, the wife of a neurologist from Vancouver who has volunteered here since 2007, says of Shoemaker: "David is, without a doubt, the face of Angkor Hospital for Children, for both the staff, the volunteers and for the many visitors and donors who come into contact with him. He is the person who instills us with so much passion for helping."

And help is so badly needed. For every 1,000 babies born in Cambodia, 22 or more die in their first month and 66 before their first birthday. Another 17 die before their fifth birthday. Poverty is a large part of the problem: More than a third of 14 million Cambodians earn less than 60 cents a day.

Walking with Shoemaker through Angkor Children's Hospital is a stirring experience. Everyone we pass along the way has a smile or a respectful nod for him. Every morning, he tells me, the emergency room is filled with crowds of children and tired parents. We encounter a Canadian volunteer play therapist, Liz Harrop-Archibald, surrounded by smiling children, cutting out paper crowns and making fish mobiles for them. Their smiles are the reward, I suspect, that keeps humanitarians like Shoemaker Harrop-Archibald able to carry on.

Shoemaker tells me that his first year here there were about 10,000 visits by families to the hospital -- about 25 or 30 a day. By 2007, that number had increased to over 100,000 visits -- an average of 350-400 children each day.

The increase in the number of tourists since I was first here, reported on various websites, is staggering. From approximately 500 in 1985, 600,000 in 2005, and with a predicted 3 million tourists coming by the year 2010, more than half of them visit Siem Reap.

It is hard to believe that the tourism boom -- it's estimated to bring $600 million to Cambodia in 2010 -- is actually hurting the survival odds of its children.

Beyond the five-star hotels and fancy restaurants, however, tourist dollars have not filtered down to the people who need it most.


Please see CAMBODIA B2

At first, I was happy to note that there were not as many street children evident this time, as opposed to the vast number of them I saw in 2004. Soon, however, I learn that the absence of street children is due to a local initiative to run them out of town exactly because of the rapid rise in tourism. It is possible that local bureaucrats fear street kids will somehow threaten their ever-growing windfall of tourist currency.

No one in this country is untouched by the horrors of the past. Mention of the Khmer Rouge creates instant discomfort and a change of subject. Many Cambodians endure poor eyesight and still don't wear glasses because the Pol Pot regime saw them as a sign of education. Wearing them could be fatal. Fear still affects behavior and signs of that are everywhere.

The next day, I accompanyShoemaker on rounds to outpatient houses benefited by the HIV/Homecare Project. He and Cambodian nurse Dim Sophearin load up the AHC truck and we head to the first house, where a couple of HIV-positive children are tending to their baby sibling in a blistering hot bamboo shack.

They get a sack with a week's worth of nutritious food and snacks. The AHC says "under-nutrition represents the single most important risk factor for the health of Cambodian children."

Shoemaker questions them on the state of their health and the condition of the baby, then takes vital signs and records blood pressure, heart rate and weight.

The HIV/Homecare Project consists of health assessments, education and counselling. With it comes the calm, natural interaction of Shoemaker, smiling and joking to lighten the atmosphere. He hands the children his stethoscope and shows them how to listen to their heartbeat.

We head back into the truck and drive another kilometre to visit with a young, stable, HIV-positive girl, whose parents died from the virus and who now lives with her grandmother. Shoemaker patiently explains, this time to a grandmother, how to take the medicines and questions the family on any changes in their health.

The little girl reacts happily as pictures are taken, with a beautiful, poignant smile. This image contrasts sharply with the sobering fact that every child we visit today is HIV-positive.

"The hospital has done a lot in the last several years but there is still so much more to do," Shoemaker said. "The biggest health challenge for Cambodia's poor children is simply better access to the appropriate health-care facilities. With 80 percent of Cambodia's population living in rural areas, it is often difficult or impossible for them to find good, effective inexpensive health care.

"What AHC is trying to do over the next several years is work together with the Cambodian Ministry of Health to build up the skills and knowledge of doctors and nurses working in these rural areas, so that these children will not have to travel so far... they will get health care faster and this will save lives."

I ask Shoemaker how he feels the training of the staff is going. He says how proud he is of them and how their skills and knowledge have progressed so thoroughly that they have gained the complete trust of the community. Moreover, he adds, 98 per cent of the staff in his hospital are Cambodian and each year there is less and less need for foreigners. "I am working myself out of a job," he adds with a grin.


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