Poorest of the Poor

I am training as an urban underserved doctor, and Tuesday I got some urban underserved experience. Troy and Tabitha had visited a displaced persons camp in Phnom Penh and wanted to take me back there to see the conditions, meet the medical student who showed them the area, and see what I thought about expanding our efforts to help the people in this camp. This was poverty.

We started out by meeting up with Isaac (pictured with a coconut). Isaac is Khmer, but he left the country when he was two and traveled to a Thai refugee camp with his mother. He immigrated to the States when he was six and grew up in California with adoptive parents after his mother died. He is a Christian and attended a Bible college with the idea that he'd come back to Cambodia and run an orphanage. Three years ago, he moved back. He now teaches English for six hours a day, runs a tuk-tuk around town, has a restaurant, has two adopted children less than 15 months old that he cares for alone, and decided to go to medical school. All of his spare time he spends running mobile clinics out of his tuk-tuk. This is an absolutely amazing guy. Interesting to talk to, too.

Medical school here is vastly different from anywhere else in the world. It's taught in Khmer in night school and on the weekends. Anatomy lab has one cadaver that was originally dissected in 1989. It's used by 200 medical students a year, all the students from both medical schools in town. Isaac says the lectures are worthless. If you don't study on your own, it's possible to go through school and become licensed without actually knowing anything. Students begin their training in the OR and treating patients, and only after many years of study will they learn anything about pharmacology, physiology, or neuroanatomy. Isaac, in his second year, has already done cleft palate repairs with minimal supervision, something I've never even seen, but he couldn't identify ear wax on physical exam (literally). The bottom line: If you get sick in Cambodia, be very careful which doctor you go to. Some of the things I've seen...

But enough of that aside. We headed out to the outskirts of Phnom Penh. There's a settlement there know as the "New Well Town". Predicatably, it's located next door to the "Old Well Town." Our first stop was a visit to the town chief. He originally just ran Old Well, but then New Well was dropped in his lap and now he has a mess on his hands.

New Well is a settlement of people who were kicked off of government land and relocated to the outskirts of the city. There was a huge settlement of squatters on government land along the riverbank, most of whom had been there for upwards of 20 years. The gov decided to sell the land to developers last year, so they moved everyone off. The wealthiest of the squatters, who owned stores or businesses, were moved to a nice settlement with doctors and shops and running water and electricity. The middle classes who owned houses or property (as much as they could being squatters) were moved to a slightly more rundown area, but still livable. The poor, who rented their houses from the middle classes, were moved to New Well.

New Well. There is one well. There is no running water. There is minimal electricity. There is one pharmacy. There are two latrines, surrounded by standing water. There are 1,554 families in 2-3 hectares of land (about 6-7 acres). For now, every family has a plot four by six meters, but new families are being moved in every day. This is real poverty.

Supposedly, the land belongs to the people who live there, but who knows how long it'll be until the government changes its mind. And how are that many families supposed to divide up that morsel of land? They run out of water already. The well runs dry in the dry season and they have to pump water in from central Phnom Penh. There is no food, and no place to grow food. Feces-contaminated standing water is everywhere. Dengue, malaria, TB, typhoid are rampant. I have never seen so many scrawny naked kids in my life.

So, we weighed and measured the kids for our study. Isaac and I saw patients and handed out a few medicines. We smiled at them, and touched them, and came home absolutely exhausted. I wanted to cry.