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Structural Violence and the Vulnerable In Cambodia

PHNOM PENH, Cambodia—My first brush with the medical system in Cambodia was in late November when a close friend had to suddenly leave a luncheon she was hosting at her house to interpret for someone at a hospital. Her husband took over supervising the festivities so we continued to sit in a circle, cross-legged, on a plastic mat on their airy balcony, eating and drinking beer poured over ice. It didn’t occur to me that the situation at the hospital might involve another friend of mine, who was about to go through one of the worst experiences of her life.

Emily didn’t share the particulars of the situation because she is a professional sign language interpreter, one of 15 or so in Cambodia, bound to a code of ethics which mandates privacy and confidentiality for the deaf client. It wasn’t until the next day or so that I discovered through the deaf network that my friend had lost her baby at almost eight months of pregnancy, giving birth to a tiny, perfectly formed but dead baby.

When I visited May at her home after she had been released from the hospital, my sweet, beautiful friend was curled up alone on the bed in the room she shared with her mother, wearing a knitted hat, a scarf, sweats, and thick woolly socks, despite it being 100 degrees Fahrenheit. In Cambodia, it is common practice for the mother to “heat” by wearing warm clothing– and sometimes in rural areas, to “roast” by sleeping over a fire to restore warmth to her body. Giving birth causes the mother to lose her “hot” state and heating restores her to her natural state. May had given birth, so she had to undergo this treatment, despite the lack of a baby.

When I walked in with Emily, May’s eyes were closed but she sensed us entering the room and opened her eyes. When she saw us, a single tear slid down her cheek. I awkwardly stood over her, not quite knowing what to say, except, “I’m sorry.”

Her mother brought a stool for me and I sat there, holding her hand, as she tried to get through her birth story. May signed to me, “They told me the baby was a boy. I wanted to see him but my mother was afraid it would upset me. She tried to stop him but my brother brought him to me. I held him for a minute then they took him away.”

As I watched May retell her story, I was at a loss for words. Emily was listening to May’s mother telling her version of the story and then signing to both of us, filling in some gaps of information for May, as she didn’t have an interpreter for much of her ordeal, especially the birth itself. What little medical information May had was conveyed through the limited gestures of her mother and brother.

Here’s what happened:

May’s family is very poor, so after experiencing some pain, May was initially taken to a local clinic near her house because it was the cheapest option. After seeing her, the clinic sent her home, saying that she was fine. But that night, May’s pain become more intense. Her brothers then took her to a different clinic, paying another fee. The medical professional on duty refused to examine her because he was a man and felt uncomfortable. They went to a third clinic. That clinic sent them to a hospital, where May gave birth to a boy.

The doctors and nurses at the hospital, as is typical, demanded payment upfront before treating May. The family had to come up with cash for the first three clinics, then the hospital. May’s brothers desperately wanted what was best for May, going from clinic to clinic. They spent what little savings they had to save May and her baby, but in the end it was futile. They then had to pay for the cremation of the little body.

May’s story is only one of many of other deaf people lost in the medical system in Cambodia. In this past month alone, three deaf people have died, including Kiry Danh, who I wrote about last week. His family spent $3,000 to try to save him after his accident in an also futile effort.

Another recent loss was the death of Keo Kolthida Ekkasakh (Kol), a deaf Khmer Rouge survivor I became close to. Her doctors pronounced her dead from an on-going battle with cancer on January 13. Her family brought her to Wat Langka pagoda to pray over her. For hours, monks chanted and burned incense as her family sat with her body, praying. To the shock of the gathered people, Kol woke up.

This is a drawing by Kol of the first person she saw upon awakening from her coma. Photograph by Erin Moriarty Harrelson
This is a drawing by Kol of the first person she saw upon awakening from her coma. Photograph by Erin Moriarty Harrelson

She would have been cremated alive if a monk hadn’t noticed the tears rolling down her face. When I went to the pagoda for her funeral, her brother explained that at one point during the ceremony, a monk, Sao Chanthol, noticed tears on her right cheek and some movement of her arms and realized she was alive. The family immediately took her home, where Kol lived for another week, awake, walking, drawing, and communicating with her family. Unfortunately, she suddenly passed away a week later from a heart attack. Kol’s family has money and connections. It wasn’t enough.

Kol shares a memory as I watch blue inked lines take the form of the crown of a palace dancer.
Kol shares a memory as I watch blue inked lines take the form of the crown of a palace dancer. Photograph by Vichet Som

The medical system in Cambodia, as in many other places, is a form of structural violence for the poor, which Paul Farmer, the founder of Partners in Health, a medical anthropologist and doctor, has written about extensively. Expatriates in Cambodia often fly to Thailand or Singapore for childbirth and other medical treatment. (I am aware of the recent article regarding expatriate vs. immigrant. In this case, I use expatriate because of its connotations of temporality, wealth and privilege). I am struggling with this, as do many anthropologists working within systems of inequality and structural violence. Should something happen to me, I will receive the best possible medical care but it pains me that my loved ones in Cambodia don’t have the same access.

For more on how the medical system in Cambodia fails the poor, here is a link to an op-ed by Kol’s brother, Youk Chhang, in the Phnom Penh Post.

Note: Some of the names in this post, except for those already published in the media, have been changed to protect the privacy of the people involved.

For a more personal and visual perspective of my experiences in Cambodia, follow me on Instagram @ErinMHarrelson and on Twitter @ErinMoriartyH

Comments

  1. Deb Weiner
    Silver Spring, MD
    March 25, 2015, 7:20 am

    A very interesting story, though very sad for the woman and family. The term structural violence is quite provocative as well. My heart goes out to them for all of their losses and for the grinding financial situation.

  2. Sam
    United Kingdom
    March 24, 2015, 8:41 am

    This is a really interesting post, and something that everyone should realise is happening! http://www.frontiergap.com

  3. SM
    France
    March 24, 2015, 7:34 am

    C’est touchant voire choquant pour les occidentaux de voir certaines pratiques ancestrales qui perdurent encore au Cambodge chez les pauvres, alors que les riches vont se faire soigner à l’étranger.
    Je confirme que la structure de soin et de l’aide médicale au Cambodge n’existe pas. Chacun se débrouille comme il peut.
    Il ne faut pas tommber malade, ce n’est pas le cas.
    Si on tombe malade, c’est la ruine. C’est la vérité vraie.
    Les pauvres manquent de moyens financiers recourent aux méthodes anciennes ou traditionnelles.
    Il y en a des cliniques et des hopitaux, mais les sous d’abord, et les soins la suite, ça c’est vrai..

    Un Cambodgien de france

  4. M
    March 24, 2015, 2:35 am

    I would like to see people stop using the word inequality when referring to discrimination. Those two are not the same.

    • Erin Moriarty Harrelson
      March 24, 2015, 3:24 am

      Dear M,

      Could you please clarify your comment? It would be helpful if you could please define what you mean by discrimination vs. inequality. I don’t quite have enough information to respond to this. Thanks!