I leave the house at 6 in the morning -- coffee thermos and latest Cambodia Daily in hand -- my tuk-tuk weaves around early morning traffic and heads for the Central Market, where I catch the 6:30 bus to Kompong Cham, a provincial capital two hours north of Phnom Penh. The city streets and tall buildings soon turn into rice fields and wooden houses on stilts. The bus honks its horn to warn schoolchildren on bicycles, farmers taking their produce to market, and the occasional brahmin cow, to stay out of the road. Two and a half hours and one more moto ride later, I arrive at Sunrise, InnerCHANGE’s project among those living with HIV/AIDS in Kompong Cham City (city in this case being a somewhat generous term). I am greeted at the gate by Chuun, one of thirteen staff at the project. “You didn’t bring your car this time, Teacher?” he asks, smiling broadly. I get the feeling that my car is something of a running joke at Sunrise. It is small and somewhat rusty and doesn’t look like it could make it to Kompong Cham with all its parts intact. “Not this time, Older Brother,” I tell him, “It’s too beautiful to risk on that road.” That gets a laugh.
I walk into the hospice to greet the two patients currently staying there. I have met them both before. Narin, the older of the two, wears a surgical mask. She has been in the hospice two months now, but we are having trouble treating her. She has drug-resistant tuberculosis that is complicated by her weak immune system due to complications from AIDS. She contracted HIV from her husband, who was a soldier.
Bopha is only 23. Her husband died of AIDS a few years ago. Her husband’s family abandoned her when they found out she had HIV. She came to the hospice looking like a skeleton but a few months of anti-retroviral drugs and good food and she has filled out and her skin lesions have almost all healed. She has even started smiling again, but not often. Her future is uncertain. Her health is good enough that she could go home and be part of our home-based care program, if she had a home to go to. Our very dignified and elderly doctor is there, so I ask him about Bopha privately. What's going to happen with her? Where will she go? Can we train her to sew? We have a small handicraft project called Hands of Hope that employs a few women sewing. She couldn't receive the training, he says. I nod. This is the Cambodian way of saying that she has a hard time learning new things, most likely a result of malnutrition during her childhood. To keep her occupied now that she is more healthy, Dr. Moni has assigned her to planting flowers and trimming the bushes until we can figure out a place for her. Feeling helpless, I make a mental note to pray for her. After a brief chat, Dr. Moni leaves to make his rounds for our home-based care program.
I too leave the hospice and enter the office to start my meetings with Darany, the program director, but my mind always lingers on the hospice. In many ways, though the hospice is one of our smaller programs in terms of the number of people it serves, it is the core of the Sunrise program. At the height of the AIDS epidemic in Cambodia, before the life-saving anti-retroviral therapy, families who didn't understand what caused HIV/AIDS and how it was spread, would abandon their sick relatives in the streets or at the hospitals. The staff of Sunrise would faithfully and lovingly pick them up off of the street and care for them until they died. Each client would receive a burial attended by all of the staff. One of my earliest visits to Sunrise, it was pointed out to me that the 'coffee table' in the office was actually the coffin used for the frequent burials. I wouldn't have noticed because it was a plain wooden box, but the staff, who knew what it was, blithely walked past it day in and day out apparently without thought. I think that they were more accustomed to the reality of death in those days.
When ART (anti-retroviral therapy) arrived in Kampong Cham, the role of the hospice changed dramatically. Fewer people came to die. They would arrive looking like skeletons or concentration camp and leave a month or two later plump and healthy. We quickly learned that the ART was ineffective in people who were malnourished. Even with the drugs, their bodies were just not strong enough to fight off the virus. We changed the name of the hospice to 'hospice/rehabilitation center' to reflect the fact that most people that come to the hospice now, don't die but recover. We stress nutritional rehabilitation and loving care. Often our hospice clients have been rejected by their families and are very depressed. I couldn't say this for sure, but it seems to me that people who have no hope don't recover as quickly as those who have hope. Through their care and their attitude, our staff offer the hope that the client is lovable and also that there is hope in Christ. Now, only two or three people die a year in the hospice and each is given a dignified funeral. The rest are able to return home and become clients of our home-based care program.
After a lunch of rice and fish soup with the hospice staff, Chuun takes me to the bus station for my trip home. I watch the sun set over the rice fields, coconut palms marking the boundaries. I am thankful for the beauty of God's creation and also for this new opportunity to serve alongside some talented and faithful Cambodian Christians in serving some of the poorest children of God I have ever met. I am also thankful for those across the ocean who partner with us financially and in prayer.
- Samantha Baker Evens, InnerCHANGE Cambodia