Archives For Cambodia

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Recent news articles, including in Newsweek and the The New York Times, recently have exposed the false stories told by prominent Cambodian anti-trafficking activist,  Somaly Mam, to generate funds for her US-based Somaly Mam Foundation and it’s Cambodian NGO, AFECIP.

For some time, Mam was Cambodia’s best known orphan, with an autobiography that detailed her own trafficking into sexual slavery. She recently stepped down from the U.S.-based charitable foundation named after her amid charges that her stories of destitution and trafficking were largely untrue.

Mam, sadly, is one of several NGO leaders in Southeast Asia in recent years caught in deception that seems to plague the orphanage industry in particular. And it has become an industry, with children often sought from parents with promises of education and a better life inside, much to the detriment of the institutionalized child.

In these instances, more children of course mean more money for the orphanage operator and a profitable business is born on the backs of children who often otherwise would be at home. Some orphanages hand out flyers or post signs outside their doors welcoming tourists – and their donations. Some keep children in poverty in order to keep the flow of donations coming.

The corollary to this, of course, is the profitable Western volunteerism business that feeds students, gap year teens and anyone else wanting a developing world experience often into orphanages, where it is perceived that the only skills needed are an ability to cuddle.  These companies have proliferated in recent years, with volunteers in the hundreds of thousands heading abroad to boost their cvs, justify a foreign trip and sometimes even “make a contribution.”

According to a 2011 UNICEF report, since 2005 Cambodia has seen a 75 percent increase in the number of residential care facilities, with 269 of these centers housing 11,945 children. Of these, 44 percent were taken to the centres by parents or extended family and 61 percent, upon departure, were reunited with their families.

Over the same period, poverty has declined In Cambodia and life expectancy has risen sharply so the numbers of orphans should be falling, not rising. In Cambodia, there are only 21 state-run orphanages, with the rest being privately managed and dependent on foreign funding.

“Sixty years of global research details the adverse impact of residential care on the physical and emotional development of children,” the report states. “Residential care has also been shown to place children at risk of physical and sexual abuse.”

As was the case with Mam and her organization, children who were not necessarily even orphans, were coached in heart-wrenching personal histories that they were encouraged to tell to those who would listen in the hopes that tales of sadness and destitution would bring more funds.

As the UNICEF report says, “residential care appears to be the first-stop solution of individual overseas donors who, with the best intentions, provide support and funding to children in orphanages.” Orphanages are also the easiest sell for businesses built on the burgeoning trade in gap year occupations for Western students, often known as “guilt trips.”

Usually students have no skills to offer the local organization, don’t speak the local language and have no knowledge of what would be required in a real job.  As a result, the work is usually unnecessary and at its worst, harmful.

The funding the volunteers bring with them, either directly, or as a result of an assignment from a Western placement agency, is what the orphanages seek.

“Since almost all residential care centers are funded by individuals from overseas, many turn to tourism to attract more donors,” The UNICEF report says. “…this becomes the basis for an “orphanage tourism” business in which children are routinely asked to perform for or befriend donors and in some cases to actively solicit funds to guarantee the residential centers’ survival.”

Rarely have volunteers been subjected to a background check or arrive with any training – the assumption being that what would not be ok in a Western context is fine in the developing world? Indeed the reality is that these experiences are much more about the Western student than making any real contribution.

At the same time, the high turnover of volunteers who offer their love to children and then leave, is seen to negatively impact children who have been institutionalized when often they should have not been in the first place.

The situation has become so bad that the long-time Phnom Penh based NGO, Friends International, has started a campaign entitled “Children are not Tourist Attractions” and FI Executive Director, Sebastien Marot, has been writing on the topic here.

Of course, the interest on the part of Western students in connecting abroad is praiseworthy, if it is real and not just an excuse for a Southeast Asia drinking binge.

Without real skills to offer, there are, however, better ways to contribute, including monetarily to organizations that have long and solid reputations for work they are doing helping to protect children living on the streets, provide free medical care, reintegrate them with their families and provide education or vocational skills while keeping the child at home.

Friends International is one such organization, M’Lop TapangAngkor Hospital for Children and APLE are others.

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Angkor Hospital is the spectacular facility in Siem Reap, Cambodia I have written about in previous blog posts. Last year, the hospital offered 157,000 treatments to children free of charge, ranging from physical therapy and dental care to heart surgery. The boy above is an AHC heart patient who prior to surgery could hardly walk. When I came across him with his mother in the packed waiting room – back for a check up – he was running across the courtyard. His mother wanted to show me his scar.

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The hospital includes an incredible team of 49 Cambodian doctors and 149 Cambodian nurses, not to mention an equally dedicated support staff of 130. Although foreign teams do sometimes assist and train in more complicated procedures, there are only two full-time foreign doctors and two full-time foreign nurses at AHC. Above is the ER team comparing notes on patients.

The AHC budget for this year is US$4.5 million U.S., which works out to a cost per child of US$23. This compares to an average cost per child in the U.S. of US$1,853. Throughout this year, an average of 1,400 children were visiting the Emergency room at AHC and its satellite clinic thirty kilometers away, while 290 patients required admission. On average, the hospital’s three surgeons performed seven surgeries daily.

Those numbers have increased over the past few months, however, with a regional dengue outbreak and a larger number of patients seeking quality medical care they can’t find or afford elsewhere. In some cases, patients have had to rest on mats in the corridor for lack of ward space, while others have been sent to other hospitals.

A new four-floor building is now under construction. This will help improve medical care and create an additional 250 sq meters in the main hospital. Among the additions will be a neonatal ward, a new ward for recovering children, an expanded ER and labs (including the research lab, which is a partnership with Oxford University). Beyond the recent pressure from larger numbers of patients, an April medical audit identified a lack of adequate space, the small ER and lack of neonatal unit as the top three weaknesses of AHC.

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AHC works hard to provide the quality of medical care and compassion that a sick child would receive in a developed world context. The type of treatment offered at AHC, which is free of charge, is rare in Cambodia. This includes support to chronically ill patients, physiotherapy and palliative care for very sick children.  A home care program follows up with many such patients and includes a social work team.

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Some patients and their parents who aren’t able to see a doctor on the day they arrive must wait until the next day. The hospital provides cooking facilities, clean water and mosquito netting, which, innovatively, is tied between benches in the waiting area.

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These two children were waiting with their mother and a sick sibling, who needed medical attention.

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Beyond providing medical care and support to government hospitals around Cambodia in developing their medical and nursing protocols, AHC helps educate communities about issues related to health care. Some of the main causes of sickness, the main reasons that patients end up at AHC’s gates, are drinking contaminated water, poor sanitation and poor nutrition. In the context of working in one of Cambodia’s poorest regions where malnutrition is surprisingly still rife, AHC staff teaches children and their families the basics to keep them healthy.