Health Education

A woman cleans a raw chicken and then eats a bowl of rice with her hands. Naked children play in mud and then their parents peel a rambutan (a small, red spiky fruit) and hand it to them to eat. This is the sort of scene I see all the time in Cambodia, where basic hygiene, like washing one’s hands, is not yet common practice. Poor hygiene adds to Cambodia’s disease burden, which includes serious diarrhea and exotic mosquito born-illnesses. The disease burden contributes to the low life expectancy in Cambodia; the average Cambodian born today is expected to live to be 60. That’s why I devote a lot of time to working with Cambodians to encourage better hygiene practices.

Here is a photo of children in the mud:

From blog 8-10

Behavioral change is a slow process. However, by empowering community members to speak out about health concerns, people can spread proper health practices. I believe this is crucial for Cambodians to take better care of themselves and for Cambodia to continue to develop.

One thing I do is bike around the district with some of my students. We stop when we see groups of people idly chatting by their houses. We then give them a short presentation about hygiene. When they answer questions at the end, we give them candy or toothbrushes. The toothbrushes come from hotels all over Cambodia because I’ve asked other Peace Corps Volunteers to collect complimentary toothbrushes for me.

Here is a picture of a presentation:

From hygiene bike ride july 2010

These students are from my summer English Club. Once a week, we focus on health. While teaching about health, I have the students practice their public-speaking skills to explain the health concepts. I do this because, in addition to practicing poor hygiene, most students slouch and speak quietly and quickly because they are too nervous to speak in public. Therefore, it is satisfying when I see students in front of a group smiling, as they interact with the audience during our health education bike rides.

I was also surprised to learn I’ve opened some of my students’ eyes to community service (Most people I work with are already inclined to it). One of my students told me (in English) when we were biking back one day that he was “happy to participate with me” and that this was his first time doing anything like this. His interest was of particular value to me considering I didn’t even expect him to show up. When I announced the bike rides, he told me he didn’t have a bike (he borrowed one) and he is usually busy tending his cows.

My presence makes health campaigns a memorable experience for the audience since many of the rural villagers have never seen a westerner, let alone one who speaks Khmer (albeit with poor pronunciation).

The information I share is also regarded highly. This was pointed out to me after a morning of giving health presentations in the village with the health center staff (a separate program from my English club). A nurse explained to me over rice and soup that Cambodian people don’t trust information from other Cambodians, but they trust information from a white foreigner (having light skin implies you are wealthier and aren’t out in the fields all day, so Cambodians want light skin). The nurse was exaggerating, as Cambodian people like to do when they compliment you, but there is some truth in what he said. Whenever I am sick, everyone I know gives me medical advice that would result in a lawsuit in America. One of my friends got bitten by a feral cat, and the locally prescribed remedy was to put some Chinese balm on it. Luckily, he chose to call the Peace Corps doctor instead.

The health center outreach usually takes place at a village chief or village health volunteer’s house (the district is divided into communes and villages). These houses serve as a rudimentary health clinic. They provide basic information and distribution of things like water filters, but no medicine or expert consultation. Local health services are essential, since health centers and hospitals can be too far for a poor villager to go. Many villagers live ten miles from a health center and most live 20 from an actual hospital. It is also difficult for a villager to miss a day of rice farming or leave their animals unattended.

The village chief sometimes invites villagers to come to the health outreach with a loudspeaker that can go nearly a half-mile. This is necessary because the villages are so spread out and the nurses only go to each village once every two months. While I like the loudspeakers when they are providing health services, I dislike them when they are used to promote a social event. 4 am announcements for a festival or all-night wedding music are not uncommon, as there are no noise ordinances in Cambodia.

It’s interesting how something as simple as washing hands is institutionalized in a society. In America, we take for granted how easy it is to find a sink, soap and a clean towel, all right next to each other. When I eat lunch at my host-family’s shop, I keep a clean towel in my bag to dry my hands and the place where I wash my hands and where the soap is kept are far apart. I’m the only one in my host-family who washes my hands before meals.

The lack of hand-washing is present in the medical establishment as well. I’ve been to offices staffed by doctors, who are supposed to monitor health in large areas, but lack soap and towels in the bathroom!

Alcohol is also a serious problem in Cambodia. A Cambodian drinking party, which frequently occurs in the middle of the work day, consists of men sitting around a table. The drinks of choice are beer with ice or rice wine that burns as it goes down (Rice wine translates from Khmer to English as white wine and I go through pains trying to explain that we drink white wine made from grapes in America. They find the idea of our white wine revolting, oddly enough). There are usually some peanuts and meat - dog meat is sometimes served at this time. No one takes a sip of their drink unless everyone takes a sip. If anyone is drinking too slow or does not drink when the rest of the group drinks, they are ridiculed and badgered until they drink more, as if they are a college freshman trying to get into the drunkest fraternity. This is the norm; high ranking officials and the poorest farmers drink in this manner regularly regardless of age.

From blog 8-10

While there are radio and TV ads encouraging good hygiene, not much is being done about alcoholism in Cambodia. However, Samon (the teacher I do a lot of projects with) and a group have been spearheading the effort locally, by biking around the village to educate people about alcoholism and having community meetings to discuss it. His group wants to get a law passed so children under 16 cannot buy alcohol (there is currently no law about who can buy alcohol).

Here, we stopped at one of the drinking parties. Usually they are friendly, but sometimes drunk people can be angry or rude as you’d imagine:

From blog june 2010

Some of our group with their bikes and our posters:

From blog june 2010

When we give the presentation, we show pictures of the heart, liver and brain and talk about the effects long-term alcohol use can have:

From blog june 2010

This home-made poster talks about some of the dangers of excessive alcohol use:

From blog june 2010

The top right is a sick person. Many people in the rural areas listen to traditional healers who tell them that alcohol can cure their illnesses. During one presentation, a person was trying to tell us that even though raw toad is poisonous, if you mix it with rice wine, it becomes medicine.

Here I am, explaining some of the pictures:

From blog june 2010

At my English club, I was teaching students how to talk about their daily schedules. One student explained how in the evenings he does housework, watches TV and then has dinner. Another student, who is usually shy, says “You forgot something.” We all wonder what. Then the quiet student explains, “You forgot that you need to wash your hands before you eat dinner.”

From hygiene bike ride july 2010