The Beach Babes of Cambodia
The first baby was born in a cave, or so they tell me. Probably some rocky outcropping near water in what is now the horn of Africa. The 1.8 million years since that first child fought it’s way into a harsh new world has softened things, made them safer and more survivable, but for parts of the world still struggling with modernity, some expectant mothers must not feel far removed from it.
The entire Kingdom of Cambodia survived the 1979 civil war with only about 45 doctors left alive – of those, half fled the country in the aftermath. Despite it’s dramatically lowered population, the survivors of the Khmer Rouge genocide had to deal with the staggering rate of one doctor to every quarter of a million people.
Even now, 37 years after the war, and 25 years after the United Nations intervention that sought to rebuild this shattered country, the services available to most Cambodians range from archaic to downright dangerous.
Traditional medicine is alive and well in the countryside.
Traditional doctors still ply their trade in provincial villages. Their cost and speed the only factors worth noting. Unregulated, they are often homeschooled – skills and tools handed down from father to son, mother to daughter. The complications arising from these unsanitary and unsafe working conditions are often terrible, such as the recent case of 277 patients accidentally infected with HIV due to unsterilized needles at a single clinic.
Things are changing slowly, but results are promising, with life expectancy rising ten years for men, and twenty for women, over the last decade. Better access to education, western equipment, and tighter health regulations mean standards are improving. Yet graduates still need only meet a 20% on their exams to pass, and can take the same test multiple times. Plus, the rampant corruption in most areas of Cambodian life means that even that 20% is probably negotiable.
A recent pregnancy highlighted the vast differences between first and third world medicine.
A stunning photo from a real North Vietnamese field hospital inside Cambodia’s swampy Cao Mao delta.
Neang, the petite young Khmer woman who’s shotgun wedding I had attended (and wrote about here – ‘The Weddin’) had gone into labor at home, as most do, and the entire village held their collective breath waiting for the good news.
After five days of breath-holding, I visited the family, fully expecting to hear the shrill cries of a newborn, but instead found only the grandmother and uncle-to-be quietly playing cards in the street.
‘How is the baby?’ I asked, peering into the rear of their small shop.
‘Baby not yet come’. Replied the Uncle, barely looking up from his game.
I was shocked and explained that in most places labor is rarely longer than a day or two (or three in my big-headed case).
‘Yes, but there is problem.’ He says, still staring at his poker hand.
‘With the baby?’
‘No, the father, Poul, he too young. Baby does not grow right if the mother older than the father.’
I sat down, stunned into muteness.
Cultural quirks are fun and interesting until there is a life or two at stake, but I bitterly swallowed my colonial indignation and held back from launching into a detailed gynecological and obstetrical breakdown to a group of people who likely believed the ghosts of their ancestors were participating in their card game.
A Khmer midwife in action. Photo by Nigel Dickson.
Only 1% of Cambodian women will see a doctor or the the inside of a hospital delivery room, and only 14% see a registered midwife. These numbers are amongst the lowest in the world, and as such infant mortality is high – losing 1 in 6 children before their first birthday.
Perhaps directly related to that statistic is the belief that drinking beer in the late stages of pregnancy will result in a lighter, and therefore more beautiful, complexion. In places where the sun and the fields create an instantly visible class divider these things are important, although usually accomplished through whitening soaps.
The most startling ‘remedy’ I overheard was the idea that a petite woman could ensure an easy delivery, especially her first, by drinking freely of the local rice liquor. While it’s true that that would ease the delivery, low birth weight is simply a result of the as yet unrecognized Fetal Alcohol Syndrome.
One in five babies is born severely underweight through this practice or simple malnutrition, and with a high rate of diseases such as malaria, dengue fever, and typhoid, and near-zero vaccination, many children will struggle to reach adulthood. In these circumstances, most Khmer women have had multiple pregnancies and understand, if in a rudimentary way, the complications that may arise from a rural birth.
When I returned, on what would have been the 7th day of labor, I was told that if the baby did not come soon the family would bite the financial bullet and take poor Neang to the city to see a doctor before she outright burst. No one seemed overly concerned, however, and perhaps it is simply the Khmer way to let things of this nature happen in due course, but internally I was screaming for sanity.
Returning to the beach yet again I am finally informed of the successful birth and introduced to a beautiful baby boy being bounced on the hip of his alcoholic grandmother.
Elated, I strolled into my local bar and ordered up a round in celebration.
‘To the new baby!’ I toasted to the bar, and the Swedish owner next to me.
‘Christ, did you hear how that went down? What a mess.’ He said, staring deeply into his empty glass.
‘Yeah, what, nine days labor? Insane.’
‘No, the actual delivery.’ He replied, shaking his head. ‘The baby being born. What a bloodbath…’
The tale he recounted needed no embellishment and rang true to those locals who know the circumstances of many families here.
On the 8th day of labor at home, the decision was finally made to trundle Neang off to nearby Sihanoukville to see the doctor (Mun-Tee-Pet in Khmer). As with all of these situations, it is a whole family affair – brothers, sisters, aunts, uncles, and the matriarchal grandmother who wakes shakily to a bottle of rice-whiskey.
Arriving at the Khmer-run hospital, the family set up mats in the operating room, and began the process of readying for the delivery. Sheets and towels and semi-sterilized surgical tools are produced and at the ready, but the doctors, for whatever reason, decide to postpone.
Whether it was a discussion of pre-payment, as is the case sometimes, or a legitimate medical reason arrived at by educated means, I’ll never know – but from what came next it seemed patience had long since run out.
As the family argued pointlessly with the doctors, unwilling or unable to perform a Caesarean, one woman put down her beer, steadied her hand, and stepped forward. She may have been in this situation before, maybe once, maybe far more, but as the soon-to-be-great-grandmother parted the crowd the doctors and nurses stood back.
Taking a waiting scalpel from the table she began the incision just below and inside of the hip bone.
Most likely this was done without any anesthetic, and on seeing the jagged pink scar later on I could only wonder at the sheer terror it must have caused that poor girl.
Removing the child from the incised womb he begins to kick and scream, sputtering and choking into his first breaths of humid Cambodian air.
By all accounts the now great-grandmother simply clipped the cord, nodded to the stunned doctors to finish up, and shuffled back to the sleeping mats with the still bloody newborn.
On hearing the finale to this now ten and a half month long ordeal I was floored. Even for Cambodia it seemed extreme. Yet another push to the edge of the envelope of what I thought this place capable of. Mother and child would, however, go on to recover in fine style from this unorthodox delivery, and grandma could cut another notch to her already well-marked belt.
The new mother will be sequestered for up to a month afterward in a sick-room. The practice, which translates to ‘set the mother on fire’, is intended to raise her ‘heat’ energy by keeping her bundled up in winter clothes, near a fire, and blind drunk on warming rice-whiskey.
In Buddhist tradition, it is believed that this baby is the reincarnated spirit of an ancestor, and the shaving of it’s head, and the tying of a red string bracelet around it’s tiny wrist, cleanse the spirit of any past transgressions.
A mix of medicine and mysticism will follow, with ancient remedies, rituals, and sacraments guarding and guiding the new mother and child through life. It can be tough to bear silent witness to these moments, especially when it seems lives are at stake, but as a guest, I must respect the customs and traditions of a country which has welcomed me with all my own failings. I must put my faith in their ability to survive in this unforgiving place, safe in the knowledge that they have been at it a very, very long time.
-Nick
Ancient birthing scene from the walls of Angkor Wat.
