CHANGE in CAMBODIA

An observer of change
The opportunity to periodically return to a country that is rapidly developing like Cambodia is quite rewarding. Though I stumbled into the process when it was already well established, the changes are such that even a casual observer can sense the momentum, and in the process feel that she is a part of something unique. Even if that part is only to record how it is taking place.

When I was first in the country in 2007 I was told that the Cambodians don't like change the way we in the West seem to thrive on it. The context of this particular conversation involved a large Phnom Penh hospital where there was resistance to how the goals of improving patient care and increasing the hospital's capacity could be achieved. I accepted this statement as "development wisdom." I'd seen resistance to change in a number of medical or surgical situations. Even small changes such as routinely bathing and putting clean pajamas on patients can become an almost impossible feat to implement.

Besides the visibly evident changes as seen in the increased number of motos on the road, the number of people crammed onto each, and the recent enforced laws about helmet use, some of the changes are more subtle. Despite what I was told was the situation in the hospital, many Cambodians seem relentlessly in pursuit of change.

Much of my interpretation of this extraordinary rate of change has to do with the zippy way everyone moves about. Everyone seems to be in a hurry. It takes me longer to cross the roads now than it did a year and a half ago because of the increase in traffic. I can't just look one way and then another and go, I have to repeat this a few times, go through a complex assessment of who is going to turn and which lane they will chose to turn from and into. One's assumptions must be rapidly amended, realizing that the Cambodians are attuned to using more paths to get to the desired space in the road than I. There are fewer walkers and fewer bicycles, and far more motos and cars. The man who delivers bread every morning between 05:30 and 06:00 used to come by moto; now he comes by truck. I would not be surprised if 5 years ago he made deliveries by bicycle.

I pass the same shops, the same restaurants, that I have passed on every daily walk to the hospital, but they seem larger and cleaner. The packaged goods for sale are more in number, the selection is broader or a few more tables or another shelf have been added to increase business. Though the air is full of dust, the glass display cases are cleaner. In the past they seemed grimy, uninviting. Now the bottles and cans, the plastic fruits for display, and the packaged biscuits gleam with the care of daily dusting. The corner restaurants where I turn into the "Street of emaciated cows" on my way to work now have cloth tablecloths draped over the plastic tables. The bottles of chili and fish sauce are wiped clean, not coated with thickened dribbles as I remember. People seem to care more about the appearance of what they have to sell. Maybe this is because tucked into a corner along the verge of the road a few feet away, another entrepreneurial family has set up a table and gas burner and starts chopping their vegetables just as early as the already established restaurant stall keepers.


Everywhere people are selling. One woman parks a trailer in front of the hospital every morning to sell watermelons to hospital visitors and the police at the new multistoried police office across from the hospital. Further down the road a young woman sits on the grass beside a cloth laid out with stuffed animals for sale. Why she has chosen this spot, I don't know and how much she sells or why these particular wares, I also don't know, but she is working. The cardboard collectors and the glass collectors are doing a brisk business recycling. Garbage is a sure sign of development.

Another change: I see more girls driving boys and women driving men on their motos. Females have always driven motos in Cambodia, but if there were a girl and a boy on the same moto, the boy drove.


Not all things change
The emaciated cows living on the street of the same name are the same as I remember--all bone and sad skin. Had Cambodia a human society, these poor bovines would have long ago been impounded. The dogs still rule this street and the black cur that rules one end continues to spread his seed along the entire length of the street.

The Hospital

Though it looks the same, the Emergency Hospital has changed. The sweepers still sweep the bougainvillea flower petals from the lawn every day. The creepers and vines crowding the small garden with its Buddhist statues still give the appearance of a secluded sanctuary.

The admission criteria have become stricter. All pediatric trauma is accepted, but only adults with open fractures or poly-trauma patients who have sustained multiple, more life-threatening injuries, are admitted. Even though the hospital's in-patient census has decreased it remains just as busy. The increased number of motos and the faster speeds that people travel on the improved roads create more devastating injuries, requiring more operating room time, more physical therapy, and more work in the wards for each patient. Two fractured femurs on one patient are not uncommon and the combination of a fractured femur and a fractured tibia seems almost routine.



At the international house I was disappointed to find a huge table that could easily seat 20 people occupying the pavilion where I do early morning TaiChi. After a week it was moved and I have recovered the use of a most perfect venue to do my exercise. The morning bird calls begin when I begin, with the click and boom of geckos punctuating the morning darkness. The hoarse chant and "music" from the nearby wats (temples) with their dreadful sound systems start at 06:00 on holy days, flooding the neighborhood with a discouraging din. These things don't change.

There was more to the statement that I heard 3 years ago about the Cambodians not embracing change: they don't accept change simply for the sake of change. But when there is a reason for change, a push from within or without, a need to go, to move, to sell and buy, then change can become the norm.