Tales of woe and need. They’re almost as common as poverty in Cambodia. Every expat hears them, often with a request for assistance (i.e. money.) To help or not to help is the question. And if ‘to help’ is the answer, you still cannot help them all. There are too many, their needs often great, and resources are limited. Not to mention the problem of liars and scammers who would exploit your charitable inclinations. A degree of distance and discrimination is necessary, if for no other reason than to shield yourself from ruin. But how distant? When to listen and when to turn your head? When to help and when to protect yourself? And once involved, how deep do you go?

Over the years I’ve been suckered more than once, wasting my money and time. And there have been times I’ve turned my head, when in hindsight I should have listened and helped. The following is a story from a several years back when, grudgingly, and somewhat by chance, I got it right…I think.

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Phnom Penh. Mid-monsoon season. Early-afternoon. Black clouds building in the southern sky. The air began to cool and the wind picked up. It would rain soon. I decided to try to beat it home. Riding up Street 13 I could see a foggy sheet of water moving across the city ahead. I wasn’t going to make it. I pulled off just as the first drops hit my visor, taking refuge in a little Vietnamese coffee shop near Phsar Kandal.

I sat just inside the open façade near the sidewalk, shielded from the rain by the overhang. I ordered an ice coffee with milk. I love Vietnamese coffee – a little tin-pot strainer perched atop a long glass, slowly dripping jet black coffee onto cracked ice and a big blob of sweetened condensed milk…drip, drip, drip…thick and opaque, the glass slowly filling. It’s a lovely wait.

The rain was full on now, pissing down monsoon hard, the street flooding fast. As motos and cars plowed through the rising waters, waves began lapping onto the sidewalk. The intense downpour and encroaching waterline dislodged customers who had been sitting farther out, sending a couple of young VN girls my way. Walking towards me one offered a jaunty, bit too familiar ‘Hello, you!”‘ At first I thought it was a come on, but on closer look I realized they were friend of sorts – a couple taxi girls I’ve known for years. Dressed casually, out of the bar context and in the stark light of day I hardly recognized them. I motioned them to sit and join me.

The better spoken of the two, Mai, was a pretty 20-something from the British pub in Sihanoukville. Good pool player. Sweet talker. The other, Thi, was a older working girl from Sharky’s here in Phnom Penh – always something of a Sad Sack and a bit of a mooch. They sat down across from me and called for a couple of glasses to pour tea from the table pot.

We sipped our drinks and chatted – cordialities and weather-talk, as our limited language skills allowed.

As we spoke the conversation turned rather quickly to the story of a “sick friend” who was staying in an apartment above the coffee shop. Being a cynical sort, I doubted the tale’s veracity and suspected it was leading to an appeal for money, but held my tongue for the moment.

Mai said the sick friend was “very hot” and had terrible stomach and back pain, motioning dramatically to the relevant parts. “She’s very poor.”

‘Ah,’ I thought, ‘the money move is coming soon.’ I waited for an opportunity to change the subject.

She continued, “very hot, wet, stomach big, same like have baby (pregnant,) but no baby. Pain. Ooo, pain a lot. Very sick. Do you want to see?”

The offer to show me lent credibility but I begged off reflexively, not wanting to get deeper. I told them I wasn’t a doctor. Still, the symptoms did seem serious and were a bit intriguing, especially the swollen abdomen. ‘What could cause that?’ I wondered. Against my better judgement, I engaged a bit, asking if she had been to the doctor or was taking medicine.

“No doctor, no money. Medicine come out (vomit), and she no shit, no piss many day.”

Even to my non-medical ear that sounded bad. Not just another case of food poisoning or AIDS or whatever. ‘Perhaps an intestinal blockage’ I thought, which can be very dangerous.

Though still wary, my curiosity got the better of me. I agreed to go see her, while emphasizing that I hadn’t any medical training. I figured I could satisfy my curiosity, and if the story wasn’t complete BS, perhaps offer the girl a few dollars and urge her to go the doctor.

We went upstairs. It was colonial era apartment block, now sporting the post-apocalyptic look – heavy old concrete structure, unlighted corridors, barren soot-blackened walls, laundry hanging here and there, the smoke of cooking fires in the air and sounds of crying babies and playing children echoing through the halls.

I entered the apartment and immediately felt I had made a terrible mistake.

More than a half dozen people were crowded into a tiny room and all eyes were instantly upon me. Sad, desperate eyes. All poor, uneducated, bottom of the heap Vietnamese. Probably 10 years of school between them. The place was dimly lit and thick with incense smoke. My eyes burned. A 20ish year old girl lay curled on a bed against the wall – face beet red, sweating profusely, hair matted wet, breathing fast and shallow, seemingly semi-conscious. Two young women knelt at her side massaging her hands and feet. An old couple with bald heads, black silk pants and teary eyes squatted in the corner staring at me, hopefully, pleadingly.

“What have I gotten myself into?” I mumbled to myself.

Mai said something in Vietnamese and a middle-aged woman handed me a little zip-lock bag of pills they had bought at the pharmacy – 6 ampicillin, 6 paracetamol, 3 vitamins and what looked like a several antihistamines.

“Is this right?” Mai asked.

This is a common practice. Too poor for a real doctor, these people go to the pharmacist for both diagnosis and prescription. The pharmacist is a lot cheaper and will dispense drugs on a mere description of symptoms, sometimes even with the patient sight unseen. They don’t have a medical degree and maybe not even a degree in pharmacy, but that doesn’t stop them from diagnosing sick people and prescribing drugs, often in combinations that seem chosen as much for color coordination as medicinal properties.

In fact, there does often seem to be some crude medical logic to such prescriptions. It’s a scattergun approach to treatment, putting together a drug combo that may not cure the problem but will make many patients feel better, if only temporarily, regardless of the disease. Paracetamol to kill pain, B vitamins for a little energy boost, antihistamines in case of allergies or cold and enough broad spectrum antibiotic to slow down a variety of infections (though never a proper full course.) In lieu of affordable care, the limited medical knowledge of these ad hoc practitioners is probably better than nothing. But nevertheless, much (perhaps most) of it is a cynical scam to separate poor, ignorant people from their pennies with only cursory regard to their actual health.

Anyway, how am I to even begin explaining all this to them – the quackery and the exploitation and the blah, blah, blah? So I didn’t. I said I wasn’t sure but didn’t think it was right.

I walked to the sick girl and felt her forehead. She was burning up. She really did look pregnant, her stomach protruding like she was 6 months along, though they insisted she wasn’t. I reached toward her abdomen and she winced in pain before I even touched her. She looked like she was dying. Shocked by her deathly appearance, I blurted “You’ve got to get her to a doctor!” and reached for my pocket to give them some money. I was now thinking $20 or $30, enough to get her examined by a real doctor and buy whatever he might prescribe.

But Mai then explained she had already been to the doctor, in fact two doctors that day.

She reached under the bed and pulled out an ultrasound film and report from that morning. Surprised, I asked what the doctor had said. She said that they didn’t understand, but that it required an operation and would cost $500. I looked at the ultrasound report. It was clear, right there in French, ‘ruptured appendix…peritonitis.’ Holy Hell, she really was in immediate danger of dying and needed emergency surgery to save her life.

“Did you read this?” I asked emphatically.

“Cannot.”

Of course not. None of these people could read French. In fact they were probably all illiterate.

“Did the doctor explain this…appendix…her intestines…her sickness…what she sick?” I struggled for understandable vocabulary.

“Yes. No. No understand. Very sick. Very pain. Cut for $500.”

So, nobody here can read and nobody helped them to understand the life or death nature of the information. This is so Cambodia – the ignorance, the poverty, the human misery, the callous indifference of those with the power to help. I told them in no uncertain terms that she needed immediate surgery or she would die. “Go to the hospital NOW,” I said.

“Two hospitals today already…Calmette, hmm, one more…No $500, cannot. No money, nobody cut.”

‘Bastards!,’ I thought. So called ‘doctors’ knowingly sending a 20 year old girl to slow and near certain death for lack of a few dollars in her pocket today. “Quacks, incompetents, selfish racist cunts,” I barked at the floor.

They stared at me.

So was I manipulated into this situation? Was I getting the whole story? It didn’t matter anymore. Now I’m hip f*cking deep in this thing. Dropping 20 bucks on the table and leaving was no longer an option. Now…now, with direct knowledge of her situation and the power to change it, I am now responsible. Knowing what I know now, if I was to walk away I would be no better than those bastard doctors, little different than killing her myself.

I phoned a western doctor who happened to be friend. He’s not a surgeon, but I figured he could give some advice. He got right on it, made a few calls and found a Cambodian doctor who said he’d do the surgery for $290 (up front,) but it had to be at his office, not a clinic or hospital. I got the address and asked him to set it up.

I had $130 in my pocket. I put it on the table. I eyed the thin gold (‘pla-tin’) ring on Mai’s finger. She pulled it off and put it with the money. With prompting so did the others. Two rings, a pair of earrings, a tiny jewel pendant, a little more cash and four broken pieces of gold necklace and we had something like the whole $290. Now we had to get her to the doctor.

Thi went to get help and returned with several cyclo drivers. Using a blanket as a litter, the group packed her down two flights of steep stairs with all the delicacy of a bucket brigade, her moaning and wailing all the way. They put her into a waiting cyclo and off she went. The rest of us followed on motorcycles to the doctor’s office near Wat Phnom.

We presented the pile of money and gold to the doctor. He fingered through it, nodded his head and then did as he said he would, performing an appendectomy right there in his office. We waited out front on the street, huddling along the curb. I sat. They squatted.

About an hour later the nurse came out and said she’d be okay. We went inside to see. The girl woke in what seemed surprisingly short order, but after a while began moaning and crying in pain. I tried to get some more information from the doctor about her condition. In broken English he said that all had gone well and that with antibiotics she’d probably be fine. Good news.

And “why is she crying in pain?” I asked.

“Because she has pain from the surgery,” he responded, adding, “patients can be very difficult in the first 24 hours.”

Thinking that perhaps I had missed something, I asked what I thought might be a stupid question, “what about painkillers?”

“Not enough money” he said.

Ah, but of course. What’s a sundae without a cherry on top?

I asked how much.

“$40,” he said with a barely concealed smirk.

‘Extortion,’ I thought.

I looked behind me at the group. They looked back at me, nothing more to offer. I could hear the girl sobbing and moaning in the back office.

I had no money left, at least not on me. I took my phone out of my pocket and held it up. A cheap old Nokia. The doctor took it from me, looked it over, then smiled and nodded and handed it back. I pulled out the SIM and gave him the phone. Without missing a beat he opened the medicine cabinet, retrieved a vial of some drug, went in back and gave her an injection. She quieted almost immediately, seemingly more comfortable.

I stepped out to the street. The sun had set but the drizzle had returned. Tapped out and nothing more to do, I made my goodbyes. Everybody was smiling now and Mai gave me a rather formal sounding “Thank you.” The elderly couple in black silk kneeled on the wet pavement, satued and bowed and hugged the cuff of my pants, making me very uncomfortable. I got on my bike and left.

I saw the girl a few times after that, working as a taxi girl at Sharky’s and Martini’s, and then never again. A couple of years later I asked some of the working girls about her. One told me she had died of AIDS. Another said that she was fine and had gone to Vietnam. I never did find out what really became of her. And, come to think of it, I never learned her name either.

Casey Nelson

(Casey runs the excellent Long Time Observer blog and has lived as an expat in Cambodia since the early 1990s)