This was a talk given by DR KIRSTEN SMALL at the January meeting of Permaculture Noosa.
“BIRTH & LIFE IN CAMBODIA”
In October last year, I was fortunate to have the opportunity to spend time in Cambodia as a volunteer. I worked with a non-government organization called Women’s Health Cambodia, which is owned by local Khmer people, and supported by Life Options Asia, headed up by an amazing Australian nurse called Denise Love. Denise has lived in Cambodia for the past 2 years.
What does Cambodia have to do with permaculture and life in Australia? Firstly, peak oil is a reality for them. If our dollar had as much buying power as it does for the average Cambodian person, then we would be paying $97 a litre. Secondly, Cambodia has survived the incredible atrocities of the Pol Pot era where 25% of the population was systematically killed. Anyone with leadership ability, or skill was tortured and killed. The adult women that I worked with had all survived this by escaping to the border camps, which is where they were trained as midwives. The generation that has just entered adult hood were born during that time.
Cambodia therefore provides us a valuable lesson in resilience. This is a culture that was sufficiently evolved that in the 6th century they built Angkor Watt, while my Scottish ancestors were still living in wooden forts and hitting each other over the head with sticks. Cambodia doesn’t provide the perfect example however, as they are still deeply reliant on outside help. The challenge is to assist the country to become self sustaining once again.
BIRTHING
I was in Cambodia in my capacity as an obstetrician and gynaecologist, to help provide medical services to women. Cambodian women marry in their late teens and early twenties, and begin having children soon after. The average number of children per family is 3. Modern contraception is available, but the choices are limited and it isn’t free, so only 40% of couples use it. One in 30 babies die before 6 weeks of age, and one in every 300 women die in childbirth, a rate that is thirty times that of here in Australia.
If you asked any one in Australia what do our women die from in childbirth and when does it happen – they’d have to go to Google to answer the question. We asked that question of a group of volunteer village health care workers. The reply was instantaneous – they die of bleeding and it happens the day they come home from the clinic. They know because it happens so often. Giving birth is called ‘crossing the river’ and is considered the most dangerous day in a woman’s life.
A woman arrives at the clinic in the company of her extended family, and the female members of the family stay with her throughout labour. Most of the labour is spent on the verandah, sitting and walking with the family. When they feel they need attention they go and find the midwife, who during the night is probably asleep in her office. There is almost no intervention in labour. Women labour quietly and don’t ask for pain relief because none is available.
All births are done in the lithotomy or ‘stranded beetle’ position. Unfortunately that is the way that the western world taught Cambodian midwives during the Pol Pot era, and even though we have long since moved on here, they are reluctant to change what they have been taught is the best way to do it. The baby is placed on the mothers chest until the cord it cut. The baby is then taken to a bench where it is weighed and wrapped in a sarong that the mother has brought with her. Once the placenta is delivered and any stitches done, dad is asked to come and carry his wife to the postnatal room. The dirty sarongs that have been used to clean up are given to the family, who go out the back of the clinic and wash them and hang them on the fence to dry.
All women breast feed, and sleep with their babies. In most clinics they will go home about 6 hours after the baby is born. With Denise’s funding extra rooms are being built so that women can stay for a few days, to get through the danger time for bleeding.
There are some interesting cultural practices around birth. Mashed up herbs are mixed into a paste that is put over the baby’s soft spot. Every baby sleeps next to a knife. These are designed to stop the mother spirit that comes in the night to take the baby’s life. The more challenging practice is called Aing Pleung or Roasting. Similar to the Chinese belief that women must eat warming foods after birth, women and babies must be kept warm. In temperatures over 30 degrees, I saw women with beanies on, wearing thick jackets, lying under blankets and the baby similarly dressed. At its most extreme a small fire is lit under the platform where mum sleeps to add to the heat. Houses have been known to burn down, killing mother and baby. Much effort is going into stopping the use of fires.
It is easy to tell how old a woman is in Cambodia. When you first marry and start your family it will be long and pulled up at the back of your head. As you get older you cut it shorter. By the time that you are a grandmother, you cut it to shoulder length. When you get to the age that you are no longer bothered with all that sex stuff, you get to shave it all off!
HOUSES
People build their own houses in family groups in small villages. Houses are raised off the ground and mostly built of wood, with iron or thatch roofs. The kitchen is in a separate detached building, to reduce the heat entering the house, and in case of fire, as you cook over a wood fire. Under the house is a raised wooden platform that serves as seating, daytime sleeping area, dinner table and work bench. Animals are also kept under the house. Water is collected and stored in concrete tanks. There are fruit trees around the house, but I saw no vegetable gardens. Most houses have no toilet, but those that do have them will have a squat toilet over a septic tank. The bathroom is the area next to your water tank.
People have no possessions so there is no need for clever storage solutions. Mats are rolled out onto the floor inside the house at night and the family of several generations sleep side by side.
Washing up is done squatting by a basin in the yard. There’s no rubbish truck, so you burn what waste you generate. It makes you very aware of what you consume. On washing day you hand wash in the same basin that you use for the breakfast dishes and hang it up over the wood pile or the fence. The fence is constructed out of whatever wood you have lying around and doubles as the kitchen drying rack. Many people operate a small business from the front of their house, which is ideal for women with small children.
Domestic animals are common even in the city. I saw chickens of every shape, size and colour. They are not fed or housed and just make do for themselves. The only sort of chicken I didn’t see were old ones! Even though the country is devoutly Buddhist, it is clear that animals here are for eating. Pigs, ducks, geese, goats and cows are kept, and they are most definitely not pets!
FOOD
Rice is the centre of life. I was there just as the harvest was starting and the country was beautiful with emerald green fields under dark blue monsoonal skies. Once the rice turns brown and starts to bend over it is harvested and threshed by hand, and then dried on mats in the sun by the house. A truck goes door to door with his machine that cleans the hull off the rice, and it is stored. It generally lasts about 9 months of the year, so there are a few very lean months before the next harvest is brought in. Rice is served at every meal with a small serving of meat or egg, and a handful of vegetables.
The flooded rice fields have multiple uses. The grass that grown on the edges is cut and brought home to feed the cow. You can wash your clothes or yourself, and the kids hop in for a swim to cool off after school. You can drop a line or pull a net for fish, or harvest the vegetables that grow wild along the edges.
Much of the food available at the markets is familiar to us. Cambodia was colonized by the French at one point so there are french bread sticks. The fruit is very similar. There are duck and chicken eggs, and lots of green vegetables, some that I knew but some that I didn’t. When you get to meat it starts to get a little more challenging, as full carcasses hang in the shade of an umbrella by the roadside, with the stall owner lazily swatting the flies off. I passed on the deep fried frogs, but enjoyed drinking freshly squeezed sugar cane juice mixed with lime.
TRANSPORT
Remember how expensive petrol is? You ration it by buying it one litre at a time in a recycled glass Coke bottle. You walk where you can, and as soon as you learn to ride you are on a push bike with your baby sister on the back. Or you use an animal cart. You don’t use petrol powered tools to do a job that people can do. If you use your motor bike, you put 4 people on it, or a big load. Or an even bigger load! If you drive a van you prop the back door open and put a wooden pallet down so that you can have a load hanging out the back, and then put 6 passengers on the roof.
PEOPLE
The Khmer people were amazing. In spite of the challenges of their life they were generous, friendly, inquisitive (many discovered that my freckles don’t rub off!), and grateful for what little they have. One advantage of their devalued currency is that even small donations go a very long way. If you can cook, garden, build, do plumbing or electricals, teach or have health skills, then Denise can use you in Cambodia. If you would like to donate or volunteer, you can find out how at www.lifeoptions.asia.