A Pediatrician Shares Her Cambodian Rounds : The Trials and Tribulations of Doing Relief Work in a War-Ravaged Country

The most surreal, if not the most chilling, moment of Clydette Powell’s two years in Cambodia came the afternoon she and a British doctor returned from work at the National Children’s Hospital in Phnom Penh.

Their living quarters, she recalled recently, were at the old Hotel La Royale, now called the Sami Ki, or “solidarity” house, a tightly secured place used to house Western foreigners. No Cambodians--or Khmers, as they are frequently called--are allowed to pass the guards and barbed wire without official permission. The same goes for Soviet, other Eastern Bloc and Vietnamese residents working for the Vietnamese-backed People’s Republic of Kampuchea (Cambodia’s official name).

Despite the security, as the two doctors entered the courtyard, Powell said, the lobby was taken over by men with machine guns ordering people about, their black uniforms the all-too familiar symbol of the Khmer Rouge.

The two doctors looked at each other. “We didn’t have to say it: ‘It’s finally happened. History has repeated itself,’ ” Powell said.

It was a distinct possibility. After all, former Premier Pol Pot and his dreaded Khmer Rouge troops were out in the provinces, still at war with the Kampuchean government that routed them from Phnom Penh in 1979, still the object of fear after a four-year nightmare that left the country devastated and the populace reduced by one-third, or 3 million, through torture and murder.

This time, however, it was different. Within moments, someone came running up to the two women to explain that a Czech film crew was shooting “Nine Circles of Hell,” its version of “The Killing Fields” and this was a re-enactment of the takeover of the hotel by the Khmer Rouge, Powell said, laughing nervously at the memory. In fact, she added, the film company needed “extras,” and Powell became one.

Everyday Life

This then is the unpredictable, through-the-looking-glass quality of life in Cambodia these days, especially life for one of the relative handful of Western foreigners, mostly relief agency people allowed to live there under very restricted conditions.

Powell, a soft-spoken pediatrician and neurologist, has returned to UCLA, where she had been teaching and doing research in epilepsy to complete work for a master’s degree in public health concentrating on epidemiology. Her return is a temporary one, she says, because she wants to return to Cambodia as soon as possible for “as long as God permits.”

Powell described her experiences in Cambodia at World Vision’s Monrovia headquarters. It was with World Vision that she went to Phnom Penh, working on the staff of the hospital that the international Christian relief and development agency built in the mid-’70s. The government now owns it, and World Vision has a consulting status, providing staff, equipment and most of the finances for the 91-bed facility.

As she spoke of the country, the people and her own experience there, she described a time of tension, hard work, sadness and joy, and high emotional rewards.

Most of the tension, she said, came from working in a place so recently and throughly destroyed and among a people so traumatized.

Recovery is a slow process in the impoverished place where every May there is an official National Hate Day during which people are strongly urged to publicly testify about their memories of the atrocities; where political education meetings are mandatory and often interrupt work routines, she said.

Phnom Penh, all but deserted during the Pol Pot regime, is now a dilapidated place, Powell said, where animals and poorly clad children roam the streets; where sparsely stocked food stalls offer vegetables and fruits priced beyond the reach of most citizens; where safe drinking water is all but a dream and the message to boil available water does not get through; where the supply of electric power is never certain; where amputees are a constant reminder of war; where the prevalence of large quantities of vodka in the shops is a sign of the Soviets. And, she added, where the memory of the United States is not that benign, because of this country’s role in postwar Indochina and the Vietnam War, which crossed Cambodia’s borders, and because of its continued refusal to recognize the Vietnamese-backed Kampuchean government.

Tact and Brevity

Because Powell is anxious to return, she approaches questions of politics with as much tact and brevity as possible.

“It’s a privilege for a Western organization to be in Kampuchea. It’s a communist country; and memories of the Vietnam War are still there,” she said.

Recently, Amnesty International has been alerting its members to reports of “widespread and repeated human rights abuses . . . (including) arbitrary arrests and imprisonment, torture and unfair political trials.” Powell said that while she had heard of such charges coming from Amnesty she personally “never saw or heard of those claims being substantiated.”

Some of the most visible changes came after tourism was reinstated in late 1986, she said. Europeans came first, followed by some Japanese and Australians, “but certainly not any Americans or Chinese (who support Pol Pot),” she said.

“It gave the city a new look. They put up some street lights, and lit them only when the tourists were there. They repaved some streets, refurbished some hotels--including putting in hot water, repainted some monuments--although maybe that wasn’t because of tourism--issued some post cards, and painted white lines down the streets.”

Because of the scarcity of motor vehicles, she said, the Khmers often observed ironically that the only function of the white lines was to indicate which side of the street the animals were on.

Westerners are isolated as much as possible and social contact with them is officially forbidden, she said, attributing the actions as more protective by the Khmers than anything else.

Any proscribed activities involving foreigners are supposed to take place only with the concurrence of the Ministry of Foreign Affairs, even for something as simple as attending a wedding. And some involve more bureaucracy than others, she said, offering the example of her request to study classical dancing at the School of Fine Arts, which had to go through three ministries--Culture and Information, Foreign Affairs, and Interior.

“I never really got a ‘no,’ ” she said, guessing the bureaucrat was telling her the truth who suggested, “No foreigner has ever asked. So we do not know how to process the request.”

She had extensive contact with the Khmers, nevertheless, and just about every other group in Phnom Penh. As one of the few pediatricians around, it was almost inevitable. In a country that had about 500 to 600 doctors before Pol Pot, there were about 50 at the most to survive his regime. The medical school is functioning again, but doctors are still scarce.

At the hospital, she worked a 12-hour day, she said. The Khmers worked longer hours. Because of the curfew, she had to leave at 6, while the Khmers stayed behind, she explained.

“The Khmers have a big heart,” she said more than once, explaining the overcrowded conditions at the hospital. They do not like to turn patients away. With a patient usually comes the family, since nursing care is largely nonexistent. Nor, do the Khmers want to give up on a patient, she said.

A Resourceful Solution

She pointed to one of the photographs she had with her and said the little girl was an orphan, so lacking in identity when she was brought to the hospital that her original name tag read “Zero.”

She needed to be in an incubator, but there were always technical problems with electricity, making it dangerous to leave her unattended. But the Khmers are resourceful people, Powell said, and determined that the little girl was so small she would fit in their pockets. So she spent her first days making the rounds of the hospital in the pockets of her countrymen.

“Zero, by the way, is now named Chan Mali, Monday’s Jasmine,” she said, pointing to the lovely child in the photo. “She went from being a little zero to a full-blown flower.”

There is some evidence of a backlash against the Khmer Rouge that is harmful, she said, and that is an overvaluing of modern medicine and a devaluing of traditional cures and medications and practices, including a devaluing of breast-feeding that the hospital was combatting.

As coordinator of the pediatric training program and consultant on more difficult cases, she said she saw much malnutrition, childhood illnesses such as measles made serious and sometimes fatal as the result of tuberculosis or malnutrition. Infections of the lung and brain can develop, she said. The most prevalent epidemic, the mosquito-borne dengue hemorrhagic fever, also could be fatal, she said, causing children to bleed to death. Usually, however, they could help.

It is one of the children she could help least, an 8-year-old girl, who seems to have made the deepest impression on her. She does not talk of her without weeping.

The little girl had arthritis, a chronic and crippling disease in children, she said, and a painful one. The girl’s mother brought her frequently and Powell got to know them well, going through “ups and downs” with them. At times she made a breakthrough, she would think, only to see a relapse come and the debilitation continue.

‘A Humbling Experience’

“It was a humbling experience. All I could offer wasn’t enough. I had to face my limitations.”

When the time came to leave, she found the whole family in the courtyard. She does not know how they got past the security, but there they were.

They had a bouquet for her, and a hard-to-obtain signed photo of the daughter, and asked Powell to let them know of any developments she discovered in the treatment of arthritis.

And then without warning, the mother begged the tenderhearted doctor to take her little girl with her.

“ ‘She’ll get the best care,’ ” she told me. “ ‘I know you’ll love her. I’m willing to give her up.’ ”

As she recalled the incident, crying hard, Powell was unable to get her voice.

Not that it would have been too much, she explained, it was just not allowed. Cambodian children cannot be taken out for adoption. Any informal arrangements would not have made it past the airport.

“Anyhow, as you can see,” she continued, “I’m very attached.”

Powell’s favorite social activity, she said, was to go to the Olympic Stadium several times a week to run. She was joined by 16 to 20 Cambodian children, boys and girls ranging in age from 3 to 16, who lived nearby, ran with her, helped her with Khmer, read stories to her and did not want to let her go.

The government must have known, she said, and turned its head. Had they disapproved, she would have been contacted.

For a farewell, Powell and the children went to two parks, took a ferry ride and ate at a restaurant. A grand excursion, but it wasn’t enough. They decided they wanted to go to the airport to see her off.

“Another official no-no,” she said of the airport send-off. Forbidden or not, it happened. Sixteen of them came, crowding into one van, of course. Airport rules and regulations meant nothing to children who had never been there before. Finally one last door stopped them, and they made their goodby and hugs with her. She left them behind. Sort of.

Something made her look back. The door stopped one foot short of the floor, and there they were, on the floor, faces and hands sticking through the opening, waving to her.

“We’re going to wait for you,” they told her.