Sovanly: Small Surprises in Rural Cambodia Part II
She didn't look like a nurse. Sovanly was wearing a modern t-shirt adorned with a geometrically-inspired elephant, a black and orange animal print hoodie and sneakers. There was no white uniform or name badge. But there she was, in charge of the health clinic at Mekong Blue, a weaving NGO that prides itself on treating workers with care and respect. "I love this job," Sovanly says. "I love to teach people how to protect their health."
Mekong Blue creates fine quality silk scarves and other products. It's located near Stung Treng, a Cambodian town near the Mekong not far from the Laos border. The managers do their best to offer incentives to talented weavers - all women - to stay and work with them rather than go to Phnom Penh's garment factories or to Malaysia to be housekeepers. For example, there's a school for the young children. There are free meals and rooms where the women can sleep. And, there's a health clinic offering free primary health care services.
Health services vary along the Mekong. Generally, if you're poor and live in a rural area, access to quality care is more limited. Wealthier countries like Thailand have fairly robust public health programming. While poorer countries like Cambodia are improving but still finding their way. There are primary preventive services - such as immunization and maternal care - but the system remains a patchwork of public and private services, with more people paying to see private providers. Of total national health care costs the government pays about 20%. International donors pay another 20%. And Cambodians pay 60% out of their own pockets. About half of Cambodians are what the World Bank calls "near-poor."* That's why the free health clinic at a small weaving operation is so important.
Sovanly's mother was a nurse, and she inspired Sovanly to study nursing as well. It was also a good choice for the family as there is a nursing school at Stung Treng where Sovanly grew up. "My parents wanted me to study, but not be too far away from them either," she says. Now 24 years old, she graduated three years ago from a class of 50 students, all of them women. She spent three years studying with a focus on midwifery.
At the tiny Mekong Blue clinic, she consults the women who work there, their children and their husbands. As we talk more about her work, it's clear that the lack of a uniform has no bearing on Sovanly's knowledge.
Take antibiotic resistance for example - an issue that is gripping the world right now as widespread misuse makes antibiotics less and less effective. In this region, when people spend precious money to see a doctor, they expect to walk away with a prescription. Doctors tend to readily prescribe antibiotics even for viral illnesses. And in any case, basic antibiotics are also easily available over the counter with very little instruction on how to take them.
For this, Sovanly sounds a warning. "I tell my patients, if you take antibiotics it's so important to finish every tablet!" And she says that when patients come in with a headache and want a prescription, she doesn't give in easily. "I tell them they don't need pills, and they shouldn't abuse them. I love explaining health issues to people, and helping them to change their behaviour."
Sovanly also has strong feelings about the right for women to access family planning information and commodities, which they can get from the Mekong Blue clinic. "These woman are quite poor," she explains. "If they have too many children, it's not good for them or for their families. They don't have enough money to feed and educate the children. So the family will have a harder time escaping poverty." She says she personally wants just two children, and that way, she can afford to send them to university.
Sovanly talked passionately about these issues. Maybe I shouldn't have been surprised, but it was impressive to hear the "global" messages - usually published in major reports, news releases and newspapers - right there in that little rural clinic. I was encouraged to hear these messages connecting where they matter most - at the point of care between health workers and communities.
Sovanly and I continued to talk. Her English - which she learned at school and practices with foreigners - is near perfect. She won't stop learning anytime soon. She's saving money so she can study management. Sovanly also uses her income to help her family. She has a brother in university and she says she wants to help him graduate.
For now she's happy where she is. "I love this job and the experience I'm getting," she says. "Maybe one day I can run my own clinic."