Kampuchea Crossings

Bump to baby on the beaten expat track

Nathalie Abejero

Vietnam: Visiting Ho Chi Minh City (Saigon)

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Of the three countries we visited, I think K fell in love with Vietnam. My consultancy back in Cambodia was on hiatus, due to financial mangling/wrangling among the health partners collaborating on the survey. It meant that K and I could not schedule ahead our entire visit with each other and instead were at beck and call of the survey’s schedule. Thus our time in Saigon was limited. However we found that it was the perfect middle ground between the ordered chaos of the big city of Bangkok and the primitive desperation of Phnom Penh. We spared ourselves the harrowing border crossing and went with a reliable tour company this time!

Saigon, or Ho Chi Minh City in bureaucratic speak, is such a great city. The Cambodian side of the border is like the rest of the poverty-stricken country, with just a small shed to shelter border officials and a handful of travelers at the front of the queue. Dust kicks up into your nostrils from passing vehicles while Khmers assemble a truckload’s worth of cargo onto the back of a small moto (moped) via improv engineering using discarded slabs of wood. The Vietnamese architectural eyesore meanwhile, at Moc Bai, looms imposingly above the Khmer dust clouds. Travelers are invited inside the building boasting spic-n-span tiled flooring, a stocked bar, efficiency. Keith was smitten from day one.

The coffee here is one of the best I’ve ever had. The street food was clean, the streets were clean. People moved about purposely, with solid intent, and the city exuded a businesslike edge on the charm of Old World Vietnam. Everyone was pleasant. Eye contact in Vietnam, which in Cambodia instantly pounced an urgent sell on you, was easy and friendly. You did not fear a scam at every turn.

Our travel styles are always in stark contrast to each other. K revels in the details, his camera always at the ready, capturing a quick moment or beautiful piece of work that evades the average eye. He beelines for the pagodas and examines the centuries-old intricacies as well as the way the wind blows the incense fumes against the open doorway. He loves the food and sitting for hours at a cafe sipping his espresso, waiting for the storm to start so he can watch the squid seller and milk vendor adjust to the rain. He’ll poise his camera on one spot and wait for just the right moment when a masseusse bikes down the street ringing his bells, and he’ll stay there watching local life fritter by. I on the other hand like to take in the big picture and walk from one end of the city to the other. I seek out the tallest vantage point to the city and scope out the landmarks. Does the city have a vibrant energy? A rich historical environment? Do they have a lively arts community? I set out on foot in a rapid pace, chasing the ebb and flow of the local schedule from morning until dusk.

The charm of Saigon was in its people. They had so much energy, and they were fierce about it. When we asked for help our hotel receptionist not just gave us directions, she made us repeat the name of the street many times so that we can get it right and get ourselves there via a taxi whose driver probably will not understand our non-tonal Vietnamese. There’s a strong drive towards something, towards a goal, and it was palpable in the air. The bustle on the streets exuded a great energy that was absolutely contagious, that I like going back!



Moc Bai Vietnam/Cambodia border


Covert Viet Cong headquarters, where unsuspecting American soldiers had Pho every day. The nondescript shop’s owners are still running their noodle business as it was over thirty years ago.


Reunification Palace, today a museum where tour guides will give you the Communist government’s official version of war history. Back in 1975, this was the Presidential Palace of the leader of South Vietnam-the target of VC spy Nguyen Thang Trung’s bombing raid on Saigon in the final weeks of the war.


This year marks the 30th Anniversary of Vietnam’s independence.


Fruit market


Market scene, Keith’s-eye view.


It is intended as a curative cocktail, these snake wines have become a tourist draw. Cobras, scorpions, lizards, and all manner of exotic reptiles are bottled and sold at the market.


There are many food sellers around the city. Grills and burners, glass bowls and utensils are carried in the baskets hanging from either end of the pole, along with the rice and food.


Throughout SE Asia these conical field hats are very distinctly Vietnamese, to shield the wearer from the harsh sun.


Would you believe there are durian connoisseurs in this world? There are hundreds of durian species. They range from bitter and pungent with less meat and bigger seeds to the cultivated lines that are super sweet and keep for long periods. My durian-fan friends like the kinds found in Malaysia and Indonesia, less affected by genetic modification or pesticide use, and more bitter and “true”. Who knew…..


Bananas fresh off the orchards.


Motos are the most popular form of transport even in the Socialist Republic of Vietnam.


Saigon Opera House


At night street stalls go up which sell all manner of Pho, the Vietnamese soup.


There are many centuries-old pagodas around Saigon. This particular one has a heavy Chinese influence, Ong Bon Pagoda.


The street food here in Vietnam looks clean (at least there is some measure of hygiene, compared to the complete absence of it in Cambodia!). Not sure what most of this seller’s items are, I’m getting a coconut-jelly dessert.


It’s a pagoda, but there were SO MANY I can’t remember which this was!


The Vietnamese government is phasing out the cyclos (bicycle-driven transportation) and they are not allowed on certain streets in and around Saigon. Unfortunately they’d do better to ban the smog-producing cars and trucks than these more-environmentally-friendly and culture-friendly modes of transport.


There is no way for pedestrians to cross the street except to just start walking. All manner of moving transport will either slow down or zip around you. Or they’ll plow into you.


View from the bus. The fare is cheaper on top of the already-top-heavy minivans and buses– hold on for dear life!


Chickens transported to the market on a moto. At least it’s a better travel alternative for the chickens. Usually their feet are tied and hung to a board off the back of a moto.


A trip to Vietnam is not complete until you get Banh Xeo from Dinh Cong Trang. The alley has two street vendors that became so popular that on any given time of day literally hundreds of patrons will be found sitting around eating these famous Vietnamese pancakes, wrapping them in lettuce leaves and dunking them in a sweet sauce. Heaven on a platter!

Free Trade and Pharmaceuticals

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The average NGO or civic group does not have adequate capacity to actively participate in the increasingly complex policy and legal environment of global trade. This puts decisions and actions taking place in corporate headquarters and multilateral assemblies out of reach of the ordinary citizen. Here is the short-version international legal framework for essential medicines, proprietary drugs, and CAFTA.

From GATT to the WTO
The end of WWII saw the creation of the World Bank (WB) and the International Monetary Fund (IMF) to regulate international economic cooperation. These are known as the “Bretton Woods” institutions, named for the town in Vermont, USA, where negotiations took place. The package of trade rules which came out of this gathering was the General Agreement on Tariffs and Trade (GATT 1947). It began with 23 countries, dealing only with trade in goods, and affecting just 10% of global trade. Thus began international trade liberalizations through progressive reductions of protectionist measures (ie tariffs), ensuring a tremendous momentum of trade growth.

GATT was legally only a provisional agreement and not a governing body. It did such a good job of reducing tariffs and promoting trade that governments had to develop other forms of protections for sectors threatened by overseas competition. Bilateral market-sharing agreements and subsidy structures were then created and implemented in effort to protect domestic products. Unable to respond to the vast overhaul of the global trade environment, the recessions of the 1970s and 80s, and increasing globalization, the Charter’s relevance soon diminished.

Multi- and plurilateral accords between contractual member countries were added to GATT during negotiations called “trade rounds”. At the Uruguay Round of 1986-1994, the World Trade Organization (WTO) was created to replace GATT. This Geneva-based intergovernmental body binds all members to global commercial agreements which are multilateral, mandatory, and permanent. It contains a dispute-resolution mechanism to enforce their mandates. In addition to trade in goods, this new organization added trade in services and intellectual property (IP) to its mandate. Trade in services is covered under GATS (General Agreement on Trade of Services) and trade in IP is covered under TRIPS (Trade Related Aspects of Intellectual Property).

WTO has 148 member countries as of February 2005. It accounts for over 90% of global trade.

WTO/TRIPS
TRIPS covers literary works, phonograms, computer programs. It also covers industrial designs such as copyrights, trademarks, trade secrets, geographical indications, patents, undisclosed information, and is an increasingly important component of trade. Minimum standards of protections against counterfeiting and piracy were laid out at WIPO (Paris Convention for the Protection of Industrial Property and the Bern Convention for the Protection of Literary and Artistic Works). Member states are given a transition period (periodically revised to accomodate country-by-country capacities) to adapt enforcement laws for TRIPS-compliance: 1 January, 1995 for developed countries; 1 January 2005 for transition economies; 1 January 2016 for least developed countries.

A 3rd WTO Ministerial Conference was summoned in Seattle, US, on December 1999 to plan the next round of negotiations, the Millennium Round. But irreconcilable disagreements among the members, aggravated by a massive global movement in protest of the status quo, led to the meeting’s collapse.

WTO/TRIPS/DOHA/Compulsory Licensing and Parallel Importing
The effect of international trade laws on the procurement of essential medicines is a topic of much concern. Patent protections are essential to promote investment and innovation by an industry. But effective legislation must balance all interests and prevent abuse by the patent holder. Pharmaceutical companies, governments, and advocacy groups have been embroiled in legal clashes over this issue, particularly with medicines for the treatment of HIV/AIDS, or combination anti-retroviral therapies (ARVs) for reducing viral load. Almost 90% of HIV/AIDS is in the lowest 10% geographically in terms of GDP.

TRIPS treats pharmaceuticals like any other article of trade, even though these are not just another commodity. These are life-saving consumerables. Pharmaceuticals are covered by patents which grant a monopoly period to the innovator company for 20 years from the date of filing. Without the safety mechanisms in TRIPS, given the existing market structure, drug therapies are not affordable to people of the developing world. The two provisions in TRIPS for health emergencies are compulsory licensing and parallel importation.

Compulsory licensing is a legal intervention for removing the monopoly rights given by a patent, in order to obtain cheaper generic versions of medicines. Parallel importation is the purchase of proprietary drugs from the cheapest source, from someone besides the authorized distributor, because drug prices fluctuate from market to market.

Both of these are powerful tools in creating the competitive environment which forces prices down. These mechanisms must be included in the language of national laws for a country to employ it in leverage against corporate interests in periods of crisis.

In November 2001 at the 4th Ministerial Conference convened in Doha, Egypt, Bush signed the DOHA Declarations under tremendous pressure from developing countries and civil society. DOHA essentially reiterates the right of member countries to break patent monopolies in TRIPS for the purpose of protecting public health, particularly in promoting “access to medicines for all”.

CAFTA/FTAA a.k.a. Monroe Doctrine II…
The Central American Free Trade Agreement (CAFTA) is an expansion of the 1993 North American Free Trade Agreement (NAFTA) further into the hemisphere, and is key to advancing the Free Trade Area of the Americas Accords (FTAA). FTAA talks were shut down by fierce opposition at the 5th Ministerial Meeting in Cancun, Mexico, 2003. Ongoing disputes between the US and Brazil further raises doubts about this pact. Elimination of tariffs as CAFTA-DR is designed to do comes with a theoretical economic boon but have far-reaching ramifications on basic rights, environment, and sustainable development.

Elsewhere, bilateral FTAs are aggressively pursued by the US government. Patent protections for proprietary drugs will be extended beyond the 20 years required under TRIPS. The new language weakens or eliminates a government’s ability to launch generic competition to lower the cost of medicines. It blocks test data from release within the patent period, denying generic manufacturers access to critical safety and efficacy information. It blocks the temporary override of a patent that compulsory licensing allows. CAFTA countries will be required to divert scarce resources to implement more stringent protection infrastructures, in compliance with rules counter to the broader interests of public health. Sanctions by WTO keep signatories from violating these charters.

These priority agendas from the Bush administration are drawing intense opposition from the global South. Even the World Bank has acknowledged the challenges these pacts will have on the participating members. A small number of transition countries who have won landmark legal battles of their own now lead this growing resistance– Brazil, South Africa, India, Thailand.

Fierce lobbying now surrounds this pivotal trade pact. CAFTA is aiming for a floor vote before the July 4 recess of the US Congress.

Free Trade: Patents versus Patients

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It’s been several years since US-backed Big Pharma sued South Africa for obstruction of profit when it bypassed patent laws to provide cheaper generic medicines for its burgeoning AIDS epidemic. The suit was retracted under furious backlash from advocacy groups worldwide. That battle has since stepped up with the ascendancy of IP (intellectual property) and trade imperatives. At issue are patent regimes affecting life-saving pharmaceuticals. It is critical to have flexibilities in global IP rules that accommodate situations whereby a country simply cannot afford brand name originator drugs to respond to a crisis. In protection of public health, and “to promote access to medicines for all”, the WTO TRIPS (Trade Related Aspects of Intellectual Property Rights) contains such provisions, called the DOHA Declarations, which specifically allow countries to break patents without challenge in face of extreme urgency. 2005 marks the year that developing countries are to come to full compliance with TRIPS. LDCs (least developed countries) have until 2016 to establish IP enforcement infrastructures. South Africa was only the beginning.

In the US, lawmakers are now duking out the fate of Bush’s free-trade pact with Central America, CAFTA, an expansion of NAFTA further into the western hemisphere. Fierce lobbying on both sides have intensified for a bill that was signed in the White House last May and stalled in the House and Senate over the past year amid rising opposition. The Congressional Hispanic Caucus has already rejected it. Health advocates cite that the IP protections will confer monopoly-like status to high-priced brand-name drugs in already resource-poor markets, rendering them unaffordable and inaccessible. It extends data exclusivity provisions in TRIPS and creates a more restrictive atmosphere against DOHA.

Outside Brazil’s UN Missions and Embassies this past weekend, AIDS demonstrators called on Brazil to summon the maximum flexibilities accorded by TRIPS for its public health emergency. Efforts to continue discounts for AIDS drugs have been met with enormous opposition from mega-pharmaceuticals (Pharma), despite the legal and voluntary sphere in which Brazil has sought to engage dialogue. This counterweight to the US in the western hemisphere is a model for the Southern Cone countries with its decisive response to its AIDS epidemic in the late 1990s, effectively using DOHA as a bargaining tool to lower procurement costs of ARVs (antiretrovirals) and in creation of a generics industry that is lauded worldwide. In exercising its right to prioritize public health by legally issuing a compulsory license against AIDS medicines patented by American companies, Brazil sits on the IP Priority Watch List for US sanctions. Its status in the Generalized System of Preferences, which bestows favorable trade access to the US market to select countries, is under threat and used as a carrot-stick.

Elsewhere, bilateral FTAs (free-trade agreements) are being pursued by the US that slip just under the radar of watchdog organizations, containing IP clauses which threaten the affordability of life-saving drugs. There is no transparency: the content of agreements are not publicly available before they are concluded. Many lives ride on the outcome of these free-trade pacts, negotiated by legions of American attorneys in language that allows for tightening of IP laws. Developing countries hardly have recourse against the gravitational pull of the Pharma-friendly US government. Thailand is on the near horizon to be sucked into these negotiations, with landmark judgments rolling out of its courts heralding a rough road ahead. Cambodia, the first LDC admitted to the WTO, is excluded from pharma-patenting until 2016.

Pharma influence is pervasive from the international negotiating tables to the consumer spheres. Pharma commands the highest profit margin of any US industry. It has more than one lobbyist for each member of the US Congress. Budgets for promotion to healthcare professionals, direct-to-consumer advertising, and sales forces exceed the GDP of Subsaharan Africa. It pays for over half of American Continuing Medical Education costs. Lucrative rewards are pushed at academics for promising research, with contracts including gag clauses to prevent the researcher from publishing unfavorable results. Leading companies spend two and a half times more on marketing and advertising than on R&D. Even medical journals have become an unwitting extension of Pharma’s marketing efforts. Regulatory agencies– the one consumer recourse– are understaffed, underpaid, untrained in multi-sector evaluations, unknowledgeable in public health concerns, and increasingly under the influence of the big wallets of Big Pharma.

The commerce of medicine and public health is a paradox. It is a complex mishmash of basic human rights, global trade regimes, economies of scale, financing superstructures, back-door legalese– all with ethical and moral underpinnings. It spawns a poverty industry that the development sector falls victim to– or is created for. . . ? Profits are not being demonized here: FTAs are established to safeguard the prosperity of the parties involved. But what good are the safety mechanisms in these negotiations if applying them will incur the wrath of an unstoppable US government?

The Stink of Durian for Newbies, and Adjusting to Cambodia

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A royal decree was issued in the night. Everyone in Cambodia who has shoes is to take them off, and they are to do it inside my room. Groan. Below my hotel window (wide open cuz the one AC unit in the entire town was not allocated to this hut) is a fruit stall enterprise specializing in durian, a treat to wake up to at 6am. It is that time of year when foreigners are subjected to Fear Factor challenges involving this foul mishap of creation. It is the season, they are everywhere, and the Khmers must share. There is particular affinity for this fruit, drawing national pride, cherished reverently, like there is a little god inside the paranormal-looking blob. When foreigners are offered a piece of it Khmer radars within a mile radius zero in and they all whip around to see what you will do. You ought not refuse– their expressions are benign enough, friendly in fact, but it gives eerie pause. If this were a scene in a horror flick or nightmare the wrong response will exact gruesome vengeance straight from the bowels of hell. Think twice, foreigner. Trips to market are now unhappy excursions. Since I have the big SUV my driver is put upon to haul the putrid cargo about, and of course the stench lingers. Usually I stay a few paces behind my translator at the market, who refuses to be seen with me because sellers tack on a “foreigner tax”. But when haggling for durian I don’t mind at all looking conspicuously foreign to jack up the price. Purchases came to a short-lived halt until she caught on.

Gastronomical conquests become a newcomer’s specialty. One of the more infamous aphrodisiacs hereabouts Asia is called balut in Tagalog. It is a fertilized duck egg, harvested just days before hatch date and boiled so that the fetus is fully formed and decadently crunchy. Bugs are also much prized fast food items– spiders, ants, crickets, really anything that moves, the more legs the better. To be fair, the cockroach that went into the fryer in Poipet was not the same creature spawned of urban squalor– they insist it’s a beetle, bred for its crispy, nutty texture, though that is hardly encouragement enough to pop one in my mouth. Everything gets fried, dyed, dried. Colors I normally associate with radioactive elements and glow-in-the-dark objects are particularly popular additives to milks, juices, and sweets. Meat jerkies are common too, and my neighbors occasionally lay things out to dessicate. The ones resembling small rodents sporting extra legs always throw me for a loop, but my inquiring mind is mum, quite content to leave ignorance intact. Flee! Flee!

These lead to sporadic obsessions I can’t shake– pasta, peanut butter, chocolate– {{When the dog bites When the bee stings When I’m feeeeeling saaaaad . . . }}}. I’m still nursing a chocolate craving that won’t go away, initially sadly coincident with the expat exodus from the Khmer New Year, which took with it all the baking talent of Phnom Penh (the French colonialists failed miserably in dessert indoctrination). That precipitated a baking fixation, a difficult endeavor in a country where appliances that generate additional heat are not popular, so you are put upon to make your own oven. Luckily my pal RS was not only able to prevent the forthcoming inferno– he offered use of his oven– his baking skills also far exceeds mine (not a stellar achievement, but desperate circumstances justify disproportionate merit). . . . . mmm, a little piece of heaven can reduce all else to insignificance.

Working off a chocolate binge is a problem. Only tourists wear shorts and/or a tank top in public, branding themselves such by doing so. Best times for activity to avoid that fresh-popped-in-the-oven feeling are either end of the midday heat– around 4am or 11pm. Volleyball courts aren’t optimal, unless diving into pavement is part of your routine. There are two gyms, and two tended tennis courts lacking weeds and cracks to assist the ball out of play. These conditions thwart an already dim resolve to work out. So one weekend I joined the Hash House Harriers, a running club that exists in most cities in response to the expat need for fraternity and drinki– err, recreation. (CW, this group must be in Maputo?). I hadn’t done anything remotely active in many months, but this truth is not impressive so I fibbed about my activity level when they asked what kind of running I do. Bad mistake, my second floor apartment suddenly presented a challenge to twitching legs for a full week.

Work is great. Fieldwork is interesting, especially when theory and practice find detours around each other. And who in public health doesn’t have a story about condom demonstrations. We set up temporary labs in the Provincial AIDS Offices, which conduct condom use programs. A woman came in one day while we were there, complaining of pregnancy. Their wooden penis went missing for a few days, so the peer educators substituted bananas. Apparently the message on where exactly to place the condom went awry, because all bananas in her house now get one. LOL. Not those bananas lady. And have you ever used a translator? I ask a question, it is translated, and immediately translator and subject are engrossed in animated dialogue. Twenty minutes later, pen and notebook in hand expecting some good material, my translator turns to me with: “He said yes.” . . . ?!. . . How long is the Khmer word for ‘yes’??

Being so often on the road reminds me how far off the comfort zone we are. I don’t usually prefer the backseat due to motion sickness, but given that everyone has the right of way here I opt for illness. It seems a widely held belief that increasing velocity will relieve other objects approaching the same intersection of mass, and I find myself in perpetual unease at having to one day demonstrate this theory wrong. There is a prompt– only the Khmers hear these voices– to shove pedal to the metal upon nearing the crossroads. At intersections across the country foreigners riding backseat in all manner of transport can be seen craning our necks in rising panic proportionate to speed, searching for the cause of this lunacy. What’s happening?! Sometimes eyes will meet and befuddlement is mirrored in a split instant– misery appreciates company. Then the imminent peril ends, contact is broken, the junction is past. {{breathe}} I’m alive!!! {{insert maniacal laugh}} Vehicles ought to be equipped with toys and other diversions, soft things preferably, for just such treacherous outings down the street.

Ah the things that guidebooks leave out. Systematic exploration of the emotional topography is Cambodia’s specialty. Theme parks bah!— close encounters with the next life are just a flight away. So come and visit!!! Beyond all this excitement, separation from Keith by the entirety of the planet’s molten magma is quite the trial, especially with the time differential. You veterans, particularly Melanie and Cherry (seems to be a Filipina-Am trend), have an indomitable will and I am inspired. And to fellow colleagues likewise traversing unknown territories by him/herself: the destination is never as exciting is it? Though emails from me are scarce I do read everything in my inbox and print the longer ones for inspiration through bleak spells of no AC, charbroiling temperature, and chocolate deprivation so keep ’em comin’!

Khmer New Year (Choul Chhnang Thmei)

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It’s a week before the biggest annual event of the Khmer New Year. Every single baraing (foreigner) I knew already left the country and there are few people at the popular expat bars. My street is lined with huge speakers, stacked one on top of the other, and every night traditional Khmer shrieking pierces the air at full blast. Female vocals have a high nasally pitch to them so thanks to the concrete makeup of structures, the screeching amplifies and reverberates superbly, while the accompanying bass pounds to the core beyond salvation of earplugs. People are on the streets boppin’ to the racket.

OK so it’s one thing to have disagreeable tunes steadily assailing your nerves. Your frazzled system adjusts and the assault can mitigate to white noise. But local deejays have perfected a Chinese water drop torture, Khmer-style. No song plays in entirety. The music starts in the middle of a screeching trill, and halfway into the track it stops. Complete silence for two seconds or two minutes–no one knows— then the shrieking explodes again without warning. Your entire being convulses into shock each time. This continues all night— And people dance straight through these intermittent gaps in the music like it is totally normal.

At midnight amateur screaming blows through the neighborhood as the karaoke begins. And every morning they wake up before sunrise to play games. Of course these would involve a lot of hollering and clanging of objects designed to transmit the unfriendliest possible noise to wake up to.

Oh, and then there’s the water and talcum powder. I wondered why there were so few people outside in the daytime. Then I saw a pickup coming down the road on the other side of the street with large drums, hoses, and riders in the back. I paid the vehicle no mind. But when it bore down on a hapless cyclist and blasted him with a high-powered spray of water so that he fell to the ground, I made for a frightened dash out of sight. People– strangers— then descend upon you when you’re down to rub talcum powder into your face. This is all in good fun I think. I might join had I not had to work throughout all of this. Sigh. I have a few days’ vacation now, so perhaps I’ll get out there and pelt my neighbors with water balloons from my balcony. Perhaps I’ll dig out an Eminem cd while I’m at it hee hee, though with my luck they’d probably like it and I’ll be responsible for introducing a suboptimal piece of Americana culture. I am hoping for escape in Ho Chi Minh City. I hope Vietnam has a sleep-friendly version of these festivities– five hours a night isn’t too much to ask is it…?

About fieldwork: "and oh, the places you’ll go!"

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I’m more often than not in the provinces for one of my bigger projects, an STI (sexually transmitted infections) survey*. I am the only foreigner, and no one on my survey teams or the provincial offices that I interact with for days on end is competent enough in English that every utterance does not need to be repeated multiple times, loud and punctuated by wild gesturing. Even my translator needs much explaining. This can be draining…

Although communication difficulties are a given, that daily reserve of energy sometimes isn’t enough to stay afloat deep waters of frustration. Especially when you are hot, tired, dehydrated, waiting to finish the day’s work, and you catch one of your lab techs taking ice out of the cold chain for his drink. Or when you find your interviewer is brokering a deal with participants on the survey incentives so your data is totally rigged and useless. Or when one of your team physicians sells some survey supplies, and you must drive an hour for a mobile signal to ask your home office in Phnom Penh to send more. Shoot me now. I find that under such moments of duress my small brain is unable to multi-cope.

I beelined for the ice cream cart when I heard the familiar bells coming down the street, my better sense seriously impaired the longer the stint in the sticks. The ice cream man sat with me on the curb in the shade listening in amusement as I prattled away, clearly not bothering to make myself understood. Out of the periphery of annoyance two of my physicians struggled to tell me something, and they were pointing accusingly at my little stick of paradise. GO-AWAY.

“For— uh, falmad— uh, folma—,” massacred fragments of English parried back and forth until finally: “Formaldehyde!” one of them spits out with glee, and they broke into contemplative debate in Khmer. I tried to educe a connection between formaldehyde and ice cream in the meantime. But the Khmers must discuss everything. At length. A simple question like “Where is the bathroom?” will provoke a drawn-out discourse if there is more than one person within earshot of the inquiry, so you start drumming your fingers, irritatedly wondering what they can possibly be deliberating. Patience for Dummies. Many sands through the hourglass later I learned that I ingested enough formaldehyde over the past few days to preserve a cow. It is used in the street ice cream industry for its preservative qualities. Forced exhale and a glare at the sky. I tell you, sometimes I just dO NOT UNDERSTAND {{down caps down}}}.

Somehow, roughing it for a backpacking trip is vastly different than roughing it for good. But I think I’m getting used to the bucket shower and squat toilet accommodations. My biggest gripe is that the mosquito net never quite manages to keep out that one endlessly active ‘skeeter. It’s quite amazing I haven’t yet contracted dengue or malaria, given the numerous angry welts my legs and arms can boast. Knock on wood.

Some of the larger problems I encounter are not the technical kind. Such as toeing the line that return-Asian females are somehow faced with: Western aggressiveness versus conventional kowtow– finding your line and getting them to accept it. We’re dealt a harsher scrutiny than Caucasian foreigners get. Another is dressing appropriately for the boonies, where the scorching sun, ever-present clouds of dirt, and endless hours on your feet make it difficult to look presentable. Of course, the gals on my team never have a problem with it. Halfway through the day when I’ve dropped ten pounds in sweat and may as well hose down at a car wash they still look dainty and fresh and perfect. Ancient Khmer secret.

Cravings of late: Chocolate– the complete absence of that rich, calorific slice of decadence is taking its toll. One of the restaurants here had chocolate fudge cake but it tasted like something *I* would make. Needless to say, my hankering is not satisfied. Put cheesecake on that list. Yogurt, a quarter pounder with the trimmings, a slice of New York pizza, bagels. . . . {{daydreaming, drooling, drooling}}} I might have to make another “civilization” run. People here frequent Bangkok for just that– to “clean themselves” and get supplies. Sounds good right about now. . .

Edited to add, since I’ve gotten questions from some family on these. Wow, I am footnoting a blog.
* Surveys are a method of providing statistical data for programmatic objectives. In research it is conducted to develop, test, refine hypotheses. To understand conditions and demographic trends of a population, governments carry out surveys every few years. Market research, opinion polls, the census are surveys. In Cambodia because of war and conflict, survey efforts have been few, making it difficult to specifically target efforts in HIV/AIDS.

The NGO I’m working with is one of the more internationally recognized leaders in public health surveillance. With the highest HIV/AIDS rates in SE Asia, information on the population’s risk behaviors is necessary for program planning purposes. FHI has partnered with the US CDC (Center for Disease Control) and the Cambodian NCHADS (National Center for HIV/AIDS, Dermatology, and Surveillance) for a nationwide survey of STI prevalence in three high-risk populations: the homosexual community, direct female sex workers, and the police (documented to frequent brothels). A cross-sectional analysis of STI prevalence can provide a quick shot of the HIV epidemic, because STI infections are of shorter duration than HIV, and risk behaviors for STIs are similar to HIV.