Posts Tagged ‘Reproductive Health’
It has been a slow-paced four days in Vientiane which kind of suits the nature of the city. On Tuesday we set up a list of photo subjects for my time here. It seemed impressive, but I managed to get through it all quite easily. Generally my days have begun with a fairly early rise and a quite-tasty buffet breakfast (mixed Asian and western food) at the hotel. The PSI driver arrives in his truck and we crawl through the chaotic yet slow traffic to the office where my days were arranged. I covered a whole range of subjects including:
- Visits to pharmacies to document birth control options (including Chinese abortion pills) and to private clinics with Tick, the team leader from last-year’s malaria project in Attapeu;
- The PSI warehouse plus the facilities of Diethelm, their new distributor;
- The “New Friends” MSM (men who have sex with men) drop-in centre, including their new branding plus information and counselling sessions;
- A new text messaging program encouraging people to get free HIV testing;
- Wandering the Morning Market looking for moms with kids to photograph for the reproductive health program;
- TB training for staff;
- A primitive clinic that provides exams and treatment for female sex workers;
- Outreach to female sex workers in the Ramayana Hotel karaoke bar; and
- PSI staff group photos.
I am happy to have accomplished all that was laid out for me. I’ve had plenty of time to wander the streets of the central city between shoots or after my day’s work. I’ve had some tasty food, particularly phe (or pho noodles) and café lao, the best of both I’ve decided are on Heng Boun Road, west of the Lao Cultural Hall. I also found really good pad thai at a stall where Heng Boun meets Chao Anou Road.
I’ve enjoyed finding a good spot to have a café lao or Beer Lao and sit watching street life or reading a book on my ebook reader.
There’s really not a whole lot else to write about. I haven’t found much personal photographic inspiration here which is probably partly a function of having spent quite a bit of time here before, of Vientiane not being that inspiring, and of the fact that my last two trips – to India and to the Arctic – were incredibly inspiring.
I have a bellyful of Hokkien prawn mee, which means that I am in Singapore Changi airport and have successfully located the staff canteen. Contrary to false rumours and suppositions, it has not closed for renovation or moved to Terminal Three. The old access point has been closed, however, and you now have to enter down a stairwell near the Burger King in Terminal in a ruse carefully concocted to keep joe average traveller out of the place. I, however, infiltrated and enjoyed one of the finest food courts in this city, dining on the mee, iced coffee, black rice pudding with coconut milk and lime juice, all for about $8 SGD. Now I sit and wait about four hours for my flight to leave for Hong Kong.
The rest of my time in Kampong Speu yesterday went very well with the exception that I was incredibly tired. A dog barked all night right next to the guesthouse in the most loud, obnoxious and random way. Earplugs didn’t help – it sounded like it and some of its friends were right in the room with me. So, I spent the rest of the time out in the countryside with a foggy and dopey head. It didn’t help that I slept through my alarm, waking at 7:01, one minute after I was supposed to meet everyone. I was packed and downstairs by 7:10, and Vaesna, the driver and I went for a quick breakfast of grilled pork on rice, and coffee, close by.
There was already a crowd of women and their children waiting at the clinic when we arrived (the three team members were already there and setting up). More continued to arrive as well. There was probably about 30-40 women there, many with young kids and a few babies, which is a testament to their interest in birth control. After registering, they all piled into a room and Pen Sopheak, one of the midwives, gave a presentation on different methods of birth control. The next step was one-on-one consultations; the three team members set up in offices and discussed with the women their history and which method they were most interested in. They followed with a quick physical examination (plus an internal one if the woman was requested an IUD) and a pregnancy check, then provision of the birth control. The options were pills, implants (active for three years), IUD, injections or condoms. The three team members are qualified to provide each one on the spot. I documented the initial consultations, plus the insertion of implants into one woman’s arm, which is not a simple procedure and requires local anaesthetic. PSI is also very interested in showing how sterile their practices are, so I documented the sterilization and equipment handling for an IUD insertion (the woman was behind a screen, but I had a clear view of the team member and the medical equipment). There was a sterilizer provided by UNICEF in place in the clinic, a large cannister like a pressure cooker that sat on top of a portable propane stove.
The conditions in the clinic were basic. There was no electricity while we were working there, and an assistant had to hold a flashlight during the IUD insertion. Nor was there hot running water, although there was an over-abundance of running water at one point out of a bathroom that flowed through one of the offices where the team was working. Although all possible precautions were taken, they were challenging conditions to work under although probably no different than what the team is used to.
It was a lively place, too, as a result of all the children around. Women were helping each other out with the babies; one I saw breastfeeding the child of another woman who was in with the team. It did the trick. One very chubby girl was inconsolable without her mother until she saw my camera and decided that playing with the strap was the best thing ever. A few other toddlers found me interesting and distracting as well. The mothers themselves ranged in age from about 20 to probably 40. Some had one child, others had three or four. One woman was crying during her consultation: she had four children and had very recently found out that she was pregnant again. Medical abortions are available, however, and Vaesna was able to provide her with some counselling (and possibly even a bit of money to help her out).
We were there until about 1:30, then drove back to the city. The first part of the drive went by quickly, but once we were past the airport things were painfully slow working our way through Phnom Penh mid-day traffic, which like Hanoi, works on the principle of critical mass. Once enough cars and scooters and tuk tuks and bikes build up, they then start making their way through an intersection until the cross-traffic does the same. Car and trucks take precedence and will force motorbikes and lesser vehicles around them, and driving in the on-coming lane is perfectly acceptable, both in the city and on the highway. It all works because nothing goes very fast, although I am sure that there are accidents.
I was dropped off at the hotel and desperately needed a nap. I tried for a bit, but decided that I had too much to do before dinner, so I headed out on a moto. First I want to Baskets of Cambodia up on Street 86. A couple of years ago, Kristi bought a great tatami-sided handbag made by this Cambodian cooperative (she found the bad in Agassiz of all places). They have a shop in Phnom Penh, so I suggested to her that I could stop by and pick her up something. The shop was more part of a house than anything, and it was run by two young folks who didn’t speak English, but were friendly and happy that I had made the trip. I bought three bags of different sizes, all stylish to my eyes, for the incredible price of $17 total.
Next stop was the Storya mall for a bit of computer software, then back to the hotel where I had enough time to drop my bags, change and head out for dinner at Sharkys with Vinh and Sue (Sharkys had a very different vibe this early in the evening). The owner of Sharkys is a great expat cook, and he put on an amazing spread for American Thanksgiving with everything you can imagine: turkey (deep fried), scalloped potatoes, green beans, stuffing, cranberry sauces, biscuits, corn, pumpkin pie, apple cobbler, and much more. Everything was absolutely amazing and was just what I needed. We had a good time, but I was dopey from the lack of sleep, plus I needed to get back and pack, so I headed out at 8:30 and was in bed around 10am, with my now-stuffed bags ready to go.
I was up at 5:30 and Pee/P/Pi the tuk tuk guy was waiting for me out front at 6:00 for the smooth drive to the airport. Check-in and emigration were quick, and the one-and-a-half hour flight easy. Before long I’ll be back in Hong Kong and dad should be meeting me at the airport. I will see if he’s any different looking as a newly-minted grandad.
The night out with Vinh (Sue was tired and stayed home) didn’t end up getting too sketchy, which is probably a fine thing. We started with a couple of Anchor beers at the Cantina bar, which is a normal, straight-up place, then walked rode over to the Pussycat Bar, right around the corner from my hotel, and as we walked through the door, I was instantly surrounded by working girls like I was the hottest new commodity. Vinh was seen as less-interesting, which was a bit disturbing in itself, but I guess that I fit the typology of the usual customer, although perhaps a decade or two too young. It became obvious that we weren’t that interested in what was on offer, and several were magnetically attracted to the next fellows to walk through the door. It felt creepy, but more because of the clients than the women, who are more easy to relate to than the sex-pats. We didn’t linger, but I did get to chatting with three of the women, not about services (that talk died down pretty quickly), but about them. The three I talked to had kids and were in their late 20s. They even showed me pictures of them on their cell phones, and I felt sorry for the fact that they had to be doing this kind of work in Phnom Penh while their kids were being raised elsewhere. I got the sense husbands weren’t in the picture.
We didn’t linger and went down the road to Sharkys, a bar clearly oriented towards the foreign crowd and Cambodian working girls. To be honest, by this point Vinh and I ended up talking more about cameras and photojournalism, but the old guy-young woman dynamic was evident all around us, and Vinh pointed out a few nuances and details.
There were seedier places to go to, but we called it quits. The flavour of what was available was evident, and I don’t think that I wanted to see anything more. I did get a sense of the kind of environment PSI and similar organizations work in in this part of the world (although the Cambodian scene is different from the sex-pat scene, and relatively much, much larger).
I didn’t sleep well at all, probably because of the four beers in my system, which for me is a lot. I was groggy most of the day. I made it out of bed and was hungry for breakfast, so I called up Rick and we walked over to Chi Cha for a filling Indian grub. He didn’t have time to linger, though, so I took off for the Russian Market, about 10 minutes by moto south of the hotel. I didn’t find much to buy there, but it was pretty photogenic in the food area. Unfortunately I only had my point-and-shoot digital with me.
Back near the hotel I went for a haircut at the Kennedy Barber shop, on the same street as Rick’s place near Norodom. It’s a classic barbershop if there ever was one, and it celebrates its namesake with pictures of JFK throughout, including on the sign. Apparently it has been around for yonks, and looks it. For $2 I got a very meticulous haircut from a serious barber, then a shave, which was very close and good. I don’t think that I’ve had a straight-razor shave since I was in Turkey in 2002. Good stuff. I actually returned there today with my Leica to take some shots of the place. The barber looked very confused and didn’t understand my intentions, but he shrugged and let me snap away. About five minutes in, a light when on in his mind and he recognized me from the day before. I was a little stunned that it took so long (or that it took any time at all), but a big grin appeared on his face and he relaxed a bit.
I like a good thing, and I’ve decided that Chi Cha is one, so I actually had dinner there yesterday as well: chicken fry, vegetable curry, chipati, rice, dahl and a mango lassi. Great.
Last night I was out with PSIs IPC (Inter-personal Communication) outreach teams, who target group is at-risk men who are likely to have encounters with sex workers. They work between 5 and 9pm in male-female pairs, and they approach groups of men in restaurants, BBQ joints and beer gardens. Any later in the evening and men are usually too drunk or preoccupied to pay much attention. The key message is HIV prevention, and the teams interact with quizzes and games. Since June of this year, they have managed to engage 40,000 men in this way.
We visited three sites where teams (about 3 pairs and a leader) were working. The first was a series of dog meat restaurants (poor woofs), which are known for offering pretty cheap eats ($1 a plate), so the men here tend work is less well-paying jobs. Our next stops were more mid-level restaurants, some offering BBQ. In all these places I was very impressed by the skill and energy of the outreach teams and they approached tables of strangers. In the very large percentage of cases they were received openly and actively, suggesting their techniques really do work well.
It wasn’t a late night. Samnang, the outreach coordinator, dropped me off at my hotel at around 9pm, and after an episode of The Wire, I was in bed, listening to music for a few minutes, then having the first long and decent sleep in a while.
I was up at a reasonable hour, maybe 7:30. There is a lively outdoor market a block in from the river, and as the sun was still low and the light good, I wandered over with my Leica and shot close to a roll of film, focusing mainly on the cyclo drivers whe were hoping to pedal people and/or goods home from the market. One cyclo was full of pineapples, one with bananas, another with grandma and her bags of groceries. The light was great and I hope that I got some decent images.
I packed up what I’d need for my overnight trip to the countryside, then headed over to Rick’s place where he was working on a video presentation that had been the subject of government censorship for showing touchy subjects. He’ll be working at the Post by the time I roll back into town tomorrow, so it was my last chance to see him. I took a few photos of him in his great apartment, working with the cat overseeing everything. I left him with the bottle of lao lao (hooch) that I brought back from Vientiane and wasn’t able to get into. He’ll enjoy it more than the Mekong Whiskey he is partial to.
From there I took a moto over to PSI’s offices and had lunch at a nearby western coffee shop with Bill from Virginia, the fellow who’s helping coordinate my work with PSI. After that I loaded into a truck with Vaesna, PSI’s Medical Detailing Manager (and a pharmacist by training), and a driver. We drove about an hour or so south to Kampong Speu, out in the country in the rice fields, where we linked up with a skilled outreach team – a doctor and two midwives – who are promoting PSI’s ‘birth spacing’ initiatives. Essentially this revolves around long-term reproductive health for couples: education about and provision of birth control (pills, injections, implants or IUDs).
The objective today was to drive around the villages in a small area north of Kampong Speu and share information about tomorrow’s information session and clinic in the local health centre. We drove around the dirt backroads looking for groups of women and children. When we came across them, the team would get out and tell them about their clinic. People were very receptive and interested, and it was all very novel to have shiny 4wd vehicles and a foreign photographer show up. The kids were particularly excited, although a couple of little ones were driven to tears by my uniqueness. Everything was very worthy of being photographed, and I shot about 250 images over the course of a few hours. There are obviously some duds, but a few photos look promising.
The villages are set among rice fields which look healthy and productive, but lack the vibrance and beauty of those in Bali. The better houses are concrete, the lesser ones wooden and rather flimsy; all are raised well above the ground on posts. The people seem generally healthy and tough, and a visibly darker than folks in Phnom Penh or the outreach team. There are kids-a-plenty, so it is apparent that there is a place for birth spacing here.
We are staying in a guest house in town, and am sitting on one of the twin beds in my room writing this. It’s a new and comfortable family-run place, and with the exception of barking dogs, it’s quieter than my hotel back in the city. We’ve just come back from a meal of traditional food at a restaurant by the river. We ate on the wooden floor on raised platforms surrounded by benches and hammocks. The food was good: dosa-like things filled with ground meat and shrimp, eaten almost like lettuce wrap; roast chicken; and beef in a salty-sweet sauce and potatoes.
We have to be on the road at 7am tomorrow, so I best head to bed.