Merry Christmas and New Year from Rose Charities Sri Lanka

(Click on image to enlarge)

Relief to typhoon stricken central Vietnam

A Song For You: the darker side of life: Poems by Lyn Hansen-Blizzard

Lyn Hansen Blizzard has known sadness, despair, pain, and helplessness in the face of relentless progress of life destroying disease. He poignant poetry cuts through the bluster of fine words and eloquent phrasing to deliver descriptions straight into the depths of the heard with clarity and simple beauty . Lyn writes about the things that matter, and about things that should matter but are so often overlooked. The poems in book will both move you to tears yet show you just occasionally those tiny glimpses of flickering hope that make us all keep going.

Helping gifted Sri Lanka students through University/College

Picture. Visiting film producer Donna Williams of Word Love organization and Mr Anthony Richard present the first Rose Charities Sri Lanka Univeristy Scholarship (2005)

Children of poor families in Sri Lanka know that the best road to lifting themselves and their families out of poverty is through attaining a proper education. While Sri Lanka has a fine education system and tuition is free for those who need it, there are other costs associated with attending university or college besides the tuition fees. Living costs, costs of books and materials needed for the courses, food and costs for those small aspects of daily living all addup.

Four years ago Amanda and Chais, two students from B.C. founded their University sponsorship program, now run by Rose Charities Sri Lanka For around $200 per year, all costs for the student can be covered to enable them to benefit from their free placed in University or College.

Sponsoring a child to go to school in Sri Lanka gives them hope and a future

(CLICK HERE)

Sponsoring a poor Sri Lanka child to go to school will give her/hm a life, a future and hope, for both them and their whole family. Please click one of the links below to see who is in need. If you are interested, please email: Contact@RoseCharities.org

(Click here for current list of children needing educational sponsorship)

The Bloom Manifesto

Diana Saw from Singapore founded 'Bloom' in Cambodia. It is not an NGO but a self sustaining social enterprise, to provide livelihood for poor Cambodians and help Cambodia. See www.bloomcambodia.com Diana has listed 'the Bloom Manifesto' (see below)... which it is hard not to agree with

THE BLOOM MANIFESTO

1. We believe in the right of all people to a decent life, free of poverty and with access to education

2. We believe you will be enriched helping the poor

3. We believe women hold up half the sky

4. We believe workers should always be paid a fair wage

5. We believe if you knew the truth, you would not be an accessory to the exploitation of workers

6. We believe exploitation is evil

7. We believe in the power of good over evil

8. We believe in the power of the individual to bring about change

9. We believe your bag is a reflection of you - are you really a sheep?

10. We believe quality is worth paying for

11. We believe in love at first sight - at least where our bags are concerned!

12. We believe in life, liberty and the pursuit of handbags!

The joy of new friendships

Vietnamese children make friends with Noot Seear ('Heidi' in the Twilight series ) and other international Rose Charities members. Artist Jason Rosenstock (Rose Charities USA) fascinates with his amazing drawings. This childrens home close to Saigon is full of happiness and laughter. It is supported by Rose Charities Vietnam and other organizations and private donors.

Lets just try ! - The song

Lets just try
A Song for Peace by David Bethune

"Only when humanity is able to overcome the boundaries that we alone have set, will we be able to take that next step towards the World of Peace that many of us search for."
Gary Newton Osborn

The road to Santiago

..The rain has stopped, but the blanket of clouds refuses to move and allow the sun to do its job, warming the way to Santiago. The path is muddy as I walk up the hill in between two strings of down flow streams trying to keep my feet dry. I look down and notice a worm that has been swept away by one of the streams. 6 Spanish people, 4 men and 2 women, stop and ask why I am limping, if I am okay? I´ve told my story a thousand times over, so I start explaining, once again, the problems I have with my legs.
As I am speaking, telling my story, I can´t help it but think of the little worm that was swept away by one of the streams. The worm was drifting with the water, when it got tangled around a pebble in one of the streams. You´d figure it would un tangle itself and continue with the flow? No! This worm, so courageous and determined, fights against the current, trying to get back to the top; to the point, where the flow of water, so strong and powerful, without any question or remorse, knocks it off its path, only to take it to an unfamiliar place.
I think to myself, I compare myself with this little worm... Have I not been swept away by a powerful tide last year? Am I not fighting against the current too? Has life presented its difficulties to test my faith, my courage, my dedication? Do I let go and drift with the flow, or do I fight back?

Denis Dronjic's voyage to Santiago continues (click for more)

Disasters and Children

The impact of disasters on children. By Dr Yaya de Andrade

(clicking on article below will enlarge it)

The never ending road

I am walking to Santiago...

The never ending road! By: Denis Dronjic

I’m not speaking of the Road to Santiago I am so anxiously waiting to begin on May 13th, I am speaking of the road we choose for ourselves; the road that brings us to our destination, only to realize, once we arrive at our destination, that the destination has always been within us during the journey.

Here I am, once again, counting down the hours before the start to the new expedition. I must say, it’s a mighty coincidence that I am starting on my Santiago expedition on the same day I set off on my ‘Pedal for the Medal’ expedition I did two years before, in ‘07. It was on May 13th, 2007 I set off from Nanaimo, British Columbia, to cycle my road bike 3,000 km to San Diego, California, to help raise money for Rose Charities. It was during this expedition when I was first introduced to my never ending road.

So here it goes…. On May 13th, 2009, I’ll be starting my walk on the Road to Santiago. I had originally learned of this 860 km road through Northern Spain , from one of Paulo Coelho’s books. Paulo Coelho is a Brazilian author whom is recognized throughout the world for some of the most amazing mystical stories written. He completed this road himself and praised it a number of times in his books; that is how I came to learn of this Christian walk.

The 30+ days it took me to cycle the west coast is nowhere near the 45 - 60+ days I am predicting will take me to complete the walk to Santiago . I know, I know! I should be able to walk more the 30 km per day and get this done in less than a month. If you are rushing to get things done, sure, a person could complete it faster, if that’s what they desire. But even if I wanted to rush - which I don’t - I can’t!! I am starting the walk on my one year anniversary from the day I almost lost my legs and my life.

On May 13th, 2008, I was crushed by a car! I was riding my motorcycle when I lost control of my rear tire – due to rain and inexperience-- and since I was not able to regain balance I had to dislodge my motorcycle, only to hit the pavement and slide underneath an approaching vehicle.

The collision with the vehicle was so severe that I was thought to be dead by all the bystanders since they literally had to lift the car off my body with their bare hands. After I was revived back to life, I was rushed to hospital in critical condition. A dislocated hip like I was dancing salsa on a deserted island hanging of the coast of Spain; broken right femur; broken right head of tibia, connecting into my right knee; broken right and left fibula; broken left tibia (open fracture with more the 3 cm of bone missing); broken left ankle; broken scapula; and last but not least, like all of this wasn’t enough-- internal bleeding and swelling in the frontal lobe of my brain. Besides the road rash, I think that is the complete list of the injuries I sustained in this horrific accident.

Now don’t be shocked, it sounds worse than it really is. If you were to see me today, you wouldn’t even know I went through this. Besides a few hidden scars and limping when I walk, I function like this was nothing more than a bad dream. I mean, physically I am not what I use to be, and I might never be again, but this hasn’t stopped me from chasing my dreams on this never ending road. And that’s what this walk is: a journey, a journey to the destination called Santiago. A journey for all the children and families that don't have a chance to dream like you and I do. A journey for this world to wake up and take care of its people. A journey for all the wonderful work that ROSE CHARITIES has done and is continuing to do. A journey for you!!

Please donate, even if a dollar is all you can afford, trust me it will make a big difference. It is people like you that make the difference in this beutiful yet unfair world. I will be doing something that doctors DO NOT think is possible, and I hope you will do something I know is possible.

www.justgiving.com/denis-dronjic

Thank you for taking the time to read my fundraising page. If you are interested in following my journey I am taking with my father, you may add me to facebook. Search for Denis Dronjic. I’ll be posting pictures and stories periodically when I arrive at a village that has internet. It is said that a person walking the Road to Santiago has a spiritual awakening during his/her journey, so I am sure my blogs will be an interesting read :-)

Thank you and may God bless you
Denis
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Dying with dignity

The Starfish Programme

San Lazaro Hospital is a 600-bed infectious diseases hospital in a poor area of Manila. It deals with people who have diseases such as rabies, measles, tetanus, tuberculosis and AIDS. The hospital is under-funded and struggles to provide care for people who are themselves poor. The life-threatening nature of many of the diseases affecting San Lazaro patients means that there are many deaths in the hospital. In 2000 Dr Pearla Albans, head of the hospital’s HIV/AIDS unit, attended a WHO training programme in Australia. As part of the programme the participants were introduced to palliative care by Larri Hayhurst, a palliative care educator from Sydney. Dr Albans immediately saw the relevance of palliative care for San Lazaro Hospital, and Larri was invited to the Philippines. Her visit resulted in a formal invitation from San Lazaro’s Medical Centre Chief, Dr Benito Arca, to introduce a palliative care education programme in the hospital. Dr Arca had long wanted to improve the care of dying patients at San Lazaro. When asked what his vision was for them he replied: “I want every dying patient in this hospital to die in the arms of a loved one”. His vision encompassed introducing the principles and practice of palliative care to all staff in the hospital, with San Lazaro eventually acting as a training centre for other hospitals. In Larri Hayhurst he found the first member of a small team who would help make his vision a reality. Larri Hayhurst invited Sydney palliative care specialist Dr Sue Marsden to join her in working at San Lazaro. In November 2000, Auckland psychotherapist Liese Groot went to Sydney to conduct seminars for Sacred Heart Hospice. There she met Larri, who invited her to become the third member of the team. Liese is a palliative care educator, who for ten years worked with and for Elisabeth Kubler- Ross, conducting seminars on grief, loss and palliative care in the USA, Europe, Africa, Australia and New Zealand. The scene was set for the beginning of a remarkable programme which was to change the culture of a hospital, and the lives – and deaths – of many people. The Starfish Palliative Care Programme, as it came to be known, aims to educate staff members from different parts of San Lazaro Hospital in palliative care. Four-day workshops in “Basic Palliative Care” are the starting point for staff willing to be involved, together with courses covering symptom control in palliative care, and courses which help staff to improve their communication with dying patients. The high stress situations in which staff worked soon made apparent the need for a Self-Care Course for those who were dealing with many dying patients. For example, on one day when the palliative care course began at 8am, a nurse came to the course from the TB ward where there had been five deaths since her shift began at 7am. The level of “carer pain” and grief overload is high, compounded by the fact that staff can not always provide the medication patients need due to the hospital’s funding difficulties. Early in the programme a Core Group of San Lazaro staff members was established, made up of doctors, nurses, chaplains and a counselor. The group receives intensive teaching when Larri, Liese and Sue visit to conduct workshops, as the Core Group will be the long term resource for their colleagues. The workload of the Core Group is high, as their participation is in addition to their duties in an understaffed hospital. Their dedication, passion and knowledge will ultimately make the palliative care programme sustainable when the Australian and New Zealand input finishes in 2006. As well as conducting workshops, the palliative care team worked with staff in wards to introduce the practicalities of palliative care. Initially Larri had worked with the staff of the HIV/AIDS unit at the hospital, and the plan was for the team to also work in this area, introducing palliative care practices and building up a team of staff who could teach others. However hospital staff were particularly concerned with the plight of the patients in the rabies ward, and the decision was made to begin by introducing palliative care in one of the most difficult clinical areas in the hospital. There are on average two deaths per week in the rabies ward at San Lazaro Hospital. If a person is bitten by an animal with rabies they have a short period of time in which injections of a rabies vaccine will be effective in preventing the development of the disease. There are queues of people at Manila hospitals waiting to receive the vaccine after they have been bitten by one of the many types of animals which carry rabies. These people are the lucky ones – many children and adults do not realize they have been bitten by a rabid animal. Animals are infectious before they exhibit symptoms, so the danger may not be obvious. The symptoms of rabies take two weeks or more to appear, and once they do, death inevitably follows a few days later. Patients suffer a violent death in a state of psychotic terror of air and water, afflicted by painful spasms. A person showing the first signs of rabies is brought to San Lazaro Hospital by several people wearing padded protective clothing. When the palliative care team began work with the staff of the rabies ward, they found that it was standard practice to tie the patients to the bed, with their arms above their heads, because they were violent as well as infectious. There were no sheets on the beds, no blinds on the windows to keep out the heat of the sun, and the patient remained in the street clothes they were wearing when they arrived in the ward. Valium was being used unsuccessfully to control the symptoms, and the dying patient spent most of the time alone. Doctors and nurses were frightened to have physical contact with patients in case they were bitten or spat upon, as staff are not vaccinated against rabies due to lack of funds. There was no furniture provided for family members to enable them to sit with their dying relative. The rabies treatment protocol was set down in a policy written by the Philippines Department of Health. The palliative care team found that changing the protocol was no easy matter. Staff believed it was impossible to control the psychotic symptoms, and little professional nursing care was given to the patients because of the fear of infection. It was also difficult to do much for patients when they were tied to a bed. The team worked with staff to bring about small changes, such as putting sheets on the bed and blinds on the windows. Instead of having both arms tied to the bed above the patient’s head, one arm was tied by the person’s side, which was a little more comfortable. A breakthrough came when the psychiatrist at San Lazaro participated in the basic palliative care course, and became involved in the care of the rabies patients. She assessed them as psychotic and was able to prescribe an anti-psychotic drug. Prompt administration of the anti-psychotic medication is critical in controlling the acute psychosis suffered by rabies patients. If the patient receives the medication on admission they do not become combative, and there is no need for restraints. The effectiveness of the medication was never in doubt, but its availability was initially a serious problem. The hospital pharmacy did not always have it due to funding constraints, and the patient’s relatives generally could not afford to pay for it. The variable availability meant that sometimes the patient did not get the vital first dose soon enough to control the psychotic symptoms. The situation was resolved when the doctor involved in the palliative care of the rabies patients personally purchased five doses, so that the medication could be on hand. Relatives are asked if they can pay, but if they cannot the Philippines Charity Sweepstake Office now provides funding to replace the doses which are used. The staff of the ward were still frightened to approach the patients even when the anti-pyschotic medication made them peaceful, and they did not want the restraints removed. A simple act by Larri helped to allay their fears and to change the practice of tying the person to the bed until they died. One patient who had been restrained for 72 hours had not received any nursing care, and his wife was in great distress about his situation. The medication had been effective in controlling his psychotic symptoms, and he was not aggressive. Larri, together with one of the nurses from the Core Team, sponged him and attended to his needs. This act broke through the fear of the ward nurses, and led to the practice of restraining the patient only until medication has controlled the psychotic symptoms. Now parents can hold their dying children, relatives can sit with and tend to their loved ones, and nursing care can take place. The situation of one particular patient highlighted another issue for the palliative carers. The patient had not been told he was going to be restrained, and was hurt as he fought with the men who tied him to the bed. He did not know that he had rabies, or that he would die in a few days. Before medication was used to control the psychotic symptoms of rabies, staff had found it difficult to communicate with the patients. With the psychotic symptoms controlled, it was possible to talk with the patient and to tell them the truth about their situation. It became apparent that staff had no training in breaking bad news, and so time was allocated in the palliative care courses for dealing with communication issues. It is now accepted that it is better to tell the patient and the relatives the truth, and staff have become experienced in handling the resulting distress. Telling the patient the truth has also opened the way for the spiritual and psycho-social care which is an integral part of holistic palliative care. During one of the palliative care courses participants expressed concern about the needs of relatives who stay in the ward and help to care for their loved ones who are dying of rabies. Relatives are often traumatized people with nowhere private to go during their stay at the hospital. A silid damayan or “room of comfort” was set up for the relatives of rabies patients, and it now provides a private space where relatives can take a break when possible, and staff can talk with distressed relatives. In the clinical area the Core Group and palliative care team are now working with the staff of the TB ward. This is a large ward of 180 beds, often with more patients than beds, which means there are two patients in a bed. Tap water is not always available for periods of the day, and a long hose is used to bring water from another part of the hospital. Some patients stay in the ward for many months; some are discharged home to their families but readmitted when the family does not want to care for them. There are children in the ward who no longer have TB but whose parents have vanished. The TB ward is very isolated from the rest of the hospital and the staff are seriously overloaded. At times there are only two or three nurses on a shift to care for 200 or more patients. Much of the care of the patients, many of whom are terminally ill, is done by the Bantay, “the watchers”, who are mostly friends and relatives of the patients. The Bantay are an integral part of the operation of the ward, which simply could not function without them. The palliative care team soon recognized that the Bantay have their own needs, and Liese was instrumental in designing the Bantay Support Programme. This programme teaches the Bantay basic physical care and infection control, and gives them time and space to express their emotional concerns and pain. They are taught how to best respond to the difficult issues they are confronted with, such as talking about death and dying with their loved ones.

Charity Rose Award 2008

Mrs Jan Johnston is the recipient of the
2008 CHARITY ROSE AWARD.

Jan has devoted at least half of her liftetime to charitable endeavours in all parts of the world. Jans father as well as her husband Bill Johnston were/are diplomats and this has meant that Jan has lived in a large number of countries around the globe. Wherever she has been however she has taken up local or international charitable causes with unparalleled energy and drive. In 2006 the Johnstons were posted to Vietnam for Bill to become the Canadian Consul General in Ho Chi Minh City. In these last two years she has been hugely active in many Consular Club assistances to the poor and vulnerable, Operation SMILE programs, and many other charities. Co-founding Rose Charities Vietnam in 2007 she has assisted in the rapid progress of the organization to its present level of around 10 projects.

The Charity-Rose Award Committee was unanimous in its decision.

"Life and work is possible because I am living mindfully....."

Life and work is possible because I am living mindfully, and in every moment I feel right to be here, to do what I am doing, and to help others to feel that this is part of their journey. There is no doubt most of us have thoughts about being here, AND about being or not being somewhere else. Only a few of the people I see are truly citizens of this town. We are all visitors, and we must remember to leave things in order, and make even better after leaving. I continue absorbing more and more David Brazier's books – I keep reading them again, and making notes, which I likely will delete soon… The desire for so many things, for company of loved ones, for a pedicure. It is amazing how sometimes it is hard to keep the fire in control, smile at all thoughts I have about somewhere, someone who is not present. And then I am able to return to my life and work in Malakal.

Yaya de Andrade (from her writings from the Sudan)

Acid burns Cambodia

This is one of Ania Kania's writings about her work in Cambdoia. Ania's wonderful work is truly in the spirit of rose charity. Please see her blog on http://www.anatopia-in-Cambodia.blogspot.com

Acid burns - her story

Chan is a woman. She is one of the acid burn patients here at ROSE Charities that I have been treating. She is 33 years old and has a 10 year old daughter - a beautiful girl with chocolate eyes and an enchanting smile. Every time she sees me she beams a smile and laughs out "hello". Before her sister-in-law poured acid all over Chan's face, arms, torso and genitals, she was a potter with her husband. She tells her story during an interview a couple of days ago - the interview was to assess the suitability of the acid burn patients for a potential weaving-training project.

She sits, bandage over the right eye socket (the right eye was removed last week because the acid had caused too much damage). She plays with her hands and looks at her knees. We ask the standard questions - how old, place of birth, how many children she has...She answers them all quitely. When we ask about what she is going to do when she leaves the hospital on friday, she begins to cry and her story comes out through her tears: she had problems with her sister-in-law and there was a family dispute of some sort, which the sister-in-law decided to settle by pouring acid over Chan. Now, because of the acid burns, her husband wants to divorce her and look for another wife. She has no family - both of her parents are dead and she has no siblings. She has no place to go now. She continues to cry, softly and quietly, while she speaks in Khmer. The nurse, Nemol, translates. She wants to die, she says. Begging is the only thing she will be able to do. She is going to go out on the streets with her daughter and will become a beggar and die somewhere on the streets because there is not other choice for her - nobody will have her. After she finishes translating this, the nurse laughs. I have been told many times that when situations are very uncomfortable or disconcerting, the Khmer response is to laugh. Half of my brain recalls this piece of information at this very moment and the other half is having a melt down at the bizzare response. I look at the nurse and explain that I realize this is a difficult situation however it is not funny, and laughing is not the response this patient needs. I think she understood because she quickly continued to inquire about further details of Chan's immediate situation.

Chan's daughter is beautiful and if they end up on the streets, she will quickly be swept up by someone and sold into some sort of child/sex trafficing situation...the idea is untolerable. She is quick, bright and lovely - like her mother. I have never met a patient as compliant as Chan- she has done everything I have asked her do regarding exercise routines, scar massage, wearing pressure garments... and her future is the streets, out of necessity, out of lack of choice. In this very moment I am greatful to have Will (an Aussie nurse) sitting across from me. It's silly really, but I'm acutely aware that although this is Cambodia, where "Cambodian" things happen, I realize that this situation is not a case of a "canadian" and a "cambodia"... what is happening here is so completely human - this has nothing to do with culture or history or nationality. This story is not uncommon in many places. These are daily occurances in many culture. Dispair, poverty, lack of basic necessities for life are the result of human activity. The places and cultures only give it a differnt colour. Helping and supporting one another is a human ability - not one determined by culture or history or nationality. I think our tolerance of violence and inaction is more cultural. I'm suddenly acutely aware of how closely and profoundly we can affect each others' lives and how most of the time we do not realize or recognize it or respect it. She is ready to slip through the very fat fingers of a system that shrugs it's shoulders at such circumstances and realities; "people here are poor and that is what happens. It's normal".
One thing I made up my mind about right now: she is not going to end up on the streets and her daughter is not going to be exploited by some sex tourists. I looked an Nemol (the nurse) and explained that we can help this woman and we are going to. Please tell her, I ask Nemol to translate, that she will have a place to live, she will find a job and her daughter is going to go to school.

The nurse translated this to Chan. Chan put her hands together to say thank you. She continued to speak softly. I know she is still in shock over all of it - how she looks, her life as she knew it is over, her husband is leaving her to find a second wife. She has no home, no money, nobody to turn to. What does she hang onto?...I don't know. I can't and won't pretend that I do. But what I do know is that for her and her daughter the streets are not the place where they will carry on their days. That is not an option.

Will and I make a few phone calls to expates working in NGOs here in Phnom Penh...we are referred to Hagar Shelter - a shelter for woman and their children. The next day we pack up Chan and her daughter into one of the trucks and head off to Hagar for an assessment interview. Will keeps the daughter close to her side and Chan hangs onto my hand. She has put on new clothes (a pajama set) and wrapped a towel around her head in the traditional Khmer way. She is wearing glasses I gave her to keep the dust and dirt out of her left eye that still cannot completely close because of the scars. Nemol does all of the talking and translating - she is fantastic. We walk around the shelter - looking at the bedrooms, the kitchen, vocational training rooms (sewing and haircutting), the shool rooms with kids couting in english. Chan's daughter counts along with them and shyly edges towards one of the rooms. Hagar shelter is an incredible place. The woman showing us around is gentle, understanding, soft spoken and very aware of what these woman go through...she knows their stories and accepts them.

Today, Chan comes into the recovery room for scar massage and dressing changes. Her scars are coming along well. Her left eye can almost close completely. Her neck range of motion is good and has maintained. She is always wearing her pressure garments. She says: I want to get fat. So when I get fat what do I do with this (pointing to the pressure garment)?". I explain she will get a new one. Nemol asks how she is. "I am happy. I don't want to die", she responds.

On a personal note: This very moment has made this entire trip worth while. This very moment is changing my life. I cannot express the happiness I feel in my heart - it is a happiness filled with relief and hope. It is a sensation where you need to take a deeper breath, your heart beats a little faster and harder, and you want to bow to what is infront of you. Chan accepts my hand as we walk back to her bed, where she has begun packing her few belongings.

Doctor of the Fallen Turtles

Kratie Province Cambodia 1994

I can still see it. The great clay green waters stretching like a slowly moving ocean. The tooth-like jagged rocks puncturing the surface as though some giant had scattered a pepper shaker of molten larva into the waters eons ago and the huge green islands basking in sun-warmed languor under the dusty sky of a Cambodian dry season day. Some time in the future there will be tourist hotels here and bars and swimming pools and stalls selling trinkets and handicrafts. But now there is just the rustle of the wind in the sugar-palm trees, the whack of small boy driving a water-buffalo to the river and the humming background chirp of a crickets.

And here in this small patch of dangerous paradise works a remarkable doctor. She is in her early 30's, dark haired and graceful in her step as she moves softly between the raised wooden houses of the small riverside village a small notebook in her hand. She wears around her waist the coloured kromma of the Khmer, and she speaks in their language to the people who come to greet her. Yet her skin is white and her dress of western style. Now and then she pauses to bend and put a comforting arm around a small child while the other lightly yet expertly assess the full curve of its protruding tummy. Then she rises to make a small note in her book while the children, unafraid stare at her with their big liquid eyes and smile.

To some of the children it is all part of a game, but Dr. Sophie Biays and the people of the river well know otherwise. For this is the land of the 'Fallen Turtle Disease' which swells children's stomachs and causes them to vomit blood until they can take no more. Old belief by some was that a turtle had fallen down inside the belly. Others considered the culprit was a bees nest. To Westerners it is known as Schistosomiasis.

For the people who live beside the Mekong it is their life. They drink its waters, use them as their source of refuge on in the relentlessly long afternoons of the hot season, wash in them, fish them, are carried by them in their small wooden boats and use them to transport the great jungle logs that they cut to be sold to eager traders from Thailand, Malaysia and Singapore.

Yet it is in these very waters that the fallen turtle disease lurks and is maintained by an unlikely creature; a tiny water snail, the largest of which are no bigger than a shirt button. The snails live on and under rocks and hence thrive in this area of the Mekong. Known as the 'Sambo Rapids', there are no real rapids in the normal sense of the word. Rather it is an area where for some primordial geological reason, the normal mud and earth bed of the river gives way to a structure predominantly of rocks and stones. As you run your eye across the glistening water great jagged icebergs of stone rise from the surface like dragons teeth and small swirls indicate boulders lying just below.

Until the French administration mapped out and marked a usable channel in the 1940's navigation through the area was a risky business. Now the large cement markers still stand, one of the very few remnants of the colonial era left untouched by the Cambodian holocaust of the 1970's.

The snails themselves are not the culprits, simply an inadvertent intermediate vehicle for one of the stages in the infection cycle of the miniscule blood 'fluke', a type of tiny short worm, which is responsible for the disease. After a gestation in the infected snail the organism is released as a tiny, torpedo shaped form known as a ceracria. The cercariae swim freely but will bore through any human or animal skin which has entered the water in their vicinity. Once inside the body, the organism changes shape and migrates to the veins around the liver and stomach. There the flukes mate and produce eggs. Of social interest in these days of increasing broken marriages it is interesting to note that the male and female schistosome mate for life. The longitudinally grooved male wraps his body around the cylindrical female to spend their days affectionately locked together as one egg producing unit.

It is not the adult flukes but the eggs which cause the long term damage. They excite inflammatory and immune reactions which block vessels and cause massive enlargement of the spleen and liver which will often lead to complications and death. Some eggs however will find their way through the intestinal wall and be excreted with the faeces. If the faeces are deposited near the river and are not treated the next rain storm will wash the eggs back into the river where they hatch into yet another form. And this form, the miricidium, penetrates the water snail to comple the cycle..

Dr Biays speaks with the soft accent of her native Brittany. She tells me modestly that the disease in Cambodia had been discovered years before and that her project was simply a continuation. The enormity of this understatement makes me smile. Although it was certainly recorded in the mid 1960's the almost umimaginable holocaust of the Marxist 'Khmer Rouge' overthro of the government ten years later resulted, along with the deaths of three million people, in the total destruction of almost every record of every fact in the country. The Khmer Rouge themselves appropriately referred to the start of their regime as 'year Zero', and set out to remould society comletely from a beginning wiped clean all local links with its past.

And within bloodshed and the destruction, the forced labour and the so called 're-education camps', later found to be basic extermination camps, the fallen turtle disease of the river and its sufferers were simply carried along in the juggernaut of horror. Their disease had been forgotten about and their lives hung like the others only on tiny threads of chance. For a smile or a tear at the wrong time was not permitted, a word or silence when it was not appropriate could mean a sentence of execution.

So when the UN men in the blue caps followed in the NGO workers so fifteen years later, they found a country almost totally devoid of any fabric of infrastructure or historical record. They found a people shattered, confused and shocked, and evrerywhre, the crumbling aftermath of mass distruction.

And into this vortex of disoriented confusion came Dr Biays, her job arranged through an NGO to assist the National Malariology Department in the capital, Phnom Penh to re-establish its role within the country. This meant regular field trips and one of these took her to the Sambo District of the Mekong.

'I was shown some "bad cases of malaria"' she said. 'Well, they do have malaria here and it does give enlargement of the spleen and liver.. but these cases seemed just too largd... I was suspicious ... I came back and took samples..'

So, far up the Cambodian Mekong Dr.Sophie Biays rediscovered Shistosomiasis. She realized immediately that there was a desperate problem. Medical services in traumaitzed rural Cambodia were in an almost totally non-functioning condition and even where help might be available, the disease was being wrongly diagnosed as Malaria, for which the treatment was entirely different. But she knew also that there was hope. Her training in Tropical Medicine had given her the knowledge that there was a cure and what was more, that it was close to 100% effective, could be given in just one dose - an enormously important point for treatment compliance. Developed originally for the lucrative vetinary world, the drug Praziquantel had to wait several more years before anyone was prepared to spent the money to carry out the necessary trials for human use. The sad fact is that the humnan pharmaceutical industry well knows there is little money to be made in developing countries where such diseases tend to lie. Eventually however the World Health Organization agreed to subsidize the trials, and a human wonder drug was borne.

But Praziquantel is relatively expensive and Dr Biays knew that if she were to start a treatment program, she would need help. And the help came from the Dutch/Belgian/Swiss branch of the NGO Organization Medicins Sans Frontieres, one of the most effective in the world. They not only agreed to sponsor Dr Biay's program but also to put her in charge and assist in building a small district hospital for the area. Early in 1984 Dr Biays bumped up the potholed hour and a half access road, moved into her small wooden house in Sambo Village and started work.

Few others would have. For in the dark brooding forests of Cambodia, the men of death, the Khmer Rouge guerillas, still lurk, moving silently into the villages at dusk or nightime to take food or money from the inhabitants. In the daytime they melt back into the forest but from their jungle bases manage the logging trade by taxing those who come to cut wood. Mainly without roads and largely ignored by their own governmment except by corrupt officials after the same lumber taxes, the villages of Sambo live in a semi- autonimous shaddow land of alleigance, bending theis way and that depending on who is making demands on them. No one, not even the villagers themselves, know when the Khemer Rouge will turn up, and neither does Dr. Biays. 'I have been lucky' she says. 'No problems so far, although there three full time Khmer Rouge villages we cant get to'

Yet there were problems, twice. In late 1994 when there was a flare up in fighting MSF had to pull Dr Biays and her team out for three weeks, and later, perhaps more seriously, she narrowly avoided being kidnapped at the time when the Khmer Rouge we looking for Western hostage. Dr.Biays had been held up by work-load in the small clinic that day and cancelled plans for a district visit. She later heard that on the road she had intended to travel, every passer by had been stopped by Khmer Rouge soldiers looking for Westerners. Of the seven that they did end up in taking in several episodes over those weeks, only one survived.

In the height of the dry season, the heat is intense. From middy to around 4pm it becomes almost unbearable as the land sweats and swelters under an apoplectic Cambodian sun. Only the tall sugar palms with their neat green haircuts seem to stand up to intensity. Yet on the doorstep of Sambo village runs the great river, its waters now low but softly calling a cool invitation to all those who are within earshot. And the buffalo and the children are the first to accept, the former wallowing happily their horned heads only visible like a cluster of Viking helmets thrown overboard by some ancient raiding party, while the latter in contrast jump and roister in a flurry of splashy antics which bring smiles to the fishermen and log cutters labouring on the sandy bank.

But it is in the dry season when schistosomiasis transmission is the highest. Then the water flow is slow and the low level brings the rocky habitats of the aquatic snail close to the surface. In their free time, the children are almost constantly in the water but to try and change this lifestyle of a thousand years or more would have been almost an impossibility.

My visit to Sambo was almost a year after Dr. Biays had started her work. In that time, with almost limitless energy she had time

systematically screened and treated the children of almost every village in the area. Like some tropical Florence Nightingale,

Everywhere we went we would be greeted by children and their grateful parents. Time and again she would point out to me a

child in the process of reverting to health under the effect of the drug or those who had ben completely cured. Amazingly she

seemed to know every one by name and I could see her overwhelming pleasure in their happiness. 'I love my work' she said,

and I believed her.