Residents of floating villages in the north of the Tonle Sap Lake had to travel as far as 100km by boat to the nearest government health centre for treatment.
The journey to consult medical professionals was difficult and time-consuming. Even worse, families were discouraged from seeking healthcare services due to the high cost of transportation and treatment.
“The people on the lake live some 30-100km from the nearest government health centre. So travelling by boat was both expensive and time-consuming,” says The Lake Clinic Cambodia (TLC) executive director Jon Morgan.
This was among the reasons he founded TLC in 2007. A local Cambodian NGO, it was set up to meet the healthcare and health education needs of the people living in some of Cambodia’s most remote areas.
Improving the livelihoods of the floating villagers can also positively impact other communities, says Morgan.
He perceived that the fisher-folk are essential to meeting the dietary needs of Cambodians, particularly underprivileged people who cannot afford other sources of protein such as beef, pork and chicken.
“The rich eat ocean fish. The poor eat lake and river fish,” says Morgan, who together with his wife, Mieko, have been full-time residents of Cambodia since 1995.
TLC is a white boat clinic that makes routine trips from village to village to provide medical care to those who cannot afford to look after their health issues.
“There are 11 villages within our catchment area in the provinces of Siem Reap and Kampong Thom. This means serving a population of between 13,000 and 14,000 people depending on the seasonal migration of some,” he says.
Carrying a baby with both hands on her chest, a pale woman brought her new-born son for medical treatment when the boat clinic arrived at her village.
“My son has a fever. I fish for a living. Sometimes I can catch half a kilogramme, sometimes nothing. He is my first child and is just six days old,” says Tum, 20, in a TLC-produced documentary.
“I have come to ask for medicine for myself, and my child. He cries all the time,” she says in a minority Khmer dialect.
Tum lives in Stung Chrov village, Anlong Samnor commune, in Chi Kraeng district of Siem Reap province.
Morgan, who grew up in the US state of Rhode Island, says so far this year, the clinic has attended to nearly 27,000 cases.
Two factors considered to be the roots of almost all health problems on floating communities are “poverty and ignorance”.
“One common question that I am asked the most is about the most common diseases, and the answer to that is poverty and ignorance,” Morgan tells The Post.
He says poverty limits the choices that people have in deciding where and when to seek proper healthcare.
“Poverty prevents good and proper nutrition,” says Morgan, who has a Master’s degree in public health from the University of Hawaii.
A former CEO of the Angkor Hospital for Children (AHC) in Siem Reap, he says ignorance impacts their decisions. People do not understand their bodies, how it works, what it needs and the changes that happen over time.
“People will seek help from their neighbours, parents, grandparents, and monks. And they will do as advised. Too often this can result in a much more serious condition.
“As a healthcare provider, there is little we can do about poverty. But we can do a lot to reverse their ignorance, and that is why we focus on professional healthcare and health education,” Morgan says.
Though education can improve people’s understanding of what “healthy living” means, Morgan says, it is a complex problem, because learning must be followed by behaviour change and that is a major challenge.
Morgan names some of the most common diseases affecting the floating villagers. They include gastrointestinal problems, diarrhoea, upper respiratory infections, trauma (accidents), liver disease as a result of alcoholism, skin infections, and more.
“Everything a doctor will see in town is seen on the lake, though the cases here tend to be more severe than what doctors in town will encounter,” he says.
Morgan’s first visit to Cambodia was in July 1994. It included a trip by boat from Phnom Penh to Siem Reap. Along the way, he and Mieko passed through several floating communities where poverty and the lack of basic hygiene were everywhere.
It was at that time when Morgan turned to his wife and said: “This is a public health nightmare.” This is when the seeds of what was to become TLC took root.
It wasn’t until about 2001, while Morgan was directing the AHC that an opportunity to partner with a community organisation, Osmose, cropped up.
Morgan was CEO of AHC from 1998 through the end of 2006. And he has served as a member of the board of directors for several local NGOs through the years.
Morgan said the AHC could begin a paediatric outreach project to two villages where Osmose was serving.
“That experience taught me a lot about the realities of the problems faced as well as what would be needed to more effectively provide healthcare consistently and with full-time staff,” he says.
Viewing “health” as more than just the treatment of diseases and trauma, the clinic provides a lot of education about health matters.
“Yes, we care for the sick and injured, and those with chronic diseases such as type two diabetes, hypertension, thyroid problems and Parkinson’s disease among others.
“We also educate them about healthy living through a dedicated team of midwives and nurses who visit families house by house and through Parent Clubs in each village,” Morgan says.
He says the curriculum involves nutrition because two-thirds of the children in floating villagers are clinically malnourished and lack family and household hygiene which is particularly important during the Covid-19 pandemic. They also lack clean water.
“Our outreach team builds bio-sand filters and sets them up, monitors their use and provides maintenance when necessary. It also follows through with laboratory testing to ensure their effectiveness.
“They are also involved in community mental health work and have intervened with local authorities in cases of domestic violence. This is done with one to one counselling as well as through Parent Clubs. Of particular importance is alcohol abuse,” Morgan says.
TLC provides clinical services for acute and chronic patients, vaccinations, home care for elderly and disabled people and family planning excluding abortions, intrauterine devices (IUD), injections, birth control pills, condoms and more.
The programmes also include ante-natal and post-natal care, monitoring of children at risk of malnutrition, dental care, oral health education, eye care and providing spectacles.
Morgan tells The Post: “Our clinical teams (The Lake Team and The River Team) are each composed of two doctors, at least one midwife and a nurse. Each team also has a dedicated chef/cook as well as a boat pilot.
“TLC also has two outreach teams composed of four midwives who provide multiple services based on needs during their house to house visits.”
The visiting teams have taken great care to protect themselves and prevent any transmission of Covid-19 to the communities.
“Each clinic day has two education periods when we teach about Covid-19, how to protect oneself, making and wearing face masks, and what to do if a villager believes he has been exposed to it,” says Morgan.
On how he funds TLC’s operations, he replied, “I beg for money”.
TLC now sells T-shirts so people can support the clinic and spread awareness at the same time. All the proceeds go to the clinic to support its anti-Covid-19 efforts.
He says that within Cambodia, donations can be made via ABA transfer directly into the TLC’s account. Overseas donors have a variety of choices depending upon their country of residence.