Living on a railway line

I spent yesterday afternoon on a railway line. Not because I’m a train-spotter – I’m much more of an aeroplane person – but because that’s where the mobile clinic was held.


If your entire community lived beside the tracks – and when I say beside the tracks I really mean beside the tracks – and you had very limited resources (financial or otherwise) to get you to the nearest clinic, and the government-run health care facilities were beyond your reach, you’d be entirely dependent on someone bringing your healthcare to you.


Crouched under the tin roof of a raised wooden platform on stilts above the rubbish beside the train tracks, hiding from the monsoon-like rains, I saw an afternoon clinic full of patients with the Medical Team Leader, the M’Lop Tapang doctor and Maggie Eno MBE, Co-Founder of M’Lop Tapang.


I spend this morning in a clinic at the main M’Lop Tapang centre – a whole queue of children had been specifically brought back to see me for a second opinion in the fantastic facilities run by the Medical Team Leader Miss Ngov Chanrary – a trained nurse – whose amazing leadership and organisational skills have helped to create a clinic which is clean, safe and accessible and delivers the highest possible standards of healthcare within the resources available.


I spent this afternoon on a beach. Not sunbathing in the glorious sunshine that has appeared now that the rain has been and gone but instead walking around with the head of child protection for the M’Lop Tapang organisation, finding children who were working on the beach, or living just off it, and who were all at risk of serious child abuse, to see the rapport-building and education that is delivered to these children to slowly encourage them into a different way of life – one of education, development and opportunities.


I could write about the poverty and desperate situation that many of the children and families are living in beside the railway line; I could show you photographs of their houses which may only have a tarpaulin or banner as their only waterproofing; I could write about the children I’ve seen in clinic this morning, and the diagnoses we’ve made together as a team, including kwashiorkor, likely beta-thalassaemia trait, global developmental delay with significant iron deficiency anaemia, fractures secondary to osteogenesis imperfecta, left lower lobe pneumonia… to name but a few; I could upload photographs showing how the children working on the beaches of southern Cambodia interact with the tourists who come and stay in guesthouses here; I could show you photographs of Cambodian people begging for money on the beach or of children collecting thrown-away cans and bottles to try and make $1 per day from recycling; I could write about the desperate lengths that families have to go to in order to try and get some income with absolutely no support from the State whatsoever; I could tell you about the tiny little child I saw in clinic this morning who was left in a cage-like box on the street whilst her Mother went out to try and make some money.


But I’m not going to.


This isn’t a Comic Relief broadcast. I don’t need to show the photographs of the abject poverty and horrendous living conditions that I’ve seen many families and children, with or without families, living in here in Cambodia. That wouldn’t be dignified for the children and families who are involved the vast majority of whom are trying their utter best to make ends meet and to improve the situation for themselves and their families, none of whom chose this way of life. But you can take it from me that I’ve seen those situations, they are very real and they have a disastrous effect on the lives of the families and children involved.


What I am going to tell you about is the success stories. And the reason I’ve chosen to do that is because out of each one of the horrendous stories I could tell you about there is real hope for the children and families involved – that hope comes not from statutory services provided by a government agency, which are shockingly absent in the community I’ve visited – but it comes from the fantastic work that is being done by the M’Lop Tapang development organisation, co-founded by British nurse Maggie Eno over 11 years ago. M’Lop Tapang is helping each and every family or child whose tragic story I could have told – I mean each and every one – and their ethos, professionalism, expertise and community-engagement are things we can all learn from and translate into improvements we can all make, no matter what our backgrounds or home countries are.


M’Lop Tapang creates an environment where all children are allowed to grow up in their families feeling safe, healthy and happy, a society where all children are respected and treated equally and a community where all children are given choices about their future.


So, why is this needed? The only way to explain is to tell the story of my time with the team explaining the services that they provide to children in this region – but what is crucially important to remember when reading those stories is that these services do not complement other government or State funded services. There are simply no other services here. If M’Lop Tapang did not exist the government would not step in to provide help to the people living and working on the streets of this region, the people would be, quite simply, left to fend for themselves with all of the problems that this would bring.


There are a significant number of children who end up here in Sihanoukville separated from their families who might live in other parts of the country. Children often run away from an environment where domestic violence prevails and whole families, with a very broad definition of what a family is, migrate here and end up living on the streets, or beside a railway line, and working on those same streets or on the beaches.


The excellent team of social workers that are part of M’Lop Tapang are able to find out about a new child or family moving into the area within 24 hours of them arriving. It is then that the rapport building can begin and that educational work can take place with the family to show them that there is a different way of life they can access for free, through the outstanding work done by M’Lop Tapang, which can help them find employment, help them to come off drugs, help them to find accommodation, help to educate the children, provide nutritional advice and supplementation where appropriate and help to protect the vulnerable from all forms of abuse.


There are a number of programmes offered to children and families with the key focus of M’Lop Tapang’s work being reintegration of children to their families even if that means a lengthy search throughout many regions of the country.


I’ve been stunned by the sheer volume of children helped by this organisation – which grew out of a simple desire to make things better for the children who were living and working on the streets and beaches of this region over 10 years ago.


There is a comprehensive educational programme for the older children including mechanics, plumbing, electrics, sewing, screen printing and the very tasty, and incredibly reasonably priced, training restaurant, Sandan (where I’ve had two delicious dinners this week – try it, you won’t be disappointed!)


Part of the battle that the staff have is convincing the children that they can have an education, that this will serve them much better than street selling as they grow older, and that there are significant dangers to living and working on the streets and beaches including all forms of exploitation and abuse. I can quite understand why this can be an uphill struggle for the staff and why it takes patience and dedication to slowly build trust with the families and children – if you had the choice between earning up to $20 per day selling things on the beaches or you were a young child and had nothing but could earn $1 per day collecting litter – then you might do these over choosing to enter educational programmes. It is for that reason that M’Lop Tapang have to make their programmes not only educationally beneficial for the children and young people entering them, but also that they must be financially viable for the people accessing them.


In 2014 M’Lop Tapang has outreach programmes which include:

  • Family reintegration
  • Street and beach working programme
  • Community education
  • Baby care programme
  • Back to school programme
  • Mobile library programme
  • Home repair business set up
  • Alcohol programme
  • Home based programme


If you are a parent who has young children and you have no resources then you may have no option other than to send the children out to work on the streets to bring in money so that you have food to eat and shelter from the extreme elements (torrential rain to bright sunshine in the space of a morning). That is where the real benefit of the baby care programme comes in. As well as enabling these children to access health and developmental support for 5.5 days a week, it also allows the parent(s) to go out to work, rather than the children, as they are being cared for by a trusted organisation.


If you are a child and you have been living and working on the streets for as long as you can remember, you may not know what a school is let alone whether you ought to go. That is where the educational programme comes in. By delivering an accelerated national curriculum programme in M’Lop Tapang’s main centre in a way that it fun, interesting and stimulating for the children, the team are able to educate children so that they can be reintegrated into government education and so that they have a much better chance in the future.


M’Lop Tapang isn’t a health organisation but they have had to set up a clinic as the burden of disease and serious clinical pathology which exists here is significant. It is one of the cleanest and most efficiently run health centres I’ve ever worked in or visited and the star of the show has to be Ngov Chanrary – the Medical Team Leader. Providing care, assessment and treatment to hundreds of children and their families, this is an incredibly impressive programme at M’Lop Tapang and it doesn’t just stop there – they take that clinical expertise into the community, to the railway lines, to the areas where people are living in make-shift houses and in communities on the streets via their Mobile Medical Clinic programme. The clinical expertise of the Medical Team Leader is superb and the coordinated, efficient way that the healthcare delivery is organised is excellent. And what if a child goes missing, does not attend for follow up or does not appear to be being treated appropriately? Well the comprehensive team of social workers are very rapidly on the case to locate the family and the child and to work with them to ensure that the child’s health improvement is of paramount importance.


Through the educational programme provided at the main centre, M’Lop Tapang have educated hundreds of children ranging right from babies to those nearing the normal school leaving age with specific classes for IT, Art, Music, Special Needs, Sports in addition to the traditional school subjects.


I’ve been absolutely stunned by the efficiency and incredibly high level of professional activities within the M’Lop Tapang community. The organisation is visible wherever you go in the town, be that between bars and restaurants, on the streets, in the hotels, on the beaches or even on a tuk-tuk. They have managed to create an atmosphere where the community is looking out for children and families at risk of abuse and where everyone is moulding together much better than I have seen in many other communities as I have been travelling to different places looking at services provided in different regions. This organisation really does turn around peoples’ lives, and you can see their work here:


And all of the above is done by a development organisation – with running costs of £1million per year – with not a look in from statutorily provided services. A small price to pay for the literally thousands of children and families they protect from abuse, educate and deliver health care to each year. If they can achieve all of that, with such enthusiasm and professionalism, within the budget they have then we too must be able to critically look at the services we provide in our own organisations and the ways that we work both internally and externally, and make changes for the better in the future.


But what can we do in the UK and what can we learn from the time that I have been spending here in Sihanoukville? Well, quite simply, a huge amount! I’ve seen at first hand the circumstances which place children at risk of exploitation, and some of the presenting features of those who have been exploited. I’ve seen how crucially important the social determinants of health are and how it is through education and social support that health can be improved without necessarily focussing on health as the primary target of the intervention, whatever that might be. I’ve seen the sorts of services that help protect children from abuse rather than simply respond to it when it does occur, I’ve learned through the teaching I’ve done that the issues faced by us in the UK are incredibly similar to those faced by the people living here in Cambodia – of course, the reference scale is different, but fundamentally the core problems, and potentially some of the solutions, are incredibly similar and inextricably linked, and I’ve seen the real positive successes that a community can have when that community works together towards a common goal.


I’ll be staying in contact with M’Lop Tapang staff to follow up on the patients I’ve seen in clinic to see how they progress. The staff working here have some of the toughest jobs of any people I have encountered and their success with such a huge number of children and families over the last 10 years should be an inspiration to us all.


Next week my adventures will take me to Hong Kong to lecture at the International Conference on Emergency Medicine and to deliver training to some British, and other friendly mission, Consular staff, then it will be downhill all the way as my flight back to the UK starts to loom. For now, though, it is time to locate the anti-histamine supply as I seem to have become a tasty snack for a gazillion nibbling insects that appear to have enjoyed their dinner just as much as I did mine at Sandan!



3 thoughts on “Living on a railway line

  1. Pingback: Polio. A public health emergency of international concern. | Dr Andrew Rowland: Churchill Fellow 2014

  2. Pingback: The ‘book’ is finished! Publication and launch of Living on a Railway Line at MediaCityUK on Monday 20 October 2014. | Dr Andrew Rowland: Churchill Fellow 2014

  3. Pingback: ChildSafe: the potential to improve the protection of children and young people in the UK | Dr Andrew Rowland: Churchill Fellow of the Winston Churchill Memorial Trust

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