Acid violence defies any bounds of comprehension. It is a violation born and nurtured in hell itself, a pitiless, hideous evil. It takes away both skin and flesh and the very soul of the victim. And it does so with finality that is often absolute.
As a physician, I saw my first acid violence injury around 10 years ago. I had set up Rose charities as an extension of my previous organization, Project Iris. Iris dealt with eye injury and sight restoration but so many injuries extended beyond the eye to the face and torso. Rose went beyond the eye to facial and other injuries. Word had gone around that there were “foreign doctors” helping the injured and had set up a simple operative and treatment clinic on the outskirts of Phnom Penh.
My First Case of Acid Violence.
My first experience with this heinous manifestation of acid violane remains seared in my memory. I came in in the morning and she was there in the waiting area, brought in by a friend. She sat there on the hard wooden bench. I took her hand. She could not cry, she had no tear ducts since the skin fused tightly over where here eyes may or may not lie underneath. She just gazed forward; her skin mottled leather membrane, shrink-wrapped; her face no longer with any elasticity or ability to display any expression. Her name is Vanna.
Vanna had been beautiful, and for many poor, oppressed Cambodian women it is their only possession of value. Before becoming a victim, she had a low paying job in a restaurant. She had a boyfriend. The story goes: One day Vanna refused the advances of a much older man, a government official of some importance. Later that evening two men were waiting for her. They held her down and slowly poured the acid on her beautiful face. And then they continued to hold her while it did its work.
That’s the thing. Simply throwing acid in someone’s face might give the person time to rush to water and prevent much of the damage. But when the victim is held, the acid will continue working. It can be poured onto specific areas; the eyes, the genitals, the breasts and there are cases where large quantities, like a bucket-full, of acid is simply flung at the victim. If the victim can then get to a source of water very quickly she can limit the amount of damage – though it may still be severe, irreversibly damaging her eyes.
It is hard even now, even as a physician who has seen many physical horrors in a lifetime to think back on Vanna’s face and body. It was as though the world had brought out a being so alien, so mutated that no one would ever recognize it.
What We Know About the Problem
Now, some 12 years later I have seen so many victims of acid burn attacks at our Rose Charities Surgery and Sight Centers. Although statistics are scanty and subject to the inaccuracies of translation it would seem that around 50% of attacks are the consequence of real or perceived extramarital affairs or other aspects of life leading to seeking of revenge. This is an extreme and tragic consequence of men seeking to control women. But attacks in Cambodia are not restricted to women. Some 15 – 20% of attacks are of men on men, or women (with or without the assistance of a male collaborator).And there are more victims. An additional 15% are secondary victims, usually a child, who have gotten in the way of thrown acid. The rest, not the result of gender-based violence but rather arise from civil disputes, such as over land and other property. Cambodia’s history of conflict and succession of imposed governments has ensured an enormous uncertainty in land ownership, resulting in claims and counter claims.
Cambodia’s conflicts of the last 50 years have been extreme and brutal. Despite attempts to keep neutral, the country became heavily involved in the Vietnam war, its people first being hit by both sides, before eventually succumbing to one of the most genocidal regimes of human history, that of the Khmer Rouge. In this period, some 2 million persons were slaughtered, tortured, starved, or worked to death. Women were forcibly married to strangers, forced to watch as their children were taken away or their babies bayoneted in front of them.
The injury and illness of conflict and post-conflict can be discussed in three broad categories; primary, secondary, and tertiary. There is ‘primary’ injury that is mostly associated with wars; bullet wounds, blast injuries, etc. Then there is ‘secondary’ victimization, which is the disease or untreated trauma caused by the conflict and the induced breakdown of infrastructure. Third, there is the ‘tertiary’ category, perhaps the most pernicious, the most long-term, and an injury of the mind where the control of others is linked with violence, fear, and terror. While sadly, as we know from global prevalence data, control and abuse of the vulnerable is not only restricted to post-conflict scenarios, however, it may well be one reason why it remains rife in Cambodia.
The throwing of acid is particularly linked with the second and third categories above. A very weak and allegedly corrupt legal and law enforcement system means that the control by physical abuse is rarely punished, or prevented. The direct injuries can be inflicted with almost no fear of being apprehended by the legal authorities, and in the event that this does occur, it is easy to buy immunity with an appropriate payment to the right person.
Long-term Consequences and How Rose Charities is Helping
Rose Charities has been dealing with the results of violence against women in Cambodia since 1998. Over this time the range of acid injury has been very wide indeed, from a few superficial injuries covering one or two isolated areas to up to 60% or more of the body covered with deep penetration, even down to bone. The eyes, ears, and nose may be partially or entirely burned away.
Acid burns create a spectrum of disabilities for the survivor ranging far beyond the terrible disfigurement and physical disability. Livelihoods are ruined; there is social stigmatization, and breakup of families, marriages and relationships. Full time care is often needed and in a country such as Cambodia, this care is not provided in any way by the state. If the victims have no family or friends to look after them then they will be utterly outcast. So often the attack takes from the victim the only real asset owned in a quagmire of poverty, her physical beauty, which in many societies is the only way for a woman to advance. So the damage is also both psychological and social.
Dr Nous Sarom of the Cambodia Surgical Center (Operation First & Rose Charities) is now one of Cambodia’s leading rehab surgeons having had years of experience working in the area both on his own and with various generous international organizations and specialists who have come to assist. Donations and gifts of equipment and transfer of expertise have improved treatment ability but there is still a long way to go. Rose Charities employs many treatment specialties in its arsenal, from direct eye and corporal surgery through physio and other therapies to give a ‘holistic’ approach to each case. Where possible specialized education and vocational training may also be provided. Counseling is always needed, though sadly can be hard to find.
The injuries are often so severe that complete recovery is impossible, even with the most sophisticated methods of treatment. Thus the aim is rather to alleviate as much of the trauma as possible both mentally and physically and then lead on to try to help the victim return to life with quality.
Three amazing ‘Givers’ to Cambodia. Left to right, Dr Hang Vra (Cambodia), Mr Mike Webber (NZ), and ‘M’ (USA)
Dr Vra has given most of his adult life to helping poor Cambodians with their eye problems. Through hard work he has not become one of Cambodias leading eye specialists. In 2002 his clinic was looted and vandalized by a crooked expatriate, leaving it as a bare shell Despite this he kept on coming to comfort the throngs of expectant patients who had been deprived of treatment by the looting. He is a Cambodian hero.
Mike Webber of Wanganui, NZ , consultant optometrist, has contributed huge amounts of time, resources and know-how on a completely voluntary basis to the clinic, flying up from NZ many many times. Without him (and colleagues, Dr David Sabiston and Mr John Veale) the Sight Center would not now exist
‘M’ an international philanthropist donated the YAG-laser’ seen in the background. This remarkable machine revolutionizes the treatment of many post-cataract complications as well as enabling effective treatment of glaucoma.
The good that these three individuals have done for poor Cambodians is outstanding. Many thousands have benefited:
The Rose Charities Eye Clinic in Phnom Penh has just received a major boost, with the arrival of high-tech equipment donated from the New Zealand optom community and a visit from Rose Trustee optometrist Mike Webber with technician Neville Wood.
Three instruments were air-freighted up early this year with the help of one of the Rose team’s guardian angels, Agility Logistics of Lower Hutt. Other benefactors, the PIF Foundation, Peter and Sylvia Aitchison, Sidonia and Adam Pertschy (of Germany ), Mrs Angela Aitken and Mrs Sue Forrest, met the cost of freight and air fares for Mike and Neville.
The three instruments are a Millenium Phaco machine used in cataract surgery, donated by Christchurch’s St Georges Hospital; a Humphrey Field Analyser used for early detection of conditions like glaucoma which cause blindness, donated by the Eye Department, Whanganui Hospital, and an autoclave donated by Alpha Technical Services, of Palmerston North.
As well, a chance encounter with a millionaire “refugee” from New York during the recent visit to Phnom Penh by Rose General Secretary Dr Will Grut has led to a $US17,000 YAG laser being given to the clinic.
The high-level equipment is in the good hands of the medical director Dr Hang Vra, who has just completed his postgraduate ophthalmology exams with top honours, and his wife Nathalie, who is topping her class as she completes her medical degree, having trained as a nurse in the Ukraine.
“Vra and Natalie have both done so well with their studies, while they work so hard for the hundreds of patients who arrive at the clinic every week,” said Mike Webber. “It is really rewarding for them and all the Rose supporters to see the first-class equipment in place.” With these latest instruments the clinic has everything it needs for the foreseeable future.
But changes are afoot. During Mike’s visit an early morning blessing ceremony was held before work begins on a new building that will become both home for Vra and Nathalie and their three sons and a new clinic where paying patients will be treated.
“In Cambodia, you don’t talk about private and public,” says Mike. “It is rich and poor. Vra will earn more money to educate his sons by establishing this new clinic. But he and Nathalie are totally committed to helping the poor as well. I feel confident the balance between their new clinic and the existing one will work out well.
“Things are rapidly changing in Cambodia, and already the city boundary has been extended past the section owned by Nathalie, which is about 15kms north of the present clinic along the main road to Siem Riep.
“So in all I believe that Rose NZ can be proud of what has been achieved over the past six years at the clinic. It is now running splendidly, with
good outcomes for the patients, and I believe that Vra and his team are running the show very well with less input from us as time goes on. They
will still need the occasional input and advice over time, but it wiil get less as their expertise increases. They are all so grateful for all the support from Rose Charities, both from Canada and New Zealand.”
Operation SMILE and Smile Train to merge: Dr Nous Sarom to represent at Op SMILE International Meeting Perth (March 2011)
Dr Nous Sarom, Founder of the Cambodia Surgical Center (Operation FIRST and Rose Cambodia Rehab), is Cambodia’s leading maxillofacial surgeon and a one of the primary consultants in many wonderful Operation SMILE outreach surgical camps. Smile Train, an equally distinguised parallel organization runs the different policy of supporting currently existing surgical centers to carry out cleft lip / palate operations. The Operation FIRST Cambodia Surgical Center is one of the foremost Smile Train Centers in Cambodia. Now, the two organizations (Op SMILE and Smile Train) are joining forces and will in future be known as Operation Smile Train. Congratulations to both organizations for this move.
Dr Nous Sarom will be visiting Perth to represent / present at the Operation SMILE international surgical conference in Perth this month (March 2011) having kindly been invited by the organization. He will then travel on to visit Sydney and meet up with Rose Charities Australia board members.
Rose Charities Australia supports the Rose Cambodia Rehab Center, the physical therapy arm of the Surgical / Rehab Unit of Operation FIRST at Chea Chumneas Hosptital, Takmau. The unit is runs under the Ministry of Health of Cambodia, an important aspect in assuring sustainability and proper support of the Cambodian medical system. It is known by many locals for its kindness and compassion to its patients and staff – an element sadly lacking in at least one other establishment.
Both the Op First Cambodian Surgery Center and Rose Cambodia Rehab are enormously appreciative to both Operation SMILE and Smile Train for their wonderful and continuing work to help Cambodia and Cambodians in need and support for the Cambodia Surgery Center. Both magnificent organizations have alleviated an enormous amount of suffering since their inception.
During a brief study abroad in 2005, I toured a clinic operated by RoseCharities in Phnom Penh and was impressed by the efficiency and dedication of the medical workers there. In fact, this was the clinic that first sparked my interest in becoming a doctor. It was one of the few NGOs my class visited that offered both immediate and long-term relief to people struggling through the effects of poverty: immediate relief through life-saving medical procedures that would have been otherwise impossible for the clinic’s patients, and long-term benefits through community outreach programs and an emphasis on improving the quality of life in Cambodia.
Even in the few short weeks we spent in Cambodia studying aid organizations, it was easy to become discouraged by the waste, and sometimes obvious corruption, that plagued well-intentioned charities, but the Rose Clinic seemed to stretch every dollar it received. As I saw firsthand in 2005, a $20 donation to RoseCharities can restore a person’s sight, and $50 can repair a cleft palate or give a child the ability to walk. For more information on how to donate to RoseCharities, please see http://www.rosecharities.info/donate.htm.
The organization’s efficiency can be traced to its formation, as outlined on the RoseCharities homepage:
“Founded by aid workers who were disillusioned by the waste and bureaucracy often seen in international aid, we started in Cambodia in 1998. The aim was to deliver effective, sustainable programmes directly to those in need, with minimal bureaucracy, and with transparency at every stage….We are run by volunteers, so administration costs are kept to a bare minimum, with 98% of donations going directly to support our work.”
I contacted Rose last October and asked if they’d be willing to take us in for a few weeks as volunteers, and they graciously agreed. Since then, Bill and Jan Johnston have been bending over backwards to find opportunities to put our random interests and talents to work. We started last Wednesday with a short tour of the gynecology ward in the Chey Chumnas General Hospital in Takmao, the hospital where Rose Cambodia is based. That afternoon we helped enter patient files into the computer (data entry is a rare example of a skill that Danielle and I both possess).
Thursday we traveled to the countryside with Sokny, the physical therapist on staff at the Rose office, to work with a woman who had laid in bed for 30 years after a debilitating bout with encephalitis (for more info visit the Rose Rehab page: http://www.rosecambodia.org/?page_id=12). The physical therapists at Rose have been working with her to help her gain the strength to sit up, and in order to get her hands moving Danielle brought a bunch of art supplies. We made simple shapes for her to paint in, and Danielle taught her a few strokes. Danielle and I were so absorbed in watching her work that it took a while to notice the dozen or so kids from the village in a semicircle around her, jealously watching her paint. It was a great visit. As we left, Danielle hung some of her paintings next to her bed with ribbon.
On the way back to the office, we stopped to visit a woman who had been badly burned on her legs by gasoline, and the physical therapists changed a bandage for her. Apparently a skin graft had failed to take, so there was still a gaping wound behind her left knee months after the accident. While we were visiting her, her neighbors brought another potential patient to see the therapists and placed him on the bed next to her. The man had been in a motorcycle accident and could no longer move the left side of his arm. The physical therapists assessed him and made an appointment to see him later at the clinic.
As we were about to leave, the neighbors convinced the therapists to see a woman next door who was having trouble walking. While the physical therapists did their thing, Danielle and I hung back and smiled shyly at some very friendly older women, who seemed to be staring at us. One of them started talking, half at us and half at the women around her. She then started wiping at her nose, as if to inform me that I powdered sugar on the end of mine, so I self-consciously started doing the same but she just laughed. One of the therapists translated, “She wants your nose.” This seemed hysterical at the time, so Danielle and I giggled about it for a while.
After the therapists had finished their work we got back in the tuk tuk, but before we could go there was some kind of commotion. The lady who couldn’t stop looking at my nose jumped into the tuk tuk and handed us each a coconut and a straw. We very gratefully accepted and drove off.
We made one last stop to see a beautiful young girl who was working with the therapists to build the strength in her arms and legs, and then we took a holiday all weekend (2 working days is long enough…)
Today Bill gave us a tour of the Rose Eye Clinic just outside Phnom Penh in the morning, and Danielle and I returned in the afternoon to observe glaucoma surgeries. We watched for 2 and a half hours as nearly a dozen patients underwent the 20-30 minute procedure. It was one of the most amazing things I’ve ever seen.
Posted by Jess at 2/21/2011
An wonderful donation of a Zeiss Humphrey Optical Field Analyser has been donated from Wanganui Hospital via Mr Mike Webber. NZOM for use in the Rose Cambodia Sight Center. This advanced instrument will enable a full detailed analyisis of sight problems of the patients coming to the clinic for help.
The Rose Cambodia Sight Center helps around 10,000 poor Cambodians per year, many who need operations to prevent blindness or restore sight. Founded in 1998, the center was robbed, looted and almost destroyed in 2001. The stolen equipment, as well as its vehicles were traced to the premises of a nearby expatriate managed clinic, but despite requests were never returned. Despite these crimes the Sight Center has helped 90,000 poor Cambodians to date and is now one of Cambodia’s leading centers.
Rose Charities New Zealand’s Mr Mike Webber NZOM, Dr David Sabistron NZOM, and Mr John Veale have been pivotal in bringing the clinic to its current status, with regular teaching visits, and obtaining donations of equipment and funds. Dr Hang Vra, Director of the Clinic is acclaimed by many international observers as being a ‘superb eye surgeon’ of the highest order.
Dame Silvia Cartwright PCNZM, DBE, QSO, DStJ,( the 18th Gov General of NZ) has honoured Rose Charities NZ as being a Patron of the organization. Dame Silvia has recently been one of the main expatriate judges in the current Khmer Rouges war trials in Camboida
Image shows the Zeiss Humphrey Field Analyser, prior to shipping to Cambodia
Cambodia Surgical Center assited by Canadian Govt. to help victims of Water Festival Disaster Nov 2010
The Canadian Government is assisting victims of the November 2010 Cambodia Water Festival Disaster by an emergency Canda Fund grant through Rose Charities Cambodia Surgical Center / Operation First Cambodia. Over 400 persons lost their lives in a stampede over a small footbridge linking an island in the Tonle Sap river just offshore from Phnom Penh, and the mainland. In addition many persons were injured and need medical, surgical and rehabilitative assistance. Cambodia Surgical Center which is run by Operation First at Chea Chumneas Hospital houses some of Cambodia’s leading surgical facilities in Camboida as well as a international standard physiotherapy unit. It is anticipated that several hundred survivors are in current need of assistance and will be helped by Canadian generosity.
YOUNG people will be the beneficiaries of Phnom Penh’s first Christmas ball on Saturday, December 18.
The black-tie ball at Raffles Hotel Le Royal will support five NGOs focusing on young people, in recognition of this year’s International Year of Youth. And one of the ball’s highlights will be a performance by Epic Arts Cambodia.
This NGO, one of the five to benefit from the ball’s proceeds, offers professional dance, drama and art classes to disabled Cambodian youths.
The group’s aim is to break down barriers in a country where an estimated one in 10 people have a disability, and few have access to jobs or training.
Recently the NGO has branched out to give creative workshops to youngsters with intellectual disabilities and also runs a café in Kampot that’s a focus for the town’s deaf community.
Rose Rehabilitation Cambodia is another NGO that helps disabled young people. Based in Kandal province, the group uses physiotherapy and holistic health care to help train medical workers and help the most vulnerable.
Children living amid sickening conditions at Phnom Penh’s Stung Meanchey dump are helped by A New Day Cambodia, another NGO to benefit.
Two centres care for about 100 children full-time, providing shelter, clean clothes, food, and an education. With the chance to enter vocational training or university, A New Day Cambodia gives youngsters everything they need to escape the cycle of poverty.
Hip hop music, breakdancing and contemporary arts are used by Tiny Toones Cambodia to spread its message of living healthily.
Encouraging children to protect themselves against the dangers of HIV and drugs, the group offers free English classes, lessons and computer lessons as well as a creative programme that reaches out to young people with Hip-hop.
The Youth Resource Development Program is the final beneficiary of next Saturday’s event. Since 1992, the YRDP has helped university students question the world around them and learn about human rights, peace, and public dialogue.
Little5year old Cambodian ‘Tot’ who has the fused jaw has now had his surgery arranged. Dr Veronica Ventura begin of Community Health Development Cambodia. He will fly down to Singapore for the operation which will be on the 4th January 2011. Funds are still needed both fro Tot’ s surgery and rehabilitation, but also for his education and any special needs for return to life. Rose Rehab Cambodia will be helping with Tots rehabilitation . Funds are still needed. Rose Charities is collecting for the Tot fund in Canada and in the USA (in both, tax receipts available). Please say donation is for ‘Tot’
Dr Veronica Venturas efforts for Tot have been simply amazing. She has worked day and night to ensure the best possible outcome for Tot. There is every chance that this little boy will rehabilitate to a happy, educated life. Bravo Dr Ventura…!.