Berkley Center

Background: Dr. Gerlinda Lucas is serving in Sihanouk Hospital Center of HOPE as deputy director of administration. Her main role is monitoring and evaluating the HIV/AIDS, TB, and Malaria program of the hospital that is funded by Global Fund. She also took part in launching a community outreach project through a mobile clinic, currently providing basic primary health care and health education to the most depressed area in Phnom Penh. In the past, Dr. Lucas served as medical project supervisor in Kabul, Afghanistan through HOPE worldwide from April 2005 to March 2006. She helped to lead the Quality Care Improvement and Management Restructuring Project at Malalai Maternal Hospital funded by the UK Embassy to Afghanistan and supervised various medical projects in the country.

You are a senior officer of this hospital, which serves Cambodia’s poorest people and addresses both basic health needs and the major global scourges of HIV/AIDS, tuberculosis, and malaria. We have heard that you have come here via a remarkable journey. Could we start there, with your own story? I understand that you were a “World Vision” child.

Yes, growing up in the Philippines, I was “sponsored” by the Christian Children’s Fund and by World Vision. They helped to finance my education, through high school.

When I was in school, a women’s organization began to take an interest in me. They saw potential and from as early as the eighth grade, they began to talk to me about studying abroad, in Russia. I later learned that they were a group with Communist leanings but I had no idea of that at the time. And so, when I finished high school, in 1989, I went to Russia to study medicine. And I ended up studying in Tajikistan.

Tajikistan was then a Muslim Republic of the USSR. I found myself studying Russian for a full year before starting medical studies; that was the system at the time. A year later I started medical studies at the Tajik State Medical University in Dushanbe (the capital). I was with a very diverse group of people from all around the world. There were Russians, Nepalis, Indians, Afghans, and many others.

It was my first experience in an interreligious environment, and quite a hard adjustment in the beginning. I was very used to wearing shorts, but for my Muslim colleagues this was quite shocking. I was used to going for walk when I pleased, but their reaction was that this was quite scandalous. So they saw me as rather immoral until they got to know me. My teachers were Orthodox, my dean was a Muslim. We learned the real meaning of friendship. It was important to be sensitive to what people were really thinking, and to respect them. And within our diverse group, with my Filipina outlook, being outgoing, loving to dance and laugh, I became very popular, the life of the group. Our group learned to live together and to respect one another. We made an effort not to step on each other’s toes. And my colleagues gave me a support that my parents could not because they were poor and far away. Friends from Afghanistan, for example, essentially adopted me. When their parents visited, they met me and liked me and were interested in my life. I felt loved by them, and in a sense they were my only family. We have stayed friends over the years.

I stayed in Tajikistan through my second year of medical school, but then, because there was civil war there, I was forced to leave. I had come to love the place. The Muslim population there was very clear in their beliefs; I found them open-minded and free in their interests and curiosity, more so than people I have met from other Muslim societies, for example Iran and Pakistan.

So in 1991 I moved to Moscow. And there I met a different group, especially the Americans. Because I had no money of my own, I had to work, and I found jobs at the American Embassy there. I adapted easily, and in many ways I found the culture much closer to what I had been used to in the Philippines. And here too I had a wide and diverse circle of friends. I was at the Patrice Lumumba University, and there were students in my group from Cyprus, Peru, Chile, Mali, Colombia, Nepal, Morocco, Uzbekistan, and Russia. I began then to get into real medical studies, with microbiology and other subjects. Altogether I spent six years in Moscow and finished my medical degree.

Did you go home during your studies?

I could not go home at all while I was studying. My family was poor and I had no money. So the first time I was able to return to the Philippines was after eight years, when I had finished medical school and started to work. I have been able to go home more often since then, and I hope eventually to settle there, but for now I am so used to moving around, and I enjoy it.

What was your religious experience along this extraordinary path?

It has been a long path, and I was actually baptized six times! My background is Catholic, Protestant and Charismatic, and I was very interested in Islam while I was in Tajikistan (until I found out about how they approached women, and decided that was not for me!). But now I am happy in my church, and in my beliefs.

My mother was a Catholic and my father, but I was not deeply convinced by their beliefs when I was very young. There was no electricity for me then! But I was very interested and started to read the Bible and other books. I wondered, as I read the Bible, why people did not practice the good things that it said. But while I was in Tajikistan I was not really a Christian yet. It was in Moscow that I began to go to church. It was after 1989 and there were many churches starting up and I joined an evangelical church.

What did you do when you finished medical school?

I decided to stay in Moscow and found work with the American Medical Center. A Jewish American was running it, so I met another religion there! I worked there for a year and a half. It was there that I first met HOPE worldwide. I had truly become a Christian by that time, clear and comfortable in my beliefs, and found myself in harmony with them.

I went on a holiday to Dubai, found an opportunity there, and so decided to go there to work. I spent two years there, working with HOPE worldwide, at a medical clinic called Manchester Bodylove. It was owned by an Egyptian married to an English woman from Manchester. But my priority there was to study the Bible. The work was interesting but not my real magnet, or my real career.

Going to Dubai to study the Bible does not seem totally obvious. How did that happen?

It was the people I met and the extraordinary melting pot there that drew me in the beginning. It was exciting at first but I tired of it after a time. There was so much worldliness there, so much wealth that, in my own view, could have been used better for other things, to help people, rather than in fancy clothes to wear and the like. I did not find much deep conviction there.

And after Dubai?

I went to Afghanistan, again on holiday, and met HOPE people there. There was an opportunity so I moved there, a volunteer at first. I spent a year at the maternity hospital in Kabul (it has a branch in Khandahar). I ran a program that was a pilot program for quality care and a management restructuring, that was supported by the British Embassy. I found that I was able to help people, and though it was not an easy environment, we were able to make a lasting difference. The couple that started HOPE there were remarkable; someone said to me of Mark, that he “was like Jesus Christ,” because he saw kindness as the Christian way of life. It was the only way to reach people and to accomplish the mission there.

It was not easy being a woman there, but I managed. I was working mainly with women but most of the staff were men. They found it hard to deal with me but I broke through by serving them, showing that I respected them. I often needed to explain to them why I wanted something, and I listened to them carefully. They came to respect and trust me. One of the staff at one point said to me that he was tired of the Taliban!

Through this very diverse and international experience, working with many religions, I came to believe that “voicing out” your doubts and differences when it is not your priority, not your mission, is not going to be very helpful. Loving people and working together, respecting them, is a much better path to understanding and to making progress.

And what brought you to Cambodia?

Again I went on a vacation here and found an opportunity which I decided to accept at the Sihanouk Hospital. I was again working with HOPE worldwide. I moved to Cambodia in 2003.

At the Sihanouk Hospital I am responsible for managing the Global Fund financed projects. These were in the first instance focused on HIV/AIDS (that began in 2000) but we are also very much involved in tuberculosis and malaria. The Global Fund support began in 2003, and there are operations under Rounds 1,2, 4, and 5 for HIV/AIDS, Rounds 5 and 7 for TB, and we are a sub sub for round 6 for malaria.

Can you tell me a little about the work, beginning with HIV/AIDS?

The hospital’s HIV/AIDS work began before ART was available. Our work was supported for a time by the Elton John Foundation. We started a small group of patients on ART—only 20, against the huge needs here. We had to focus on the priorities of priorities. Through that process we worked with communities, to help set the priorities as to who would receive treatment. We created a commission ion each community, with the head of the village and others, to decide who would go on drugs.

In 2004, ARVs became available and there was a big jump in treatment. We began to hire doctors to run the program. Today there are about 2,900 people under treatment. We recruit about 40 to 50 HIV positive patients to the program each month, and each day four to five new patients come to the hospital. We have such large numbers because people come here for so many different things.

We also have palliative care programs. In the beginning this was all we could do, to treat for opportunistic infection, and to provide hospice care.

Do you screen all patients for HIV/AIDS?

No, only when we see that the person is high risk or shows obvious signs of the disease. When we see those signs, the doctor calls a counselor. And if the person is HIV positive, we send them for TB screening (this follows the national protocol).

What kind of spiritual guidance can you give to patients, especially in the hospice?

We have volunteers who come, from different faiths, and we respond to what the patient asks for. If they are Buddhist, we call a monk, if they are Christian, a Christian volunteer.

What about tuberculosis?

Most of our TB work is with the community. If patients need to be hospitalized, they are hospitalized here. If they need to be isolated they are sent to the government hospital.

A lot are developing MDR TB. However, there is no significant research yet on the situation. The response is essentially responsive, on a case by case basis. And of course it is expensive to treat. CENA’s center on TB is the appropriate place to take the lead. There is a clear sense here in Cambodia that action is needed.

Are there any ways in which the Sihanouk Hospital engages with Buddhist leaders or communities on these major global diseases? How widespread is knowledge through the faith hierarchies?

Many NGOs are working with community leaders, including Buddhist monks and networks, on HIV/AIDS. The CCM (Country Coordination Mechanism) will be bringing on one member who comes from a religious group, and that will most likely be a Buddhist monk. The process of constituting the CCM is still ongoing; members will be elected. There will be one NGO representative, representing people living with HIV/AIDS, and a religious leader, in addition to the government and donor representatives. Making the CCM work well is a challenge.

There is so much education coming into Cambodia these days through the many NGOs that operate here and civil society more broadly. There are many workshops at the community level, and it is common practice to invite monks to participate. Many are increasingly open minded.

In this culture, as in the Philippines, it is very often older people who care for children. Thus whatever older people believe is passed on to children.

Traditional healers are very common. We find that even the medical staff of the hospital, well trained in science, use traditional medicines and practices. When someone coughs, they may go to the clinic, but many go to the traditional healer.

Are there programs that reach out to traditional healers?

Very few. There is not a lot going on, but it is important.

This is especially true for malaria. In one area, 20 deaths were reported in a three month period. When we investigated we found that the patients had gone to the clinic but when the medicines they were given did not cure them, instead of going to the hospital they went to the traditional healers, and the remedies they were given did not work.

What can you tell us about maternal mortality? The statistics for Cambodia are high, and of course reducing maternal mortality is the Millennium Development Goal (MDG) that is lagging furthest behind. What can be done?

Mortality is high, and essentially the whole system of ante-natal care is not functioning. There are many problems. One is staffing of clinics in the rural areas, which is particularly difficult. And when midwives come in for training, often they decide to stay in the capital. Many women go to traditional healers. And the problem of low levels of education plays a role. People are poor and uneducated.

The issues of practices that contribute to high mortality would seem to relate more to culture than to religion. Many girls marry very young and have babies too early, before their bodies are fully developed. Women have many children. And malnutrition is very common. If women do not have children, the husband may well leave them. Generally women, I am told by many Cambodians, occupy a lower status than men.

What seemed to be the main preoccupations at the regional meeting on HIV/AIDS that you just attended in Indonesia?

The focus was on empowering people (especially from marginalized communities) and on networking. Civil society and community groups played a big role. They were encouraged to speak up. Thus there was much focus on the gay community and on sex workers.

I agree with many of these concerns but there are aspects that worry me. There seemed to be a sense that no one should criticize behavior. But this behavior can endanger people. Empowering can damage people sometimes. And the arguments that sex work has been with forever and is a reality is also important. But the idea that we just let happen is worrying. I agree that making sex work illegal drives it underground so that the disease spreads. In short, the discussion left me divided!

There was also a strong focus on youth, which was good. There were many young people, who spoke forcefully about the need to engage and work with youth groups and communities.

Are there many faith-run hospitals in Cambodia? We understand that there are few Catholic hospitals and the Adventists do not have a large medical presence here. Are there others (besides the Sihanouk hospital)?

Not really. There are many small health projects run by religious and faith groups, but not many larger hospitals or health programs. Where you do see many involved is in HIV/AIDS. The Maryknoll Sisters have a significant program. Caritas runs programs and the Sisters of Charity are here.