Strange (to me) but true. An introduction to Cambodian Style healthcare through coining and cupping.

It’s a real shame they aren’t medically qualified.  Well, not yet anyway.  My students I mean.  I am a bit better insect bite wise thank you.  However, although the itching has subsided the visible evidence of mosquito attack seems to remain with me.  I don’t know if there is a super mutant breed of dalmatian that has raised red-welts where there should be black blotches on its coat, but if so, I must look like a hybrid version of this beast.  More red-welted dalmation than woman, and, truth to tell, it’s not altogether a good look.  I am not excessively vain, but I do have to protect my image to some extent in case of future fame/notoriety, so I’m taking the precaution of not posting any photos of my skin at present.  I would defy anyone to carry off this look with any semblance of dignity at all, and as I generally inhabit the unkempt/ got dressed in the dark/ unfortunate physique end of the poised and beautiful people continuum the odds were stacked against me from the start.

So, what has this to do with my students?  Well, the topic for the major part of this week was ‘health and environment’, including describing symptoms to doctors, recommending treatments and making an appointment to see the dentist.   Since our course books are based on Cambodian culture and reference points this has led to some genuinely interesting and eye-opening revelations about traditional Cambodian health practices.  Truth to tell, the sessions this week have been a bit up and down.   Some have been spectacularly good – I loved my students when they were acting out Doctor’s consultations, writhing around with fake injuries, and making ‘patients’ wait outside in the corridor before letting them in for their appointments.

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Also hilarious (though possibly not health and safety compliant) was their animated version of the scenario ‘I was walking along the street, when I slipped and fell backwards.  I banged my elbow on the ground, but it didn’t bleed.  Today it is really swollen, and I can’t bend my arm.  I think it might be broken.’  Pretty dry to begin with, I was despairing of how to create a bit of interest, so I got all the students up on their feet and began by getting them to do elaborate walks, flirtatious, purposeful, eccentric, and then act the whole thing out. They got massively in it, to such an extent I thought we’d end up with a mass slippage incident and a genuine medical emergency, but it was fun at the time so that was the main thing.

In a later segment, students looked at how to give advice.  This is to me moving into very dodgy territory, as they learned the vocab for common ailments and generic advice. Now, I do readily concede I am not a qualified medical professional, but teaching students to trot out advice along the lines of any stomach ache requires an antacid or if you have food poisoning you should ‘cook at home’ seems of limited help to me. And as for applying sun-cream once you have sunburn, well the phrase ‘locking the stable door after the horse has bolted‘ or even ‘building a fence round your land after the water-buffalo has left‘ which I understand is the Cambodian equivalent, rather spring to mind!  There are many Khmer proverbs apparently, I have only come across a couple.  Maybe I should try to unearth some more.  The water buffalo picture comes from the saying ‘to look at someone like a water buffalo looking at a television.’  Which I consider to be rather splendid as an image.

On the other hand, I have to admit they really made me laugh as they went free range with their own advice.    At first I thought they hadn’t understood the exercise, but in fact I think their English was fine, it was their advice that was frankly below par.  So for a headache one recommends exercise.  A sauna and massage was a universal remedy for another student.  Another felt anyone who was ill should just come and party with him, he also insisted that whenever he was ill (cold, headache, toothache) he would go to hospital, ‘because I have a special friend who works there‘ contacts eh?  Maybe he does?

By coincidence, this week fortuitously one student had a genuine arm injury, so that was clearly marvelous from a teaching perspective if not from having a functioning arm perspective.  I had some difficulty explaining broken bones of all things. This was partly because when they asked me if I had ever broken anything and I said yes and started to list them all I think they just thought they’d misunderstood. Well, on reflection I have broken rather a lot – knee; arm; wrist; collar-bone; toe.  No wonder they were confused.  Many students have also had a cold, which means they have been coming to class wearing masks which presents an interesting challenge for language tuition and pronunciation practise.  However, all of this is still not the point. The point is that one of the exercises we had to do, was look at the vocabulary for traditional Cambodian remedies. These include cupping – which Wikipedia (so it must be true) describes as:

Through suction, the skin is drawn into the cup by creating a vacuum in the cup placed on the skin over the targeted area. The vacuum can be created either by the heating and subsequent cooling of the air in the cup, or via a mechanical pump.[3] The cup is usually left in place for somewhere between five and fifteen minutes. It is believed by some to help treat pain, deep scar tissues in the muscles and connective tissue, muscle knots, and swelling; however, the efficacy of this is unproven

and coining.  Thanks Wikipedia for this summary:

is a traditional Chinese medical treatment in which the skin is scraped to produce light bruising. Practitioners believe gua sha releases unhealthy elements from injured areas and stimulates blood flow and healing. Gua sha is sometimes referred to as “spooning” or “coining” by English speakers, it has also been given the descriptive French name, tribo-effleurage.[1]

Walking around Cambodia I have seen a lot of evidence of both.  Many men don’t wear shirts as they are working, and so their backs are exposed. I’ve seen the red circles from cupping covering large areas, and horrific (to me) bruising which I now know is from the practise of coining.  It looks like the aftermath of self-flagellation to be honest, and both seem to the outside-eye frankly brutal.

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So the point is, that after introducing the vocab, I check the understanding.  I ask about coining and the mask-wearing, younger woman with a cold, pulled back the sleeve of her hoodie to reveal her naked upper arm which was ridged with deep, wide scars several inches long. She had tried coining for her cold.  ‘Does it work?’ I asked.  ‘Of course‘ she replied.  I was pretty dumbfounded really.  Within my group of students reactions were mixed.  To be fair, assuming they were telling the truth –  the majority completely rejected both.  However, my nurse, who will complete his training in a couple of months’ time said he used to, until he had his medical training.  Most, if not all, had memories of older relatives using it on them when they were young, and the coining was excruciatingly painful.  One student said he’d tried both just to see what they were like.  The student who was actively using the treatments considered this bizarre as what is the point if you are not ill, how would they work. This took us off on a whole confused trajectory around preventative health.  I don’t think I communicated it very effectively.

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One of the older women (relatively speaking, I’m still the oldest by a country mile) was quietly open-minded.  I got the impression she does use the treatments but was reluctant to admit to doing so here as she also recognises the lack of empirical evidence about their effectiveness.  All said that it was seemingly a generational thing, older people very much do continue to use these treatments with enthusiasm, belief and vigour.  It was all very interesting, enlightening and puzzling in equal measure.

My students also tried to explain to me some other painful ‘healing’ practice. One that seemed to involve violent pinching of skin and flesh across the whole body.  I wondered if it might be around acupuncture pressure points. They didn’t seem to know what acupuncture was, and although I’m not the best at drawing I think that should have been easy enough to convey if it was used here.  I got back blank incomprehension in return for my efforts.  I don’t know what the pinching one is.  I think it might actually be called pinching!  I came across this rather fine Cambodian Cultural Profile which mentions it, so maybe it is.

So, having listened to my students  both express sympathy, and dispense a wide range of medical advice on a wide range of ailments, I am of the general opinion that their English is way better than their advice.  In any event I didn’t strip off to expose my insect bites, impressive and extensive as they are in both individual appearance and the surface area they collectively cover!  Some students were more sympathetic to one another than others to be fair.  One flatly refused to express sympathy to another for a hypothetical black eye, being of the opinion that it was no doubt richly deserved.  I’m not sure my students have signed up to any ethical codes of practise, maybe that’s covered in a later unit?

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My final session of the week was around booking appointments at the dentist.  I don’t know that it actually bombed, I think they just found it really hard, and having embarked on a paired activity where they had to find a free slot to see the dentist, I was too far down the line to abandon it. It wasn’t the most fun-filled of finales for a friday.  I felt a bit low about it afterwards.  I know not every single session I deliver can be a fun-fest, but it’s nice when they are, and I’ve got a whole weekend of questioning my tactics and competence now.  Oh well. Worse things happen at sea.  and in American politics, so I shall try to keep some sense of proportion.

Next week the topic is celebrities.  I know nothing about celebrity culture anyway, and Cambodian Celebrity Culture is likely to more elusive than UK or American Celebrity culture.  Hopefully it will be like the weddings sessions.  They will end up telling me. Watch this space … unless you have  a life to live elsewhere of course, in which case don’t, live your life instead, move forwards, don’t wait for me I wouldn’t want it.  I want you to be the best version of yourself, not held back on my account. Truly… never look back, never… not even a peek!

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