Expert Breakfast Report for 9 May 2018: Dr Steve Tripp, Dept of Physiology

An unusual and fascinating presentation, this. Dr. Tripp is a Medical Teaching Fellow in the Physiology Department, a post he has held for over 4 years. He spent 7 years working in Cambodia, where an outstanding feature of his work was to look for the heart of the problems faced by ordinary people, and attempt to address some of those fundamental causes. And runs ultra-marathons on the side.

Child of a solo mother with three children in Dunedin, “I had a shaky start to life”. After school he tried farming and hated it, so he hitched all around the country doing around 18 different jobs in 5 years, including making ice-cream, picking tomatoes, and a bit of computer programming, “all sorts of weird things”.

“Eventually I started to, I guess, grow up a little bit - part of that was through a Faith experience that I had when I was 23, and I ended up at a Bible College, and through that I got into Community Development work.” This led to working with people with psychiatric illnesses in Christchurch at a time when such people were being moved out of institutions and into underfunded community houses. His work consisted partly of helping them to integrate into the community, “or just to find a sense of home, of belonging in small groups in the community”.

This led naturally to nursing, then medicine, making him a late starter in medical studies. “I remember going along to the Christchurch School of Medicine and talking to the Dean.” Here Steve was told he could either finish his Nursing degree after a couple of years experience, or “you could try for First Year Health Sciences, but I really don’t recommend that, because it’s full of young people who are very smart. You know, the system’s engineered against late developers like you.”

Steve went on to First Year Health Science and from there to Medicine. After working as a junior doctor for a while, involving a bit of teaching, he ended up in Cambodia. What induced him to go there was a recognition that “there are people on this planet who are a hell of lot worse off than we are.” He and his wife went to live in the capital Phnom Penh in 2006 and worked there for 7 years. He described aspects of the cultural changes, such as adjusting to the virtually continuous noises of the city.

At first he was working with people most of whom had HIV-AIDS. “It was a very steep learning curve. One of the fascinating things in Medicine is that you’re always put on a pedestal, even though you don’t know anything.” Having seen only a single patient with AIDS before he went to Cambodia, he found himself suddenly surrounded by people who often had both AIDS and Tb living in poor communities. As an example, the life-span of someone in New Zealand without medication was 7 years, while anti-retroviral medication would extend their lifespan to normal. In Cambodia, without medication, the lifespan of a sufferer was about 11 months, due to malnutrition and poor hygiene with its associated diseases. He was working with local unqualified people who had been helping AIDS sufferers for a long time.

As the white, western male ‘expert’, these workers who actually knew what they were doing would always, nevertheless, defer to him. “It was a really interesting introduction into power dynamics, and you can have power even if you don’t recognise it and you don’t believe it - and it’s very easy to abuse that power.” As a doctor, people will give you power even if you don’t deserve it, and you have to be very careful how you use that.” Which applies not only to doctors, but to many other professional positions.

He found this somewhat hampering, in fact, as he wanted to learn from the local workers, but they always deferred to him. He was used to problem-based learning, in which the learner seeks the answer to a presented problem, whereas they were accustomed to simply being told. “It was a very difficult fit, so I actually shifted out of practicing medicine in Cambodia, at least with the AIDS home-care team. As a result of working for a while in community clinics, he moved into Community Development. Part of the reason was a recognition that a lot of the problems he saw were really due to a lack of hygiene and of a decent water supply.

Steve claims with some justification to be a generalist in everything, rather than an expert at anything. This has a lot to do with his ability to address the real cause of a problem, rather than the bit that impinges on a particular expert field.

“We worked with local communities to help them develop clean toilets and clean water supplies, which included both education and working with the local people.” There were problems. One NGO that provided toilets found they were getting damaged, so decided to lock them and leave the key in the care of a local. That person began to charge people to use the key, with the result that people went back to their old low hygiene practices.

In one community with 100 families that they surveyed before bringing in toilets. Over the previous 3 months, 100% had had a diarrhoeal illness that affected their lives. The impact of this was enormous, not least because anyone with a job could well lose it if they were off sick. Only three months after the toilet were installed, the rate had dropped to 25% - still quite high, and work continued on improving it even more.

Another area he moved in to was income generation and the development of work skills, another basic cause of problems down the line. One reason for this very dysfunctional culture was the loss of role models in the genocide - “The fathers, the teachers, the professors, the librarians - everyone who was educated got slaughtered.”

One upshot of the income generation initiative was the formation of a T-shirt screen printing business for teen-age boys. Hours of work allowed them time to go to school, and they would keep the job as long as they continued to go to school, with the small income they generated helping to keep them at school. (See ‘WHAT CAN WE DO? below). This ‘Justees’ - (T-shirts for justice) business is still operating.

There were other problems, again largely stemming from the enormous upheaval Cambodia had gone through, largely through the Khmer Rouge and the Cambodian–Vietnamese War (1979–91), pervasive corruption being just one.

As usual, there was much more of interest for Members who attended than I can report here, such as the learning, teaching and introduction of non-violent activism in response to government-backed theft of homes, running ultra-marathons to test just what the human body can do, and more.

WHAT CAN WE DO?
Well, at least this: justees.org - take a look at the custom printing section. For an order of 15 shirts, colour of your choosing, you can have custom printing at $25 per shirt and help mentoring and training of people in the Cambodian slums. Next lot of SMC shirts???

Posted: Tuesday May 22, 2018