In each of the past 4 years, I have volunteered for 3 or 4 weeks at the Angkor Hospital for Children in Siem Reap, Cambodia. Founded in 1999 by the Japanese photographer Kenro Izu, the hospital has become a busy and important source of health care for children in Siem Reap and surrounding areas. Siem Reap has grown dramatically in recent years because it is the gateway to the temples of Angkor—wonders of the world like Bayon, Ta Prohm, and Angkor Wat, which attract thousands of tourists from all over the world. But the temples are not the only attractions in Cambodia.
One day, a physician friend and I made an afternoon excursion to the temples. We rode in a tuk-tuk, a comfortable but small cab pulled by a motorbike. That mode of transportation allowed for conversation as we slowly drove along the pleasant tree-shaded road that connects the town to the temples. We had both been “templing” before. The charms of the temples vary according to the time of day, with early morning and early evening being the nicest times and midday being nearly unbearable because of the heat. This was an early evening outing, with the idea of watching the sun set from the vantage point of one of the temples.
As usual, we were assailed by several young children eager to sell us postcards, T-shirts, and other souvenirs as we exited the tuk-tuk at the temple. These children are persistent and use a number of ploys to charm tourists into buying whatever they are selling. Although their English-language skills are limited, many try to impress by naming the capital city or the population of the tourist’s home country. They make personal appeals, ensuring the tourist knows that he or she was the first little merchant to approach them. When I brought my 14-year-old daughter on a previous trip, the favorite appeal was, “Mister, your daughter very beautiful. You buy something?”
On this particular day, eager to gain some altitude before the sun set, my friend and I had no interest in souvenirs or bargains. We passed through the crowd of kids gently waving our hands to signify “no thank you.” Three children would not take no for an answer, though, and they followed me through and up the temple, repeating entreaties and adjusting their prices in the hope that I would relent and buy something. It is tempting to buy only to get rid of them, but I really didn’t want anything they had to offer.
My friend and I became separated, a common occurrence when one or the other of us stops to pay closer attention to an architectural feature, a stone carving, or something else of interest. The 3 small children, 2 boys no older than 4 and a girl who must have been 6 or 7 years old, continued to follow me. They sat close by when I finally stopped to watch the sunset, only to renew their offers when I got up. By this point, the sun had gone down and I found myself alone with them in a remote and darkening corner of the temple. They made a final sales pitch, with the girl taking the lead. When I said no once more, the girl looked at me with narrowed eyes and said, “Boom-boom?” making an “o” with her mouth and pointing into it with her index finger.
That this could be the face of child prostitution caught me completely off guard. I reeled in horror, almost losing my footing as I involuntarily stepped backward among the rough stones. A swarm of emotions assailed me all at once: surprise at this most unwelcome offer; shame that this girl could possibly believe I might be tempted (didn’t the monsters who might exploit her look different from me?); distress that, indeed, there were men who would take her up on her offer and, in all likelihood, already had; helplessness to do anything to change her situation; and inability to make sense of the whole scene. I stammered something meaningless as I hastily retreated, looking for my friend to rescue me.
The fact that adults can find children sexually attractive, much less act on those attractions, has always been appalling to me. And yet I know it happens. In the more than 20 years I have worked as a pediatrician in the United States, I have encountered several children who had been sexually victimized by adults. But I had never seen this. Even if I hadn’t been paralyzed by shock, I cannot think of any constructive action I might have taken in that moment to change the circumstances of this little girl. There was no official assistance to summon. Had I tried to say or do anything myself, it may very likely have been misunderstood, or worse, misinterpreted.
Cambodia has only recently emerged from a dark period of its history. Two decades of war and atrocities have left a legacy of poverty and social disruption. With an annual per capita gross national product of approximately $260, the $150 that a family might gain by selling a daughter to an unscrupulous businessman can be too tempting to pass up. It is not always clear at the time of the transaction that such a sale means that the girl will work as a prostitute. Families are sometimes tricked into believing that their daughter is being hired to work as a kitchen assistant or a maid. I had no way of knowing, however, whether this described this little girl’s path to prostitution, or, as is probably more likely, she had simply learned that the amount of money earned in this manner far exceeds the return on sales of souvenirs.
Like many developing countries with large populations of young people and few opportunities for economic advancement, Cambodia has become a popular destination for the sex tourism trade. Some of those sex tourists come to Cambodia looking for sexual liaisons with children. Big signs on the streets of Phnom Penh and Siem Reap warn: Have sex with a child in this country, go to jail in yours. You would get no argument from me on that point. Western countries can and should prosecute their citizens who exploit children in other countries. There have been a number of recent newspaper accounts of that happening in the United States and Canada. There are also organizations that seek to illuminate and eliminate the problem of child prostitution. They find it difficult to attract funding because no one wants to be tainted by association with the problem. Indeed, linking my own name to this topic makes me queasy. On a personal level, I worry that I might in some way insult or embarrass the Cambodian people, who live in a country I love and who have always been extraordinarily kind and friendly to me. The complex conditions that allow for the reality of child prostitution mean there is no easy solution to the problem. But making people aware of it, supporting efforts to alleviate those circumstances, and interceding with those who exploit children and profit from them should be a priority for all of us who would like to see improved conditions and possibilities for the children of Cambodia and the rest of the world.
My confusion and distress upon encountering this little girl has made me realize that not all of the problems of Cambodian children are apparent at the hospital. Until this encounter, child prostitution had been an abstraction to me, a phenomenon that I had read about in newspapers, something I had never witnessed and hoped never to see. Now I know it exists, and overcoming the complex social and cultural conditions that allow it to exist may not be possible. What may be possible is to create in Cambodia the child protection infrastructure we are so fortunate to have in the United States. My own institution, under the leadership of Carole Jenny, is seeking to partner with the Angkor Hospital for Children to develop multidisciplinary child protection teams throughout Cambodia. One aim of this effort will be to educate local health care providers to recognize child exploitation and to intervene when they can. It’s a step in the right direction.
© 2007 Ambulatory Pediatric Association. Published by Elsevier Inc. All rights reserved.