Monday, 25 February 2008

Davik's heart: The journey begins

Davik Teng, 9, and her mother, Sin Chhon, live in a one-bedroom hut in the village of Svay Chrom in the Battambang Province of Cambodia. Davik soon will undergo open-heart surgery in California.(Jeff Gritchen / Press-Telegram)
Davik receives a blessing from monks outside a hotel in Phnom Penh during her trip to collect her visa.(Jeff Gritchen/Staff Photographer)
Above, Tim Keo, left, greets Davik, Sin Chhon and Peter Chhun in front of her Long Beach home. Davik and Sin Chhon will stay with Keo while in the United States.(Jeff Gritchen/Staff Photographer)
Davik woke up groggy on the morning she was due to fly to the United States. Here, her mother, Sin Chhon, comforts her child hours before they both will travel by van to Cambodia's capital Phnom Penh.(Jeff Gritchen/Staff Photographer)
After visiting a mall and Western-style restaurant Sin Chhon, left, Davik, center, and close friend Chantha Bob, of Long Beach, eat french fries during a tuk-tuk ride in Phnom Penh. (Jeff Gritchen/Staff Photographer)


Long Beach group brings Cambodian girl to Southland for life-altering surgery

By Greg Mellen, Staff writer
02/23/2008

SVAY CHROM, Cambodia - The morning Davik Teng is to leave her village in Cambodia does not start well.

The 9-year-old is groggy and grouchy in the way of 9-year-olds worldwide who have had too much excitement in too short an amount of time.

"I told you not to play too hard," says her mother, Sin Chhon, in Khmer as she hauls the girl by the arm out of their tiny hut to wash her face. Sin dips a ladle into the outdoor cistern and splashes water into Davik's face. Later, Davik scowls as mom tries to coax a spoonful of medicine down her throat. At breakfast, the child cries because of a stomachache.

In the future, Davik may see this as a milepost day when her life changed forever. In a few hours, she will get into a van that will take her to Phnom Penh where she will catch a plane for the United States. It's the beginning of a journey that will lead to open-heart surgery to repair a hole in her heart that, if successful, will extend the length and quality of her life.

But that is all to come. And for the moment Davik is out of sorts.

A day earlier she had laughed and played with her friends, something to which she is unaccustomed. It is the kind of activity that just three months earlier would have been unthinkable. Since receiving vitamins, heart medications and money for better food, Davik has rallied.

Her father, Souen Tap, who left the family years ago but will see Davik before she leaves for the United States, will say she looks cured. But she is far from it.

Her face and body are now a chestnut brown - a far cry from the pallor she exhibited in October. But she is still reed thin and small for her age.

The exertion of the day before has not been without cost. And today, Davik is tired and irritable. For most of her young life, Davik has been a child denied of play. She would linger in the shadows, watching. She could only engage for short spurts, until her lungs and heart would burn and she would have to stop. It was as if she lived life on a dimmer switch.

Those who have devoted themselves to her want to see that change. They want her to have that rite of childhood - to play with abandon. It is for her they have come together.

This is Davik's journey, but it is also the journey of two men, Peter Chhun and Chantha Bob.

They are the ones chiefly responsible for making sure this little girl in western Cambodia, 180 miles away from Phnom Penh, won't wheeze her life away in a one-room, 6-by-9-foot bamboo hut to become just another sad statistic from a struggling land.

Three people, three journeys, one heartbeat.

A failing heart

Here is what the arc of Davik's life would have looked like if not for encounter with a waiter from Long Beach and his friend, who runs a Long Beach nonprofit that seeks out the Daviks of this world.

Davik's days would have been a slow downward slide possibly ending in an early death and certainly diminishing in quality. Her overworked and inefficient heart would continue pumping blood through the hole and stressing out her lungs. Her breath would come in ragged jags.

Eventually, a heart that had worked too hard for too long would give out. That was Davik's future.

It's called a ventricular septal defect, or VSD. The condition develops in the womb and its causes are unknown. It is not an uncommon ailment in Cambodian children. In about one-fourth of the
cases it heals itself. In Cambodia, where one in seven children die before the age of 5, it is estimated that many children have the defect and it goes undetected.

In Davik's case, it was apparent at an early age that something was wrong. Sin says Davik's problems were apparent almost from birth.

"When she was born she was a chubby kid," Sin says through translation. "Then she lost a tremendous amount of weight and was skin and bone. I was very worried but had no idea what to do."

As a single mother who makes less than $2 a day when she can find work in construction, Sin couldn't afford pediatric care. She didn't know what was wrong, and was powerless to do anything about it if she did.

Sin made the long trek to Phnom Penh with the infant Davik, paying several days' wages to ride the bus. Sin says the doctors diagnosed lung disease and said nothing could be done.

Davik just had to survive and let nature take its course.

The defect in Davik's heart is 1 centimeter in diameter, according to Dr. Mark Sklansky, a cardiologist at Children's Hospital in Los Angeles, which has volunteered its facilities and a world class cardiac team for Davik's surgery.

"A centimeter? That's significant," said Dr. Bill Housworth, the new director of the Angkor Hospital for Children in Siem Reap, which has helped Davik. "It's big and it would cause her big-time problems."

Typical symptoms include fast breathing and accelerated heartbeat, low weight gain and pale skin with cyanosis, or a blue discoloration. Davik had all these symptoms.

"She easily got tired," Sin's sister Souen Chhon said of her niece. "She moaned and cried at night. Most of the time she was sick in bed and not playful. Everybody worried about her."

Sklansky says the surgery should be relatively straightforward.

The route Davik, Peter and Bobby have taken has been anything but that.

Village life

To get to Davik and Sin's home, one turns left on a narrow unmarked dirt road and leaves the century. Only a few miles from the province capital of Battambang, Svay Chrom might as well be on another planet.

Davik, her mother, older sister Davin and a great aunt share a one-bedroom hut on the family compound. It is the smallest home in the complex and the only one without any photos or decoration on the walls. With no electricity, running water or toilet facilities, the compound consists of four homes where Davik lives with her family, 20 cousins, uncles, aunts, a grandfather and great-aunt. They also share the space with five dogs and an assortment of chickens who boldly walk in and out of the homes as if they were family.

Even in comparison to their meager neighbors' holdings, the poverty is stark. No family member has even a motor scooter or any other motorized transportation. They have no electronics, although they do have a battery that powers a fluorescent light. Sin rides a bike with a broken fender.

Ched Souen, the family patriarch, says this has been a hard year in the compound. He lost his wife, two sons-in-law and two grandchildren: an infant and a 4-year-old. He barely understands the diseases and ailments that led to the deaths. They are just part of the ebb and flow of life here.

In the early morning of Davik's last day in the compound a cock crows as sunlight begins to wash out the stars and the chirp of crickets is replaced by the squawks of birds. Somewhere nearby floats an eerie, rhythmic chant of monks praying at a funeral.

After breakfast, Davik feels better and her mood improves. For lunch, her aunt makes Davik's favorite meal, sam lor mchou, a sour soup made with tamarind leaves, watercress and pork ribs.
"This is our last meal together," Sin says as lunch is being finished and suddenly the tears start to flow.

Lina Prom, Davik's cousin and the girl closest to her in age, begins weeping. Then so is older sister Davin and Sin and another cousin, Liyik.

Sin begins to say her goodbyes and now the whole compound is weeping, as if the funeral had moved here.

Even the normally stoic Ched seems weakened by the ordeal. As he sits down, a crying Sin drops to her knees, touches his knee several times with her forehead while holding his hand.

Cousins and aunts choke out farewells.

"Kyum sabay chet nas," or "I'm so happy" is a typical refrain blurted between sobs.

"She never expected to go to America, she never expected to have her daughter's heart repaired," Peter translates as Sin's message to the family.

"And then the rest of the people, most of them said, 'Just come back with a new heart. Just come back with a new heart,"' Peter translates. He, too, is crying. Even the van driver wipes his eyes with a towel.

As they prepare to leave, Choeun Chhon, an aunt, touches fingers with Davik through the window. Then the van pulls away and family members fade in the dust.

Bobby's journey

Chantha Bob, or Bobby as he's called, has been looking for love. At 41 years old, he has never been married though he says he's still hoping.

Whatever successes or failures he's had in adult relationships in the U.S., in Cambodia Bobby found what he sought in the unconditional love of a child.

Bobby is the linchpin in this story. If he doesn't come across Davik, the story ends differently. Ends the way it does for so many ailing Cambodians, hapless and forlorn.

A waiter at Sophy's Restaurant in Long Beach, Bobby looks younger than his age. His face is open and innocent, his eyes almost child-like. Yet they belie a hard life. A survivor of the Cambodian genocide, Bobby was robbed of much of his childhood. When he was 8, the Khmer Rouge came, tied his father's hands behind his back and marched him out the door. Bobby never saw his dad again.

Bobby spent almost three years in refugee camps in Thailand and the Philippines before emigrating to Oregon.

Growing up without a dad has left a void in Bobby.

"Whenever I see parents and children, I get emotional," Bobby says. "I think about what I missed. This is what I want to give them when the time comes, give them what I missed."

Bobby makes frequent trips to his home country. When he does, he goes out to villages to deliver food and supplies to the needy. In 2005, Bobby made such a trip to Davik's village. His older brother Sambo Bob actually discovered Sin and her family while scouting for those in need of help for the Cambodian American Community of Oregon, an aid group for whom Bobby's younger brother Chanley Bob is a volunteer.

While delivering the food, Bobby didn't even notice the little waif in the corner, who barely came out. Later he would hear about her and the miracle of coincidences would converge to give Davik her second chance.

However slowly their relationship began, it has now bloomed. To watch Davik interact with Bobby is to see two people so utterly comfortable with each other, you would swear they were family. Bobby is Davik's hero.

When the pair is reunited in Phnom Penh, Davik jumps into Bobby's arms and rarely lets go. For the next three days, she is like a vine draped over him. And Bobby, it seems, couldn't be happier or more content.

Theirs is a symbiotic relationship.

Whether Davik realizes Bobby's role in her life, or he's a surrogate for her absent father, or just like the cool and generous uncle, the connection is unmistakable.

And for Bobby, who longs for marriage, kids and a family of his own, Davik fills the hole in his heart.

Peter's journey

The ghosts are everywhere in Peter Chhun's homeland. As a cameraman for NBC News as the conflicts in Vietnam, Laos and Cambodia raged, Peter filmed his share of carnage. He saw man's brutality and war's devastation.

Before leaving for a brief holiday in Thailand in early April 1975, Peter kissed his mother on the cheek and said he'd see her in two weeks.

He never did.

Phnom Penh fell on April 17, 1975. Peter's mother became one of the estimated 1.7 million Cambodians who died from executions, starvation and deprivation during the Khmer Rouge's brutal four-year reign.

It would take 15 years for Peter to learn his mother died in 1979.

In 1983 and 1984, Peter spent months scouring refugee camps in Thailand searching for her. Peering through the throngs, praying for a spark of recognition.

That search would become the subject of a documentary Chhun made that resulted in four Long Beach families becoming reunited.

"I looked at 1,000 faces and captured 1,000 faces in my camera," Peter says, but none of his mother.

To this day, the loss haunts him. As an only child, Peter believes it was his responsibility to care for his parent and he says he failed.

In the late 1980s and early 1990s Peter returned to Cambodia a number of times looking for ghosts. After the failed attempt to find his mother, Peter succeeded in locating the burial sites of several network newsmen captured and killed by the Khmer Rouge.

When the United States withdrew from Southeast Asia and turned away, it seemed to Peter many Americans forgot his homeland, so he brought Cambodian stories to the U.S.

"At least people started thinking 'Hey, this is Cambodia. It's alive again,"' Peter says.

In 2002, Peter produced a "Today Show" segment of "Where In the World Is Matt Lauer?" from Angkor Wat.

In 2006 with retirement just a few years away, Peter wanted to do more. Rather than chase the ghosts in his homeland, he wanted to help the living.

At the suggestion of his friend Lakhena Chuon in Long Beach, Peter founded the nonprofit Hearts Without Boundaries, with the vague goal of aiding Cambodians.

In October 2007, when he accompanied doctors from the University of California San Diego working with Variety Children's Lifeline who were performing minor surgeries at the Angkor Hospital for Children in Siem Reap, Peter found Davik and his purpose.

Seeing the children who were helped by the outpatient surgeries and being devastated when he learned Davik would be turned away, Peter saw what the rest of his life would look like.

"I had never thought of children before," Peter says of his aid missions. "Now I start my new life. My new mission."

The survivor's guilt still dogs Peter, but by helping children like Davik, it repairs the hole in his heart.

Saving Davik

For most of her life, it seemed there was no hope for Davik. Every time there seemed to be a spark, a reason to believe, it was quashed - whether by ignorance, a culture of fatalism, or the lack of the right tools.

Three years after Davik was misdiagnosed with lung disease, Sin took her daughter back to Phnom Penh where she was diagnosed with the heart problem. Two years later, Sin visited Jayavarman VII Children's Hospital in Siem Reap for surgery but learned the hospital lacked the heart-lung machine needed for the surgery. Sin was told she would have to take her daughter to Phnom Penh for the operation. Sin was overwhelmed and confused.

Sin and Davik returned to the village, defeated.

Fast forward to 2007. Bobby, who first met Peter at Sophy's, learns Peter is going on a mission with doctors to fix hearts in Cambodia. He remembers hearing about the little girl in the remote village and wonders whether the doctors can fix her. Peter says "Why not?" Neither realize that Davik has already been seen and diagnosed at another hospital.

They send a message and money to Davik's family. They believe Davik will finally be made whole.

"When I got the message from America I was so happy," Sin says. "I had high hopes my girl would be fixed and made normal."

Davik and her mom arrive at Angkor Hospital for Children. They join the throng of children and families who regularly gather outside waiting to be seen. Finally, they see a doctor. The news is not good. Tests reveal what earlier doctors had noticed. Davik needs open-heart surgery that is beyond the hospital's capabilities.

"When they told me they would not repair her, I lost all my hopes," Sin says. "I know (death) will come and it's just a matter of time."

But Peter and Bobby won't concede. If life in the West has taught them one thing, it is the can-do attitude of Americans. If Angkor Hospital for Children can't help, they'll find a place that can.

Eventually they get Davik an appointment at Calmette, a French hospital in Phnom Penh. While Peter is in Phnom Penh, Bobby spends time with the family in Svay Chrom and becomes more emotionally attached to the beautiful girl with the sad eyes.

When Bobby gets news Davik can be seen, he hastily arranges transportation and he, Davik and Sin dash to Phnom Penh. This time they are sure she will be saved.

And once again they are devastated. Davik is too sick for surgery. Her blood count is frighteningly low. The doctors tell her she will have to return another day. There are tears when Davik and her mom have to go home yet again.

Back in the U.S.

Peter can't take it. He won't accept that Davik is beyond hope. He starts fundraising to get her proper nutrition, vitamins and heart medicine. Davik's condition improves. But it's only a stop gap. The heart is still leaking, the hole remains.

One day Peter is at work at NBC printing flyers for Davik when a co-worker says, "Hey, why don't you talk to Lauren?"

She means Lauren Ina, one of Peter's compatriots on the Lifeline trip. More important, Lauren is the wife of Sklansky, a cardiologist at Children's Hospital of Los Angeles.

Once again hope percolates. Mark is cautious. There are variables. Defects like Davik's can cause irreversible lung damage. Also her blood counts have to be elevated.

Tests are done and finally, good news, she seems a candidate for surgery. Furthermore, Children's Hospital of Los Angeles agrees to provide its facilities and surgeons for the operation.
Peter is over the moon. Maybe they will be able to save this little girl after all.

Back to Cambodia

It all happens quickly. Peter doesn't want to waste one day, one heartbeat waiting. Within days after CHLA agrees to do the surgery and sets a date to see Davik, Peter and Bobby are on a plane to Cambodia. They arranged to meet Davik and her mom in Phnom Penh.

When the pair pulls up in a tuk-tuk, Davik jumps out. She hardly seems like the girl of just a few months ago. Everyone is elated.

But this is Cambodia, a country of land mines, both real and metaphoric, and there is always an underlying sense that at any moment it can all turn to sludge.

There are still hints of Davik's frailty, though they are more subtle. She is still dangerously thin. When she sleeps, her breathing is fast and shallow, though she doesn't moan and cry anymore.

On Monday morning, the mother and child go with Peter to the U.S. Embassy to get travel visas.
Davik and Sin enter the doors at about 9 a.m. Peter must wait outside because he is not family.

After about an hour-and-a-half Sin emerges alone. Peter runs up to her. She needs money for the visa.

"If they want money, that must be good," Peter says as he crosses back to a grassy area where families of those trying to get visas wait.

Occasionally, a Cambodian skips out waving an approval letter. More often they silently return to the family, rejected.

It's after 11 a.m. when Sin and Davik emerge. There is no joy. Officials want to know why Davik doesn't go to Thailand, where surgery is cheap and more advanced. They question why the mother must travel abroad. Because Sin's name is misspelled on her visa as Chhun instead of Chhon, the official assumes Peter is the father.

This is how it often happens in Cambodia. Officials are suspicious and mistrusting. Applicants can't explain themselves. Things get lost in translation. Misunderstanding and miscommunication abound. Because governments are seen as corrupt and the Cambodian culture is subservient, people rarely question fate.

On Tuesday, Peter talks his way in to answer questions and clarify misconceptions. Several gruelling hours later, it is Peter, Sin and Davik who skip out in celebration. Suddenly, going to America is no longer an abstraction.

Back to the village

Bobby and Peter take Sin and Davik to their village so the family can say its goodbye. As an added treat, Peter arranges for a ceremony to be performed by folk dancers and monks to bless the journey.

It is one thing to be told that people live in poverty, it's another to witness it firsthand in all its deprivation. When Peter sees the mean little bamboo hut that is Davik's home, he is reduced to tears.

It also reinforces what he's doing.

"All I know is I'm so happy to help her out," Peter says. "You walk around in this country and you see so many people who need help. I think I do the right thing by picking her and helping her out."

There is a second reason Peter is crying. It's the ghosts again.

Peter says when he was in Phnom Penh, the trip felt like many others. But seeing the circumstances of Davik's life reminds him of his village and his life as the child of illiterate parents.

"I'm thinking of my own life and I think I am so lucky," Peter says. "Her life and my life here were no different. America gave me a new life and they don't have the same chance."

The day before Davik leaves is a day of celebration. The dancers perform a New Year style dance about a deer and a hunter. Throughout much of the story the wily deer, who represent's the past year, eludes the hunter until at last he is killed. Water is then sprinkled reviving the deer who leaps up and prances away. In this particular ceremony, it is Davik and Sin who sprinkle the water.

It is a story not so much about eluding the past perhaps, but about the regenerative power of hope and love.

In their three journeys to one purpose, Davik, Bobby and Peter have sprinkled each other with holy water. They are mending each other's hearts.

On a Friday morning there are tears once again. Davik is about to board the plane that will take her to the U.S. and another shot at hope. Once again the tears stream as Davin and her little sister hug. Davik's father tries to remain stoic, but he blinks rapidly as his daughter hangs on tight.

There may still be obstacles. Sklansky worries about various "contra-indicators" to surgery, such as possible abscesses due to the lack of dental hygiene in Cambodia.

It is clear Davik's last best shot at life-changing surgery will be here in the U.S.

If all goes well, Davik should be home in Svay Chrom for Cambodian New Year in April.

Peter likes to say he'll bring her home for New Year with a new heart.

A literally inclined person might say it isn't a new heart, it's a repaired heart. Maybe it's both.

Greg Mellen can be reached at greg.mellen@presstelegram.com or 562-499-1291.

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