Some of the most visible changes came after tourism was reinstated in late 1986, she said. Europeans came first, followed by some Japanese and Australians, "but certainly not any Americans or Chinese (who support Pol Pot)," she said.
"It gave the city a new look. They put up some street lights, and lit them only when the tourists were there. They repaved some streets, refurbished some hotels--including putting in hot water, repainted some monuments--although maybe that wasn't because of tourism--issued some post cards, and painted white lines down the streets."
Because of the scarcity of motor vehicles, she said, the Khmers often observed ironically that the only function of the white lines was to indicate which side of the street the animals were on.
Westerners are isolated as much as possible and social contact with them is officially forbidden, she said, attributing the actions as more protective by the Khmers than anything else.
Any proscribed activities involving foreigners are supposed to take place only with the concurrence of the Ministry of Foreign Affairs, even for something as simple as attending a wedding. And some involve more bureaucracy than others, she said, offering the example of her request to study classical dancing at the School of Fine Arts, which had to go through three ministries--Culture and Information, Foreign Affairs, and Interior.
"I never really got a 'no,' " she said, guessing the bureaucrat was telling her the truth who suggested, "No foreigner has ever asked. So we do not know how to process the request."
She had extensive contact with the Khmers, nevertheless, and just about every other group in Phnom Penh. As one of the few pediatricians around, it was almost inevitable. In a country that had about 500 to 600 doctors before Pol Pot, there were about 50 at the most to survive his regime. The medical school is functioning again, but doctors are still scarce.
At the hospital, she worked a 12-hour day, she said. The Khmers worked longer hours. Because of the curfew, she had to leave at 6, while the Khmers stayed behind, she explained.
"The Khmers have a big heart," she said more than once, explaining the overcrowded conditions at the hospital. They do not like to turn patients away. With a patient usually comes the family, since nursing care is largely nonexistent. Nor, do the Khmers want to give up on a patient, she said.
A Resourceful Solution
She pointed to one of the photographs she had with her and said the little girl was an orphan, so lacking in identity when she was brought to the hospital that her original name tag read "Zero."
She needed to be in an incubator, but there were always technical problems with electricity, making it dangerous to leave her unattended. But the Khmers are resourceful people, Powell said, and determined that the little girl was so small she would fit in their pockets. So she spent her first days making the rounds of the hospital in the pockets of her countrymen.
"Zero, by the way, is now named Chan Mali, Monday's Jasmine," she said, pointing to the lovely child in the photo. "She went from being a little zero to a full-blown flower."
There is some evidence of a backlash against the Khmer Rouge that is harmful, she said, and that is an overvaluing of modern medicine and a devaluing of traditional cures and medications and practices, including a devaluing of breast-feeding that the hospital was combatting.
As coordinator of the pediatric training program and consultant on more difficult cases, she said she saw much malnutrition, childhood illnesses such as measles made serious and sometimes fatal as the result of tuberculosis or malnutrition. Infections of the lung and brain can develop, she said. The most prevalent epidemic, the mosquito-borne dengue hemorrhagic fever, also could be fatal, she said, causing children to bleed to death. Usually, however, they could help.
It is one of the children she could help least, an 8-year-old girl, who seems to have made the deepest impression on her. She does not talk of her without weeping.
The little girl had arthritis, a chronic and crippling disease in children, she said, and a painful one. The girl's mother brought her frequently and Powell got to know them well, going through "ups and downs" with them. At times she made a breakthrough, she would think, only to see a relapse come and the debilitation continue.
'A Humbling Experience'
"It was a humbling experience. All I could offer wasn't enough. I had to face my limitations."
When the time came to leave, she found the whole family in the courtyard. She does not know how they got past the security, but there they were.
They had a bouquet for her, and a hard-to-obtain signed photo of the daughter, and asked Powell to let them know of any developments she discovered in the treatment of arthritis.
And then without warning, the mother begged the tenderhearted doctor to take her little girl with her.