Leaving Cambodia

As I jammed one year’s worth of stuff in the back of a crowded minivan at 3am, I reminisced that this is probably the last life threatening taxi run I would be doing for a while. I felt a little embarrassed packing my hammock, but considering the fact that I shared the minivan with a motorbike and a chicken, I thought it wasn’t too strange.

These last few days have felt like I fate is showing me all the things I will miss about Cambodia. We had a reunion with our original September group, with people travelling down from all sides of the country. A dinner at a posh, but remarkably reasonably priced Vietnamese restaurant. We were joined by our awesome language teacher Sopheak.

Guy Love

The following night was a night of craziness, involving multiple drinks in multiple locations. We moved from Jazz bars, to DJ Club and eventually ended up in the Heart of Darkness (an appropriate name for the kind of things that go on in there).

It was sad to say goodbye to everyone on the Sunday morning. One by one, my good friends hoped on motos, minivans and buses to return to their provinces. I would have been more depressed, had I not made a lovely new friend with an equally strange sense of humour to my own.

Time to Party!

Although I will be leaving tomorrow, I can safely say that today is not my last day in Cambodia. I have had many good memories here (and some crazy ones as well); and I will endeavour to find my way back here in the future. I am glad my mum doesn’t read this blog, else I have a feeling she may have a few words with me about this!

Last chance to travel

A couple of weeks ago, I took the opportunity to explore some of the more local tourist sites around my area. By local, I mean only a 3 ½ hour moto ride away through muddy roads and potholes. My sore bottom and muddy feet arrived in Ban Lung, Rattnakiri late on the Friday afternoon. I was lulled into a false sense of security by some of my Ban Lung buddies that had regaled me with tales of the wonderful new road to Rattnakiri.

The Open Road

I did have a moment of panic as I trundled along this unknown barren dirt road without a soul in sight. After 2 hours, I even had to phone Helen to make sure I hadn’t accidently wandered into Vietnam by mistake! It didn’t help that I had a flat tyre from all the potholes I managed to hit on the way. After another hour of swerving around with a flat back tyre, Black Magic and I made it to a repair shop.

Mr Fix It

Cambodian repair shops are easily recognised by the large air cylinders and 12 year old mechanic with grease up to his elbows.

Ban Lung is an odd town, or city as I have been correct by some of the volunteers based there. It is much more spread out and appears to be a bit more developed than its provincial capital counterparts. I had a chance to swim in the volcanic lake and visit some waterfalls.

Waterfall in Ban Lung

As part of my research, I also sampled some of their finest fried chicken. It’s not quite as good as STFC (Stung Treng Fried Chicken) and certainly the colonel had not added his secret recipe, but it was good nonetheless.

The following weekend, I was graced with a visit from “Awesome” Gilly and Jess, her friend from England. Regrettably, her husband “Super” Sam could not make the journey this weekend. We explored areas of Stung Treng that I had yet to visit.

Mekong Blue is an NGO that recruits women from rural and impoverished parts of the province to learn the trade of silk weaving. The rather nasty looking silk worms feed on mulberry leaves, before cocooning themselves in tough silk.

These are rolled out into long strands and then boiled to soften them. The silk is then dyed and processed. These are then weaved using complicated wooden machinery that look like medieval torture devices. The end product is an eco-friendly, locally supportive product that is as expensive as it is high quality. However, seeing the amount of work that goes into a single item, I was willing to dip into my savings.

We visted the infamous “Bird Sanctuary” of Stung Treng. I am not sure whether it was the lack of any birds, or the fact that chicken is served on the menu, but I did wonder how this place got its name. You could however, hire kayaks and paddle your way along the Mekong. While Gilly and Jess opted to waste their energy fighting the fast flowing Mekong currents, Paul and I sat and drank some hot coffee at the bar.

The following day we toured some of the waterfalls that traverse the Mekong near the Laos border. Our rickety boats struggled to fight the rapid currents and I am pretty sure we spent more time going backwards. It was only until we arrived safely back on land, I was told that the boat capsized last year and they don’t often make this journey this late in the wet season. Furthermore, our boat driver was a novice and had needed a practice run the day before. Ignorance is bliss!

Goodbye Stung Treng

I have spent the last few weeks, gradually saying goodbye to my friends in Stung Treng. I am not quite sure Dr Mesa had acknowledged this fact as he was eager for me to join the first blood donation drive (to be held the day after my flight back to England).

There have been a few moments recently where I have felt reassured that things in hospital have moved on a little bit since my arrival. I was observing the ward round and Dr Mesa was telling a patient that he wanted them to stay one more day for observation. The parent had run out of food and so were insisting on going home.

The nurse then proceeded to advise the parents on what signs to look out for and explained why it is important to return to hospital. She then looked at me to check she had explained correctly; all I needed to say was “baan” (good!).

Later in the day, I attended a meeting about the blood bank. In fact, I didn’t need to do or say anything! Dr Mesa had invited a representative of the police force and had started to work out the logistics for a donation run. I had a good feeling that these activities will continue in my absence.

On my last day, I took some time to say good bye to the market ladies of Stung Treng:

1. Curry girl

Finest Curry in town

 2. Vegetable lady

A free lime and chilli with every purchase 🙂

3. Green Pepper and Potato Girls

Service with a smile

  4. Egg Lady

No foetus in these eggs

Happy Family

You may think that the calendar picture below indicates that I am counting down the days until I leave. Well, ok I am. But not because I am looking forward to returning to grey skies and drizzle; but to remind myself to make the most of my limited time!

I thought I would share a story about a family I met a month ago. Unfortunately I did not take any pictures, so the photos in this post are from around the hospital.

The hospital priority list displayed on a billboard at the entrance

A father brought his son and two daughters into hospital. The son was 18 months old and  particular unwell. Despite a week of treatment, he was not getting better. His wife had come down with a similar illness and was also admitted to hospital. The dad was ill himself, but would still work as a labourer in the morning and tend to his children in the afternoon.

Just in case you were not sure about the hierachy

I remember the family pretty well because I was as stressed as the father, racking my brains to think about what could be the underlying cause. While Dr Mesa does have a limp and I have a flip chart, somehow we were missing the genious diagnoses of Dr House. I would have searched the patients house for clues, but they lived in a fairly remote village.

I had tested for malaria several times, all negative.The limited number of blood tests I could do were all normal and yet, every day the young boy had a high fever and would lay lifeless on the hard wooden bed frame. A high fever, enlarged liver and general oedema. The causes are numerous, but the number of treatments the hospital can give are limited.

Formerly used to fire a laser at James Bond's private parts, this machine now resides in radiology

Antibiotic resistance is a problem because everyone takes them like candy. The hospital has a limited choice of antibiotics, so if I wanted a particular one I would have to purchase it from the market myself. Strange that the local market is better stocked than a hospital. The child got a bit better with the new medication, his swelling came down and he started eating and drinking. However, he still had a fever every day.

It had been almost 3 weeks in the hospital now and I knew I had reached the limit of what I could do in the hospital. After 2 seasons of House and 4 seasons of Scrubs, I was none the wiser. I didn’t want them to go home knowing that he was still unwell. I suggested to transfer him to Phnom Penh, but the father said that he could not go. Coming to Stung Treng town was difficult enough, he could not imagine going all the way to the capital. In addition to this, there was no way he could afford the transportation costs. He told me that he is a labourer. He does not have any assets he can sell, only his body to work. Even now, he has to go to work because the income is not regular.

Believe it. Blood in the Blood Bank.

There is an organisation called YWAM that funds patients to travel to Phnom Penh. However, he will have to see them personally in order to receive the grant. He said he dared not to go. Speaking to barang about his situation will be too difficult. Then apart from transport, how can he afford to stay and eat in Phnom Penh? How can he afford the return journey?

I felt a bit frustrated. Not with him, but with the whole situation. At the end of the day, I could only do so much. I told him that I have done everything I can with what I have in this hospital, even buying medications with my own money. He must take responsibility and be courageous enough to visit this organisation of strangers; to head to a big city for the sake of his children. He went to the NGO the following day and I added an extra $40 from my allowance for their food and return journey.

The following week, my VA bumped into a relative of the family. All the children had been diagnosed with malaria in Phnom Penh. They had received treatment and were now all better. The father wanted to come and say thank you but had not been able to.

My chief nurse

The moral of the story? Perhaps it is that you don’t need to be a foreigner to experience culture shock. The father showed a lot of courage speaking to foreigners in an NGO and travelling to an unfamiliar city.  Or maybe the moral is that sometimes the answer to a complicated medical puzzle is actually the obvious. Or really, is it that if you have money then your problems can be solved? Either way, I was happy with the outcome in the end. No capacity was built, but one family was saved.

Team Effort

Tick. Capacity Built.

As I am nearing the end of my placement, I have been reflecting a lot on how things have been progressing….

I wrote a particularly participatory presentation (try saying that really fast) on dengue fever recently and it seemed to go down fairly well. I could not believe how much more work is involved in a non-powerpoint presentation. Actually having to make a lesson plan gave me a little insight into what teachers manage to do every day. It was worth it see student midwifes, nurses and doctors all discussing problems together. This doesn’t happen very often!

On the other hand, I have also become more and more frustrated with the amount of direct service I have been doing. It is not like I do not want to see patients, on the contrary, it is what I enjoy most about my work. But the level of dependency has been growing and my time here is only getting shorter.

One positive development was the chief nurses being given permission to prescribe medications for patients when the doctor is out of town. This allows the chief nurse to dispense medications rather than wait for the covering doctor to turn up late (if at all). It also allowed me to observe and teach during the nurse led ward round.

I was pleasantly surprised to see some of my habits had been passed on by osmosis. I noticed that the nurses have started to carry around the alcohol gel to use between patients, they would explain what medications are used for and even provided very good discharge advice. Unfortunately, it will be a while before they are able to distil the information they gather from patients and have the confidence to start or stop treatments independently.

Unfortunately, they can only prescribe when the doctor is out of town. But when he arrives 2 hours late, the nurses remain at a loss; patients cannot be discharged, prescriptions cannot be dispensed. When I asked the chief nurse why she just doesn’t phone the doctor, she stayed silent for a while. I asked whether she was afraid of being told off, and she exclaimed– “how do you know what is in my heart!” The paediatric ward appears to be a close knit community and certainly Dr Mesa is not the scariest person I’ve seen. Nevertheless, I guess the fear of being told off and losing face lies pretty close to the surface.

After a small meeting with Dr Mesa and the nurses, I suggested to him that the nurses be allowed to ring him in order to see patients if he is late arriving (incidentally, I didn’t get told off). He accepted that they can see the routine patients and organise the discharges, but unwell patients would need to wait to be seen by him. I understand that he wants to see the sick patients himself, though delaying them to the end is probably not the best solution either! But at least giving the nurses some freedom was a step in the right direction.

One of 8 Private clinics in Stung Treng

As if to lift my spirits during this somewhat de-motivating week, I walked into a patient bay to find 3 familiar faces. They were the parents of patients I had previously treated. They told me how their children were close to death, but they survived because of me. I was glad to hear that those children were doing very well now and even gaining weight! Direct service is not really part of VSOs ethos, but I nevertheless it is always nice to hear a thank you.

Where the streets have no name

Capacity building is a buzz word that gets thrown around a lot in our work and sometimes it feels like you are expected to do specific tasks and say, ok now your capacity is built. Everything is about measurable outcomes and tangible results.

In reality, I found myself splitting into two tasks. There are the large impossible tasks of changing ideas, attitudes and behaviour which often leave me feeling somewhat like a failure. But I hope that I have at least laid the foundation for change in deep recesses of peoples mind (at least I tell myself that). In the meantime, I have been completing tangible small activities like training sessions to keep my mind sane.

Ultimately though, I really believe that the wider issues that seemingly have not budged one inch since I started banging my head against the hospital’s newly built brick wall, in actual fact, has shifted just slightly. Like a girl who manages to open the jar after you have loosened it, the ground work has been laid and it will be down to the continued efforts of other volunteers to continue this process.

I am reassured that those people who have lived a long time in Cambodia can say honestly that times are changing. I like to think VSO has played a part in that change.

30 Years Old

In the preceding weeks, I have been mulling over how best to express the inevitable mid-life crisis. I have already been through a full-length leather trench-coat phase which, in conjunction with my moustache phase, got me arrested in Leicester square tube station. Furthermore, my Wesley Snipes phase has been going on so long that I would need to have a Sri Lankan phase to count as a crisis.

Human Canonball

When I looked up midlife crisis on wikipaedia, it comes up with – a period of dramatic self-doubt as a result of sensing the passing of one’s own youth and the imminence of old age. By this definition, I have been going through a mid-life crisis since I was 7 years old.

I reminisced about the day I started shaving my head – it was the day my friends stopped mocking my bald patch. Paul said I should let my hair grow while I still have it. Clearly, he had not realised that I simply don’t “have it”. Besides, there is nothing worse than getting sunburnt on your bald patch.

Biker Lingam

In the end, I opted for a road trip to Mondulkiri with Gilly. We cruised along lush forest highways, dodging cattle and over-excited puppies. Gilly had a near-miss with one particular pooch; I tried to get him as I followed past, but just missed as well.

A short lunch stop in Snoul broke up the 5 hour ride from Kratie. The main road was situated above a large embankment and Gilly suggested we go around to enter the road, rather than foolishly try to mount this cliff-like structure. I agreed and then revved my engine as I turned. Not realising I was in first gear, I was catapulted forward into the embankment and in my panic, accelerated further. As I went flying upwards, Gilly was unable to assist me due to the fact that she was literally crippled with laughter. A true friend 🙂

Waterfalls

Mondulkiri is a beautiful province with waterfalls and amazingly diverse terrains. Some of the countryside even resembled rural England. Paul was a great host and deep-friend everything for us to eat. We finished off lunch with a $2.5 bottle of whiskey between 5 of us, and finished dinner with a further 4 bottles.

Paul and I had a heart to heart ……

Paul: "I am just gonna kick like this, and if you are in the way its your own fault"

……..and then a cuddle on the bed after.

Ingran: "Ever played roulette? Always Bet on Black!"

It was great to spend my birthday with close friends and waking up in Cambodia eliminates any feelings of being stuck in a rut (unless by rut you mean karaoke bar). I think it’s safe to say that my 30th has passed without any breakdowns or tears. The only time I cringed was when Paul said that my next big celebration will be my 40th. Thanks Paul 🙂

End of the Night

How to organise an Awesome Party

1. Spread the word out early

2. Buy lots of beer

3. Start the night early

4. Make sure everyone is drinking before the dance music starts

5. Make sure Dave hasn’t wet himself (again)

6. Invite celebrities e.g. Charlie’s Angels

7. Supply a little Crystal Meth

8. Hire a troll to be a bouncer

9. Ensure people adhere to road safety standards on the way home

10. Watch out for rapists at the after party

Holidaying in Asia

In mid April I was very happy to be visited by my cousins, Paran and Tasha. I have known them since I was still in nappies and they know me better than I know myself. So, it wasn’t too much of a surprise to them as I proceeded to fall in love with almost every Khmai girl who brought me food, poured a glass of water or stamped my bus ticket. We had a great 3 weeks, including Sihanoukville, Kampot, Kep, Rabbit Island, Koh Kong as well as Ho Chi Minh and Fu Quoc island.

Sihanoukville

It was an impressive itinerary and I think we did well to cover so much without feeling too rushed. Sihanoukville was obviously quite touristy but having lived in Stung Treng, a bit of tourism isn’t all bad.

Paran and Tasha

We visited Rainbow Lodge, a lovely eco-lodge located a little outside Koh Kong. The owner was a very helpful, though slightly neurotic ex-barrister. She put a lot of effort into ensuring that we were well looked after and helped to plan our activities.

The Lodge

The lodges were surprisingly high quality and they also provided a electric mosquito killing tennis racket (see Sam’s blog for a demo). I was slightly traumatised by the jungle trek which started out as an energetic ramble, but ended with torrential rainfall and an army of leeches. The leeches were cleverly camouflaged against by Blackanese skin tone,  allowing them to stealthily make their way up my legs. I managed to flick off about 30 or 40, but a further 10 managed to cross the threshold of my shorts. Once engorging on my already skinny Asian legs, they are a bitch to remove.

Cheesy Grins

So, when we finally reached the majestic waterfalls, Paran took one for the team and inspected my “hard to reach” areas for any renegade leeches still feeding. It was a while before he could look me in the eye again. The day was exhausting, but thoroughly exhilarating.

Dave No-Mates

From Kampot, we visited Bokor National Park. When I hear national park, I kind of imagined a safari or some kind of leisurely stroll. Unfortunately, it was another jungle trek! At least now, I was a seasoned leech fighter.

Crouching Tiger

We visited the ruins of a once thriving hotel / casino. The bullet holes in the wall and broken infrastructure spoke of the violence that took place here not so long ago. This place witnessed of some of the fiercest battles between the Khmer Rouge and Vietnamese forces.

Welcome to my Hotel

Cool Fungi

Following a night in the bamboo huts of Rabbit Island and a night of luxury in the veranda hotel in Kep, it was time for Tasha to head home. Paran and I went on to Ho Chi Minh City to continue to empty our thinning wallets.

Ho Chi Minh is a great city, filled with excitement, great food and a legion of motorcycles. I thought Phnom Penh was crazy, but HCMC was in a league of its own. We visited the War Remembrance Museum – formerly known as the Museum of American War Crimes. Apparently, some tourists were a little put off by the original name.

Not compensating for anything?

Having said this, the museum itself was pretty much a detailing of the atrocities committed during the Vietnam War. Most of my knowledge of the Vietnam War is based on watching half of Apocalypse Now and the double episode of Quantum Leap set during the war.

I had never really appreciated the scale and cost of the war, nor did I fully appreciate its knock on effect on neighbouring Laos and Cambodia. I did wonder whether the bitter after taste of such a prolonged military effort contributed to the lack of international intervention when the Khmer Rouge freely committed acts of genocide.

Having done a lot of travelling, Paran and I chose to fly straight to the island of Fu Quoc. It is an island that you would expect to be part of Cambodia given its geographical proximity (a view shared by Cambodia). It is a well developed island with lots of small resorts. We were initially misled by the guidebook to a small off-the-beaten-track budget guest house that was far from civilisation. So we trekked through rocks, sand, grass and sea to find a place to eat.

Paradise

My Cambodian lifestyle means that lunch is at 11am and dinner at 5pm. Paran clearly had no intention on converting to the Cambodian meal-time zone, and opted to force me to starve until an acceptable dinner time (9pm!). I was going to throw a hissy fit, but having seen Paran deal with a jelly fish by punching it in the face, I chose to keep my silence.

Without sounding too gay about it, I was really happy to have my closest friends make the journey. It is not cheap to travel here, nor is it cheap to travel with a VSO volunteer (we are spongers by nature). Cambodia is not en route between St Albans and Hendon, so sadly my brother could not make it.

So it was with great sadness, that I said goodbye at the end of the 3^rd week. All the karaoke bars in the world could not fill the void that was left. So, I headed to Siem Reap to tick the Ankor Wat box.

Bayon

Not being particularly intrepid by nature, I found the first day a little isolating. However, the following day I was taken aback by the scale of the temples constructed. I did the short circuit – Ankor Wat, Ankor Thom (including Bayon) and Ta Prom (aka the Tomb Raider one).

Awesome Trees in Ta Prom

Given its prominence is Cambodian life – from the flag to the famous beer brand, Ankor Wat is definitely worth a visit. Siem Reap itself  is not really representative of what most of Cambodia is like. If want to see real Cambodia, come to Stung Treng. But make sure you visit early, because by 6pm I shall already be tucked firmly in bed.

Better to have Loved and Lost

I didn’t know that I could develop such strong feelings in such a short time. I had no idea that falling in love could happen so fast and so suddenly. How naive could I be?

I had resigned myself to the prospect of a 5 day weekend in Stung Treng, where life moves at a snail’s pace. Perhaps by chance or fate, I was introduced to her through Linda’s VA (Volunteeer Assistant / Translator). When we met, it was love at first sight. They say black is beautiful, and she was no exception.

On our first day together, we strolled around Stung Treng. I guess it took us a little time to get to know each other. But by the end of the day, we were practically inseparable. Early on the second day, we decided to head to the neighbouring province of Kratie. She knew the lie of the land well, and we rode comfortably together alongside lush forests with the mountains of Ratnakiri in the backdrop.

Rapids in Kampi

In Kratie, we both stayed at Gilly and Sam’s house. They were gracious hosts as always. We took a trip to see the rapids at Kampi. As the day was coming to the end, it was weighing heavily on my mind that soon this love affair would have to come to an end. As it happens, she belonged to someone else.

Coffee Stop

Back in Stung Treng, we spend our last few hours saying goodbye. Although her command of English wasn’t so great, I could tell by her humming that she was happy that she had met me.

It wrenched my heart as she was wheeled away by her owner. I hope that one day we shall meet again. It is better to have loved and lost, then to have never loved at all. My first Moto 

My first love

Sleeping on my moto

 

Ankor Children’s Hospital

Previously, I had organised with Oly Shipp (Management Advisor in Thmar Puok) to do some paediatric teaching in the North West regions. Apart from sharing knowledge to other hospitals, it was a good opportunity to visit Angkor Children’s Hospital and Siem Reap en route.

Siem Reap: Just off Pub Street

Angkor Children’s hospital has steadily grown in size since its opening in 1999. It was the vision of the famous Japanese photographer Kenro Izu.  He had arrived in Cambodia to photograph the Angkor temples, however was struck by the deficiencies in medical care for children. Angkor Children’s Hospital provides free medical and surgical treatment to any child that is able to make the journey. In addition to this, they also run outreach programmes to local communities around Siem Reap province as well as run training sessions for Cambodian doctors.

After attending a ward round, it seems that the spectrum of illnesses I encounter in Stung Treng is not that dissimilar to what I observed in Siem Reap. With the advantages of biochemical, microbiological and radiological investigations, the doctors are able to reach some conclusive diagnoses. Whereas in Stung Treng, I have learned to be comfortable with very little certainty. It was certainly reassuring to see that my presumptive diagnoses and treatments have been fairly appropriate.

A limiting factor in Stung Treng is the absence of any breathing support. In the final stages of respiratory illnesses, the effort of breathing becomes too great a challenge for the patient to bare, resulting in an apnoea (stopping breathing). In the absence of any breathing support, these children will almost all die.

One type of respiratory support is providing CPAP (Continuous Positive Airway Pressure) i.e. using a machine to force air into the lungs and so reducing the effort of breathing on the child. ACH have a low tech solution involving the use of nasal prongs, oxygen and water. Unfortunately, they get the components from a company in the United States!

CPAP at Angkor Childrens Hospital

However, having grown up watching Blue Peter, I have managed to finally make use of that double-sided cellotape and have created a CPAP set-up of some design. Hopefully, it will prevent the children from deteriorating beyond the point of recovery.

CPAP Stung Treng Style

When visiting ACH, I had the opportunity to observe the admission of a new patient – a premature baby. I was highly impressed with the coordinated team efforts of two doctors and five nurses as they set up the monitoring equipment, IV drips and prescribed the medications. Everything was done with calm efficiency. It is worlds apart from the apathetic inefficiency I’ve observed elsewhere.

Ankor Children’s Hospital has integrated also into Cambodian medical system by offering paediatric training programmes for newly qualified doctors. Furthermore, ACH has close links with the government’s Provincial Referral Hospital.

Cooking Facilities for Patients

The staff receive significantly higher salaries than their government counterparts.  I am sure that this places no small part in achieving a motivated and hard working workforce.  The staff all work full time in a shift system, which includes the afternoon! There is also a culture of ongoing professional development, with daily lectures and bedside teaching.

The Childrens Play Area

There is a government project underway to provide a higher salary for healthcare staff, with the condition that they do not practice privately. However, the proposed new salary is still significantly lower than what they would normally earn overall. So, you can imagine not many people are willing to accept this condition! Interestingly though, while the ACH salary is considerably higher than the average government wage, the absence of a private practice means that some doctors will be accepting a pay cut in return for the training benefits.

Court Yard

While the hospital excels in its quality of service and semi-integration into the official health service, its weakness lies in its financial dependence on foreign aid. Therefore, it once again highlights the cycle of dependency that exists in Cambodia.

The fragility of vast numbers of NGOs has been demonstrated as organisations struggle to weather the current economic climate. NGOs fiercely compete for limited pools of money, spending huge amounts of resources simply trying to exist. Local people strive to work with international organisations rather than government for the benefits of higher salaries and the opportunity to work with foreigners.

Having said this, it is hard to argue about ‘sustainability’ when your objective is clear– children deserve to receive decent medical care. ACH is staffed by dedicated Cambodian staff who genuinely work hard for the betterment of their nation. While it is not yet self-sustainable, at least it is achieving what it was intended and more.