How time flies........

How time flies dear blogger and indeed how does a body keep up?
I am now way behind on my blog and my personal e mails (so sorry to all my chums) so this entry is going to be succinct and will try to get you all caught up with my exploits here in Cambodia since my visit to Stung Treng
Work well work has gone from bad to so much better some of my more astute bloggers will have gleaned that I have had a bit of a struggle with CMA since last October may be all down to me of course but capacity building when no one comes to have their capacity built was challenging even for the most able and experienced OD expert (which I am not) and it was very frustrating and demoralising hence my defaulting to other activities like the clinic and setting up the Health/Related professional network so after several meetings with VSO and thanks to our new VSO health programme manager Clare my placement was switched to work with the Cambodian Midwives Council. As we share the same office there was no big upheaval but I do feel a sense of failure in that I could not persuade and inspire the CMA executive to develop and strengthen what they do but I guess you cannot "win em all" We have though parted friends which is good
Onwards and upwards since 1st July my working life has been so much better the Council want me and have already responded to some ideas and suggestions they are  a very committed group of women trying to get to grips with putting in a regulation system to make midwifery safer in Cambodia is a tall order especially with so few resources  its a pleasure to help them.
The network is also going well attendance has been excellent at some meetings with some interesting presentations we were a bit thin on the ground last Friday because its holiday time and I have been asked to be an external assessor on an interview panel so am very busy at the moment.
Last week too I spent most of it in a village called Thmar Puok in the far NW of the country only 15kms from the Thai border I was invited by Olly another VSO volunteer there working as hospital management advisor.
I went to take up some learning resources for their midwives and to do a bit of teaching. Thmar Puok  is 60kms from the town of Sisophon along a dirt road the only major dirt main road left in Cambodia and it makes for very hard traveling especially in the rainy season with pot holes the size of craters imagine what it must be like if you are in labour and need transferring to better facilities the rains often wash away the bridges and the mud acts just  like black ice.
The hospital has had a lot of international investment it has a new children's which Olly and Alison (a VSO child health advisor)and some other education volunteers have decorated and made more child friendly and they have raised funds to buy toys below I am outside the new ward with some of the children

Me outside the new children's ward Thmar Puok

I stayed with Olly and his partner Katja in their house in the heart village with a small market just around the corner where we wandered after work to buy fresh provisions they are both great cooks and I ate really well if I can find it I will post Olly's pumpkin curry on my next blog
Their house was a typical Cambodian one and I have to say the only place I have stayed in Cambodia not surrounded by a high metal fence barbed wire and locked gates just a little wooden fence marking out the boundary.
They had a fab balcony with a hammock which I took advantage of as you can see below

Visiting the maternity unit on the first day was interesting and eventful it was extremely busy and chaotic but the head midwife was not there in the labour ward a women recently delivered was attempting to get off the labour ward bed and promptly fainted in front of Katja and I so we went into nurse mode laid her back down quickly she was bleeding although not too badly but no midwife in sight mind you neither was her baby so in my faltering K'mai and with the help of Sophal Olly's translator I suggested that the midwife should bring back the baby and help mum to breast feed which amazingly she did not bad I thought for a very rusty old midwife when we went back later in the day mum and baby were both doing well
The next day I went onto the ward the head midwife was there and it was in pristine condition by Cambodian standards any way I presented the books and learning .materials and Lineka the HM could not have been more pleased as you can see below

Lineka the Head Midwife at Thmar Puok a great role model

I just want to take this opportunity to thank once again the fantastic staff and students of the midwifery school at the University of Huddersfield who held a coffee and cake morning and raised over £400 to buy the books which are now in 4 different locations in Cambodia and being used by many midwives and students across the country 

Some participants in the training session

On the social front I cannot let this post get published without mentioning the great reunion I had with my family David and Sally arrived in Cambodia on July 27th we had not seen each other for 10 months open displays of affection/ emotion are rare but we did not care all the Cambodians waiting at the airport must have thought we were mad.
During their stay in PP we visited a lot of my favourite haunts and where I live VSO office work and some of the sights of PP they loved it especially riding around in the tuk/tuk's.On one of the evenings some of my VSO and work colleagues and their partners joined us at the Khmer Surin Restaurant where we sat on the floor in the traditional Khmer manner it was a very memorable evening pictures to follow.
From there David had arranged to fly to a wonderful island off Malaysia called Pangkor Laut what a paradise 5 days doing nothing except be pampered it was a location in a James Bond film not sure which but I can certainly see why.
We completed our trip with a couple of days in Kuala Lumpar not my favourite place I have to say but some good shopping and it rained all day every day too but we were upgraded to suites at the hotel and the food was fantastic so it didn't matter as we had so much to catch up on.
Saying goodbye at the airport was not as hard as I thought (not like last August ) as we all knew I would be back home in a few months and as I said at the start how time is flying by!!!!........
Next episode will include......................
An update on the clinic mums and babies and our trip to the Kirirom national park where Chris and I had a real adventure...........
Lee Howie   Kath

Stung Treng Episode 2

My two days spent with Angela a new volunteer midwifery advisor in ST were wonderful disturbing frustrating and enlightening in equal measure Angela is a midwife of great standing and has forgotten more about midwifery than I will ever know her role is to help the referral hospital in ST and about 8 health centres improve standards of midwifery practice my visit started in the hospital.
From the outside it looked quite impressive with a new emergency care and maternity unit however it belied what lay beyond.
The maternity unit was stark cheerless and somewhat dirty and depressing the toilets and sinks were not working were over flowing with dirty water soaking the floors Angela told me that only the operating theatre sinks were in good working order.
The labour ward bed was just a wooden frame no mattress and looked like something out of Dickens there was a more modern bed which had been donated by a well meaning NGO but it was not suitable for the purpose and the midwives did not like using it which I could understand the only position women could possibly give birth on it was flat on their backs there was absolutely no privacy which is common here.
The operating theatre was reasonably equipped but as with every thing else needed a good fettle there was still blood on the table from past incumbents and as I was to find out later in the afternoon when I observed a C. Section the same blood remained on the table.
The theatre lights and other equipment were really dusty and only one bulb was working but that said the Dr's technique including the epidural were I would say on the acceptable side but the nursing care was sadly lacking the lady giving birth was conscious throughout strapped to the table and no one spoke to her they took the baby away without even showing him to mum.
His first introduction to the world was of being plucked from his mothers womb by his feet held upside down and then unceremoniously hurled at a metal tray being held by the receiving midwife fortunately she caught him  OK I grant you it was covered in a green towel but it was a metal tray nevertheless.Wouldn't a pair of warm arms have been so much better and safer!!?
He was though a very healthy 4.6 Kg baby a rarity in Cambodia and despite everything he and his mum survived.
Angela was extremely worried about a lady with pre eclampsia but none of the other midwives seemed to be with her intervention she did manage to get the right treatment but the baby died however the mum lived which I am not sure she would have done so at least one family of 6 didn't loose their mum.
To counter balance the rigors of the day Thea invited Angela and her husband Chris for dinner and I have to say what a dinner fit for a queen and with the Beatles Cat Stevens and S& G to accompany us there was no better antidote to the rigours of the day.
The following day we visited Thala an island on the other side of the river to ST town to visit midwives in a health centre. We met 5/6 midwives and talked to them about their work and their training needs.
The difference between the midwives in the HC all primary midwives (1 year training ) and the ones in the hospital was quite startling as they were bright and interested although most were very inexperienced
We returned to ST by ferry accompanied by a great assortment of passengers and livestock including a couple of live pigs strapped to motorbikes imagine the din!!!
I left ST full of admiration for Angela Wendy and Ingran all health volunteers in ST they have their work cut out but were so inspirational optimistic and cheerful it was a joy to spend time with them.
It was also a wonderful to spend time with Jan and Thea who put me up in their house and Thea got up at 3 30 in the morning to see me off now that's friendship
Some pictures will follow