Stung Treng Where?..........

Stung Treng Province

Last week I took matters into my own hands in relation to finding out more about how maternal and newborn health care is delivered in the far reaches of Cambodia waiting to go out and about with CMA members was clearly not going to happen I have tried many times already and been thwarted every time.
The dedicated follower of these musings will recall that several of 'my group' are placed in Stung Treng which is in the North East of Cambodia on the border with Lao. Ingran a young ra......paediatrician and Jan and Thea from Holland working in education I had made a long standing promise when we parted in October to visit them in situ and there are a couple of new volunteers there now Wendy a hospital management advisor and Angela (and her husband Chris) have recently started a new placement there. Angela is a midwife of long standing and has forgotten more about midwifery than I will ever know she is there as midwifery advisor to the referral hospital and 7/8 surrounding health centres some of which are very remote indeed and can only be reached by boat.
As I had little to do at CMA I would kill two birds with one stone and go on a field visit as it is known in NGO land and see at first hand the challenges of delivering maternal and child health services in one of the remoter and poorer provinces
I travelled by minibus an experience in itself let me explain the procedure when you ring to book in English someone rings you back and tells you to be awake by 3am in my case I got another phone call at 4am to say they would pick me up in 10mins 40 Min's later they arrived I was bundled somewhat unceremoniously into a mini van occupying the middle seat which is very hard with no proper backrest or seat belt (don't tell my husband) and when you have lost as much padding as I have on the old derriere a 7 hour journey is a long time.However my fellow passengers were quite friendly and seemed to appreciate my faltering attempts at K'mai which caused great hilarity but looked after me throughout the journey.
I arrived at Jan and Thea's at about 11 as it was Sunday I spent a very enjoyable day with them in their home a little corner of Holland they have created. Thea is the most incredible cook and even made fried eggs and tomatoes taste amazing we caught up on all our news it was just such a relaxing time which was good as the next two days were to prove quite taxing in more ways than one............... 

Town of Stung Treng

A Glimpse of Paradise

Hello again dear blogging buddies
Just when you think that you have seen the best place in Cambodia along comes another one and  blasts you away such was my experience over the past few weekends but before I wax lyrical about my travels lets get you up to date with the business end first.

National Day of the MidwifeThe conference to celebrate National Midwives day went really well over 400 delegates attended mainly midwives from all Provinces in Cambodia we all wore CMA " T" shirts even the Prime Minister's wife Lok Chumteav Kittiprittbandit Buny Rany Hun Sen. She was the key note speaker and gave what I thought was a very hard hitting address calling for midwives and Dr's to show more kindness and compassion to women and the newborn she also called for the Ministry of Health to close down unlicensed pharmacies and clinics which was music to both mine and the Council's ears as they strive to introduce a regulation framework and system for Cambodia

 

Some of the midwives gathering to celebrate International Midwives Day

  Valuing Life Clinic
 I have missed a couple of Saturdays as I have been away but last Saturday I returned absolutely armed to the teeth with yet more baby clothes from my great pals at choir and the Nursery/Nursing students at Wakefield College thanks to you all once again.
Its great now as I am getting to know the women more and they always seem really pleased to see me.
The lady with malnutrition is doing really well her baby is continuing to grow and she looks so much better Baby Jinnie our 1.2 kg baby I did not recognise she is now 4kgs and looks as fit as a fiddle bright alert and feeding brilliantly. Her mum though is not doing so well she came to clinic full of bruises because the roof of her house (shack) caved in on her fortunately the baby was not with her at the time her blood pressure is still high and the clinic are going to refer and pay for her to have investigations she is the most fantastic mum and thanks to her little Jinnie is doing as well as she is so we must do all we can to get her well although her living conditions are awful.
The clinic is desperate for a permanent midwife to support Toinette the missionary midwife there they really need a Khmer midwife and I am going to try to help them find the right person but its a hard task so wish me luck.

One of the delightful students at the clinic doing ante natal checks

Health /related Professions Network  I have set up and chair an new informal health and related professions network for people either new to Cambodia or who work in isolated posts like me we have had two meetings so far and they have gone really well.
We have some really interesting people attending from all nations and its really good to see useful and productive connections being made
On my travels again
May dear blogger in Cambodia is just one long public holiday there is the Kings birthday for one which with the weekend gave us 5 days off. My pal Chris has had a friend Jenny staying with her and they very kindly agreed to let me tag along with them on their trip to Kep Province which is South West  of the country I have been before in November though but the weather was not brilliant this time it did not disappoint there was rain but not enough to put us off long country walks and dips in the the sea which was the most beautiful azure and as still as a mill pond.
The first day we went on a mountain (I use the term loosely) walk and Jenny a keen ornithologist was in raptures at the fauna with all kinds of birds and butterfly's the size of tea plates or so tiny they resembled flecks of brightly coloured confetti.
The following day we took a boat to Rabbit Island what a little haven the three of us found a quiet cove stripped off (not a pretty sight for the local fauna) and bathed in the cool calm sea Jenny did some snorpling (a Sally ism) and a great time was had by all only topped by a leisurely lunch eaten on the shoreline fresh grilled fish and salad there's no wonder I'm slim now!!! To be honest I did order chips but they were off that day.........

Rabbit Island

On my travels........As I mentioned in my introduction just when you think things can't get any better they jolly well do this time a trip to the opposite end of the country took Chris and I to Kratie Province staying in Kratie town which is situated on the Mekong river.
Gilly and Sam from my ICT group are both volunteers lucky enough to have a placement there they planned our trip with military precision and it did not disappoint after a long hot and noisy bus trip Chris and I were met by G&S and taken to their lovely Khmer home for afternoon tea and cakes plus fruit free jam!! then on a little tour of the town and drinks by the Mekong river to watch the sunset.
Kratie is reputed to have the best sunsets in Cambodia so who am I to argue they are stunning
The following day G&S had arranged for us to visit Koh Trong Island after a short boat trip and an exercise in walking the plank to get on to the boat which was scary! we disembarked into what I can only be describedSophal who took Chris and I on a tour of the island in his pony and cart sitting back to back we stared in wonder at the beauty and peace of this magical place.
The island is situated in the middle of the Mekong and visitors can travel the 9km loop road around the island through the peaceful Khmer villages fruit orchards rice fields whilst watching the daily routines of village life which has not changed for many years 
Sophal was brought up in an orphanage in PP he met his wife there although her parents were from the island he is a christian and they have 3 children Hannah (5) Martha (3) and Luke (1) they left PP to try to create a happier and healthier life for their children. Sophal has been asked by the commune chief to be in charge of tourism on the island he has set up a little information office and hires out bikes and takes folks around in his cart pulled by Mao his miniature pony.
After our tour he took us to meet his family who were a delight we were given refreshments including Pomello's for which the island is famous they are a type of huge grapefruit and also fresh mango's his wife showed us her small holding where they grow a range of fruit and vegetables the whole island acts as a cooperative and aims to be self sufficient in fresh produce.What they don't eat they can sell in Kratie
We visited the floating village where Vietnamese people live and the island's pagoda. The island has two schools two Watt's or Pagoda's and a police station with 7 policemen! unbelievable and says every thing about the police service in this country.
We bade Sophal and his wife a fond farewell wishing them luck for the future and their dream to open a small restaurant on the island
I cannot remember ever spending such a wonderful morning as I thought then life just does not get any better......
But in the afternoon G&S arranged for us to go to see the Irrawaddy Dolphins and it kept getting better we travelled by tuk tuk through villages full of  friendly happy children smiling waving and shouting their hello's at the landing point we hired a boat which took us out to where the Dolphins were basking and in the peaceful twilight we caught many sightings of these beautiful graceful creatures often hearing them blowing air before seeing them. I do not have the words to describe the beauty adequately enough I just know it will remain with me forever............
Lei Howie
Kath

An Irrawaddy Dolphin now a protected species only around 100 left in Cambodia. Many were killed by the Khmer Rouge and their oils sold to Viet Nam

 

News from Cambodia

Valuing Life clinic a midwife and student examine a new baby

Richard and Sopheap

Well greetings dear blogger from Cambodia its only two weeks since my last entry but much has happened so I need to write it down before it disappears from my memory because as many of you know my memory is a weakness.
Sadly I have to report that there is still 'trouble at t'mill' in Cambodia the border issues between Cambodia and Thailand over ownership of Preah Vihear Temples is not resolving many hundreds of people from villages on both sides have had to evacuate their homes after enduring artillery fire and worse.
Several of my fellow volunteers posted in the area have now been evacuated to Siem Reap for their safety one of them Wendy a nurse advisor in Anlong Veng recently wrote a very moving article for our VSO magazine on the impact of the fighting on the people of her little town. Anlong Veng was previously a Khmer Rouge stronghold the home of Ta Mok and the cremation site of Pol Pot She described the fear and resignation of the people as they watched the armoured vehicles pour into the town and as the fighting grew worse evacuate their homes and board up their businesses.
Many had to stay in camps with no sanitation facilities fresh water etc a terrible situation indeed and very tough for those volunteers who live in these communities their sense of abandoning the people acute indeed lets hope that the politicians on both sides reach a peaceful settlement the people deserve nothing less.
On a lighter note I along with two other pals attended a friend's engagement blessing the happy couple Richard and Sopheap were the centre of attention but unbeknown to me I had to take on an active role as Richard's Aunt in the ceremony it was a very happy and colourful occasion see photo's attached.
Last Saturday I sang with Bella Voce Community choir in our spring concert it went really well and was attended by over 300 people including 6 of my pals who came to support me.
On Thursday Cambodia celebrates International Midwives day and CMA is co hosting with the Ministry of Health a big conference attended by the Prime Ministers wife Lok Chumteav Kittiprittbandit Bun Rany HunSen. This is a very big day for CMA and should help to raise the profile of midwives in Cambodia and the importance of their role in reducing maternal and infant mortality rates. I have helped the President of CMA write her presentation so fingers crossed that it will go well if not OI may well be sent home on the next plane!.Will make a full report next time.
Valuing Life Clinic I am loving going to help at the clinic and am pleased to report that Jinnie the 1.2 kg baby against all odds is doing well and is now 2kgs there are several  poorly pregnant ladies who attend and all are doing well thanks to the care and kindness they get from the staff there.Thanks to all at home who have contributed to my work there by sending baby/toddler clothes and equipment which is being delivered by David when he visits in June.
Finally the temperature is rising and how!!It's well into the 90's now and when its windy it feels like a blast from an oven but on the plus side the mango season is at its height and the mango's are just dripping from the trees as are the jack fruit which are being sold on almost every street corner.
Please note all pictures appearing in the blog are with the kind permission of the subjects 
Lea Howie
Kath   

The happy couple me as Aunty and Chris in background was Richard's mother(sorry about the quality)

 

Another Visit

 

Me and two of my visitors from the University of Huddersfield Sue and Jan

My blogs are just like no.10 buses you don't see one for hours and then two come along at the same time but I must report to you my last visit from pals in the motherland
On the last Sunday in March I made my way to the Pavilion Hotel (a great little spot right in the heart of PP an old French Colonial building with lots of character and charm a great place to stay if ever you need somewhere in PP there I go digressing again) to meet up with Sue Julie Jan Graham and Ian from The University of Huddersfield they were on their way back from Kuala Lumpar where they had been presiding over graduation of students from their outreach top up degree there and were hoping to establish links with Cambodia very good news for me as I got to see some of my favourite academics show them my new world and catch up on all the gossip (Oh how I miss gossip!!!)
What great ambassadors for the University they were (That's if you exclude the rather unfortunate swimming pool incident!) after doing a bit of sightseeing around PP on the Sunday including my apartment The Royal Palace National Museum and the blue pumpkin and ta heir first Tuk Tuk ride through the city we got down to business early on Monday with Ian and Graham going off to do social work type workshop things and I took Sue Julie and Jan to PP's national training school for Nurses midwives and allied professions unfortunately as it was national final examinations week we could not have a tour of the building but were treated to a presentation from a very inspiratioal young nurse teacher about their new health academic learning centre a first for Cambodia and will be used to "train the trainers".
The following day I took Julie a senior lecturer in Midwifery to my clinic where both her practical and teaching skills were put to very good use we had a very good morning and I do not think that Julie will forget meeting those women and their babies in a hurry no one I have dragged oops! I mean taken there has failed to be impressed by the set up and commitment of the staff to the women and children who live in such poor conditions.
I cannot thank Sue and the team enough for taking time out to meet up and for all the things they brought for the clinic (and me I have enough deet to last me 20 years in Cambodia now) but most importantly I hope that "The Visit" leads to a long and sustained partnership supporting health and social care education in Cambodia

Sue Julie and Jan enjoying an evening boat trip on the Tonley Sap

  

A Toad in the Toilet

There is nothing dear blogger more able to guarantee constipation than having a toad in your toilet! I speak with authority on the matter after my recent visit to Ratanakiri Province in the far NE of Cambodia my knowledge about matters toad are limited but I am reliably informed that from my description of this creature who insisted on spending the entire 5 days in or around our toilet it was likely to have been a banana tree frog all I can say is that its time would have been better spent with the bananas rather than in trying to get to acquainted with my nether regions.

Toads apart my visit to Ratanakiri was fantastic one of my best pals Janet a teacher is placed up there with her husband David played mine hosts for almost the whole trip and fine ones they were too. I together with 3 fellow volunteer travelled to Ratanakiri by service bus from Phnom Penh an 11 hour trip in total but time passed very quickly as we travelled through many Provinces Towns and Villages before reaching our destination which is very close to the Vietnam border. The country side was extremely interesting and varied a village barely touched since French colonial days which for some reason unknown was left untouched by the Khmer Rouge.
We encountered the usual hazards on the roads including chickens cows oxen small children on bicycles and every thing but the kitchen sink being carried on motto's.Sadly we saw the remains of several RTA's both coming and going the roads here can be treacherous as I have already documented on several occasions.
We arrived at "Tree tops" our home for 4 nights this is an Eco lodge comprised basic but comfortable log cabins/bungalows and contrary to what I understood we did have electricity and even toilet paper I shared one of their new mosquito proof bungalows with Chris which was set into a hillside surrounded by tropical fruit trees in particular cashew and jack fruit which were growing in profusion the sound if cicadas and other fauna was deafening  especially at night.
We had a veranda with I have to say a very comfortable line in hammocks!which was put to very good use over our stay (photo to follow)
The next day we met up with Janet and Dave who took us by motto to Boeng Yeak Laom a volcanic lake said to be a perfect circle and been in existence for 700,000 years.We walked the circumference and then spent a good part of the day swimming in the cool clean and very beautiful water.We were however the entertainment for the many Cambodians who were there celebrating Khmer New Year
In the afternoon it rather resembled Brighton beach on bank holiday Monday so we escaped the crowds and went in search of the Cambodian equivalent of high tea we were not disappointed the banana cake was fab!!
That evening Janet made a curry and invited all of us for dinner we had a great time thanks both.
The following day we returned to our lake for more swimming then in the afternoon we were invited to Narin  Janet's translator's house blessing ceremony.
This was a fantastic opportunity to share a glimpse of life in  Ratanakiri Narin had built the house himself and he was justifiably proud of it. 4 Monks from the local Wat came to bless it and it was a very moving but simple ceremony followed by a big party.
During the afternoon we visited local waterfalls but due to it being the dry season there was not a lot of water to fall only a lot of people and rubbish sadly!!
The following day we said our goodbyes to Wendy and Janet as they had other fish to fry and Chris Eileen and myself set off for the day to do a jungle trek organised by tour guide Narin (Yes Janet's translator) everyone has at least two jobs here in Cambodia.
For those of you who know me well I dare say that you are finding it difficult to believe that I would do such a rash thing and who could blame you for me a 10 mile trek through a tropical jungle represents extreme sport! but I did it slowly and not without incident but I did it.
We had a local Tampoon ranger who led the way and Narin spent a lot of time showing us the flora and fauna and explaining how the authorities were trying to support and encourage the indigenous people to care for the land particularly the trees as illegal logging is a big problem so that they can make a living from tourists and others who visit.
It was fascinating to see how the people lived we visited their houses which have changed little in centuries many now use mosquito nets and water filters but many still live very simply with almost all their belongings made from the land I learned a lot and it made me think very much about our very materialistic society and what is important
No trip to the provinces would be complete though without a journey from hell our return journey did not disappoint we decided to take a mini bus as it would be quicker despite buying 5 tickets we only had 4 seats great fun my sciatic nerve will never be the same again!!!!!! but the trip was worth it

Boeng Yeak Laom Banlung Cambodia

A big thank you to Janet  David Narin and my companions Chris Eileen and Wendy for making it such a great visit.

Well I guess its Easter over in the motherland I want to wish you all a very happy peaceful and sunny Easter no hint of an egg over here so enjoy!
Lea Howie
Kath

Half way through already

Apologies dear blogger for the lack of posts in March it has been a funny old month one way and another and I have had real problems with my blog particularly uploading photo's so here's hoping that they have been resolved.''
I am now half way through my time here and at last I feel that I may be getting somewhere at work thanks to the support I have received from VSO Cambodia and UNFPA the midwives now seem to understand why I am there and are being a bit more receptive.
I have been working hard on a proposal for securing more funding for them to develop further their work in supervising midwifery practice out in the provinces there are 23 provinces outside of Phnom Penh and a team of competent experienced midwives from PP go out for 1 week at a time and visit hospitals and health centres.
This is of course very labour intensive and demanding on only a few people and because of logistical reasons they just cannot reach all the remote areas where they are needed most I think that I may have found them another donor to support this work and help to translate it into a nationally recognised form of clinical supervision linked to registration so for the time being my star is ascending lets hope it lasts.
I am also now formally working with the Cambodian Midwives Council so I am now ideally placed to influence the above.
The Council is really motoring now and is establishing offices in the provinces to get registration of midwives in place by 2012 it will be a great privilege to help them.
Their other big task this year is to reach agreement on Midwifery competencies which is tricky here as there are two levels of midwives so getting these right is a huge task.
Last week CMA held a workshop in Prey Veng Province which is one of the poorer provinces right smack bang in the middle of the country we travelled by minibus and despite the language difficulties a great time was had by all the midwives were great fun and included me in everything after the first day of the workshop we had a little tour of the town and I will try to post some pictures.
The purpose of the workshop was to put together a plan for next years activity I did a presentation on some of Cambodia's new maternal and child health  of which eg fertility levels and  uptake of births in govt health facilities havestatistics some all improved however there is still much to do and I want them to grasp the concept of targeting CMA activities to the provinces with  the biggest needs as they do not have the capacity to do everything.
As a result we have a plan and managed to do some prioritisation.
On the social side I had another "visit" this time from Pauline and Mervyn who were on a tour of Asia and called in to Siem Reap to see the temples at Angkor Wat this gave me the chance to take a couple of days off and go back to Siem Reap one of my favourite places
I have known Pauline since I was a student nurse in Huddersfield she was a medical ward sister and a great role model for me so it was great to meet her and Mervyn. Unfortunately their schedule was changed at the last minute which meant that we didn't have much time together but as the saying goes its quality not quantity that matters thanks so much to both of you for a lovely time.
Last week my great ICT group were together again for our second lot of language training this time it was here in PP. Some of my chums I had not seen since October my X room mate Vicky was not with us as she has had to return home due to her husband's illness so I wish them both well.
The language class was harder this time with much more conversation I was bottom of the class but I still learned a lot and will try hard to put it into practice.
we had a young bright and enthusiastic teacher called Sopheak she was great and very patient!
In the evenings we did a "Cambodian version of Come Dine With Me" what larks Pip! I partnered with Janet for the last night for a dining experience with style and guess what we won! against very stiff competition I might add and despite Janet's husband Dave giving us his lowest marks ( that's loyalty for you!)it was great fun seeing all the film footage including bedroom scenes I will remember it forever.
One of the down sides of being a VSO volunteer is that volunteers come and go with increasing regularity and it seems that we are always having to say goodbye to someone whom you have grown very fond of next weekend we say goodbye to Danny who finishes his 6 month assignment with the Ministry of Education and returns to Scotland. He has been a great pal but on the up side he lives in Sterling a place David and I visit every year so we will certainly be dropping in to see him and Joan when we go in 2012.
The best news I have had though in March was that Sally and David have now booked their trip here in June they are coming to PP for 4 days then we are flying off to Malaysia for a 10 day holiday together which will be wonderful I cannot wait!!
Lea Howie
Kath

1. 
   

some of my midwife colleagues at CMA 's planning workshop

Prey Veng Province

Some of Cambodia's finest Midwives'

     

"The Visit"

There is nothing dear blogger more able to gladden the heart of lowly volunteer than to get a visit from someone back home just to hear another northern accent is heartening [sorry Danny but Scottish just does not quite do it!] and so imagine my excitement when along with my pal Chris on the 18th of February I met up with Viv and Jim Howard where? Phnom Penh Raffles hotel cocktail bar no less. Viv and Jim were en route to see Angkor Watt Temples having visited their son in Hongkong and done some serious chilling out in other parts of Asia.
Viv is a choir chum [Vocal expressions] and it was great to catch up on all the gossip oops I mean news ! and to hear all about 'the doings' in Holmfirth Chris and Jim got on like a house on fire whilst Viv and I caught up.
We were forced into having a couple of Raffles special cocktails well one cannot be unsociable on these occasions and as Viv and Jim had only ventured out into PP briefly and were soon frightened back in doors at the thought of crossing the road (and who could blame them ) Chris and I took them out for dinner to a very nice Khmer restaurant by the river which had Aspara dancers and a very jolly French wedding party going on. They had their first tuk tuk drive and a good time was had by all.
The next day I collected them again by tuk tuk with Hak's brother doing the honors this time he took us on a tour of the city stopping off at the Royal Palace and then on to refreshments at The Foreign Correspondents Club after that we had a tour of my apartment which overlooks the national museum.
The heat at this time was at its worst so the choice was visit museum for more artifacts and culture or lunch and a dip in Raffles pool I will leave it to you to guess all I can say is Raffles do a very nice line in chips!!!!
As Viv and Jim were leaving early the next morning to fly to Siem Reap and after afternoon tea (what else) we said our fond farewells.
Viv and Jim thank you so much for being my first visitors it was a great privilege to show you PP and also thank you for your generosity in sharing a part of your holiday with me you will never know how much it meant.
In my next blog will update you on my second visit and will include updates from the clinic and other stories
Lea Howie!! all
Kath




PS For some reason I cannot download any photo's of my visit will keep trying