My Work with the Cambodian Midwives Association

I cannot start this post without first explaining a little bit about midwifery and how midwives are trained in Cambodia  so that there is some context to my role here.
Despite a lot of investment in maternal and child health services in Cambodia the maternal and infant mortality rates remain some of the highest within the region and maternal mortality have remained static for the past 10 years.MM 470/100,000 whilst Infant Mortality rates have reduced at 28/1,000 they are still unacceptably high.This is a great concern for the Royal Cambodian Government and for the Non Government Organisations (NGO's) working with it in this area.
26% of maternal deaths occur through unsafe abortion practices and investment in services in the area of safe abortion services and those for adolescent sexual health family planning or birth spacing as it is known here have been widely promoted.
The other main causes of maternal deaths are Post Partum Haemorrhage and Eclampsia both of which are preventable when there are sufficient numbers of well trained and skilled health professionals and resources in place.
It has now recognised that midwives are essential to the delivery of safe reproductive health services and that investment needs to be made in increasing their numbers ie by training more and by improving the clinical skills and competence of the existing workforce.
As with all professions because of Cambodia's past there are big gaps in the workforce which will take many more years to fill.
How Midwives are trained is both interesting and complex there are two types a bit like the UK used to have with the old Enrolled Nurse role there is a primary nurse/midwife these practitioners have done a years combined training in nursing and midwifery and they work to a national job description.They were introduced to address a shortage of midwives in the North East of the country which is largely rural but are now more distributed across the country.They have a restricted range of duties commensurate with their skills but can still be the sole care provider in many of the remote areas of Cambodia.
Secondary midwives are either nurses who have undertaken a years post basic training known as a 3+1 or more recently Cambodia has introduced a 3 year direct entry midwifery programme and this has almost doubled the numbers of midwives in training.
There are 5 public training centres 1 in PP the others at Regional Training Centres (RTC's) across the country.
Teaching and learning facilities and student support seems to vary in each centre. Some have received a lot of support from either the govt or NGO's whilst others less so what they do have in common though is a shortage of space and teachers to accommodate all the additional students.
This is also the case in clinical practice with a shortage of high quality placements [now where have I heard that before] Interestingly VSO and other NGO's are doing some great work in the RTC's on developing preceptor ship and other forms of student support with very little.
From what I have gathered so far non of the courses meet international standards so the Govt has commissioned a new 4 year bachelors level curriculum to be developed but this is at the very early stages of development.
Cambodia is also in the process of developing its regulatory framework for both nursing and midwifery laws have been passed to establish both a Nurses Council and The Cambodian Midwives Council this is a very exciting and essential development and I am really pleased to be sharing an office with the Cambodian Midwives Council as there is so much potential for collaboration between the CMA & CMC to strengthen the midwifery workforce.
The pay and reward schemes for public servants in Cambodia are going through reform so it is hard for me to understand exactly what midwives are paid here I have gleaned that they have recently had a pay rise and incentives added to their pay per hospital/health centre based deliveries they perform
In addition to the "approved" midwifery workforce there are also traditional birth attendants [TBA's] who have had little or no formal training but have been delivering babies within local communities for years and years. Many women and families either because of poverty/tradition or other factors still look to TBA's in preference to accessing mainstream services
My role with the Cambodian Midwives Association is to help build its capacity to work as strong voice for women in the area of reproductive health there is evidence which supports a strong correlation in countries which have effective professional midwifery associations and a reduction in maternal mortality rates.The CMA has been through some challenging changes over its 16 year history it now has a new elected President and executive team and it is my job over the next year to help and support these very committed midwives to strengthen membership and activity  in ways which helps to raise standards of midwifery practice and the personal and professional development of midwives for Cambodia.
We have a CMA conference in two weeks when I will get to meet over 70 midwives from all provinces in Cambodia and this is their opportunity to contribute to the future development of CMA as a democratic organisation. I will let you know how it goes and what I get up to in future.
Please feel free to comment on what I am doing help and advice is always welcomed
Kath         

Tragedy Hits Phnom Penh During Water Festival



Some of the magnificent boats at the start of the water festival




Me in my very baggy britches watching the boatrace from a very posh marquee



some of VSO's boat crew

Dear All
There is no way that I could start a new blog without making reference to the most horrendous incident to hit Phnom Penh for some time and particularly in view of the many texts and e mails enquiring about my safety it is really good and heartening to know that so many people care thanks to every one.
At the time of the bridge tragedy I was on a short break to Mondulkiri with 5 friends we had decided to leave the heat and crowds of the capital and head for cooler and quieter climes.
The first I heard about the incident was when David text me about the incident which was on the news in the UK before I got to hear about it.He knew that I was going away but wasn't sure for how long so I was able to reassure him that I was OK
I was then contacted by VSO's in country Director Alice who was verifying that all volunteers in Cambodia could be accounted for so thanks to her and the team too.
The Water Festival is Cambodia's most spectacular event which in effect is a very big boat race with varying size long boats some carrying as many as 60 men competing in different categories of races. The boats come from towns and Provinces all over Cambodia for the 3 day festival to race it is very prestigious for the winners. VSO has a boat much to the amusement of the locals but rarely if ever gets further than the first heat so I was in PP on the first day of the race which was Saturday.
It was the most fantastic day I watched some of the races including the VSO boat and cheered on my many pals who paddled their hearts out.
The atmosphere in the city was great and the crowds were well managed I even ventured out in the evening to watch the splendid fireworks over the river.The crowds were big though and I lost my friends but as I live near the river was able to make my way home.It was great to see families together having a good time so it was such a shock to learn of the tragic events 2 days later.
In Mondulkiri I was discussing the incident with a young waiter at the nature lodge he said it was like Khmer Rouge times which he doesn't remember and just goes to show that the past never goes away for these lovely people and it is such a shame that their main festival will be blighted possibly for years to come.
Well lets hope not but if you can please spare a thought for the 500 dead / injured here in Phnom Penh and their families.
In my next blog I will definitely be telling you about Midwives and my work here in Cambodia
"Lea Hei"
Kath   

Picture Gallery

Dear All just thought that I would post some pictures from my "doings" in Cambodia they are a little random as I have just downloaded them from my camera
In my next blog I am going to tell you all about my first few weeks at work in Cambodia and what I have found out about Midwifery training and practice here
I hope you enjoy looking at them

My washing and bedroom facilities at VSO programme office on arrival in Cambodia





This is Dave whom I have adopted now working in Kampot a super young man

This is Janet to the left next to her husband Dave they are now up in Ratinakiri Province and Thea and Jahn on the right now working in education in Stung Treng They are the best pals any one could have had.

This is the view of the National Museum which I have from my balcony

This is my loung apologies for the socks how did they get there and thanks Neesey for my new ones they were very welcome

My bedroom (rather stating the obvious)



 Kath

My Visit To The Seaside

Last weekend was yet another Khmer Public holiday to celebrate King Norodom Sihanouk's birthday we had the Friday and Monday off so along with 3 other VSO chums we spent 3 days at the coast in Kep. Chris our social secretary booked us into The Veranda an eco hotel which was located about a mile out of the centre in an idyllic setting half way up a mountain surrounded by lush green landscape and forest.
Chris and I shared accommodation a wood and bamboo cabin which was set in the grounds with great views of the landscape and the sea it was a tad on the small side particularly as we had to squeeze in a put me up bed but we are only volunteers and have to travel steerage but it was still wonderful.
When we arrived after a 4.5 hour bus journey which is an adventure in itself in Cambodia the sun was shining and the air was light and breezy what a joy after the stifling heat and humidity in PP so what can a body do but climb into the old "cossie" (2 sizes too big now!!) and christen the pool and that I am ashamed to say is where we stayed for the rest of the day.
Kep is the St Annes equivalent of Cambodia's coast line the next day was very cloudy and the sky a bit menacing however set off to explore Kep and planned to go to the beach and have a swim we did get to the beach at just the time the heavens opened so we migrated to one of the many crab shacks lining the coast.
This in itself was and interesting pass time watching the women fishing for crabs they go into the sea waist deep it looks both hard and dangerous. The crabs come straight out of the water and into the cooking pot or barbecue food does not come fresher than that and they are delicious
The weather unfortunately set in for the rest of our stay so we had to cancel our boat trip to rabbit island and our trek up a mountain which sadly means that we will just have to go back!!!!!
Talking of going back the bus journey back was another adventure the bus when it finally came was full despite having booked seats well in advance so what does one do when the bus is full? put up plastic chairs and fill the isle what else fortunately I was given the little seat belonging to the drivers mate who had to stand all the way to PP but it also meant that I saw all the near misses too scary or what!!!!
Bye for now my old buddies next week I will tell you all about work and how I am getting on with the Cambodian Midwives Association

Here are 3 of us just about to set off on our epic bus journey home  you can just about see the sea in the background

"Okun Charan Lea Hei"