A Singapore Fling!

The Singapore skyline from a great height

This building needs no introduction

Well dear blogger on the 29th of October it was King Norodom Sihanuock's 90th birthday and hence another 5 day public holiday in Cambodia so me and a couple of pals Chris and Jan decided to go explore another Asian country Singapore I had heard a lot about this country in particular how developed, clean and orderly it was and I have to say from that perspective it did not disappoint
But for me it was somewhat of a personal pilgrimage in a way as this was the place my father was captured during the war when Singapore fell to the Japanese  
We flew into the airport quite late at night but were efficiently processed and within an hour had been swiftly transported to our hotel no repetition of our Viet nam psychopathic taxi driver experience thank fully just swift efficient service and even in the dark the sky line looked impressive we passed Singapore's equivalent of the London Eye situated at the mouth of the harbour very impressive.
We stayed in "Little India" and it is just what it says on the can at a delightfully restored small colonial style hotel in the midst of bustling streets filled  every kind of Indian merchandise my favourites were the spices herbs fruit and exotic vegetables we spent a few hours I can tell you exploring its nooks and crannies and the food here was fantastic as both my travelling companions are vegetarians we found a couple of great restaurants only yards away from our hotel and sampled the local delights.

A corner of a Mosque in Little India

No visit to Singapore could be complete without a visit to Raffles so we spent a very pleasant evening there sipping on a Singapore sling [only one as they cost the equivalent of a small house!]

The 3 towers building the cross part is home to the highest swimming pool in the world

During the day we explored the city by open top bus with its mix of old and new buildings and did some shopping well even volunteers need new knickers!!
We also used the underground system very swift effecient and clean as you would expect Chris got told off for finishing a chocolate bar as no eating and drinking allowed on the trains how embarrassing!!!
We went on the Singapore flyer thats what the big wheel is called there the views were incredible and shared our pod with a group of Australian scouts then we visited the Botanical gardens which has the worlds largest collection of orchids they were unbelievable I could have stayed there all day below are some pictures of the Botanical Gardens and the orchids but they do not do justice to the sheer beauty of them

The entrance of the Orchid garden

Wow

We also had a great evening at the night safari which was a bit like Disney in the dark but nevertheless it was a privilege to see the animals including lions, tigers, elephants a beautiful Rhino and my favourites the flying squirrels most if not all have been rescued we were taken around in an electrically driven tram and asked to be as quiet as possible so as not to disturb the animals who were just going about their business


The highlight though for me was our visit to Changhi prison and museum which told the story of Singapore in WWII as I have mentioned it was a very emotional visit to be in the same place as my father when he was captured and to learn more about the horrors  of internment but also thankful that he survived as so many hundreds of thousands of people did not.

He was a prisoner of the Japanese for four years and was soon moved out of Singapore but we as a family no little of his story after that as he was so reluctant to talk about it one day though I hope his story will be told he was a wonderful man

Changi prison's reconstructed chapel where you can light a candle and leave a message about loved ones who passed through in 1942

A map of Singapore in 1942 in bronze set on the wall of the prison museum

As good as Singapore appeared on the surface with its social housing its affluence, broad well tended boulevards, good roads with all the traffic going in the same direction and in an orderly manner there were aspects of the society I found disturbing like the very and I mean very elderly people clearing tables in the big shopping malls who had to use their trolleys as walking aids  and our taxi driver who explained that people have to continue working because there are no state pensions and health care is so expensive as is the cost of living. He had retired but drove a taxi because their family's life savings were used up on saving the life of his granddaughter who was born 2 months premature.
So the impressive skyline and order comes at a high price and you know somehow it was kind of nice to touch down at PP airport where we were met by Rotan our Tuk Tuk driver who trundled us back to town through absolute chaos dust, rubbish plus the heat and humidity but it felt like home.
Lea Howie
Kath

The Saddest Journey to Siem Reap

Apologies dear blogger for the lack of updates over recent weeks as predicted I am in a race against time to complete all I agreed to do for the Council before I leave in early December before I bring you up to date with my progress I just want to share with you the plight of some in Cambodia who have fallen victim to the excessive flooding here and who do not appear to be getting much help at all
Last week it was yet another public holiday for the water festival where normally the wonderful boat races are held on the Tonle Sap river which runs through the centre of Phnom Penh well they got cancelled by the Prime Minister understandably because of the flooding and the money saved was to be diverted to bring relief to those most affected and although clearly not as bad as in Thailand there are still thousands of families badly affected.
I witnessed a little of this on the road to Siem Reap where travelling through some provinces notably Kandal and Kampong Thom there were still many temporary shelters lining the road with cattle taking refuge in whatever dry land they could manage to find. These stoical people doing their best to carry on normal life.
Many schools and health centres seemed badly affected too even though the water was clearly subsiding the play grounds were a sea of mud but still the children were going to school and in their pristine white shirts and blue skirts/trousers amazing
Many of the houses now have tiny long and very precarious bridges on stilts running from their homes to the road how they balance across these I do  not know but they do

Water as far as the eye can see these should be lush green rice paddies!

The week before last was an important for the Council as it held its second annual general meeting and was attended by the newly formed provincial and regional Council members.
The AGM was held in Kampong Cham where I did my language training so it was very nostalgic to go back there it is the third largest town in Cambodia and situated on the Mekong river which was very high.
The event was well attended and the provincial council members gave an update on their progress in registering all midwives working in Cambodia over 2,000 now and growing The star Council member and province was Preah Vihear also one of the most remote has registered all 99 midwives working there she was an inspiration and was able to give other members good advice on how to develop good relationships with health departments and encourage midwives to register.
I ran a session which was an introduction to investigating complaints I needed to do a lot of preparation using real life case studies and  role play as dealing with complaints and disciplinary issues will be a key role for the 5 Regional Midwives Councils
I have to say it went very well and the President was very pleased there was great engagemnt and participation and the midwives showed a lot of insight into this aspect of the Council's function.

35 Council midwife members gather for the second AGM for CMC

Council members get to grips with the case studies

      In addition to the work for the AGM I have now finished drafting complaints and disciplinary protocols and procedures they are being translated into Kmai and then will be considered and amended by the national executive team there are 9 in all another big piece of work but I have had help via the net from a range of international regulatory bodies and also some legal advice from a fellow volunteer which was invaluable.
Work on a midwives handbook is also nearly complete and is just awaiting ministerial approval for the Council's standards which are an essential component.
On the last evening of the AGM the president took several of us out for a 5 course meal it was wonderful see below

Just to let you see that I am earning my keep here!

From left to right Sochea, me and Ing rada (CMC president)

    My final task is to complete a Council training manual comprising 4 modules (2 to go) thanks to Kerry Mari and Kuldip for your help and advice with this so the pressure is now on I have 13 working days to go.
The valuing life clinic continues its valuable work it was a quiet clinic last week as many of the women would have returned to their provinces for the public holiday.
However we did see some sick babies one very sick who was only two days old and could not have been examined properly before he was discharged from the health centre as he had a pulsating mass in his chest was not feeding was blue and cold so he was taken to the free hospital for sick children with all due speed but I fear that his chances are pretty poor.
Little Jinnie is doing well despite her disabilities and her mum is now being helped to set up her own rug making business.
The wonderful students there are an inspiration and I really admire them they were all looking forward to the holiday and excited to be going home

Jinnie and her mum

On Saturday I delivered the last consignment of baby clothes my wonderful choir Vocal Expressions has been constant  in sending out baby and toddler clothes for the clinic supported by child care students from Wakefield college and I can assure every one that the staff, mums and babies are so appreciative.

Next time I will report on my trip to Singapore
Lee Howie!!!

Pchum Ben again and on my travels!

You may recall dear blogger that last year around this time I was in Kampong Cham for the Buddhist festival of Pchum Ben it was about five weeks into my stay in Cambodia and I was struggling (and still am) to get to grips with the Khmer language that said my translator Sarith paid me a great compliment just before we broke up for the holiday by telling me that although I don't have a great vocabulary when I do speak Khmer "it is very clear" believe me from him that is quite a compliment as he is something of a perfectionist.
As ever I digress Pchum Ben is a family time when every one goes back to their homeland (province) to celebrate and make offerings in the pagodas to their ancestors so Phnom Penh empties out quite remarkably making it much safer to cross the road but every where is shut and a little dull so Chris and I decided to explore our neighbouring country Vietnam.
This turned out to be a very wise choice on several counts one being the severe flooding in the lower regions of Cambodia making travel even more dangerous than usual Cambodia is no stranger to flooding but this rainy season has been very bad with many homes animals and rice crops destroyed over 100 people have been killed in the flooding and thousands made homeless not to mention the food shortages which will inevitably happen in the longer term as far as I can ascertain non of this has made the international news.
Below are some photo's pinched from Gilly and Sam's blog of the flooding in Kratie [thanks both]

The tops of palm trees in Kratie

going by boat to the Pagoda taking rice and other food offerings

   The other count was that Vietnam was such an interesting and beautiful place to visit and I am ashamed to say not one that was top of my 'must see' list probably as I am old enough to remember the 'spot of bother' there in the 70's
Hanoi was our first port of call and we touched down at the airport after dark unfortunately and despite the warnings in lonely planet about airport taxi scams we ran headlong into one!! we were unfortunate enough to encounter a psychopathic taxi driver who within 5 minutes tried to extort money from us however he had not bargained on the resourcefulness and fortitude of two older British women who refused to be intimidated it was not a great start to our visit but fortunately all's well as the saying goes. 
The following day we were picked up at our hotel by a cruise company Calypso Cruises (very Vietnamese) to take us to Ha Long Bay for a 2 day one night cruise around the bay which incidentally is a nominee for the 7 natural wonders of the world competition [it gets my vote] We were told that the company had upgraded us to a 4* junk Oh yes we thought here we go again but they really had and it exceeded all our expectations and made up for our earlier and somewhat unpleasant first encounter of Vietnam
Ha Long Bay or Descending Dragon Bay is a UNESCO World Heritage site in the Quang Ninh Province of Vietnam it is comprised of 1,960 islets and we loved the place so much we extended our stay on the junk to 2 nights 3 days on the spot and spent our days touring the bay stopping off to explore some of the limestone caves with their amazing stalactites and stalagmites, kayaking in some of the smaller coves and swimming in the cool clear emerald seas.
I saw the most wonderful sunset whilst swimming though of course this could not be captured on camera but it will stay with me for ever what a lucky woman I am.
The service and food on board was first class [especially sea food as you would expect ]and I must have gained several of those kilo's I have lost since leaving the UK there was a cookery demonstration on how to make fried spring rolls so I will be trying those out when I get back now I know how to stop them unravelling.
Chris and I tried our hand at fishing for squid but with no luck but it was fun trying.
The weather was warm and sunny less humid than PP we were so lucky as on our return to Hanoi we never saw the sun again!
For more info on Ha Long Bay  go to http://en.wikipedia.org/wiki/H%E1%BA%A1_Long_Bay
We spent 3 nights and 2 days in Hanoi at a nice inexpensive hotel right in the heart of the old quarter great location although a bit noisy the staff were ultra friendly and helpful giving us some recommendations for restaurants which were great and inexpensive
As it rained non stop we had to find indoor activities this was not hard and included a visit  to the Museum of Fine Arts The House of Literature Vietnam's oldest University, The Water Puppet Theatre and a renovated merchants house all were very interesting Oh and we managed a bit of shopping too well one can have too much culture!!!!
Barring another brief encounter with an aggressive young man in a coffee shop [who could have been the brother of our airport taxi driver] we had a very good stay in Vietnam the traffic though made Phnom Penh's seem benign it mainly went in the same direction just very fast and aggressive a bit like the men really!!
Lea Howie

I climbed to the top of this island phew!

Ha Long Bay picture gallery

One of the limestone caves

Our fab junk at Ha Long Bay

Map of Ha Long Bay one of the beautiful islets

One Year On

Well old blogging buddies its very hard to believe but I have now been in Cambodia for a year and it seems like only yesterday that I said my tearful goodbyes to David and Sally at the airport and so much has happened to me since.
I have managed to negotiate a short extension to my placement although VSO Cambodia thought I was there for two years any way so that was not difficult the Council wants me to stay another year and in many ways I would love to as they do need help to really develop into a more confident and fully functioning organisation but sadly I must return home by Christmas but VSO has agreed to consider another volunteer for them next year which may actually work by then as I hope by that time they will have got the ministerial approval for the standards that have been developed by the Council for essential competencies and a code of ethics for midwives without these its hard to see how the Council will be able to move forward in the future.
A donor proposal is now ready to be presented to some major international donors by the President on the 14th October my colleague Pros and I are helping her and the other midwives on the exec committee to build their confidence so that they can put their case with conviction and passion.
securing resources to accelerate their progress is vital
In addition I am helping them to write some basic policies and guidelines for dealing with complaints and disciplinary issues

Our new hemacue HB analyser in use at clinic

We had a Council meeting last week and someone always brings lovely food the time before we had banana fritters this time we had 'cadow K'ti' which are sweet rice dumplings and coconut milk wonderful! how I have lost 15 kilo's I do not know by the way did I say I have lost 15 kilo's and am now a size 12!.......................
On the clinic front all the new equipment donated and or purchased is now being put to good use last week the staff were very distressed as one of our women sold her baby for $50 to a complete stranger in another part of Cambodia fortunately the woman returned the baby as she found it to be sick so the NGO has placed the baby in a place of  safety with Cambodian foster parents whilst they support the mother in making a decision about the baby's future. Child and baby trafficking is rife here and who knows what could have happened to that baby had it not been returned it makes me shudder to think but these are the realities and the outcomes of severe poverty. Baby Jinnie is doing as well as she can she has quite severe problems including blindness probably although her mum thinks that she can see a little and my money is on her as she is devoted to that baby.
Lea Howie
Next time what makes me smile and cry in Cambodia...............................

This is my most loved photograph taken in Mondulkiri Cambodia I was sitting on a log not 10 feet away from this beautiful creature

Cambodia the Country of Wonders

The waterfall at Kbal Spean

Hello again dear blogging buddies " Cambodia the country of wonders" is a common slogan used here to promote the up and coming tourist industry it has come alive for me on many occasions over the past year as recorded in previous blogs but my latest travels to Cambodia's spiritual and cultural  heart really did reveal "wonders" on the grandest of scales
Siem Reap is described in the guide books as 'a charming town with its many colonial style buildings tree lined streets and winding river' it is now growing and thriving on the increasing numbers of tourists on their way to see the Temples of Angkor.
When the French explorers rediscovered Angkor Watt it was not much more than a village

The wonderful Banteay Srei temple

The main Temples of Angkor are about 6 kms from the town centre. Chris and I stayed at our favourite hotel Terrace Des Elephants the friendliest and quirkiest hotel I have ever stayed in it was my third stay there and now I would not consider staying any where else including the legendary Raffles and many other 5* hotels springing up in Siem Reap
On our first day we got up at 4 am (yes I know I am mad) for a 5 am departure by tuck tuck to see the sun rise over Angkor Wat this was an act of faith in itself as its the rainy season so no guarantees that we would see the sun at all and it was looking doubtful as we passed through the dark tree lined streets through a light drizzle. We were joined by several other hundreds of mad people but the complex is so vast that we felt as if we were there alone and dame fortune did smile upon us as day break approached the clouds cleared and we did indeed see the sun rise over Angkor Wat .
The history of Angkor Wat starts around the 9th century Khmer religious beliefs, art and architecture all stemmed from India who introduced both Hinduism and Buddhism to the country which had a profound effect on the culture.The indigenous Khmer's though did not entirely abandon their beliefs in their heroes/guardian spirits good spirits and evil spirits who roam the land bringing sickness and death.
'Spirit houses' are in evidence outside most homes and buildings to this day complete with offerings.
We had a great guide who took us all over the temple complex including Angkor Thom entering along the impressive causeway through the south gate -Bayon where I saw the carving of a woman giving birth which is the emblem of CMC -then on to the Terrace of the Leper King  -Elephant Terrace - Bayon - Ta Prohm where the trees and temple ruins have become as one then back to Angkor Wat
The following day was even better we travelled about 30kms in our tuck tuck through small villages past vivid green paddy fields and other crops its so interesting traveling in Cambodia especially by tuck tuck as you get the chance to see how people live their homes how they cook and spend their time as just every thing goes on outside.
As we neared the Kulen mountains the heavens opened up and the rain just poured but undeterred we donned our rain capes and set off on a 1050 m climb/walk over rocks and tree roots crossing precarious bridges and other obstacles to reach our destination of Kbal Spean.
Our goal being the 9 th century river bed carvings along a tributary of the Stung Kbal Spean which eventually finds its way into the Tonle sap river. These ancient carvings are just above a very attractive waterfall which for those brave enough to try it was accessible me and my pal took the view that we were wet enough as it was so declined the offer of our guide to sample the healing waters
We were however bowled over by the sight of these ancient stone carvings which included many lingus arranged in rows images of gods and animals as clear as the day they were carved.
The most impressive for me though was the 4 faced god of Brahma on a lotus North of the natural bridge.
A stunning place well worth the climb.

After a very good lunch our guide took us to my all time favourite temple Banteay Srei ( means woman's fortress ) It was so intricate made from sandstone and being beautifully restored I just loved this place it had much more of a spiritual feel to it than some of the larger temples 

Two young monks entering Angkor Wat temple

 

Angkor Wat one of the 4 basins of the cruciform cloister

Almost at the top of Kbal spean

Not the sun rise and a pity about the scaffolding but this is me in front of Angkor Wat temple

Reclining Vishnu in the stream just N of natural bridge ( note sun just come out )

 

Making History and other tales from Cambodia

Some of the Phnom Penh Provincial Council midwives being sworn in at the Council's official opening of its 22nd provincial office

Well dear blogger there is much to do here in Cambodia and not enough time to do it as reported in my last missive  my work at the Council is going well I have just completed an outline proposal for them in order to secure more resources to accelerate their progress towards achieving the regulation of Midwives in Cambodia. This is hugely important as the evidence shows that in countries where there are robust systems in place for regulating the profession then maternal and newborn mortality and morbidity rates improve.
There is not a week goes by now that there is not a horror story in the newspapers here of women dyeing for the want of skilled/ birth attendance and increasingly the public are going to the press with their concerns (note not the authorities!) about the behaviour or competence of midwives which on the one hand is terrible but on the other it is good  for pushing forward the case for registration and regulation.
Last week I had the pleasure of attending the launch of the Provincial Council for Phnom Penh so far the Council has opened 22 offices one in every province where all midwives will be expected to register it was held in PP's Municipal referral hospital I was told about it 10 minutes before it was due to start but as it was only around the corner from the office I got there on time.
Cambodians certainly know how to put on an occasion the hospital director was there ( a very stylish lady) and her deputy plus 45 invited guests from the district ie hospitals and health centres.
The event kicked off with the national anthem and then introductions I was asked to stand and got a round of applause!! my only regret was that as I didn't know in advance I didn't look particularly smart and would have liked to have taken the opportunity to wear my new sampot ( Cambodian Skirt) after introductions Ing Rada read out the Royal Decree which set up the Council and outlined its role and function after which the nominated midwives for the provincial Council were sworn in. Below are pictures of the event.

In the centre is Ms Ing Rada President of CMC on her right the hospital Director a Dr and on her left the deputy Director also a Dr.

  The Council has two further provincial offices to open and one regional office but has not the budget in this financial year so further delays CMC's progress in achieving full registration of all midwives even further so it seems more important than ever that our proposal to international donors is successful we are planning to meet with them in the near future.
These fantastic midwives had no idea that they were making history by pioneering regulation of midwives for Cambodia it was great to be a part of it
All efforts now are going into preparing the Councils executive team in presenting their case at the donor meeting  I want the international donors to see how committed these midwives are and that given more resources they will make a big difference although this will not be easy as money is tight.
Wish us luck!!!!
I have been busy on other work fronts too the informal health and related professionals network meetings are going well and gaining new members all the time we are now at 31 and I can see people making connections and we friendships are blossoming which is so important here we have had some very interesting  presentations and discussions so I hope that it will continue when I leave.
Also just written an article for Health Messenger which is a health magazine aimed at nurses and midwives at health centre level so a wide readership. It is unique in Cambodia and is produced in English and Khmer.
My article was about the attributes of a good midwife which of course included the clinical skills and competencies required but  also I tried to emphasise the personal/behavioural qualities including care, compassion and advocacy vital  components in my view and much in need of here.
I used as a case study one of the student midwives I have met at the valuing life clinic here in PP Theary is a second year student at University and is just the sort of role model for the future midwife Cambodia needs she is kind listens to the women understands their problems and talks to them as equals she gives me hope in the future
Talking of the clinic there was great excitement last Saturday as I took more of the equipment sent over from my old pals at the SHA and clinical skills network and pride of place was the haemacue (haemoglobin measurement machine) purchased using donations raised by my wonderful Vocal Expressions Ladies Choir of Holmfirth it was fantastic we tested every woman attending the ANC as it is so long since we have been able to rest their Hb every one had some degree of anaemia which is endemic in poor communities but can be a killer for pregnant women after delivery as even moderate bleeding with a depleted Hb can be disastrous.
One young woman had an Hb of 8.7g (normal 12-14g ) at 32 weeks she really needs urgent treatment so as you can see already the haemacue has been worth its weight in gold

Testing for anaemia

The wonderful haemacue

Lea Howie!!!
PS ALL photographs published by kind permission of the subjects

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

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