Meeting Midwives and a Mouse in My Mop!!!

As I have been talking about midwives quite a lot in this blog I thought that I would include this image from Angkor Watt of a woman giving birth

The last two weeks or so have been quite busy for me at work which made a great change as on the 16th and 17th of December it was CMA's annual conference for branch leaders and at least one member from each of the 24 Provinces plus some midwives working in NGO's and the training centres.
Before that though on the 15th I experienced my first executive team meeting. As the President had been in Brazil on a 3 week study tour I had asked her before she left if I should prepare the agenda for her which after a little thought she agreed to.
The meeting was scheduled for the whole day which I thought perhaps a little excessive however not so in the event it finished at almost 6pm having started at 8 which puts some of the SHA executive meetings in the shade!!The executive team are new they like the President were appointed in May and have only met once before.This I took into consideration whilst preparing the agenda which I did in English it was then  translated into K'mai very ably by my VA there were 4 accompanying papers all of which were colour coded to the items on the agenda and each member was given a pack as I knew that I would not have time to go through every thing with the President beforehand.
The only problem was no one followed the agenda despite lasting for 9 hours only half the items were covered. I learned a very valuable lesson that day and also got some great material for my future capacity building.
The executive team of 8 midwives though were very warm and friendly women who despite the language barrier did their best to make me feel welcome most were about my vintage several had quite good English and wanted to practice on me whilst I tried valiantly but not very successfully to speak in K'mai but as my VA tells me if I don't practice I will never get better
Despite only completing the conference agenda at 6pm on the night before the conference itself went really well and I got to meet midwives from all over Cambodia my presentation on why CMA is so important for Cambodia seemed to go down well and I did a little interactive session at the end of day one to help prepare them for the workshop on day two when we wanted their views ideas and opinions on what CMA can do to become stronger.
I had been warned that there could be some reticence in coming forward with ideas and views not so for Cambodia's midwives they came up with some excellent suggestions most I have to say accord with my own which made me feel a whole lot better and we now have a clear mandate in order to move forward.
Now all of this has to be translated for me and put into some kind of future plan which is great. at last I felt that I had been useful.
The President seemed very pleased with how things went as it was her first formal event it was important that it was a success she and her team did a great job in my view but it was a bit close to the wire for me but again perhaps I can help with that in future.
Since then I have been putting together CMA's annual report/Newsletter the first for some time and also I have been trying my best to network having visited colleagues in WHO/UNICEF/ UNFPA and NMMP whose advice has been very helpful.
So what else has happened well I was mugged (not literally) by a one legged monk! yes that's right I was in my street when I was approached by an elderly one legged monk who asked me for money in exchange for a bracelet made from wooden beads what does a well brought up girl do but pay up!! not convinced he was a bonefide monk though so will keep an eye out for him in future
The other big excitement was I have had a mouse take up residence in my mop which is a very fluffy affair and I dare say a big attraction to rodents mind you it got more of a shock than I did when it got tipped out onto my floor and was then chased by this mad woman all around the apartment until I had the wit to open the balcony door through which it fled for dear life straight over the balcony. I haven't seen it since!!!!!
So its all go in PP Christmas was much better than I thought it would be I really enjoyed the simplicity of it all just being with friends exchanging small gifts having a meal together (although no turkey)was enough the only sadness was not being with Sal and David but we did see each other on Christmas Day albeit through a grainy skpe screen.
On Friday I hope to be going to Kampong Speu with one of the midwives to do a training session on either "Free movement in labour" or "Family Planning" not quite sure which so will report back soon
HAPPY NEW YEAR EVERYONE
Kath

Happy Khmer Christmas

How could I let this time of year go past without wishing all my blogging buddies a very happy Khmer Christmas I will try not to gloat as I apply the sun [and mossie cream so no where is perfect]and .
As Christmas Day is on a Saturday my fellow volunteers  and I do not have to use any annual leave to enjoy a Khmer Christmas.
Plans for the day so far:-
At about 8 with my pal Chris and a bucks fizz or two
12 00 Lunch at Khmer Surin with 12 or so other volunteers
1600 A river boat trip up the Mekong [Tonley Sap] to watch sunset
2100 SYKPE David and Sally celebrate with a drink or too
Hope my liver is up to all this!!
Thanks to every one who has sent me cards real and electronic and pressies particularly my old buddies at Y&H SHA who have pulled out all the stops to send me some Christmas cheer and I have to say they are the only parcels to make it through so far so at least I will have some thing from Father Christmas to open on Christmas morning Bless you especially Kim who organised it all and in the midst of yet another NHS reorganisation will we never learn!!!.
Special love and good wishes to Kath and Heather I am thinking of you both
Thank you to every one who is being so kind to David and Sal in my absence they are both still so supportive even though it is hard for them and I am really looking forward to seeing them in February.
I really hope that you all have a very Happy Christmas and New Year
See you in 2011 keep tuning in
Kath  

A Khmer Wedding

This is a picture of the modern part of the wedding which took place in the evening complete with banquet music and dancing [ALL PICTURES PUBLISHED ARE WITH KIND PERMISSION OF THE BRIDE AND GROOM] 





Traditional Khmer wedding attire made from beautiful Cambodian silk

Hello to all my blogging friends
I will just update you on the weather forecast here in Cambodia it is 32oC and the sun is burning t'thack off as we say in Yorkshire or some such thing as I go about my daily chores I still have sweat dripping off my nose [not a good look I grant you] but I have to say infinitely preferable to being thigh deep in snow and ice so my commiserations to all of you who have to brave the M1 and M62 and every other road by the sounds of things to get to work and other such pleasures. They say timing is every thing and I have to say my timing in taking my gap year so far has been brilliant.
A couple of weeks ago I got my first invitation to a Khmer wedding it is wedding season at the moment in Cambodia and they are taking place all over the city As is customary in our country there is a formal part to Khmer weddings and less formal parts with dancing taking a prominent role.

This is Pros and Sochivy accepting their blessings

The wedding was of a work colleague Pros and his very beautiful bride Sochivy they had a combined traditional and modern wedding. The weddings in Cambodia are very colourful and joyous affairs in the traditional part which usually takes place in the morning the two families meet up and gifts are brought and this is the time that wedding rings are exchanged and specific songs are sung. After that monks offer blessings to the couple after which a hair cutting ceremony takes place. This is only symbolic nowadays but it represents the couple preparing to make a fresh start in a life together family and friends all take part in this bit of the ceremony and again songs are sung afterwards. This is followed by a pairing ceremony where the bride and groom have their right and left wrists respectively tied with blessing strings and they receive praises from their well wishers for happiness good health and success followed once again by 4 songs this time.
After the traditional part of the wedding is over a party is held and my case I was treated to a veritable feast ne banquet at least 7 course I stopped counting after 5! it was fantastic
I was sat at a round table of 10 people all of whom were friendly and kind and I tried out my faltering K'mai to my delight and relief I found that I was sitting next to a lady who had studied accounting in the UK in the 1990's for a year so her English was very good and she explained every thing to me.
During the banquet people kept arriving throughout the evening and just got fed as they arrived during which time the bride and groom and parents welcomed new arrivals
During the entire evening they must have changed their clothes 4/5 times and for one of her out fits the bride wore a very beautiful white gown. Indeed all her clothes were stunning but my favourites were the Cambodian silk traditional dresses just amazing.

My new wedding outfit which will come in very handy for all other formal occasions

Of course getting this invitation gave me a dilemma one familiar to my husband 'I don't have a thing to where!' So to remedy this I hot footed it to the Russian market and ordered a very nice made to measure traditional Khmer number pure silk I hope that you like it here I am just before I set off for the wedding.

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"