So sorry dear bloggers that it has been some time since I updated my blog I'm not sure where the time goes
Since my last post much has happened particularly on the work front hence the title of this blog. Up until now CMA has been very reluctant to tell me what it expects of me and how I can best help the senior team here.
Trying to analyse the reasons for this and find ways of overcoming the blocks has been exercising much of my ageing grey matter and occupying a lot of my thoughts and I have come to the conclusion that I have to ignore my in built paranoia and look at things from the perspective of these women in CMA
All are busy full time midwives working in local hospitals and clinics and now that I have visited a few more of these institutions I can well see their difficulties which include poor facilities and equipment far too many students to train and very poor pay (The head midwife in one hospital told me that her pay was less than $100 per month about £75)many like this lady are the sole breadwinners and therefore take on private patients as well as their government jobs
Most of the exec team and a few more experienced midwives from Phnom Penh undertake supervision and teaching visits to midwives and clinics in referal hospitals all over Cambodia there are 24 Provinces in total and CMA went to 8 last year and intend to go to the remaining 16 in 2011 This is a massive undertaking given that there is no infrastructure support to help them organise these trips which they fund themselves and then get back (eventually ) from the MoH so to have someone like me come along with loads of bright ideas there is no which they have no capacity to take on its no wonder they have given me a wide berth (excuse the pun!) but following a seminal meeting things are taking a turn for the better and I am to accompany the teams on their provincial visits and that will enable me to do some work with the branch leaders.
I have also got agreement to work with branch leaders on rewriting the constitution for CMA in return I have agreed to do a funding proposal to send to our health development partner NGO's and any one else I can think of to ask if they are able to support CMA financially over the next few years.
In addition through making contact with midwives working for WHO I went to work [yes bloggers you read it correctly actually do hands on work] in a clinic run by a christian charity in one of the poor districts of PP It is held mainly for ANC and a baby clinic but they also seemed to get a collection of other conditions turning up including a lady with a sprained ankle and a nail in a foot so despite my limited indeed rusty clinical skills I was able to take B?P's test urine and generally help the staff there. I have to say it is the most useful I have felt since arriving in Cambodia and therefore want to return on a regular basis and they want me to go back too!!!!!
So am busy updating my clinical skills
They rely totally on donations of equipment to stock the clinic they always need clinical gloves syringes needles hand gel common medicines used in pregnancy and for new babies and so on so I may well be calling in a few favours from all my old pals working in NHS hospitals.
they also need baby and toddler clothes many of the babies and children coming to the clinic had no clothes on it was very sad to see but the place was so happy and cheerful despite the hardship and conditions it was wonderful to be a part of.
The clinic is free to the patients who use it and the charity also can help the very poor meet hospital expenses when they have their babies it also gives contraceptive advice so all in all a very comprehensive service.
Socially I gave a dinner party for four /five if you include John who turned up just in time for pudding not easy though when you only have 4 plates but it went well and every one seemed to enjoy it Gilly and Sam were the guests of honour as they had to come down from Kratie as Gilly had fallen and managed to break two fingers including one with a dislocation too so poor her I hope she is on the mend.
My social secretary Chris is on holiday at the moment with her family so my social calendar is a bit quiet i have had a couple of meals out with friends and got a busy weekend planned as I am going to a TED event on Saturday so that will be something to tell you all about next week
Take care all
Lea howee
Kath
Sunday, 30 January 2011
Wednesday, 12 January 2011
Me and My Big Mouth
Well dear bloggers I tempted providence in my last blog and was not let down since bragging about how to stay safe and well in Phnom Penh I have had
3 very nasty mossie bites on my leg it seems the little bugg....s can read as well as spot rich pickings at 50 paces....
I broke a tooth and have had to have some very expensive dental work done....
Had a tummy bug the details of which you would not wish me to share.....
and now to cap it all off have got the worst cold I've had for years with violent sneezing fit to blow my head off and a very tight chest so just hoping that doesn't progress into any thing worse so a great way to start the New Year and a lesson in how not to brag in future.
Well since we last spoke the weather here has been a little cooler on the whole it has been very pleasant especially walking down by the river where there has been a breeze most times temperatures I would say averaging 28oC we have not had any rain since the 16th of December and its unlikely now to see any more before Sept The temperatures will start rising after February and I've been told to brace myself as once April comes the temp will rocket into high 30's I can feel a trip to Ratank kiri coming on by then.
We have just had two more public holidays the one we shared for New Year and last Friday January 7th was "Victory Over Genocide Day " This was the day that the notorious Khmer Rouge regime was overthrown In the papers reports about this event seem very divided should the date be celebrated or not ? as there is a view that it just marked the invasion of Cambodia by yet another country Viet Nam. but no one disputes that to be rid of the KR and putting an end to the genocide was a great step forward for Cambodia.
Since December when we had CMA's annual conference not much has been happening on the work front write ups have been completed on the event and I am waiting for our President to organise an exec meeting so that we can agree how to take members views forward into the future. Since then I have attended a few interesting meetings one called the 'Quality Improvement Working Group' Now where have I heard that before ?that meeting was in K'mai so I struggled a bit there although the power point presentations were in English so that was OK and another involving NGO's in health which was extremely interesting as they were talking about things like workforce planning and strengthening education I thought I'd died and gone to heaven!!!!! somethings just come back to haunt a body
I do wish sometimes though that I had trained to be a plumber I would be far more use to this country is it too late to train do you think?
At the weekend going to have my hair done always a very stressful experience here last time my hair was coloured I asked for light brown and got vivid almost fluorescent red!!!! they had to pick me up off the floor Carmen my hairdresser at home would have had a dicky fit but its all part of the fun
Next week I'll tell you about Cambodian food Oh on the subject of food I managed to find some weighing scales in a chemist last week I have lost about 22llbs!!! beats weight watchers any day
Kath
PS Thought that I would post some pictures of Christmas here in PP
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| Sunset over PP on Christmas Day magical! |
3 very nasty mossie bites on my leg it seems the little bugg....s can read as well as spot rich pickings at 50 paces....
I broke a tooth and have had to have some very expensive dental work done....
Had a tummy bug the details of which you would not wish me to share.....
and now to cap it all off have got the worst cold I've had for years with violent sneezing fit to blow my head off and a very tight chest so just hoping that doesn't progress into any thing worse so a great way to start the New Year and a lesson in how not to brag in future.
Well since we last spoke the weather here has been a little cooler on the whole it has been very pleasant especially walking down by the river where there has been a breeze most times temperatures I would say averaging 28oC we have not had any rain since the 16th of December and its unlikely now to see any more before Sept The temperatures will start rising after February and I've been told to brace myself as once April comes the temp will rocket into high 30's I can feel a trip to Ratank kiri coming on by then.
We have just had two more public holidays the one we shared for New Year and last Friday January 7th was "Victory Over Genocide Day " This was the day that the notorious Khmer Rouge regime was overthrown In the papers reports about this event seem very divided should the date be celebrated or not ? as there is a view that it just marked the invasion of Cambodia by yet another country Viet Nam. but no one disputes that to be rid of the KR and putting an end to the genocide was a great step forward for Cambodia.
Since December when we had CMA's annual conference not much has been happening on the work front write ups have been completed on the event and I am waiting for our President to organise an exec meeting so that we can agree how to take members views forward into the future. Since then I have attended a few interesting meetings one called the 'Quality Improvement Working Group' Now where have I heard that before ?that meeting was in K'mai so I struggled a bit there although the power point presentations were in English so that was OK and another involving NGO's in health which was extremely interesting as they were talking about things like workforce planning and strengthening education I thought I'd died and gone to heaven!!!!! somethings just come back to haunt a body
I do wish sometimes though that I had trained to be a plumber I would be far more use to this country is it too late to train do you think?
At the weekend going to have my hair done always a very stressful experience here last time my hair was coloured I asked for light brown and got vivid almost fluorescent red!!!! they had to pick me up off the floor Carmen my hairdresser at home would have had a dicky fit but its all part of the fun
Next week I'll tell you about Cambodian food Oh on the subject of food I managed to find some weighing scales in a chemist last week I have lost about 22llbs!!! beats weight watchers any day
Kath
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| Here are some fellow volunteers at the Khmer Surin for Christmas Lunch |
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| Christmas morning at Chris's house just before opening my presents thanks again to my old SHA buddies and Denise / Vicky whose parcels made it through |
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| Dressed to the nines Anna Chris and myself setting off in our tuk tuk for Christmas lunch |
Tuesday, 28 December 2010
Keeping safe and well in Phnom Penh
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| Get the picture |
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| Some of the traffic dangers!! |
Firstly road safety a contradiction in terms here there is NO ROAD SAFETY it is a nightmare out there no one obeys any rules and where there has been an attempt to bring order like installing traffic lights they just seem to add to the chaos as some people adhere to them others don't so for the poor pedestrian like me you are left wondering what the heck to do and which way to go and if heaven for fend there is a policeman trying to direct traffic then forget it the chaos is tripled go home to bed is my advice.So my strategy for surviving PP traffic is
1. get yourself a trusty motto driver I have and he is wonderful and navigates these streets with skill we have had some near misses though
2.get yourself a local tuk tuk driver I have 2 they are great and get to know your regular haunts so getting lost is not such a regular habit no cabbies street tests here!!!!
3.When out walking never step on a manhole cover two of my pals have come a cropper doing that one ended up on crutches
4.Don't get distracted by what you see on the road and what is being carried on a motto my record sighting is 6 monks and yesterday I saw one motto carrying a double bed and two chairs but not to be outdone my friend said that she once saw a house being carried on a motto [me thinks she had one too many cocktails that day!]
5 I still cannot get over seeing babies and toddlers being held in one hand whilst their mums drive with the other with vehicles of all types including the Lexus menace coming at them from all angles it is amazing that there are not more accidents but not surprising that deaths from RTA's are rising here
6 By and large when crossing the road its a case of "He who dares wins" once committed then you have to keep going a hesitation confuses the Cambodians that's when disaster strikes as they tend to miss a moving target but stop suddenly and it can be curtains!!!
Next avoiding getting ill in particular getting bitten by the old mossies There is no Malaria in PP so I have stopped taking anti Malarials they are now just taken when visiting out in the Provinces but Dengue Fever is prevalent and to be avoided it is a nasty illness and spread by the day mossies I have pals who have had this illness and it is not nice at all so as they say prevention is better than cure every morning and any other time I am going out the old deet insect repellent has to go on this is now a part of my ablutions as washing my face not as pleasant though no perfume either as I don't want to attract the little blighters so all in all perfume less deodorant and constantly smelling of deet mossies are not the only thing being repelled!!!It also leaves an altogether very unflattering sheen on the skin not a good look in the mature woman.
I have had one or two nasty bites but of late they have not been too bad but just wait till the hot season......
Tummy bugs avoiding these is more tricky my hands are raw from washing and constant application of hand gel I have almost turned vegetarian too and only eat meat/fish in trusted places some of the best places to eat are veggie and cheap too we are advised to take worming pills every 3 months not done that yet so must sort that out!I never eat from street vendors although the food looks and smells good in the evenings here pavements come alive as street vendors just set out plastic chairs and tables and start cooking its amazing to see really.
At home it is a constant battle of wits between me and the ants they are cunning little devils and just appear from no where at the first splash of orange juice or grain of sugar I made the fatal mistake of not closing the lid of my muesli box the day I was going off to Mondulkiri for 4 days when I came back my shelves with all the dry good boxes were awash with black ants they were having a field day it was like something out of a Tom and Jerry cartoon as when I started throwing things away they formed an orderly line and marched up the wall and disappeared through the ceiling amazing.
A trip to the market for fresh fruit/veg is a task and a half as on return I wash and scrub every thing first with tap water then dry it and wrap and store in the fridge every thing that is except bananas they are kept on the shelf and the ants don't seem to bother them somehow [Why is that?] when I come to use the fruit and veg they get washed again in fresh/filtered water so it is quite a performance but at least I have running water and electricity[ most of the time].
I have pals who don't have these amenities these are the real heroes but they do have fresh air something that is in short supply in PP so can't wait to get out and see more of the countryside.
Kath
Monday, 27 December 2010
Meeting Midwives and a Mouse in My Mop!!!
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| 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 |
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
Wednesday, 22 December 2010
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
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
Sunday, 19 December 2010
A Khmer Wedding
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| 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] |
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| Traditional Khmer wedding attire made from beautiful Cambodian silk |
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.
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| This is Pros and Sochivy accepting their blessings |
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.
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| My new wedding outfit which will come in very handy for all other formal occasions |
Tuesday, 30 November 2010
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
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
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