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

  

A Toad in the Toilet

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

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

Boeng Yeak Laom Banlung Cambodia

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

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