Chris is working in the Hospital.

I am currently working with Angela at Stung Treng Referral Hospital on an Infection Control Project funded from VSO.

 

Blocked wash basin and general mess in Maternity toilets.

 

Three main areas have been identified for attention and improvement within the hospital:

·         Ward Cleaning.

·         Ward waste disposal.

·         Hand Hygiene.

 Typical wash basin in the hospital toilets. Tap broken and water turned off.

At present, these areas have very poor compliance with the Infection Control guidelines due to many reasons including:

·         Lack of regular training of both cleaners and health staff.

·         Lack of equipment to facilitate cleaning, waste disposal and hand hygiene –no clean mops, buckets, soap, towels and bins etc.

·         Taps, sinks and drains are in place. Due to lack of maintenance, responsibility and abuse, the taps and plugs are broken and the waste pipes blocked. The sinks presently are unusable.

·         Lack of understanding of basic principles of cleanliness in the ward toilet environment.

·         Cleaners are poorly paid, have little equipment and poor facilities to do the job therefore are likely to be demoralized and stop trying.

The Lead person for infection control has plans to commence training of hospital cleaners and is aware that implementation and compliance will, at present, be severely affected due to lack of facilities and equipment.

Objectives of the project are:

·         To inform ward managers and all ward staff of their responsibility for the cleanliness of the ward.

·         To support the training of all hospital cleaners in the basic principles of ward hygiene and waste bin usage.

·         To support the training of all staff in basic hand hygiene and waste bin usage.

·         To provide equipment for the implementation of the ward cleaning and waste training.

·         To provide equipment for the implementation of correct hand hygiene.

·         To provide tools and basic equipment to facilitate the maintenance of the sinks and taps in the ward and toilet area.

·         To improve the working environment of the cleaners which will lead to a measurable improvement in ward hygiene.

                        

So where do I come in?

 Pic of wash basin before repairs

 

 Same wash basin repaired with new tap and waste trap on basin outlet.

Water turned back on and ready for use.

The original Infection Control Bid identified the need to mend the wash basins to enable better hand washing and hygiene. However, when a detailed assessment was carried out to identify what was required to mend the sinks it soon became apparent that the majority of wash basins, toilets and wash areas in the hospital were broken beyond repair with taps and wastepipes corroded and broken.

 Scrub sink outside the Medical ward. Tap broken,water turned off and waste outlet disconnected. Yes and full of rubbish.

Same srub sink repaired and in use- new tap,waste pipe beneath sink repaired and connected.

 



Consequently the funding for sink repair was grossly underestimated. Therefore, the teaching of both hand hygiene and ward cleaning was not possible unless the sinks were repaired.

Further investigation revealed that the reason all sinks were broken and blocked was that patients relatives who have to prepare food for the patients, wash pans and dishes in the hand basins and toilets as no alternative place is available. The sinks and toilets are then blocked with rice, fish bones, vegetable matter etc.

 This wash basin had been repaired but a day later is blocked with rice from the patients relatives pans.

Objectives:

·         To provide a low maintenance practical solution for washing dishes and clothes which stops relatives using the ward sinks.

·         To mend all the taps, toilets and wash areas with the involvement of the maintenance man.

 The Hospital maintenance man pondering Life, the Universe and a redundant sanitary fitting.

I volunteered to help repair the wash basins, taps and other sanitary fittings and equipment. With the hospital maintenance man and Porm, a VSO Volunteer assistant, who had hours to spare awaiting a new Volunteers arrival, we started work at the end of August 2012.

 The Team.Service with a smile ( Well from two of us!) No job is too large, or too small. Chris, Mr Krong and Porm with the nice pink gloves.

The original intention was to dismantle, clean and refit a lot of fittings e.g. waste traps under the wash basins but it soon became apparent that this wouldn’t work. The waste traps were corroded to the extent that the force to unscrew them smashed the fitting. So, from then on it became; remove and replace with new which should ensure a few years of survivability.

 

Waste trap under wash basin come to the end of its working life. The scrap bin looms.

 

 

Yes, it is dirty and sometimes smelly work but I have found it enjoyable; why?

There is an obvious practical sense of achievement approaching a dirty, blocked hand basin with a broken tap and leaving a clean(er) working wash basin and tap in the afternoon. Also, most of my time in Cambodia to this point has been spent working in an office so it was great to escape the four walls.

 

The end of a dirty working day . Note Hospital dog going home after a shift lying in the office corridor.

 

However a greater joy to me has been working with the young Cambodian Porm. He is very practical and has a positive sunny attitude and he appreciates the fact that I give my time and effort freely to help ordinary Cambodian people.

I will never forget some conversations:

Porm: Ohhh Chris! Big problem! we have big problem Chris!

Chris: What? I can’t see Porm; you are in the way, what is the big problem?

Porm: Chris! Do not worry, we have a solution, we will fix it, do not worry!

 

Porm repositioning brackets for new wash basin. We had to borrow the drill.

 

Also, being in the hospital everyday on the wards has been an experience in Cultural exchanges. Stung Treng Referral hospital has a large catchment area which includes a large proportion of poor village people with little income. With every patient admitted there could be five family members who stay around the patient’s bed to care for the patient the whole time they need to be in hospital.

When I enter the Maternity area there could be 15 Cambodians sitting around with nothing much to do. As we start work on a wash basin I hear the word Barang spoken a few times. When I turn around there will be typically three Cambodian men staring at me, unblinking:

 It's a hard life - but not for this Cambodian. He is watching us repair a wash basin, so is the man at the door- assuming the Universal I'm very relaxed watching you work pose.

Chris: Porm, what do these men want?

Porm: Nothing Chris.

Chris: Why do they stand here staring at us?

(Porm: No answer, he doesn’t recognize the question, it is usual for Cambodians to stand and look.)

I guess most Cambodians in the hospital are wondering why an old(ish) white foreigner is getting his (gloved ) hands dirty fixing the hospital wash basin, taps and toilets, But why not?

So currently we are still finding more wash basins that haven’t been used for months because of, typically, a broken tap.

 

Also we need to create alternative pot and clothes washing areas so the hand washing sinks are not blocked again with rice, fish bones etc as the relatives presently wash the cooking pots in the hand washing basins.

 

Previously repaired wash basin now blocked with rice. We also had printed the sign you see saying hand washing only.

 

Probably this requires a concrete hard standing with drain and water from a stand pipe in the hospital grounds.

These are the big tasks for the next few weeks; incidentally Porm is no longer helping as his new Volunteer has arrived in Stung Treng. Porm is now assisting at a local NGO in the livelihoods programme.

Also, we will provide training and tools for the maintenance staff so they can carry out the maintenance work in the future.

 This is a tricky problem we tackled- water leaking out of the wall, Mr Krong is chopping out the wall around the pipe to see if the pipe fittings are leaking. The reception area of the Maternity was constantly pooled in water.

Same problem ,we are chasing the leak back along the pipe to see what the problem is.

 

It may be basic practical work but there is much to be learnt and gained from living and working with another culture in the Volunteer setting. I enjoy it.

 

Children's Playground

 

Another challenge if I have the time, the children's playground outside the children's ward.

So still a lot of work to do and it will keep me occupied until I leave.

I am still teaching English Language classes as well, but not in my pink marigold's.