Hygiene, Human Rights and HIV

As part of my VSO work, I have recently been preparing a bid for some funding to improve the general hygiene of both the staff and the hospital environment. As part of this project, I’m preparing some before and, hopefully, after photos which are proving interesting. Maybe, I will hold a competition for which ward has the dirtiest sink? Winner gets a bottle of bleach?

Ward sink ready for use?!

 Another example of the present state of the ward sinks.

Ideally, these will improve when we get some clean mops, detergent, bins, towels and soap. I’m also trying to get tools for Chris to have a go at mending the sinks. Lucky chap!

Sink has been used for mopping but is blocked- can you unblock it Chris?

 On our way back from taking photos my new VA Thol spotted a bed under the hospital which we then realised had a patient in it:

HIV patient placed under the hospital - because he smells.

We enquired about this and were told that the patient had HIV/Aids and had a very bad smell and no wife (as she divorced him) to care for him so they put him away from the other patients under the hospital, next to a building site and general thoroughfare. We asked at the ward managers meeting was there not somewhere better, as the poor patient care reflected badly on the hospital never mind the lack of basic human rights: privacy dignity etc. There are no single rooms and it was felt this was the only place.

An improvement of sorts- screens now placed around the bed.

Note this photo taken from the public walkway.

The ward staff did then move the bed to a slightly cleaner area and did put screens around him but he was still outside, under the hospital. I bought some water to wash his face and dripped water into his mouth. This felt woefully inadequate as he needed a bed bath, change of clothes, clean sheets, comfortable bed, lip salve etc. etc. etc. But there were no clothes, sheets, water etc. A woman paid for by YWAM, a Christian organisation, helped give care as he had no family, (the usual care givers in hospital) but there was little she could do at this stage in his health deterioration.

By then he was semiconscious and thankfully died that night, no doubt alone apart from the creatures that roam under the hospital.  Just when you think you have seen it all the lack of care, dignity and privacy continues to shock at times. 

YWAM are just finishing the building of a small ward for HIV patients at the hospital which has white, clean tiles, fans and toilets so hopefully this will be the last poor soul to die like this at least here in Stung Treng hospital.

The Fantastic, lovely new ward ready for it's first patients- even the old beds have been given a coat of paint.

Cambodia has an accepted culture of men going to bars and being ‘entertained’ by ‘beer girls’ –this is where they catch HIV. Many NGOs are working with the government to change this culture but it is still very acceptable behaviour at present.

Kangaroo Mother Care

This is a brief insight into my ongoing work in Stung Treng and is typical of the  work I have come out to Cambodia to do:

I was asked by the Stung Treng lead for Maternal and Children’s health to run a workshop for midwives. After some discussion I decided on three topics which may make a difference, decreasing the number of babies who die at birth or in the first few days of their lives. The neonatal death rate in Cambodia is 22 babies per 1000, in Western countries it is 3 babies per 1000.

I wanted the day to be very interactive and participatory with all attending midwives joining in rather than me standing at the front just teaching. This was the first of many challenges as the midwives are used to being told things, not asked questions or asked to do anything.

I called the day Helping Babies Live and this topic was split into three parts:

The first was a regular skill drill covering resuscitating a newborn baby. After a demonstration every midwife was able to practice the skill drill of resuscitation and when confident could do a test with either of two senior midwives who helped facilitate.

Part two was practicing the daily neonatal check which we did in groups of three as a role play, again with the more senior midwives showing the way first, then everyone taking a turn.

Finally we had a quick question and answer session in two groups about Kangaroo Mother Care (KMC).

KMC has now been fully recommended for healthy premature babies as being 41% more successful than babies being cared for in an incubator. The 2012 report Born Too Soon by World Health Organisation (WHO), and others promotes KMC over incubators.

In my work so far I have had little success in persuading midwives and mums to use KMC, so at the study day we did a game looking at the barriers to KMC and what we could do to overcome them.

I brought the workshop to a close; the day went well with midwives seeming to enjoy the participatory style.

The next day on the Labour ward was extremely busy and included care of a young sixteen year old brought in from home with a retained placenta and bleeding. As the hospital midwife competently removed the placenta, I looked and saw it was very small and asked where the baby was and how big it was. At that moment the Dad arrived by motorbike with the baby wrapped up in a blanket, the baby weighed 1.4 Kg (3.1lbs) and was cold and grunting. The midwives who speak little English looked at the baby and said - Kangaroo Mother Care and proceeded to explain this to the parents.

Twenty Four hours later he is still lying on Mums chest and his breathing is normal. He has had two hourly tiny amounts of colostrum expressed from Mum and this afternoon he suckled for three minutes at the breast. His parents are both young and very keen to help him live. Dad has already had a go at KMC too, whilst Mum had a shower and rest.

 In England being a healthy premature baby at 1.4 kg, he would most likely live and become a healthy child. In Cambodia who knows? But I think the midwives and parents greatly increased his chances of survival by practicing KMC.

  Update Monday 11^th June.

Before leaving for a weekend in Phnom Penh I sat with one of the midwives, as she again talked the parents through the principles and positive benefits of KMC: warmth, less infection risk, and frequent breast feeds. Three days later, on arriving back from Phnom Penh, I found the parents had taken the baby home, still doing KMC. The baby had been mostly breast fed with a few breast milk top-ups by spoon. He still has a long way to go, but so far so good.

Right, now, what's my next challenge.......?

Sponge and custard

Friday 1^st June was International/Cambodia Children Day and a public holiday for us. We decided to visit the Childrenville orphanage where Chris is involved, another of our quite regular visits.

Last time we were there, we took a Jigsaw of the British Isles for the children to complete and during putting it together we were talking about British food. Angela was explaining the dessert sponge and custard and promised to make it on a future visit.

So to celebrate Children’s day we decided to make and serve sponge and custard. We bought the basic ingredients on Stung Treng market and bought pieces of cake at the bakers shop on the way to the ferry across to Thala Barivat. The ferries don’t run to a timetable, they leave when they are more or less full or when the driver wakes up. This time we patiently waited maybe one hour before making the 10 minute crossing.

At the Bakers in Stung Treng

There are now 20 children at the orphanage, four children from the same family having recently come to stay permanently.

Making Leggo people . Donated by our friends Pauline and Graham.

 As usual the children were happy to see us and after an hour or so of playing games Angela started to make the custard.

The person in the cap is Sebastian a short term Volunteer from Germany.

The older ones were very interested to watch the basic ingredients blend into the finished custard.

Separating the eggs etc

Quickly the cake was cut, put into dishes, custard on top and the children all sat at the table and ate every last drop and crumb.

In the kitchen, custard under way.

 They loved it. Typically they never hung around to talk about it- each one picked up their dish and spoon and carried them around the back of the building to the washing area.

Don't talk to me I'm busy!!!

We were surprised that all the children from the smallest up took part in the tidying and cleaning up from the meal.

Looking good, almost there!

Then they went to play one of their games which involved no expensive equipment just needed some lines drawing in the sand with a stick. When they got bored of that game, a short rest then another game this time with a plastic bottle partly filled with sand. This was thrown, retrieved by one, whilst the others hid and tried to overrun the base with the bottle on it.

Playing a game with lines drawn in the sand

I have given one of the older boys a copy of Treasure Island to read and he is using it to practice his English language. We talk about the story and how far he has got and he asks about words he cannot understand e.g. oilcloth, earshot, I understood when he told me about Jim saying goodbye to his mother and leaving the Inn where he had lived all his life. I demonstrated Fifteen men on a dead mans chest should be sung with gusto!

At the table

We left mid afternoon having enjoyed their company.

Typical Cambodian camera posing!

 The return journey involved two hours of waiting for the ferry in the rain; we are told it doesn’t sail during the monsoon rain which happens every day at this time of the year.

The ferry jetty in Stung Treng viewed from the beer table.

We arrived back in Stung Treng town at 5pm and finished with a can of Angkor Beer or two sat at a table by the river watching the sun set.

Sun in my eyes! Note ice and straw with the beer.