Health and Safety and Risk -Alien Concepts for Cambodians

There are some extremely high risk activities in Stung Treng which the locals see as part of everyday life such as:

• 28 people crammed into an old minibus with 12 seats (plus boxes chickens furniture etc.)
• 4 very drunk lads going home in the black darkness, on potholed streets, all on the same motorbike
• Children swimming in the Mekong river which is the main sewer never mind the added risk of Bilharzia

Have a look at the following photos and imagine what would happen in England! EU regulations eat your heart out!

Motorbike Safety?

Having survived one of the greatest risks of all,that of being born. you then face a journey home from hospital on the back of a motorbike. Dad is driving in the front with all the luggage including the bed role on his lap. New mum with wool hat on of course is riding side saddle in the middle while grandma is managing to balance on the back with the baby in her arms. They ride away without a care over rough roads full of pot-holes.

Where to start! None of the three have helmets on. The child in the middle has an IVI drip up which  his sister on the back is helpfully holding up. The young woman driving has flip-flops on. Sadly as the roads are improved there is a growing trend for serious motorbike accidents. Mainly young men riding too fast often after drinking beer or whiskey. As they have no helmet and no safety gear they often don't survive. These deaths are reported every Monday morning at the hospital management meeting I attend. It is the law to wear a helmet but everyone says you don't need to bother after 11am as the police will have gone home for the day  - missed the point entirely.

Again a very young child with an IVI drip up which dad has hung up in the tree while the child plays on the slide. It is easy to send a child into heart failure and even death by over infusing him with IV fluids - in Europe its normal to control the rate by using a failsafe drip counter machine which prevents over infusion. Here children are all over town with various drips up running at various uncontrolled rates.

Men at Work?

This is a gem mine. The hole is about half a metre wide and there are foot holes in the sides to help you climb down about 5metres before crawling along horizontally to the gem seam. When you have finished with this hole you just walk away from it and dig another leaving the old one as a trap for unsuspecting folk to fall down.

This is one of our assistants in our office sawing a piece of metal pipe. Note his bare foot and hand  holding the pipe while the hacksaw skids about over the pipe,all balancing on the edge of the desk. The following week, at home,  he drove a screw driver into his hand down to the bones -he then had to get it sutured with no anesthetic as usual.

The two boys driving the Road roller are about 12 years old. The traffic dodges around it while it rolls up and down the road outside the cafe we were at.

Building scaffolding Cambodian style -I wonder if he will put safety end boards and  grab rails around it?

Scary Creatures:

This buffalo and her calf have just been chased out of the hospital again. It seems to be her favourite place and you often meet them roaming along the hospital covered walkways -you need to be very careful not to come between her and her calf -she has rather large horns.

I like to think our house is fairly safe but these two were some of the residents. The  spider is about 12cm across and bites. The scorpion was found in the clothes washing bowl. Chris bravely got rid of both. We also have rats or birds in the roof space and lizards everywhere -kitchen bedroom etc. but they aren't really scary.

Children at play

Depending on your point of view these boys are either just enjoying themselves on a hot day or are risking their lives climbing up a slippy rockface and jumping into a rocky pool at the foot of a waterfall.

Travelling Safely?

This is our bus. The front tire had a complete blowout - see shredded tyre in foreground. But not to worry they soon  fitted the spare which has not even 1mm of tread on it -completely smooth -perfect for the poor roads?

This is the runway and helicopter landing pad. Luckily planes are rare

If you do have an accident you then have to weigh-up whether it's safer to just go home and consult the local medicine man or to admit yourself to the Health Centre above or to be carried on the back of a motorbike for 2hours on a rough road to the hospital- difficult decision.

Lawnmower engine V the Mighty Mekong

We have visited the Khone Falls area, on and above the Cambodian/Laos border, twice; once in the Wet season and again in the Dry season and what a contrast in the scenery.

 

 

Say Cheese!!!! (happy cow cheese)

We went up to the falls in a small boat in August 2011 during the Wet season. The Mekong was in flood with water pouring down from Laos and the boat’s engine wasn’t strong enough to overpower the river current and make positive headway, at times we were moving backwards.

When I say engine we are not talking Mercury 20 HP outboard motor , no on the stern there is a homemade affair consisting of lawnmower- type engine , 18 foot of steel tube with a propellor welded to the end.(You should expect me to be critical, I'm an engineer)

We didn’t know when we cast off; in truth the river conditions and size of the boat made the journey very risky and it was only the skill of the local boatman which prevented us from capsizing on numerous occasions. Many times we had to cheat; creeping along the leeside of partly submerged trees and bushes. The boatman refueled direct from a dirty plastic container whilst his helper restrained the boat by him clinging to a partly submerged tree trunk.

 

Helper clinging to tree branches to keep us head into the current

 

As it turned out, the closest we could get to the falls was maybe 300 metres downstream and the atmosphere in the boat was tense as we dared to moor and take quick pictures.

 

The closest we could get to the huge natural barrier to Navigation.

 

We experienced close at hand the Mekong’s pure unrestrained aggression as millions of litres of water crashed over the rocks and into Cambodia every second.

 

 

Poor pic quality due to hands shaking with tension!

 

It was a spectacular sight but the relief was palpable when we cast off , swung round and the boat withdrew, helped on the return journey by the river current.

April 2012 and the Dry season gave entirely different conditions at the falls. Our friends from the UK, Pauline, Graham and Sarah were staying with us and we rode motorbikes up the brown roads following the Western bank of the Mekong to the Laos border region.

 

 

Slow down for the Buffalo crossing

 

 

Chris , Angela, Graham and Sarah, Pauline taking the pic

 

 This time the river was so low we could walk over the huge rocks and leap over the smaller cascades. Fun but difficult in sandals, the rocks were razor sharp.

 

The Same falls this time in the dry season.

 

We enjoyed a refreshing swim; having to keep our valuable close by.

 

 

Chris swimming ,(left of pic), Sarah (centre right of pic)

 

 

An effort to stay anchored in the strong current 

Lovely temperature - now how do I get out?- strong current/bare,sensitive feet- sharp rocks?

 

Then we rushed two hours South; retracing our route to catch the last ferry across to Stung Treng.

Wish you were here?

Recently, when Michael and Laura came over for a holiday, we went for a few days to Sihanoukville.
This place is a long way from Stung Treng which is probably why we had been in Country 18 months before we went for this, the first time.

I'm quoting mainly from the guide book here:

Named in honour of the then - king, Sihanoukville was hacked out of the jungle in the late 1950's to create Cambodia's first and only deep - water port, strategically vital because it meant that the countries international trade no longer had to pass through Vietnam's Mekong Delta. During the 1960's the city experienced a tourism miniboom.
The main attractions here, in addition to the islands, are the beaches ringing the headland. On weekday's it is possible to have stretches of casuarina and coconut - palm - shaded sand to yourself.

After Michael and Laura had left we decided to stay on a couple of more days to treat ourselves with some money our good friends Pauline, Graham and Sarah had given to us.

In the morning we decided to explore the beaches:

 

Chris forgot his hat and had to shelter under a towel

 

 

It was very hot but the beaches were spectacular. The above picture was taken on Occheuteal Beach along from where we were staying near Serendipity Beach. I remeber the morning as being very hot and you would soon burn without sunscreen on .

Our idea was to carry on walking along the beach to its southern end ( the fishing village here was recently removed by the government) and to carry on up and over the small headland to arrive at Otres Beach.

 





Getting closer to Otres Beach.

 

 

By now we were getting hot and bothered , there wasn't any sign of a cafe or bar to rest in the shade and have a cool drink. Then when we got to Otres Beach - Bingo! we found somewhere:

 

 

 

 

I think this beach bar is called Indigo at Otres - only been opened a few months, it was idyllic.

 After being in Stung Treng town for 18 months we could'nt get over what it was like to sit in comfort on the beach gazing out to sea. We felt a bit guilty- we are Volunteer's meant to be roughing it.

 

 

 

The view from our seats in the bar.

 

Apparently small beach shack type accomodation is available for 15$ a night.

 

We spent an hour or so sitting, well  aware that this was the last beach/ sea for a few months.

 

Wish you were there now ?

 



                         

Typical Monday morning in Hospital

There are usually a lot of people about in Stung Treng hospital on a Monday morning.
Basically for treatment in the hospital the patient has to pay before they go home. The exception to this is if they are very poor and have a card signed by their Commune chief ( I think) to say that they are from a poor family and cannot afford to pay. The system is means tested and questions such things as :do you have a metal roof on your house?; do you have walls on your house?; how many Buffallo do you own? If you own a buffallo forget the card - you pay.
Anyway, because the Admin staff do not work at the weekend nobody is allowed to go home and they have to wait in the hospital until Monday morning - the first chance to pay for your treatment.

 

No more beds on the ward so the Women with newborn babies lie on the floor in the reception area.

 

This Monday morning I was called to the Maternity unit with Angela as there were 29 Women with new babies and no water in the toilets ie no means of washing etc. The reception area looked like a temporary disaster relief area with women, babies and visitors lying on the floor.

 

Inside the main entrance door a new mother and her family wait to go home.

 

 

This area a few weeks ago was regularly flooded as water leaked out of the walls. I have been able to stop this hence the people can lie on the floors but I have so far been unable to find the leak, the pipes are buried in concrete walls.

 

 

 

So why had the water been turned off?

He who shall remain nameless had turned off the water to the bathrooms as one washbasin had been blocked again by , yes you've guessed it, rice.

We turned the water back on and showed the Cleaner for this area how to unblock the washbasins, but more inportantly, provided a new plunger and sieve for her to do the job on a regular basis as the need arises.

10 am we usually go for a coffee over the road from the main exit and watch the new mums go home on the back of a motorbike.

So, father driving the bike then all the equipment they used for the stay including rolled up mat to lie on, then mother sits on side saddle holding the new born baby in her arms,off they go into the mid- morning chaos of the market traffic.Oh! I hope they paid first - otherwise they are classified by the Management as having escaped!

 

 

 

 

 

 

 

 





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.



Chilling (?) Cambodia

Friday night and having a beer after a challenging week in Cambodia

 

Looking at this pic shows a few things about our Cambodian lifestyle.(Yes- you are lazy I hear you cry!)

In the UK Friday evenings were usually spent in Kendal town in one or other of the bars or pubs. In Stung Treng there are no bars or pubs so that is not an option so here I am in my chair in our house.

The furniture in our sitting area is not typical Kamai furniture, as we moved in our landlord went to the Capital and bought a vinyl 3 piece suite with foot stools for us to use.Very kind but it is fairly uncomfortable in the heat- sticky on your bare skin. Also it is fairly hard and has many cracks for the ants to hide in waiting to attack. So this is my favourite position.

You can also see the wood floor and walls as our house is a wooden construction on stilts. The landlord lives underneath us in a tiny room with his wife.

We are very happy living here and have been lucky with our accomodation.

Rental prices are increasing in Stung Treng as the Chinese are building a new bridge across the Mekong , in the short term bringing a lot of workers into the town needed somewhere to live. However when the bridge is finished with the new road system then Stung Treng will really change with a lot more traffic.

Note the wood stool in the bottom right of the pic. This is very typical in Cambodia, it is solid wood and very heavy to move.

My teeshirt was a Xmas present from my friend Linda last year it reads:

I'm Unreliable/disorganized/innefficient/unmotivated & immature BUT I'm FUN!

Oh how I have changed! (always was fun!)

 

Saturday evenings - the view from our table by the river

 

 Saturday evenings typically are spent at our favourite riverside stall by the river. I will have to get a pic of the stall but these are a cart on wheels with a cooler box full of iced drinks. There could also be a charcoal pot on which meats are cooked and served with sauces. Tables are set out with plastic chairs and as the sun sets it is very relaxing and special.

There is a choice of a dozen stalls but we go to the same one each week as we have grown attached to the Kamai family who run it. Mum,Dad and small child are there most evenings and have a lovely smile for us as we pull up on our bikes at 5 pm.

It is a great place to see local people - sometimes young lads are there drinking Mekong whisky and I have seen them unable to stand up afterwards.

 They get hauled onto their friends motorbike and dont fall off as they are sandwiched in the middle as three people will be on the motorbike.

About 7 pm we go to Mr T's restaurant for burger and chips our treat for the week. 

At these riverside stalls locals eat the popular chick in the egg which you may remember from an earlier post.

So nearly 5 pm on a Saturday and must be off to the river. Just checked the temperature inside the house it is 35 degrees C on a Saturday evening.



 



20 Months In Country!

 

Still close after all this time ahhhh!!!!

 

So, we've been in Cambodia 20 months now and plan to return to the UK 1st(ish) March 2013.
I'm (Chris) looking forward to returning , I'm missing the Lakeland hills and mountains amongst other things. As the time gets nearer there is that sense of trying to finish things off as there wont be another chance.
 I am presently teaching Intermediate English language and have a full Student's course book to get through with my class of some 15 students, they are a great bunch. Yesterday we were looking at the past tenses,the topic was sport and the two angles were cheating in sport and what happens to sportspeople when they retire.
We looked at famous (cheating ) moments in sport including Divine intervention?, Argentina playing England in the World Cup quarter finals in 1986. Diego Maradona scored a goal with his hand.
Amusing for my students as I stood at the front of the class jumping to head an imaginary ball, and then flicking the ball into the net with my hand. I understand Kamai teachers would never behave like that. The other fun point for them was the fact that I was alive and watched the match as it happened on TV - 1986 ? when was that?
Please keep watching the blog.
Friday evening now - beer time . Mmmmm Angkor beer, ice and Pringles.