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.

Mud and Midwives!

So what is going on with the VSO work I came out to Cambodia to do?

Last week my VA Thol and I arranged to go out to the remote health centre at Chankaleu in the west of the province. It’s the rainy season here at present but the Health centre chief assured us the road was still passable.

First we drove along the Mekong River bank to the ferry port.

Photo of the ferry just arriving at the port.

Then with motorbike safely loaded we crossed the Mekong River and set off on a 30k journey.

Photo of Thol on the Ferry -it leaves when there are a minimum of 3 motos on it.

The road started as a rough gravel surface which rapidly deteriorated into mud and streams. I must have jumped off and pushed about 20times, dragging the motorbike(moto) out of muddy streams or more often walking round while Thol paddled through with the moto.

Photo: Yes this is the road!-Now I need to find a way across.

Almost 3 hours later we crossed the final stream and arrived covered in mud and wet up to my knees at the tiny wood shack –the Health Centre where about 20 women a month give birth.

Photo: Chankaleu Health Centre

The four amazing young midwives who cover the Health centre 24/7 were pleased to see us and we then had a teaching session on Haemorrhage, Shoulder Dystocia (when the head is born but the shoulders get stuck)and recognising infection in the newborn. They then made us lunch of Fried egg, Omelette and rice –I think this was because I’m a foreigner and might not like Khmer food.  Then it was back to the mud and wet road for 3 hours home again.  I did wonder if it had been wise setting off in the rainy season but then what do the women in labour who need to transfer to the hospital do? They take the same road of course on the back of a motorbike too.  I also thought it might help avoid a transfer if the midwives are well trained in emergencies.

Later the same week, two hospital midwives and me again ran the same full day workshop as in June on Helping babies live. (Previous post) This time an amazing 27 different midwives turned up instead of just 14 last time which was great.

Photo: midwives practicing resuscitation.

Then last week I had another much easier trip to Kompun Health Centre 20k away and did skill drills again.

Photo of the lovely Kompun midwives with Thol joining in the skill drills for Shoulder dystocia.

Photo  Health Centre grounds complete with local buffalo that wandered in followed by kids.

After the drill we sat and chatted; one of them told me that last year they had a baby where the shoulders got stuck. They didn’t know what to do so transferred her to the hospital where the doctor managed to deliver the baby. The baby had a paralysed arm (a side effect of poorly managed shoulder dystocia) and died after two days. They said they did not know what to do to help get the shoulders out –they had never been taught before. They have asked me to go and teach suturing next time.

After that I stayed working with staff on the ward –two health twin girls were born at 1.8kg each the midwives gave them lots of advice about feeding and keeping warm and I gave them a cardi each, for the nights, that my friend Pauline brought out from England –thanks to all the knitters!

Photo –Twins in Cardis!

Women's Development Center Stung Treng

 

On Monday 13^th August I was invited to attend the official launch of the Women’s Development Center in Stung Treng.

 

 Tucked away over a rise, on the higher ground above Stung Treng town, I had no idea the place existed until I visited and must admit I attended not knowing what actual event I was going to witness. This happens quite a lot to me –

Chris you are invited to attend tomorrow at 8.00am.

Thank you, what am I attending?

- Yes tomorrow!

- Yes, but what?

- What?

- Yes, what?

- Tomorrow you attend.

(The person issuing invite now answers their mobile phone or drives off on motorbike)

Yes, thank you, I will.

So I attended and found I was to witness an important event, surprisingly, but in possible anticipation, I had dressed up a bit (Chris you look handsome today- male Kamai colleague).

I was particularly interested to see His Excellency Carlos Blasco Villa, Spanish Ambassador to Cambodia as guest of honor.

On listening, or more correctly, reading the speeches, all became clear:

Under an agreement between Peace and Development (PYD), an NGO, and The Ministry of Women’s Affairs, the Women’s Development Center (WDC) of Stung Treng was built from February 2011 and completed on 12^th October 2011 taking some 8 months. The money was provided by the Government of Spain through the Spanish Agency for International Cooperation and Development (AECID).

 

The WDC comprises two buildings:

 Building A is 25m x 13m and has two floors. Inside are four training rooms and one meeting room, five offices and two storerooms.

 

Pic of reception area

In the reception area, some nice furniture inviting you to relax, and I think the plan is to offer refreshments in the future.

 Building B is 25m x 11.2 m, again has two floors and is the home stay of the trainees coming from rural areas to receive training. Inside are a dining room, two rooms for preparing food and sleeping dormitories.

 

It became apparent how generous the Spanish people have been, the construction costs were

$ 246,047 in total including chairs, tables and equipment for the training rooms.

The WDC will be used for vocational training; teaching skills such as sewing, weaving, food processing, computer skills, accounting, marketing, leadership and other skills. The centre is to  be used to support the service delivery to rural poor women that aims to uplift their living conditions and their status and to move them out of poverty and to give prosperity to their lives. They attend the Center for six months as residents and leave with manufacturing skills but also business awareness to be able to start up a small business in their home village.

The speeches finished (finally! thankfully!) with the four gems of Buddhist blessing:

 Longevity, Nobility, Health and Strength.

After the ribbon was cut, everyone was invited to tour the WDC and look at the training rooms and samples of the produce in the small shop area.

 

 The display area where items made at the Center are on display for sale.

Photographs of the construction were posted on a large display board. Curiously, I was the only person looking at the photos; why was nobody interested to look at the shape and number of steel reinforcing bars in the concrete pad foundations?

Why weren’t they interested to see how the reinforcing bars for the vertical concrete columns were tied into the reinforcing bars of the ground ring beam? - Your Excellency: Ambassador Sir: have you seen this detail?

I think it is a lovely Center and the buildings are the nicest I’ve seen in Stung Treng and possible Cambodia. It is light and airy and gives a positive, happy feeling to be inside.

 

Another view of the Sales area. Nichol , Angela and our guide.

Initially I thought it was designed by a Spanish Architect along the lines of:
Spain is providing the money so they would wish to give the project to a Spain practice as a challenge to design a project in Cambodia. I have since been told the initial ideas and scheme were advised by Spain but a Cambodian Architect was employed and designed the Center. So my considered opinion is Well Done and the Construction team can be proud. I never took my camera on the opening day, why would I, not knowing what event I was going to.

However I have been back taking Angela and Nichole to show them around.

 

The weaving training room. On the day of the opening there were four women demonstrating their skills.

We were very lucky to meet a member of staff who showed us around the whole complex including living quarters.

 

Women's dormitory

 

Clothes made in the training rooms and on display for sale.

Angela bought a bag:

 Bag: $5, made from Bamboo. Lots of different sizes and designs to chose from

 and blouse and Nichole ordered some made to measure work clothes.

 

The training room for sewing. The sewing machines appear to be second hand and of the foot treadle type.

The challenge now for the department of Women’s Affairs is to move forward and make full use of the facilities. It stands at the top of the town but do the residents or visitors to Stung Treng know of its existence?

In the shop the stock levels are low and the display cases are gravitating into the corners, there is litter on the floors. I hope it will prosper not stand still.

 

Equipment in the weaving room

 

This Little Pig went to market.......

This video is one I took a few months ago whilst waiting for my ferry to leave. The small passenger ferrys runs across the river linking  Stung Treng and Thalaborivat district, which is where the target beneficiaries live for the NGO I work with.
All kinds of goods are taken on the ferry icluding plastic containers of petrol , and heavy pieces of wood destined to be turned into furniture. Whatever comes onto the ferry, the passengers have to move themselves and rearrange around the cargo. Health and safety is left to your own wits.... and animal welfare?.......
So on this day I was waiting for the ferry to fill up before it could leave. There is no ferry timetable so you may have to run and jump on board or you may have to wait 1 hour.
I heard the awful noise first and turned in the direction of the loading ramp. See video........

 

The noise was very upsetting for the young children on the ferry and you can see the small child trying to block his ears.

So animal welfare in Cambodia , yet another challenge for the Western Volunteer.

 



Riding the bamboo train

Recently we went for a few days break to Battambang , Cambodia's fourth tourist destination (after Siem Riep, Phnom Penh and Sihanoukville).
We started the journey with a 3am wake up phone call from the mini van driver who called round our house to pick us up. Then the battle began to get a seat in the bus but to be able to put my feet on the floor and not sit with legs bent on a big sack of wood etc.
By mid day we were in Phnom Penh and caught a bus to Battambang, arriving about 6pm , a long day of travel.
One of the reasons I wanted to visit was to ride the Bamboo train described in the Lonely Planet guide as one of the world's all- time classic rail journeys- ........the train clicks and clacks south east to O Sra Lav along warped, misaligned rails and vertiginous bridges left by the French.

The following article emailed to me by a friend describes a typical experience:

 It rattles along at 20 miles an hour, swaying back and forth on uneven rails, the engine so loud it makes your teeth hurt. Then, rather unceremoniously, it runs out of petrol and dies.

And you find yourself stranded in the middle of Cambodia on a handmade "norry" train, feeling a bit exposed on a 25-square-foot platform made of bamboo and scrap metal attached to wheels salvaged from old tanks.

Picture one of those hand-pump rail cars depicted in old Westerns, and you're close. It's powered (when it has petrol) by a converted outboard engine. The brakes (when it has petrol and you need brakes) are a wooden board pushed against the wheels. No seats.

All this bamboo and scrap metal give it a makeshift appearance, and appearances do not deceive. Pretty soon, driver Path Chanthorn starts pushing the disabled norry with hands that are missing a few fingers from a run-in with a water buffalo -- "a strong cow," he mutters.

Another norry approaches from the opposite direction, every inch of its platform covered by a dozen people headed for a festival. With a single track to ride on, etiquette dictates that the norry with the lighter load be taken apart so the other can pass. So Chanthorn and his assistant quickly dismantle their vehicle and let the other one by, then put theirs back together again, all within minutes.

And you are on your way.

Now a government plan to upgrade the country's rail system may end up forever stranding the norry, an ingenious response to the decades of war, destruction and dire poverty that have afflicted Cambodia.

Under the Khmer Rouge in the mid-1970s, as the country descended into civil war and mass murder, 2 million people perished. And in leader Pol Pot's quest to reach "Year Zero," Cambodia also saw most of its roads destroyed, its trucks blown up, its locomotives charred.

By the early 1980s, as Cambodia started to emerge from the nightmare, people remembered the small vehicles used by rail workers in the 1960s to repair the tracks and started building their own. The norry, a name some say is derived from a mispronunciation of "lorry," was born.

The humble norry is a reminder of how much Cambodians lost, but it also speaks to their persevering spirit. All but left for dead under Pol Pot's genocidal regime, they defied the odds to rebuild, sometimes literally: Witness the land mine victims who picked up their lives by crafting homemade wooden limbs.

"It shows how ingenious people can be," says Ith Sorn, 55, who's been driving norries for three decades. "Cambodians came up with this when they had almost nothing."

The unique mode of transportation saw its heyday in the 1980s when other vehicles were scarce. "There were bombs and mines everywhere, roads were destroyed and rail cars a shambles," says Kot Sareurn, 50, a union leader for 23 norry drivers in Battambang, a picturesque provincial capital along the tranquil Sangker River. "Norries helped a lot of people survive, get to hospitals, get food."

Initially operators "rowed" the norries with poles, gondola-style, carrying loads of up to 40 people, eight cows or three tons of rice. After a few years, small gas engines were added.

So what about our experience riding the train?
Angela and Nichole sat on the bamboo train:

A view down the track .Yes the rails are very much out of line the worst points are at the butt joint of two rails which produce a lound bang and jolt when you pass over them.

 

Just about to set off. Note the wheels from another train lying on the ground

 

 Moving a train off the track to allow another to pass.

 

 

 Nearly ready for our train to move forward



The engine and drivers seat. the stick in the foreground of the pic is used to lever  the engine block and put tension on the drive belt to give motion to the wheels. Moving the lever the other way releases tension the drive belt goes slack and the wheels loose the driving force. The brake is a board pushed against the wheels by the drivers foot.

Nice and light to pick up, the train is lifted off the wheels.

Getting ready for the return trip. This picture shows the train and how the passengers sit on it. 

 

So now enjoy the video I shot from my perch at the front of the train. Watch until the end when you see we wait for an approaching train. This then stops in front of us and the drivers dismantle the train so our train can move forward and pass. They then put the train back together and proceeded away from us in the opposite direction.

 

So after a trip like that what is ther left to do?

Buy the T-shirt of course, been there ,done that, bought the T shirt.