Yesterday I started to give the teachers in the RTC lessons for the first time. I do that now every day from 16:30 – 17:30. We have two groups, one group for Baby-English, one for advanced English. So far so good. It’s really fun. I really like it very much. The groups are not big and that is nice, so it is very participatory.
I like to prepare the lessons and when I develop a photocopy, I put a picture of England or Germany on it.

On Thursdays and Fridays, I also teach my neighbours girls English from 18:30 –19:30. I really like that and I have the feeling, I give something to individuals who benefit from it hopefully at some point.

Otherwise my days are a little bit dull. Getting up early in the morning, sitting in the RTC from 7:30 – 11:30, then going home for lunch, shower, nap, back to work at 14:15 –17:30, then usually home, shower, dinner, DVD, shower, bed, reading, lights out at 22:00. Because I’m on my own it is just uneventful. I never thought it would be like that, but it is. Well, we have nearly September and in October, my ICT starts and I’ll meet more new volunteers and that will hopefully give me new energy.
I think, that live is so much more worth if I can share moments and experiences with somebody else.

On the other side it is good to spend so much time in the RTC. I have the feeling to be on top of things and also that I’m doing what I can at the moment.

09.09.2009
Well, generally I am over my low point now, I think.

On Saturday, I usually have my 3 student nurses at home around lunchtime. One weekend I cooked my very famous Thai curry and the other weekend, they said they will bring something around. So they did. And we had a feast of Khmei soup and we had a small party and invited Delia as well. It was fun. Then after lunch we usually watch a DVD on my laptop, of course action film, and then they have to go to study.

Srey-mom, Delia, Sareth and Parim

Sareth, Parim me and Srey-mom

On one Sunday I asked Chantra, to show me the place where you can spot Dolphins here in ST. So he took me at 8am in the morning to a place, in fact a school, where he taught in the past. It was a beautiful morning, lush green forest apparently with monkeys until a few years ago, and so we waited at that little beach at the Mekong river for them.

students at work

wooden art, it took around 10 days

Chantras farm

Chantras pond for growing fish

poor things

they smelled delicious

Otherwise the rainy season has fully started now. It rains nearly all day at the moment and that is inconvenient with white trousers, cycling to the RTC. Fortunately I got those ‘Crocks’ like shoes before I left and they are worth gold now. The water for washing clothes and flushing toilet I actually save in buckets at the moment. So less to pay water bill.

my favorite Cambodian animal, the waterbuffalo

a maybe pregnant Waterbuffalo

What else?
I spent a lot of money on a few shopping trips over the past weekends in Stung Treng market. I bought 4 blouses there

my new blouse

Balloons seller at ST market as well as a sugar cane seller behind it

on my balcony

With Delia I meet up usually on Saturday mornings for breakfast at the market and then we have our toenails painted at a special place where I get to know the people already slowly. I’d never thought of doing that in England, but here it is just something, people do. Women walk in their pyjamas in daylight on the markets and have their nails done. And it is a very good business. It’s supporting Cambodians and getting to know them and the other way around of course. Even very little children sit in the little stalls, have their toe and fingernails painted red.

Delia and me, having iced-coffee after the nails got painted

In the RTC I am doing ongoing supervision with the teachers and they seem to be ok with it now. Lately, I observed one of my favourite teachers, Mr. Sokhouen, in class, demonstrating a practical skill, ‘Indwelling Catheter insertion’. The problem was, that although the RTC has dummies, they don’t have enough material like catheters or sterile gloves. So they have to improvise and that is sometimes tricky. After his demonstration, some students take the used gloves out of the bin, re-powder them for the next demonstration. They re-use every single thing until it’s completely not useable any more. Then they start to practise.
Afterwards I gave Mr. Sokhouen feedback about his performance and also suggestions, how he could improve his teaching.

The English lessons for the teachers are a success and even if there are only a few people, I think it is still worth it to teach them. And the ones who come are very enthusiastic and keen and they actually learn something.

11.09.2009
8 years after the New York Ground Zero.
Yesterday I finally had my 3 month review.

the evening Daniel came, all volunteers ate out

me, Daniel, Hor and Channa at my 3 month meeting

13.09.09
Having had severe hair loss and maybe worms, I am still alive.
Talking about health, I would like to share some information with you:

The 2008 population of Cambodia is approx. 13.3 million, about 80% of whom live in rural areas. Although still very much a least developed country, economic growth over the 1994-2004 period averaged 7% per annum and the proportion of people living below the poverty line declined from 47% to 35%. As a result of a massive ‘baby boom’ from the 1980 through the mid 1990’s, the country has an extremely young demographic structure, with almost two thirds of the population under the age of 30. The first wave of ‘baby boomers’ are now in their early 20’s and generation a second, smaller ‘boom’ as they marry and start families. Consequently, despite a steadily decreasing total fertility rate, the crude birth rate is a high 25.6 per 1.000.

a empty house in Stung Treng

Although the level of education is low by international standards, it is significantly higher than in the recent past. 57.8% of 15-19 year olds have completed primary school, a more than 20%age point increase over the age group immediately ahead of them, and a huge difference when compared to less than 10 percent of persons aged 40 and over.
Equally important, this gain is basic education has been equitable and a formerly pronounced gender gap is rapidly closing. For the age group 20 to 24 years the female: male ratio for completion of primary school is 0.68, whereas for the age group 15-19years it has risen to .92. These trends seem certain to continue; the net attendance ratio for primary school is at an all-time high and the gender parity index for primary school attendance is now 1.02. Although males still outnumber females with respect to secondary schooling, that gap has significantly narrowed in recent years as well.

a department for ? in Stung Treng

Fertility and infant and child mortality decreased significantly in Cambodia between 2000 and 2005, along with a noticeable improvement in intermediate indicators as child immunization and contraceptive prevalence. However, at 84/ 1.000 live births, the under 5 death rate is still one of the highest in Southeast Asia, and maternal mortality has shown no improvement at a very high 472 deaths per 100.000 live births. Progress has been made in curtailing new transmission of HIV but the epidemic is far from over and transmission from mother to child remains a neglected area in terms of prevention.
Tuberculosis remains hyper-endemic, affecting approx. 225 per 100.000 of the population.
Dengue fever is endemic with major outbreaks occurring every 2-3 years.
Malaria is endemic in the more remote, forested parts of the country. The population remains vulnerable to unpredictable out-breaks of other infectious diseases such as SARS, avian influenza ( AI) and other respiratory infections.

Public Health System

The Ministry of Health (MOH) administers health services through 24 Provincial health Departments (PHD) and 76 Operational Districts ( OD). Within each OD is a network of Health Centres ( HCs) designed to provide primary preventive and curative health services known as the ‘Minimum Package of Activities’( MPA). Although the HC’s each cover a catchment area of only about 10-15.000 people, roads are poor and distances can be considerable. Consequently, immunization and other key preventive services are provided on an outreach basis, which is supposed to occur monthly. HC’s vary in how reliably they follow this schedule and tend to perform best in areas with technical/logistical support from NGO’s or other external agencies.

a patient in the hospital corridor, in front of A+E

Supporting the HC’s is a ‘Referral Hospital’ (RH) which provides inpatient care and an expanded set of services known as the ‘Complementary Package of Activities’ (CPA). Development of the RHs to their officially designated CPA status is still a work in progress; many RHs lack surgical and blood-banking capacities and, by extension, the ability to handle obstetrical emergencies.

Weaknesses in the public sector service delivery
system include:

- inadequate financing and erratic provision of essential drugs and equipment
- Health provider incentives do not reward quality service delivery and performance; the health systems suffers from overlapping, counterproductive payment and incentive schemes and low public sector salaries leas to simultaneous practice in the private sector..
- Inadequate (numbers and skill-level) human resources at the service delivery level and inappropriate allocation of available human resources, especially midwives
- A general lack of accountability and transparency, and an organizational culture which is not merit-based or performance-oriented
- De facto autonomy of multiple vertical national programs; while this has, in some cases, been helpful in ensuring rapid action in response to specific public health needs (eg the HIV epidemic), it creates a considerable obstacle for needs that cut across administrative program lines, eg PMTCT and diagnosis/ treatment of HIV/ TB cross infection

Overall Government Hospitals perform poorly, especially in rural areas. Both service statistics and the CDHS indicate very low levels of utilization. While the previously described limited range of services available in many of the hospitals, as well as poor quality of care ( both technical and interpersonal) undoubtedly plays a role, there is data to support the common belief that financial barriers are paramount. The median health expenditure for treatment in a government hospital is $26.63 for an illness of moderate to serious severity, slightly higher than the median expense found in private hospitals. Most importantly, all but the highest socio-economic quintile experience problems in meeting this expense, as indicated by the percentage who report having taken a loan or sol an asset to finance it.

-Cambodia, Secondary analysis of the 2005 CDHS, unpublished-

some very young monks doing cleaning work at a pagoda

I miss you all very much, take good care and keep in touch.

Yours Katja

written by  katja-horsch on September 13, 2009 from Phnom Penh, Cambodia
from the travel blog: end of August, beginning of September 09
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