August 2009

12.08.09
So. After being on holiday and having fun, I’m now back at work and do what I am supposed to do. Capacity building and development work.

Stinka is the prettiest cat from Stung Treng

I really have the urge to achieve something while I am here and it is hard sometimes to motivate myself and just keep going. So I try to keep myself busy with putting as much into the day as possible to keep myself occupied. Also having things to look forward to helps, in a short term meaning.

Part of her diet are also gekkos, grashoppers and flies

Yesterday I was looking forward to go to the market and do my weekly fruit and vegetable shopping. I really enjoy that now. A few month ago I felt uncomfortable and anxious about it because of all the people staring at me and laughing and well it’s just so different here. Now I can laugh about myself. The highlight actually yesterday was when I met Delia for lunch and we had a Burger in Stung Treng Burger bar, which I didn’t know it existed at all. Burger with chips, and it was tasty.

a cow sleeps in the middle of the road, why not?

Today I am looking forward to my hairdresser appointment at 5 after work. Lets see if they can give me the highlights I want.

my hairdresser, me with new highlights and she gave a good head massage

I am on my own in the office at the moment, the teachers are mostly busy because students have exams at the moment, Hor is off sick, he came yesterday morning with a big bag of tablets and said, he has Malaria. After the meeting on Monday, he had a bad headache and rigors and he went to the hospital for a blood test. Malaria positive, one plus. Which is not too bad, mild. So I hope he’s taking plenty of rest and his tablets, which he didn’t want to take initially.

On Monday, we had a meeting with all the Health Volunteers from Kratie with their VA’s and Stung Treng Health Volunteers with VA’s.

Purpose was information exchange, discussions about improvement on our work and the VA’s also had the opportunity to gossip about their ‘bosses’, the volunteers. We also invited the Regional Chief Nurse Mr. Sethyl and he came, which was nice. He told us about the coming Nursing Council, which is very exiting and his role and responsibility.

eating pirianha for lunch

I offered my big house because I also have altogether 20 chairs available and originally we planned to sit in the living room on mats on the floor. Deep down I knew at the end it would all happen on the balcony, and it did.

Stung Treng - Kratie Volunteers & VA's on my balcony

It was a whole day meeting, in the afternoon the Kratie group went home again.

girls round

Delia and I decided to go to Kratie on Friday afternoon by motorbike. We will have one moto each and the journey might take 2 to 3 hours. The reason for that is, that it is Suzanna’s Birthday ( she is a Behaviour and Communication Change volunteer in Kratie and has Dengue at the moment) and her husband Roger ( a dedicated English teacher) plays in a Jazz band. And for Suzanna’s birthday, he and his band are playing and I really would like to hear that. Can’t imagine a Jazz band in Cambodia!

At work, I am just trying to prepare for Daniel’s visit in September. We have to develop the Annual Work Plan with planned activities, expected outcomes and evidence of change. We then will meet together with the director of the RTC, the RCN, 2 teachers from the RTC and Hor and me. This is a basic thing volunteers have to do. Proof of evidence that I am doing what I am supposed to do. Which gives me also a clear guideline and aims.

20th of August
As agreed with the RTC, I’m now every Friday in our hospital. Trying to strengthen relationship between hospital and RTC. Also for me it is a good opportunity to see, what’s actually going on in there and I get closer to the preceptors and also to the regular staff and they know me now and are very friendly to me. So in the morning I went with Channa and met students, preceptors and chatted to them and promoted Nursing documentation, showed them how to fill out an Observation chart and a Drug chart. They just don’t know how to do it, so they rarely document anything. It’s pathetic and so frustrating. In the afternoon, we were on the paediatric ward, seeing students there. I noticed, that one of the students went out of the staff room with a syringe. When he came back I asked him, what he had done. He said he gave an IM injection to a child. I asked him if he had documented at all what he gave and when, and he said, the preceptor will do it when he comes back from the lunch break. I didn’t agree with that and made him write a new drug chart for the actual day and tick the box with the time and sign for it. I asked him to report to the preceptor and let him countersign later.
Next I saw a female student, also 2nd year, fiddling with a syringe. I asked her, what she is doing and she said, she’ll give also an IM injection to a child. I asked, who told her so and who will observe her. She said nobody, the preceptor said to do so once the drugs arrive from pharmacy. I asked her if I could observe. So we went to a little boy, max. 3 years old. When he saw her coming, he started crying. Cambodian nurses are very cold. They never try to calm down or take away fear. They just go ahead and do what they are supposed to do. I just couldn’t believe it, seeing a second year student giving an IM injection to a child without any qualified staff around. And the boy was so much crying. The needle was thick and I sat next to the boy, holding his hand and try to calm him down. She gave the injection into his thigh, not very confident though but she found the right spot. I just couldn’t help myself and cried together with the boy while calming him down. I tried to pull myself together but when children cry, I just can’t help it.
Afterwards I asked her, what she gave. She didn’t know and had to look it up from the drug chart. It was Paracetamol. I asked her, if she checked the temperature at all of the child before she gave it, she said, it was last checked yesterday. How often is it prescribed? Three times a day. I nearly started crying again when I found out that the doctor had been already, only comes back the next morning, this boy gets everything else orally and he has to get those bloody painful injections maybe three more times by unqualified staff until somebody comes around to change the prescription. I was really upset and just needed to leave the place.

Nurses here don’t think independently. I even think, they don’t think at all. They don’t care and usually have no background knowledge. They just go ahead, following any order from somebody in white uniform, if they give the wrong injection, tablet, nobody will know, because it’s not documented. If somebody dies, it’s just another one of so many. Nurses here don’t know how to care, to sit down with a patient, having a friendly chat or even holding hands, none of it happens. They don’t even know how to follow the nursing process. They just do the absolute minimum, no cleaning, no tiding, they don’t give painkillers before they change a wound dressing. Patients have to be very tough here, and they are. I’ve seen women after caesarean operations, so weak and pale, they do anything themselves because they don’t get any help from the nurse. All the dirty stuff is usually done by relatives, like going to the toilet or cleaning up afterwards. Nurses here don’t wash patients either. The nurse gives tablets or other meds whenever they arrive from pharmacy, probably they don’t even know about side effects or pre cautions.
It is shocking and I feel that I can’t do anything. And I struggle with that.

On Friday afternoon, Delia and me drove with our motos fortunately to Kratie and that was a good time to take a break from all those things and enjoy Cambodia. It took 2 and a half hours and it was a good ride, because the road was done only a few years ago. Apparently 10 years ago it was still unsafe to go that way because of soldiers and rebels, but now a days it is very safe.
We stayed at Emily’s and it felt like a proper girly weekend. On Friday evening we went to the birthday party which was actually Roger’s and Carl’s B-D-party. Karl is German and is a Chief Technical Advisor, IP-consultant. Works for IP and GOPA. Although he celebrated his 58th birthday, he swung me around with his Latin salsa skills and we had a proper party actually. Half Khmei, half ‘Barangs’, as they say. Barang means foreign, actually French. Also Roger played the Saxophone and Karl the Muntamonika, don’t know the English word, and they had a cool 30min Jazz session.

they gave everything

We drank a lot

Tommi, Suse, Delia, Emily, Karl and me

and had lovely food and the next morning, I had to take it very easy because of a strong hangover. So we lazed on the balcony, watched a film, discussed the men and had lots of Roibosh tea. In the evening we went to a new massage place in Kratie, and we all had a massage for $5. One hour Khmei massage, which is like a workout. No relaxation there, they squeeze and pull and slap and push. But it helped with my back pain which I had then for nearly 2 weeks.

Remnants of the Birthday party

Afterwards we went to Joe’s and had his special of the day. Beef stew with mashed potatoes. Yummy…

On Sunday Delia and me went home around midday, trying to spot some dolphins on the way back, but again, no luck for me.
In the evening I did my washing and packed my bag one more time to go back to Chhlong, passing Kratie the next day, to do Supervision with the Regional Chief Nurse.

Chhlong is a very small, very basic town behind Kratie, passing through it on the way to Phnom Penh. We saw a lot of flooding around that area, which effects harvest and already poor people. I wasn’t aware that the flooding was so severe, but the river is high and maybe there will be also flooding in Stung Treng.

Flooding in Kratie Province

Sethyl and me stayed at a nice guesthouse, very basic, no shower and toilet flush, but it was charming and cheap.

Breakfast in Chhlong

Channa stayed at his brother’s house. After the first supervision day, the clinical instructor persisted, that our group had ‘pregnant egg’ for a snack. I thought I knew what was coming. It is a speciality here in Cambodia, to eat duck egg, with the fully grown duckling inside. So they boil the eggs with the ducklings and then eat the duckling out of it with salt, pepper and lemon. They couldn’t get enough of it, but I just couldn’t. Looking at the little face and the wings and the feet, I tried my best but couldn’t. I had little meat kebab sticks instead.

Channa, Sophany and Sethyl enjoying their eggs

The supervision was interesting. It is not easy to make preceptors learn new things.

during Supervision, preceptor next to me

When you give advise to them they look down, and it feels like speaking against a wall. So I nag them and ask them at the end what they remember about what I’d just told them. Usually it’s a complete different context they start to talk about then. So I try to tell them the key points again and ask them to remember them for a successful assessment of a student.

Wat in Chhlong

During a student assessment, I realised, that another student struggled with a drip of a patient, next to where we were standing. She had a syringe with a needle and tried to inject the drug into the giving set of the drip. Completely on her own. Of course I went there and looked closer what she was doing there. She fiddled with the drip and liquid suddenly purred out. She wasn’t sure what she was doing, but eventually she managed. Afterwards I asked her what she gave and she didn’t know. I asked her who ordered her to give it. She said she was a Primary Midwife student ( equivalent to a Healthcare assistant in the UK and they only have one year training here) and a 2nd year student nurse ordered her, to give that IV drug to a patient. I thought, I need to explode.
So after we gave feedback to the preceptor, who didn’t have a clue what she was doing, I ordered all the other preceptors into the staff room.
I asked them, how come, a 2nd year student can give instructions to a primary student to give an IV drug to a patient, but the students are not allowed to go to the patients and do Observations ( Blood pressure, Pulse, Temperature, RR) on their own.
That just so upset me but I really tried to stay calm and not get carried away.

The preceptors looked at me and found excuses. They had told them to do so, they were around all the time, there is no time to check Observations and so on.

It just didn’t make sense to me. I asked the clinical instructor from the RTC why primary students are allowed to give IV drugs, although they only have one year training. Apparently they do the same as a nurse, but get played even less. I just don’t understand that.

While looking more closely what the other students were doing, I saw them inserting Venflons on their own, mixing IV antibiotics, giving injections, all on their own and to all age classes. Children or Adults, it makes no difference. And they just do it, nobody looks or checks. The nurses are usually not bothered. They also send the students instead of doing stuff themselves.

So how can I live with that. I feel so powerless and want to change things, but I think I just can’t. It is very very frustrating and I feel very sorry for the patients. But they seem to accept it, although they are generally afraid of students.
It is really a complete different world with so different rules and assumptions. I thought I was over the culture shock but now I feel, I am in the middle of it again.
At the moment it feels difficult to accept things like that, because it is against everything I have learned and taught in my home countries.
I feel like I can’t do anything here, it’s like blowing hot air, nothing happens. And it breaks my heart, seeing all those people in pain, babies and children crying, nobody takes real action or good care of them. It’s not good and I’m sitting at the RTC in front of my laptop, trying to train the teachers here who are not interested at all.

Budda at Pagoda

Is this really good what I am doing? I have the feeling it’s not. So I have real doubts at the moment about my placement and being here.

But I want to try and hang on for a bit longer. At least a year. That’s when I should know for sure if it’s worth it or not.

Today, Thursday the 20th, I will give 4 girls from the neighbourhood English lessons. I agreed that at the beginning of the week with their mother, who owns a little restaurant around the corner from my house and I went there a few times now and she speaks good English so we can communicate. I am looking forward to that. A new challenge for me though. But a good experience I hope. We’ll see.

Roundabout in Kratie

22nd of August:
The English lessons went very well and I had a lot of fun. After I practised the ABC song with Delia again, I had forgotten how it was ending, I taught them basic things so far. What is your name. (There names are Peach, Krasmey, Theda and Touch). Where are you from. What is your country and what nationality are you. I can use all those nice participatory teaching methods with them because it is a small group. They are also very interested in singing, so next time I will provide the lyrics for Celine Dions Titanic song, it’s still very popular here. Some are very bright, some not so. To my delight, Vandy, the mother of the four owns this little restaurant and so she didn’t want to let me leave without having had something to eat afterwards. That saves me cooking dinner and her food is really good. Even on Saturday, Theda ( one of the daughters) came along and brought lunch, for ‘le cru’, that means: teacher. They don’t say my name but always teacher, and I don’t know yet if I like it or not.

Helen gives health education about respiratory desease at the hospital

24th of August:
I still have mixed feelings about being here. This morning, cycling to the RTC, I nearly had an accident with a moto, who wasn’t looking. Then I was really frustrated. 5 meters further two little kids shouted ‘hello’ to me, waving and with smiling faces.
That made me feel better immediately.

sunset over the Mekong

Hor has recovered from his malaria and was bright and cheerful in the morning. He asked me if I want to try to apply for home- internet with Mobitel. Of course I want, so we will go to the phone shop this afternoon and maybe I get wireless installed into my house! It’s around $30 per month and I think its not too bad.

a visitor at night

After Channa told me that he had grilled mice for dinner, apparently special mice grown for eating. He said they were very tasty, specially the tail… He also told me that his girlfriend left him. She found a much older married man, who offered her to support her studies with money and gets from her in return a sexual relationship. And it is so sad, because he really loved her but she left him because he is poor and supports his family, with the little money he earns.

Another thing for me to look forward to is that my beloved mum and sister will come next year in January to visit me for 2 weeks. That is soooooo nice and I can’t wait. I feel so happy that first Carmen comes and then my family. So exiting!!!

To all my friends, who have clothes or material, anything that can be used but isn’t in use, instead of throwing it away, please give it to my friend Carmen in England – Oxford or to my mum in Germany – Guestrow. Everything is needed here and poor people appreciate everything. So collecting can be started now. Especially expired hospital material or teaching equipment. Even English books would be great!

Thank you! Hope you are all well! Lots of love, yours Katja

Wat in Chhlong

a travel blog by katja-horsch

August 2009

Phnom Penh, Cambodia