Home

 

Sorry for delay. Have started new job. Needed to settle in. The tale continues

21st July

Watched ‘Money or Blood’ on Alyson’s DVD whilst recuperating. Describes another aspect of Cambodian Health care system. 2014 Georges Gachot. It is about Beat Richner German man who has built and maintained hospitals in Cambodia. Very controversial. Who should be paying for Cambodian health care? Did give me yet another insight.

Was well enough to attend my friend Liong’s family leaving party. She is off to Thailand to study nursing. It was a great family party and I did eat something. Lovely meeting Liong’s family and even her mum who had travelled all the way from Battambang.

 

13754204_640355369444799_7239394390970182819_n

 

Finally arranged to meet up with Madam Chea-Ath. Back at the NMCHC known locally as the Japanese hospital as lots of funding from JICA (Japanese International Co-operation agency).  This was a lovely visit. So nice to meet up with the President of the Cambodian Midwives Association. We had worked so closely in January 2015.

 

We celebrated the reunion over lunch and it was great being back to eating properly again.

Finally met up with Julia Stewart and new friend Andrea. It is great to meet up with people you hardly met last time but because of the nature of travellers, you are always friends well met.  I love being part of the traveller community. I have acquired friends all over the world.

 

So bye to Phnom Penh and on to Dubai.  Cannot wait to see my friend’s Twins.

 

15th July 2016

My tuk tuk man delivers me to the bus stop.  Me, being English had envisioned a coach of some sort to take us to Kampot.  But the 12 seater small bus was the bus being cleaned and made ready for the trip.  Thank goodness I had asked for a seat at the front near the air conditioner.

I should have known this as it was similar transport we had used last January to travel to Kratie.

The journey to Kampot was as expected dusty, bumpy and very interesting. You really do get to see the real Cambodia once you are out of the cities.  There is a lot of agriculture and a lot of new building going on. But the basic Cambodian house remains the same and the majority of people are travelling by scooter.

 

We finally arrive in Kampot and I organise a tuk tuk man to take me to my booked hotel.  We arrive and I am shattered. I quickly book in to what appears to be a very nice hotel with a wonderful view of the river from the restaurant.  I was hoping for a view of the river from my room.  Alas I am disappointed but I am too tired to argue. I quickly fall to sleep.

When I awake a couple of hours later I re-read my details for the hotel and it definitely says a view of the river. I am disappointed with the room they have put me in and I also realise I cannot lock the door. Not good at all.

So I go out to talk to the manager who begins to talk to me, then dismisses me as a group of men arrive to book in.  This makes me a little mad. So I return to my room collect my belongings and return to reception. He still does not seem to understand I am not happy. So I give him the keys and I leave.

Hmmm.  I am now an English tourist out on a road in the middle of nowhere in blistering sun with no plan.  Sometimes I do wonder about myself!

Then I wander down the road and find a nice Cambodian man.  I know he is a good man. I can feel it. He also speaks a little English.  He understands my predicament. He gets me to sit down while he arranges a tuk tuk. This other tuk tuk man takes me on to another hotel.  It was no good so we return to town to the second Hotel suggested by my new friend.  Here I stay.

The Kampot Diamond Hotel.  Not the most salubrious of establishments but it will do nicely.  I went to the famous Australian bar Riki tikitavi’s for dinner, but there is a feeling in me growing that I was about to be ill.  I was not wrong.

 

I did meet up with LIongs friend Heang the following day and she was great. She had arranged for me to have a tour of Kampot Referral Hospital.

 

We watched as a woman in labour wandered about a general waiting room obviously in pain. She was supported by her relatives. Apparently she would only go into the delivery room when she was ready to birth.  I can imagine how this very public birthing would be regarded in the UK, but this is what they know. This is routine to them.   They let me take photos of the hospital but I was wary of taking individuals without their individual consent.

 

 

I came away thinking this was a great facility. This is basic but it is health care. If you have nothing else this is fantastic. It even had an intensive care unit. Not in the least like the equipment driven wards in the UK but at least they were recognising the need for continuous care. I am sure it has saved lives.  They have a caesarean section theatre too.

 

 

After the tour I was beginning to feel very unwell and returned to the hotel.  I then began two days of being quite ill with gasteroenteritis. I am glad I did not vomit but it sure was a good way to lose weight. What went in definitely came out very quickly.  I had never been ill in Cambodia before. In fact, I am hardly ever ill with my stomach.  I tried to think what I had eaten since I landed.

I spent my time in Kampot in the very nice hotel bedroom. Venturing out for breakfast and for water.  I slept and slept and slept.   I did see Heang a couple of times but not for long.  I was very disappointed, but there was nothing else I could do.  I could not face the bus trip back so arranged an expensive car to take me back to Phnom Penh.

 

And so it continued for the next few days till finally I had to admit I needed to go to see a doctor. Luckily the ex-pat network knew the place to go

I called and arranged an appointment at the Local SOS clinic.  I have no photos. I really was not in the right frame of mind. But the friends network cared for me very well.   I was threatened with a drip but I reassured them I was still capable of drinking.  So I drank myself back to full hydration.  They gave me potassium to take too as my blood work showed it was low.  $250 later and I was on my way back to the flat.  Thank god for good travel insurance that is all I can say and thank god I was not carrying some dreadful bug. It appeared it was viral and would just take time.

 

So I saw a lot of Alyson’s flat and her DVD collection. Her friend downstairs would pop in to make sure I was alive and I was in regular contact with the outside world via social media.  There is a paper in it somewhere about social media and its use in healthcare to help keep patient’s morale in place.

Eventually I came around and started contacting people I had wanted to meet up with again whilst in the Kingdom.  The president of the Cambodian Midwives Association Madam Chea agreed to meet up and also Alyson Stewart an Australian Midwife working at the TSMC.  I even went out for a couple of hours to the central market.

13770502_1772592262980523_3185587364208118311_n

 

A crazy hot, buzzing place selling everything from jewellery, vegetables, flowers etc to knickers.   I got a little lost coming out as all the entrances look the same but was saved by calling Dim a tuk tuk driver we had used when we had been in Cambodia last January 2015.  He got me home to the flat and I collapsed into bed again.

13782251_1772592246313858_3292973332087971698_n.jpg

 

 

13th July 2016

I have flown from Osaka airport to Kuala Lumpur airport and then onto Bangkok.  Then onto Phnom Penh.  I have never in my life been on so many aeroplanes in my life.  I am shattered.  Thank goodness I have a car waiting for me to drive me to Alyson’s apartment.

And there at arrivals there she is-  Liong. My informally adopted Cambodian daughter.  She was my translator last time in Cambodia but she has become a really good friend.  There she is with open arms. It is so nice to be met in a very strange foreign land.

She introduces me to her friend and then travels back with me to the flat. It is late so she stays. Phnom Penh is not the place to be out and about late at night. It is nice to have company on my first night in the Kingdom.  The view from Alyson’s flat is tremendous.

20160714_001402_LLS.jpg

Sadly Alyson is not here she has broken her leg and is recuperating in Australia but she still has allowed me access to her flat in her absence.  I did not realise how fortuitous that offer was until later in my trip.

 

It is hot 34 degrees. I have gone up a few degrees since Japan.  It is supposed to be the rainy season but they have not seen much rain so far.

The first day I go with Liong while she is collecting data from Health Clinics in Kampong Spue.  It is a hot, bumpy, interesting experience.

This is the front line of health care in Cambodia.  I am impressed by the teaching going on to the men and by the basic but at least some facilities for birth.  I wish I could do more to help this far away from the local hospitals.  Maybe sometime in the future.

 

I need to get used to the traffic and lifestyle again. I am jetlagged and exhausted Liong leaves me to sleep.

The following day I wake up late and we go Visa hunting for her. The beaurocracy in the office is amazing. We wait and we wait and we wait.  Finally we emerge triumphant with her visa for Thailand.  We also go and buy my bus ticket for Kampot.  We celebrate by having a foot massage followed by dinner and a cocktail in Anise.

20160715_183937

This weekend Liong is off to visit her family and I am off to visit Kampot.  She has put me in touch with her friend Heang who will show me the sights. Looking forward to another long journey on dusty, bumpy roads.

Well now I am finally feeling better after being told I am not dying of some dastardly disease, I can continue writing my blog.

 

7th to 10th of July Japan

After all that teaching, Emiko let me have a day of rest.  I did try and do some of my blog.  But on the 8th of July we set out for yet another trip.  There is no way I am going home from here without seeing Japan, if it is up to Emiko my our guide.  This time we headed for Mount Fuji and Tokyo.

“The draw of this mountain is felt worldwide” and yes I am reading from the brochure, but it does kind of feel like that too.  A real volcanic mountain that might do it again at any point.  Scary hey?

I have been to Vesuvius in Italy and was aghast by its size and obvious strength of destruction.  Mount Fuji held a similar fascination.  That is in fact if we get to see it.

The weather has clo20160708_190522.jpgsed in, and wait for it, Japan is at the end of a Typhoon!.

This one named  Nepartak, is currently hitting the coast of  Taiwan.  In reality we were not expected to see much disruption, except torrential rain and we got it and alas Mount Fuji was in the mist.

The nicest thing was that we were to stay with another of Emiko’s midwife friends in yet another Midwife house.  I actually got to sleep in a delivery room.  I have not done that for years since we had staffing issues in a UK maternity unit and I stayed overnight.

Sleeping together in the same room brought back memories for Emiko and I. We usd to share a room during our studies together. Her in the bed me on the floor.  I laughed. Her friend had put me in the bed and her on the floor. Justice at last!

 

 

Her house was lovely and reflected every essence of the midwife whose house it was.  She just is very motherly and kind and oozed calmness.   She met us off the bullet train.  Oh yes, oh my goodness.! We went on the bullet train!

It is amazing how much you forget when you just go from one day to the next. I  do keep short notes but when writing sometimes it just gets out of sequence. But maybe that’s the way its meant to come out, as I remember it.

 

Oh yes, bullet train or the Shinkansen.  Beautiful bit of Japanese engineering.  No one in Japan calls it the Bullet train by the way, so don’t ask for it. Look for Shinkansen signs.

You can actually feel the difference when it reaches its higher speed.  But the higher speed does depend on which Shinkansen you are on, so be aware that you do not want to be disappointed.

There are 3 levels  Shinkansen Kodoma, Shikae, and Nozomi.  Nozomi being the fastest as stops at least stations.  At full speed you can reach 300km/hr. Yes, I am getting this from the guide book. You expect me to remember after a bout of Gastroenteritis?

 

20160709_100224

 

It was however an unforgettable experience. The Shinkansen lived up to expectations. I have never in my life had so much leg room anywhere travelling. It was like being in first class on an aeroplane. Only done that once.

 

The seats were very comfortable and despite Emiko’s concern we might not get a seat initially, we walked straight on to two together. My advice – book seats.  It gets very busy and this was the rainy season. My personal parking and seat finding fairy was looking after us.

 

 

 

 

Alas at the end no Fuji to greet us. But we did have Kazue.   We went for noodles of course and then onto her house which was delightful.  Again as with the others already seen on this trip the emphasis is on the family, not just the woman.  It was about bringing a new life into the family.

 

She had arranged a little party to say hello with her fellow midwifery staff and I got to hold a Kazue baby born at the house the previous year.  They had some English and thankfully I had Emiko we had a lovely tea party.  We had great discussions about Japanese mainstream midwifery care and local midwifery care.  Midwives houses are very similar to Birth Centres in the UK but much smaller more intimate and with fewer staff.

 

Apparently to do a proper Japanese tea party you need to be trained which takes ages and then you get a licence.  Kazue has a licence and so it transpired does my friend Emiko.  In Manchester we just mash the tea and have done with it. Ha.

20160708_155009

 

This by the way is a Mt Fuji bun.  But we thought might be useful when discussing breastfeeding. Ha ha.

 

We did get to the Shiraito waterfalls at the foot of Mount Fuji.  Lots of steps, lots of water but wonderful scene despite the rain.

Ah well I thought I might get to  write about Tokyo in this chapter but alas not to be.  See the next installment for Blog 7 Part 2. The highs of the Tokyo Sky Tree.

 

 

After a wild round of site-seeing it was now down to business again.  Emiko had lined up a few lectures for me at Kobe Municiple University and Kobe City University to give, with regard to Global Midwifery and a Comparison of UK and Japanese Midwifery.

I even gave one lecture on UK Pharmacy and their role in pregnancy. A challenge, but the pharmacy students appeared to enjoy.  Emiko was beyond wonderful with her translation skills.  We seemed to make a great team.  She is very distinguished in her career in Japan and has written many books.  I was worried about the demotion to translator but she appeared to enjoy it. It is rare for a English midwife to speak in Japan.

1468054585056

It was an honour to talk to these nursing and midwifery students. They were attentive in the main but there were a few who nodded off. I was reassured this was not my teaching technique but the busy lives Japanese students have to fund their studies.

I was honoured to have lunch with a group of midwifery students and their lecturers.

 

But of course after the teaching was over there was time for food.

20160704_193850

Japanese Pizza  Delicious and far less calorific than the UK kind

I have really become accustomed now to eating with chop stix. I might do this at home it really makes you slow down and enjoy each morsel of food.  I think I have lost weight as a result.

 

 

 

My blogs are getting behind now.  I have already moved on to Cambodia but I will complete the Japan experience very soon.

Time to go East again

June 15, 2016

 

It is just about two weeks before I embark on yet another journey.  My family and friends are now tired of the phrase “..and where’s Helen off to now! I am going East again to revisit friends I am very lucky. This time I will visit Japan, re-visit Cambodia and return to Manchester via Dubai.

All of these countries are special to me and I have a different reason for the visit in each.

In Japan I have a dear friend who is now a Professor of Midwifery. She and I did a Master’s degree in Midwifery Practice many moons ago at Thames Valley University. 1995 to be exact, over 20 years.  We have kept in touch on and off over the years, thanks to email and social media.  This is an opportunity to view Midwifery in Japan and their midwifery education system and to catch up on her children who are all grown up now.

 

A long time ago just after completing her Masters, she returned to the UK with other professors of Midwifery from Japan. They stayed in my house in Leicester at that time.  My memory is of these ladies doing Tai Chi in my living room. Marvellous.  We also visited Manchester on the same visit. Quite a UK tour and my midwifery colleague in Manchester also gave over her house to the visiting group.  Bless them they got up very early so as to leave the bathroom available for the rest of us.  Can’t wait to hopefully meet these respectful humble women again.

Of course I intend to travel to Tokyo and also visit Hiroshima.  An act of violence against human kind not unlike the Killing fields in Cambodia.

 

Camboida Jan 2015 (3) 010

In Cambodia I am revisiting Phnom Penh where I spent last January with the RCM Global Midwifery Twinning Project. Again I have kept in touch with the President of the Cambodian Midwives Association and other midwives who shared the experience.  I really cannot wait to meet up with the main translator we used, as we have become firm friends and use all the varieties of communications to keep in touch.

I was only there for a month but hope to revisit the hospital in Phnom Penh and see how things are. I really do hope also to travel to Kampot too which I missed on the previous visit.

Alas a dear friend, who I should have been meeting up with, has broken her leg and has returned to Australia to recuperate. But such a good friend has given me access to her flat for the visit.  I will miss her greatly.

It will be rainy season in Cambodia so I very well might get wet but it will also be very warm. I can’t wait to travel in a Tuk Tuk but will care better for my phone that went missing on the first day of my last visit.

In Dubai I am visiting yet another friend who has birthed twins six mo

nths ago.  We met whilst working in Jeddah Saudi Arabia together 2006/7.  It will be wonderful to see her where she has lived since. I am not sure what to expect of Dubai but at least I can speak a little Arabic still to get me by.

There is of course that very high building to visit. The Burj Khalifa  2, 716ft.

 

I think the journey will be full of challenges as usual and many, many, contrasts of wealth poverty, climate, language and scenery.  I will try and blog every couple of day’s travel internet connections permitting.

Home – Cambodia Blog 16

February 15, 2015

It has been just over two weeks now and I have settled back into the UK. I really have had to pinch myself several times and keep looking at the photos to believe that I actually was in Phnom Penh Cambodia in January 2015

Camboida Jan 2015 (3) 001 Camboida Jan 2015 (3) 028

It is said that volunteering can be unsettling to your normal life in the UK. Luckily my life in the UK has never been that normal and my Cambodian trip found me between jobs. So my life on return is all about looking to the future.

But in order to move on I need to reflect on my experience in Cambodia and what the challenges were and what we might have achieved.

To be honest the big impression of the Global Midwifery Twinning Project was how much our two maternity care systems share similar problems or issues.  I have put them in a table to assist the reader.

Cambodia UK
Theory Practice Gap What is taught is not practised.What is taught is not practical in all situations in the provinces. Clinically competent teachers.

Students don’t work with women till late on in their education.

What is taught is not practised. Midwives get influenced by local culture. Culture influences practise and model of care offered.Hard to maintain clinically competency as a University lecturer.
Politics Ministry of Health totally in charge of care provision. NHS subject to the wishes and whims of each government.
Funding Local NGO’s fund different aspects of care – no cohesion. Projects end and care returns to pre-project standard. Politics dictate where money needs to be spent or cut. Have to prove care is efficient and effective use of resources.
Role of the midwife Supported by evidence now in the ascendance. Drive to educate lots of midwives.  Have extended role in Cambodia , family planning, abortion and manual removal of placenta. Supported by evidence now in the ascendance. Drive to encourage women to use more midwifery led services. Move to have less intervention in pregnancy and birth.
Emergency skills Midwives being trained in emergency procedures especially important in provincial clinics. Midwives attend annual updates on emergency skills especially important in home birth, birth centre circumstances.
Hours of work 24 hour shifts the norm. Midwives often work alone in small provincial clinics. But of course only work if woman to attend to. 12 hour shifts the norm in the UK. Moves to more caseload practice – on call service.  Recognition in UK that very long shifts are not conducive to safe care.
Transportation Difficult to transport women to regional referral unit along none-adopted roads.  Minimal ambulance service in provinces.Annual flooding will change plans. Important to plan transportation in advance of emergency at home or birth centre births. Weather issues can impact on this process
Women who are poor Many lack any financial support to care for themselves or their baby.Access to care decided on ability to pay.  Poor women tend to have more health needs. Many women suffer financially and need help to access benefits and help during their pregnancy. Poor women tend to have more health needs.

It is clear to me now that we all need the support of a strong Midwifery Association to help us practice Midwifery to the best of our ability. I am proud that I have helped in some small way to move their Midwifery Strategy along.

The experience has made me realise how little I used the Royal College of Midwives in the UK and worse how little I tried to contribute to the association.  When you work with another country’s Midwifery Association that is trying to find its feet, it makes you understand how lucky we are in the UK.

So what next?

I hope to continue to provide support to the Cambodian Midwives Assoaciation from a distance for as long as they want me.

I hope to make a connection with my new RCM Branch here in the UK and try to make a bigger contribution to the general practice of Midwifery as a whole.

At the same time I hope to deliver care to the best of my ability in my new post, empowering women to achieve the best birth they can have.

Oh and yes, to continue blogging of course.

Camboida Jan 2015 (3) 08728th Jan 2014 Cambodia 09420150129_210226_1

Pictures taken with permission of the people in them.