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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.

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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.

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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.

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We move from the tea plantations of Shizuoka at the base of Mount Fuji that look like massive green caterpillars onto Tokyo.

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We stay at the huge Shinagawa Prince Hotel.  It has over 3560 rooms. It is right at the heart of Tokyo and near all transport links.  So off we wander spending our afternoon walking around the rainy tourist streets of Japan.

 

It is an overwhelming, extraordinary experience and I am inducted into the Japanese fondness for cartoons. There is shop, upon shop, catering for this national obsession especially with young people.  I am slightly peterbed by the young girls in cartoon costumes plying their trade on the streets.  I am so pleased I do not have a photo.  There were photos enough!

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We seek solace in excellent food back in the complex beneath the hotel and retire to bed.

 

 

 

 

The following day the end of the typhoon is hitting hard but we still venture out to Akihabara and Uneno Park.

 

We watched an excellent juggler perform his trade in the rain.  Magnificent.  All credit to him for continuing despite the weather. He was greatly appreciated.

 

20160709_155501.jpgWe also met a Japanese English literature student. It is just so funny how you meet people. Of course she heard my accent and said Hello.  I wish you well Lala.  Hope to be in touch

 

 

 

The following day we achieved a dream of mine.  We went up the sky tree.  Amazing.  I love high buildings and this was indeed a high. 634metres high.  The highest tower in the world its claim.  Much higher than Blackpool UK -158 metres.  The Eifel tower in Paris is 324 metres.   I hope to see the Burj Khalifa Tower in Dubai later in my trip – 828 metres.

 

The experience starts with a fantastic trip in a lift. I felt like I had stepped inside some computer game. Loved it.  The views from the top were of course fantastic.  The weather had cleared after the typhoon. We had chosen the perfect day but Mount Fuji, which apparently can be seen, was still in the distant mist.  Fantastic experience.

 

Later we went on to the Asukasa Shrine.  This was the day of the Hozuki festival so many people were there purchasing their flowers and praying for happiness.  Yes I prayed too.

 

Only two more days in Japan.  Going to visit the local Hospital in Osaka tommorow.

 

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?

 

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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.

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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.

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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.

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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.

We travelled on from Okayama to Hiroshima.  We travelled through seven tunnels to get there. On these islands there are many mountains and the only way is through. Amazing Japanese engineering

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It was very important to me to visit the Hiroshima Shrine and the Museum.

I had visited the Killing Fields in Cambodia scene of mass killing by the notorious Pol Pot and his regime. Hiroshima was no less terrible as inflicted from abroad without thought to the effects on the local population.  I really hope we do not do it again.

The Shrine was beautiful as Emiko says a celebration of the lives that were lost. A permanent place for people to go and pray and remember. The weather was kind and also the tide. It was out so we could walk right up to the structure that floats in the water generally.

Many people were here and there are often weddings. I think we saw three!  All the couples beautifully dressed.

 

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We had lunch nearby then were back on the boat back to the mainland.  Falling in love with noodles.

 

 

 

 

The HIroshima museum was very moving.  All the clothes and personal items collected, from people who had literally ceased to exist in a moment.

 

We visited another Midwife house here.  Again lovely homely atmosphere.  These are really great facilities used by local women to these houses.  They are not encouraged by the government but as they are private they exist.

 

 

We travelled back via the longest bridge in the world (The Akashi Kaikyō Bridge).and travelled soon on the highest bridge in the world. This made me very philosophical about Japan being a group of islands connected by bridges and how really we all have to connect with each other across the globe as midwives and as people to make it a better world.

We travellers need to share our experiences as we know we all just global citizens.

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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

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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.

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Pictures taken with permission of the people in them.

We are now just over three weeks into our Global Midwifery Twinning period in Cambodia.  The things we have witnessed, the discussions we have had and the sheer size of the issue of midwifery care in Cambodia make it all feel a bit overwhelming.  I certainly have felt very tired and very stressed at times and may have not been on my best behaviour at all times either.

It has however, been great to be a traveller again and to share the time in Cambodia with other world travellers.  Whether they are fellow volunteers, or just people on holiday.  There appear to be many people, who spend many weeks, just going from country to country in this part of the world.  Some work for a while and then holiday a little: some alone and some with partners.  Our group has taken time out from the work to visit some cultural sites, both here in Phnom Penh and elsewhere.  It would have felt disrespectful not to go to Siem Reap and experience Angkor Wat and other temples.  The visit to the Killing Fields was fundamental.  It has, I believe, embedded the work  we are doing in the life of the people of Cambodia.

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We have been tourists too and treated as such.  You never really know the true cost of anything or whether the price is based on your country of origin or the seller’s belief in what you can  afford. We have bartered for goods in markets and tuc tuc trips, but you are never sure who got the best deal.  You just have to decide how much you are prepared to pay and be happy.  We have got lost and discovered how difficult it is to say where you want to go when no one around speaks English. The passing of phones to someone who does, has been a good technique to solve the problem.  But to stay here and work for longer you would really need to learn Khmer and it really is not easy.

When you travel or are a tourist you really do have to respect the place and the people you are visiting.  Knowing a little about the context enhances the experience and ensures we don’t damage as we go.  Many of the temples now have wooden steps up to the monuments as many feet have destroyed the original stone.  The challenge of protecting these sites, whilst making them available to view, is ongoing.

Travellers and tourists do bring in money and this does make a difference to many lives. But some countries; including Cambodia, have people who are incredibly poor. So the waiter, the cleaner, the girl in the spa doing your reflexology session, may not be paid a lot in their actual wages. So tipping directly appears to be really important, especially if you have received excellent service.

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Food is also a delicate issue.  As travellers and tourists we eat a lot on our journeys and this helps the local economy.  But we need to be careful not to insult or be disrespectful.  If you go to a foreign country the food will be foreign.  Food is often offered as a welcome, as a way that even very poor people can share something with their visitor from overseas. We have been given lots and lots of fruit and local food items, whilst here.  In the hotel I witnessed a very sad episode. A full breakfast had being ordered and then left on the plate. Perfectly edible food that may well have fed a few people was just left.  The look on the waiters face as he cleared the table really touched my heart. He did not want to waste it. I desperately wanted him to eat it.  But of course he did his job and it went in the bin.

To work and live here has required teamwork.  We have had to work at it at times. Knowing where each one is to be, where they are working, keeping in contact and caring about how they are feeling and being in this strange land. Respecting time away from the group, understanding the need for separation and privacy as well as enjoying the fun and camaraderie on trips.

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We will manage to get to the end of the project together intact and I thank my fellow travellers and colleagues for their company and understanding of my personality.