Life isn't fair, especially not here.

Today it feels like Cambodia stuck its little claws in and said, 'So you think you've got this sorted!?'.

I went in to see a patient that Noni was worried about, young and only 10 weeks post partum, she had come in from another hospital where she had had 15 units of blood (Hb 5) and TB treatment, when she arrived she was GCS 6/15 and in shock, lungs full of fluid saturating 50% on 15L.
Her prognosis at this point was very poor, and when she stopped breathing we administered a brief amount of poorly organised and probably, had it been good quality, still futile, resuscitation. As I completed a couple of rounds of CPR I pushed into her chest and felt her small rib crack under my hand. I was so shocked I lifted my hands off and then put them straight back on and continued.

After this we went to a ribbon cutting ceremony and listened to the in-country director of our supposedly non-religious organisation talk about how blessed we were etc. which did nothing to improve my mood.

I went to Kinyei after work, whinged to Liz a bit and tried to do some work that I'v been stressed about not being able to complete and then I came home. I went out to get some beer to write this with and turned around to be face to face with one of the poor homeless kids who hangs around Battambang, I was so wrapped up in my head that his grinning face scared the shit out of me more than it would have normally, When I got back he was still hanging around and I told him to go away. I feel like its wrong to tell a hungry kid to go away, but at the same time he scares me often when he is hanging out there in the dark, and I don't want him to be there a lot. There are a lot of kids addicted to glue and I don't want them to know where I live and to hang out in the alley there.

I don't really know what the point of this post is, maybe just to vent about the fact that life's not fair, things are far from perfect,  especially if you happen to be born in a war ravaged country with poor infrastructure, health care, and social support.

Ethics, emotions, money and mortality.

The universality of nursing experience became apparent to me today. I worked with five of the D ward nurses and an American and a Khmer doctor for three hours trying to keep a patient alive. Despite the language and cultural differences that can often make things so difficult we worked well together, and differences between an Australian hospital and one in Cambodia aside, the arrest was well run. We were organised, we documented, we didn’t get in each other’s way, we were calm and focused.

Unfortunately the patient deteriorated, we couldn’t keep a blood pressure, we defibrillated her heart 6 times but couldn’t keep it in a sinus rhythm, her kidneys weren’t making urine, she was fluid overloaded and eventually she stopped breathing and her heart rate fell. After we decided not to continue I tried to tell the nurses how well they had done. I was having trouble dealing with feeling sad for the family, sad that we couldn’t save her and adrenaline and shock at having expected to save her and having her die. When I said you worked really well together today and you did a good job they said ‘ot sabai jet’ we are not happy because we could not save her. I felt so impressed with the way that had handled the situation, so proud of them integrating new knowledge and skills so well, and still, I know the feeling, of putting in the work to save someone, starting out expecting that we will and then having them pass away. That switch of focus from focusing and concentrating on how to save a person’s life to taking everything off and letting them go and trying to support a grieving family has always been hard for me, I think it is for everyone in that situation. I felt immense respect for our team, and understanding of the fact that you can try your best and still fail to save a life, and yet trying to reassure them I was close to tears myself.

The other difficulty here is that when deciding how much to give the patient and how long to try and save them is that the family (of our medical patients) have to pay for those drugs, and I never know what their financial situation is. It can be an emotionally charged decision to decide to stop trying to save someone, but there is a point where it becomes futile, their heart can no longer beat, no matter what drugs you give or how many times you defibrillate, if they have spent long enough without oxygen going to the brain the chances of surviving with viable brain tissue are reduced. To continue trying last ditch attempts in these situations can make you feel sure that you have done your best, but in cases that are futile can cost the poor and grieving family money that they could have been saved. I have no answers to this dilemma, I wish we could treat everyone, that we could give free care, which we had guaranteed funds and resources but that isn’t the case here.  I am going to try and get the hospital agree that patients and their families don’t have to pay for the cost of care given during life threatening situations. While this might help for the acute situation the reality is that many many people are going without treatment for their medical issues because they cannot afford it.

How to win friends and influence people; A lesson in cake fights and kitchen flood

My first dinner party went off with a literal bang, Jason was the first to arrive and within about 5 mintues he had bumped a pan which fell and knocked the attachment for an old tap of the wall causing a torrent of water to us to start jetting out of the wall, spraying us with water and making the water level in the kitchen quickly rise. He apologised and we laughed and he rode to our local café to ask the guy who works there and who I pay rent to, to come look at the house. Jason came back a little later and took over holding a pot against the flow to try and redirect some of the water into the sink. In the mean time I called Noni and go the phone number of Buff, out local hero and fixer of everything, and also the smiliest guy in Cambodia, and maybe the world.

My phone ran out of credit half way through the conversation and I decided not to bother Buff anymore, and then Yong rocked up and turned the water off (which is way easier to do than I thought). Yong then tried to shove a kitchen sponge in the hole in the wall with a knife and talking about maybe calling someone to fix it tomorrow. I wasn’t convinced about the kitchen sponge, but was happy for the plan to fix it the next day (probably needless to say when Yong turned the water back on the kitchen sponge went flying and the water spout re-started).

After Yong left Buff rocked up (somehow, I don’t know how he found out where I was or what they problem was…) with a bunch of tools and looked at the hole in the wall, then took a few screw drivers to the hole and chipped out the rest of the metal pipe. He turned the old fitting around, put it back in the wall and it was fixed (He really is the coolest dude ever). I offered him a beer or dinner, but he just happily headed off to do whatever it is that Buff does when he’s not fixing all of our problems.

Then Alexa Noni and Allison arrived with take away Indian Jason swept out most of the small flood,  and I proceeded to be the most unorganised host ever, not having any plates or cutlery or anything, and feeling so happily amused seeing all my bongs in my house J

It was a lovely dinner, and we talked about all the things and teased each other and gave Allison the mug that we got made for her birthday with a picture of Us and all the Kinyei staff on it, and eventually it was time for cake. Khmer cake is an interesting conglomeration of oil slick like puffy cream and spongey cake… It is often thought to be better for throwing than for eating, and so, in a moment that I feel really christened my new home, I took a chunk of it and smooshed it into Noni’s face…  It was Cake-on from then and we quickly deceminated the cake, re-homing it to each others, faces, hair clothes and my entire house, It was one of those moments where you realise your friends are real friends because your can smooth oily cake all over each other and then stand together on the balcony in the rain trying to wash it clean and laughing. Not long after that everyone went home and I bemusedly removed cake from some surprising places, washed it out from behind my earsand went to bed. J

 

Pailin Adventure

On Saturday we rented motorbikes and rode to Pailin. After a 5 minute lesson at the abandoned airport on Alexa’s bike and a trip to Kamping pouy last weekend on an automatic bike I decided to hire a semiautomatic bike (gears, no clutch).

The ride to Pailin is about 2 hours, so after waiting around from 8am to 09:30 for everyone to turn up we got on the road and headed out to Pailin. The landscape changes a fair bit between Battambang and Pailin and it was so beautiful, I kept wanting to stop and take pictures but didn’t want to slow everyone down. We had a few stops on the way down for snacks and flat tyres and just to let our assess get some blood in them, and then we made it to Pailin. The idea was to ride out to the waterfall so we headed down a dirt road that turned into more of a mud puddle than a road. A couple of people fell, and Jason got splashed all over with mud by some amused locals riding by. When we got to the waterfall the bridge was out and we were pretty hungry, so Mark and I jumped in for a quick swim, but we didn’t walk up to the top of the waterfall, and we decided to head out and get some lunch. We rode out to this beautiful spot with a little lake with a swan boat on it and an orchard between these hills but the place was eerily deserted and so we headed off to somewhere else. On the way back from the waterfall Mark slipped out in a particularly muddy area and ended up in the bushes with a 3^rd degree burn on his leg. We didn’t have any cold water so at Untac’s suggestion he covered it in toothpaste J “khmer traditional medicine”. I offered him some codeine I had in my bag but he seemed to want to keep his wits about him while riding so he just toughed it out.

Sitting at the new lunch place in a grass hut I was super hungry and tasted the tasty beef with lime and pepper… so tasty! (sorry cows) then I wanted to eat all the lime and pepper beef, and we ate food there for a few hours and generally talked crap as usual. Afterwards we were going to head to another waterfall but it was getting late and some people wanted to go home, so they headed back and we decided to head back by a back road that had some other waterfall on it, with Untac as our trusty guide we turned around and headed through the most stunning rural areas of Cambodia, I am so desperate to go back and see it all again slower. It was the kind of riding I like where you have to pay a lot of attention because the road is mostly potholes with the odd excited dog or flock of cows. There are lots of plantations out here which I hadn’t seen before and I am so keen to go back and spend some more time out there. Eventually we reached a little gate around a puddle, we followed Untac through it and soon the road disappeared and we were just riding through grass… which quickly gave way to a track which fairly resembeled a mudslide and eventually we had to stop and just walk. As we walked away from the bikes we heard a big thump and turned around to see a monkey pushing over a bike. Mark was concerned that they would steal the keys to the bikes so he went back, armed with a stick, to get the keys, but got ganged up on by a bunch of monkeys and had to turn tail (Untac later informed him that these are all the wrong things to do with monkeys).

When we got down to the waterfall it was beautiful, and we jumped in and it was so amazing, so refreshingly cool and nice and we swam under the waterfall and got waterfall massages. Then tried to drown each other a bit… just for fun J  I could tell people were starting to get antsy about the (at least 2 hour) ride back, so soon enough we started the ride back. Riding in Cambodia at dusk is never fun, it is very hard to see, people often have no lights or the lights don’t work on their vehicles, there are fires everywhere burning off the day’s rubbish, releasing toxic smells and reducing visibility further…  riding on an unknown dirt road full of significant potholes was no easier, luckily for me Jason soon ran out of petrol so I stopped with him and we spent the rest of that dusk time trying to figure out what to do. We decided I should ride off and get petrol and bring it back, by this time it was dark and the visibility for me much easier. I went and bought two coke bottles of petrol (spilt it all over my hands) and rode back with it in a plastic bag… As I rode I noticed an odd thumping happening with my bike and realised I had a completely flat tyre. By this time the rest of the gang had heard what was going on, and when I asked Untac what to do about the tyre they all decided to come back. We rode slowly up the road looking for anyone who could help us (tricky, especially in the countryside). Eventually we found some lovely nine-year olds outside a little wooden shack who replaced my inner tube somehow without removing the wheel and then asked for 50c for their troubles. The rest of the ride back was long, dark, involved getting a lot of bugs in the eye, had a few more stops for petrol etc, and eventually got us into Battambang around 09:30pm.

Over the next few days 8/10 of us also contracted a lovely pink eye conjunctivitis!

All in all I had a great time, I love adventures and being potentially stuck in the countryside, and waterfalls and mud and being a little unsure of what’s going to happen. In fact I think I may have had more fun than anyone else …

The bikes before the monkeys started pushing them over.

Waterfall no. 2 (In Angelina Jolie and Brad Pitts nature reserve place)

Riding through a flock of Cows.

Waiting to get the tyre fixed...

Flood relief clinic

So after the floods in Cambodia some of the doctors who knew people in certain communities around Battambang decided it would be good to do clinics with people who had been displaced from their homes by floodwater. The first of these clinics was in a wat near Phnom Sampov.

We arrived on a Saturday morning and set up desks with nurses taking vital signs and names, then sending the patient to the doctor who would give a diagnosis and prescription and then to the makeshift pharmacy who would fill the prescription and explain to the person what to do with the medication.

I was with the nurses taking vital signs all day, there was a constant stream of people (I think we saw almost 200 that day!) and so I felt I hardly stopped or got to really interact (although my Khmer is so poor I couldn’t have said much anyway). At one point I was presented with a teary baby and realised that apart from the fact that we don’t have any BP cuffs small enough, in my work as an adult nurse I have never had to assess kids or baby’s (not even in english!) so I looked at the now crying baby and tried to get a heart rate or resp rate but wasn’t having much luck… I asked my colleague (and generally awesome dude) Tum if he could help me, he replied ‘sure’ and calmly asked the mother to walk into the shade with the baby and to point up into the sky and watch the leaves from the tree’s above… by doing this he distracted the child and also got it to stretch out it’s abdomen making it easy to count the resp rate, humbled, I said thank’s to Tum and went to see the next patient.

At lunch I saw a big hole in the ground with a web on the inside like an Australian funnel-web but much larger, I assumed something lived in it and thought I should tell people, as the hole was just behind one of our doctors desk’s. I pointed this out to people and asked what it was, thinking that they would tell me what animal it was and sensibly leave it alone….  That was my first mistake… Vichet (one of the doctors) happily told me it was a king spider, (about the size of my outstretched hand, highly poisonous, and apparently quite tasty). He then started pouring water into its hole and poking a stick down trying to make the giant poisonous scary hairy spider come out to kill us all! By this point of course there are a crowd of interested barefoot onlookers crowding round the hole, and I am standing well back having a little whitey conniption about the whole situation. Eventually when everyone had seen the big spider and Vichet had noticed that I was paling a bit, people lost interest and left it alone, went back to seeing patients etc. Meanwhile a pig about the size of four of me wanders out of the jungle and past the nurses desks and off into the camp J

We treated a lot of people for general illnesses, colds, boils, a broken arm that had been wrapped in leaves, dog bite, gastro issues etc, although sometimes I feel the diagnosis and prescription leave a little to be desired… It was an interesting day. Afterwards we went to Kamping Pouy where the people in the camp were from to see what had happened. Kamping pouy is a huge man made dam built by khmer people in atrocious conditions under the khmer rouge. During the flood it had been dangerously full and so the area had been evacuated and the gates opened to let some water out, as the pressure of the water was so high however the water ripped the gates out of the walls of the dam and surged through where the town had been. The damage was scary, I’v never seen water do so much damage, having been to kamping pouy weeks before to go swimming, the changes were drastic and almost unbelievable.

Flooding

So there has been extensive flooding across South East Asia due to typhoon. 80 people have died in Cambodia. Crops and homes have been damaged, and the large amounts of residual dirty floodwater will make it easy for outbreaks of disease to spread (both from infection and mosquito's breeding).

These are some pictures from Battambang.

 'Old Battambang' where I live is in the city and wasn't as badly affected.

From the top of Phnom sampeu - Usually you can see fields of rice paddies from here.

 The highway close to the hospital.

 

 Fishing on the highway.

 The highway towards the hospital.

 So glad the medical centre was built on high ground.

 

So lucky to have these pumps and an awesome team of people helping to keep the hospital functioning and open. Admin and the Dr's were out the front filling sandbags, maintenance made bridges, lifted massive amounts of equipment of the floor, sandbagged the hospital entrances and rigged up pumps, and the nurses and admin staff all came in to work despite most of their homes being flooded.

 

The road on my walk/wade to the hospital.

I love you but your homophobia breaks my heart.

So this post is about two different things. One is about vulnerability, friendship and homophobia, and the other is about what I understand so far of being gay in Cambodia.

The first thing;

This is a feeling I get from time to time, with particular friends or places. Friends I would love to feel wholly comfortable with, but there is something, like an edge, a topic I feel I have to avoid because to talk about it brings up this huge gap between us, and reminds me that there are things that feel to me like a part of the core of me, that my friend cannot understand or does not respect.

This occurs about a few different things, my politics, my views in things like racism and abuse and respect, that are things I don’t feel I can compromise.

 And inevitably it occurs with being queer. I love the people that I love in my life who are queer, trans*, and wonderfully uniquely their brilliant selves. I feel that all of the things I associate with queers can create so much joy and celebration and sparkles and growth and challenge and love. And I know that there is also difficulty and often pain involved in being outside the status quo, In being who you are when people don’t understand it and are threatened, disrespectful, angry or many other reactions. I love the understanding I find with many queers, and I feel love and care for the people who are experiencing difficulty and abuse because of it.

It tears at my heart a little to love something or someone but know that we can’t be friends in the way I wish we could be friends. Because there are differences in our lives and experiences that give us different takes on the world, and trying to explain is gruelling and painful and involves being so vulnerable, sometimes for so little pay off. I sometimes try to explain it all, to help someone understand how my life has shaped me into the person I am, and why comments and ways of treating people that seem fine to them are so hurtful to me… but the process of baring yourself to someone you care about things you deeply believe in and can’t change, and them having them not understand or not care is so painful and demoralising that most often I don’t attempt it.

Cambodia too of course has a certain homophobia, It is not something that really makes me feel personally uncomfortable or threatened. I fit into Cambodia as an expat ‘baraang’. Different expectations and understanding apply to me as opposed to someone who is khmer and was raised here. But for Khmer people who are gay, queer, trans*, I can’t imagine how difficult it would be.

Cambodia is a place I am still getting to know, and as far as I understand (which probably isn’t very far) Homosexuality sort of “dosen’t exist”, It’s understood that people might do a bit of ‘searching’ but that eventually they will settle down and get married. Talking to a distressed Khmer friend the other night I realised how good I have it back home, I can hold another girls hand most places, kiss where I want to, live somewhere where there are lots of other queers, live with my partner and probably have kids if I ever wanted to. Here I think that would be a very hard option if you could do it at all.

I’m aware that I don’t know much about Cambodia, I’v only been here a few months, so maybe this is not the way it is, I don’t have much of an understanding of Khmer culture and I think it differs in the cities and rurally and maybe province to province a bit as well. So this is just what I’v heard (and mostly from other foreigners).

Mainly I feel sad for my friend who is having such a hard time here, and I felt shocked to try and imagine how hard it would be to know I was queer if I was growing up in Cambodia as opposed to how it has been the past few years living in Newtown.

And I feel sad when that point comes as it sometimes does when someone I care for and trust says something out of left field that just makes me feel uncomfortable and shocked, and like I can’t be honest and that they don’t understand me at all.

** Also, I know this sounds a bit whingey and I feel weird writing about myself like this, I am sure I have misunderstood people and made them feel uncomfortable and I feel sorry about that. I also think a lot of people feel like this about differen things so… yea…. Disclaimer ! : )

Questioning our efficacy

So the other day we (the other two young expat nurses and I) started talking about whether we are going the right way about what we are doing here and whether it’s likely to have any lasting effect after we leave.

None of us really have experience in this kind of work which is sort of looking at the hospital and then making projects to try and improve it – trying to increase patient safety and reduce rates of infection, and to introduce idea’s of leadership, self regulation of the ward and trouble shooting and critical thinking and self/hospital improvement to the Nurse unit managers. Also trying to create a culture where everyone feels that they have a say and promotions etc. are given out on merit not bribery.

Culturally we are very different, and I don’t think any of us understand much about Khmer culture, it is easy to put something down to someone’s culture, but I don’t know how much of that is assumption and how much is accurate. There are also big differences between khmer culture in city’s and out in rural provinces and among people who have had more jobs and more contact with westerners and those who haven’t and I’d say probably it differs with class as well. So a blanket statement about something being ‘their culture’ is maybe just going to be inaccurate anyway. Our lives have definitely been very different up to this point.

 There are so many assumptions that you just can’t make, and so many inherent misunderstandings that occur and we are learning as we go. Things like talking about medication errors, because it has been so ingrained into us what they are and that they are bad, when we introduced the new medication charts I think we forgot to explicitly say that if you haven’t signed for having given the medication, that is an error, even if you gave it correctly, you still need to document it, there’s no rule like at home that ‘if you didn’t document it you didn’t do it’ because there aren’t the regulating bodies and authorities here to do anything about it.

And we gave the NUM’s calenders to fill out the other day to help us all stay on the same page with what’s going on and when they were sort of looking a bit confused I asked has anyone used a calender before? And only one person out of eight had. Sometimes you just have to go ok, and go back a few steps. It’s a bit of an eye opener about just how ingrained our culture is and how much we assume.  The NUM’s are great and try really hard, I have such respect and appreciation for them working with us and our crazy ways. We have started meeting briefly everyday to keep up with introducing all of the things we want to introduce and trying to keep up with following everything up etc. It’s also hard to know how much is just doing what we say because we are white as well, and whether they feel comfortable really telling us their opinions, but a few times recently they have told us problems they see in our plans which is really heartening.

So back to the question of whether it is effective, there are a few reasons that perhaps these changes won’t stay in place when we go; one is that we don’t know much about the culture and if we aren’t doing these things in a way that fits in with the culture here, it will probably just go back to the old way when we leave, (although we are making some changes to the culture of the hospital as well, and I will be interested to know if they will stay). Also we are introducing many changes,  we have so so many things we want to introduce and I think we need to calm down a little and pick some focus area’s to work on that are the most important perhaps and do really good follow through with our projects, I might only be here for another four or five months, (or maybe a little longer) and The others might only be there for a further eight months (unless they get further funding) so we need to be a bit realistic about what we can achieve in that timeframe…

We are trying to do a lot of things right now, we have changed the medication charts and vital sign charts in the hospital, opened a medical ward, introduced a crash cart, started Nurse Unit Manager meetings, started portfolio’s for staff and writing policies and procedures, started writing a pharmacy book as a reference for all the drugs, started teaching anatomy and physiology and pathophysiology, we are about to try and introduce a new way of documenting, make a system so that patients have unique medical record numbers and introduce medication error reporting forms, trying to get the policies that we have written part of hospital culture and self regulating checking of those things, (trying to convince the hospital board that the cost of paper towels to dry hands is worth the reduce in infection rates that proper handwashing is shown to have). And I’m sure I’m forgetting things, so within all of that I’m sure that some of those will not get followed through, or fall by the wayside..

It can be disheartening trying to make changes, but I think some of that is just wanting things to happen to fast or misunderstanding why it’s not working. The time I usually end up frustrated is in the middle of a nightshift when there is someone very sick and I can’t communicate well and the standard of care that I’m used to for a patient, and things that I take for granted as basic don’t get done, but I just try to remember that this hospital has been running for a long time without us and yes some people probably have died from aspiration pneumonia etc, but also the hospital has saved a whole lot of people who would have died otherwise.

It's a very funny situation to be in helping a hospital that was set up as a war hospital to start accepting medical patients, and to be trying to bring the standards of care and the idea of responsibility for your patients to be more like a western hospital, and still being constrained by resources and budget and trying to make the best of the material we are donated. I think its sort of a unique situation in that, and I am hopeful that we can help the hospital to become a little safer and the nurses hopefully to develop more knowledge and pride and responsibility in their work.

We'll see, but its 02:30am, so goodnight for now!

 

New House! (in retrospect)

So my lovely friend Nat had been generously letting me stay in her apartment with her, and then she moved out and so I am now living in the apartment! It is beautiful and quirky, and I love it. It has a huge bedroom/living room with a little balcony and about 30mhigh pitched ceiling, and then a little outside balcony type section to get to the other side of the house and down the rather low stairs to the bathroom kitchen bit, which opens into the lane.

I unpacked all my stuff (in about ten minutes) and put up my new fairly lights (which subsequently broke) and made myself at home.  One of my favourite things is the acoustics in this room are great so I sing a bit.

The lane I live down is pretty dirty, mossy, and there is a fellow who seems to live and poop in it, as well as rats, cats, cockroaches, a rooster and at least one scorpion L It teaches me to walk slowly because many times I’ve almost ended up head to toe covered in poop/mud/general refuse and I’m always a little scared of stepping on a scorpion…

Virtual house tours have been requested so here are a few pictures (sorry they aren’t the best..);

 

 

 

 

 

 

Working on my thong tan...

So yesterday I was riding to the post office but It was closed and I was on a bit of a roll ;) So I just kept riding. I rode down by the river for a while checking out all the beautiful temples and the riverside shacks, It was lovely and I rode out along the highway for a bit through the rice paddies with the strangely bony cows and people working on skeletal bamboo frames around the cement foundations of new buildings. It was really nice to be going along at my snails pace and just seeing Cambodia, and providing a source of amusements for a lot of locals :P

This morning I woke up feeling a bit funny so I decided to go to the markets, get some food, do some life chores etc. As I passed the markets I thought, ‘I’ll just go for a quick ride along this road first…’. I rode until I got out to the rice paddies and rural houses and it was so lovely, quieter than the highway and one of the first times I’v felt almost alone in ‘ the nature’ since I got here there was a lovely breeze and it was really peaceful and I felt heaps better. As I kept cycling I got to the rubbish dump, which was on fire and really stinky, I decided to go back cause I’m pretty sure the fumes would have been carcinogenic as well as just really unpleasant. As I was passing the building that I thought would be the ‘waste management centre’ or some Cambodian version of this, A small boy with full face makeup rides out on a little pink unicycle….    That was a little surprising and I wanted to use my little bit of khmer so I went to say ‘la-or nah’ (very good). As I rode over a tree started saying enthusiastically ‘Hello!’ and I noticed it was full of children, and then about four more extremely made up kids came out of the building and started chatting to me, turns out it is an English, circus and cosmetics school! Of course! Don’t know why I didn’t recognise that straight away! I chatted to them for a while and then headed off wondering about how they work all day in that smell and with all the burning chemicals etc.

I followed what I thought was the road back to Battambang and rode happily for another 40 minutes or so before the lack of breakfast and water started to get to me and I decided I really needed to figure out where Battambang was and go there, It was fairly embarrassing having to point both ways down the road and say ‘Battambang!?’ and I think it was pretty funny, my go-to for any situation where it’s a bit awkward and I can’t explain myself is to grin and laugh a little and sometimes say ‘have no brain’ cause it’s one of the few things I know in Khmer, it seems to have gone down quite well so far… got a few laughs and smiles at least.

I arrived back in Battambang sweaty, very sunburnt and shaky with low blood sugar, but happy to have made It back. I really want to try this again with water and food and maybe even a map or vague plan cause Its really fun. I also found some lovely picnic spots that I would like to get back to if I can.

And my thong tan slowly improves.

First moment of homesickness

So last week I had my first feeling of homesickness…  It was the day Nat moved out and therefore I started living alone and I was trying to sleep because I had a nightshift that night. It was hot and I couldn’t sleep and I had just been beginning to realise that I live in a different country now to a lot of my friends and family. I woke up in the middle of the day lonely overheated (the power had gone out) and just missed home and the support network that I have there.

I went in for my night shift and realised that I had looked at the roster on so usually I work a night shift with one of the khmer nursing supervisors so that I can communicate as my Khmer is barely existent yet. I called my boss and told her and asked her what she wanted me to do and she asked me to check on a COPD patient who had been a bit sick when she left, and then either stay or go home depending on whether I felt comfortable. So I walked into the ICU and went to see the patient… Who I couldn’t rouse at all, I got the nurses to tell me what his GCS had been because to me it looked like it was a 3/15 now, I gave him a sternal rub but got no reaction, one of the nurses managed to get a 7/15 but this was down from a 12/15 and obviously he was pretty  unwell, I listened to his lungs which sounded super wheezy/crackly and noticed he had pitting oedema… I also noticed an audible wheeze from his airway just sitting next to him. We have to real option to intubate or use NIV here yet, and I wouldn’t have liked his chances of getting off a ventilator even f I had so I called my boss to update her and she and then her husband (the head medical Dr) came in and had a look. We had started the guy on new antibiotics and Dr wanted to keep him in to see if the second dose would improve anything, but the family wanted to take him home if he was going to die. As this was happening the Dr was called to see another patient, and it turns out this patient had angina, and ?MI so needed to be transferred to the ICU for a nitroglyceride drip and “cardiac monitoring” Which in this case involved me hooking up the archaic defibrillator as a monitor… We continued to monitor him overnight, with on and off chest pain etc, but he stabilised which was good.

About 5am I came into the ICU to find one of our severe head trauma patients (GCS 7/15) sounding like she was breathing underwater and looked to see her O2 mask had traces of vomit and although she had been suctioned her airway was obviously threatened and she had aspirated on her vomit. She had a guedels in and I suctioned her but with little effect, I could tell she was in respiratory distress due to the fact that she had just aspirated, and I also knew that her quality of life was not going to be great if she did survive, I didn’t know what else we could do apart from saline nebs, chest physio, suctioning and starting antibiotics, I suctioned her again and managed to get her airway sounding a bit clearer, but when I left in the morning I was still worried about her and later on I found out that she had died during the day.

It is so frustrating in those situations, not to be able to speak to the nurse’s doctors and family with any degree of clarity, to be unsure if these patients are getting a high quality of nursing care, to be unsure if the family member has been properly informed that their loved one may die. I was feeling pretty overwhelmed and unsure of what I could do, if I could have done anything better that night and what I could do in the future to make sure that the standard of nursing care is high and that families are informed of what’s going on.

I was also really tired as I hadn’t slept the day before, and as I rode home I bumped into a car on my bike, It wasn’t very hard and I didn’t fall or anything It was just very shocking and I couldn’t understand what they said when they wound down the window to yell at me, but I was already feeling a bit fragile and it just scared me.

I didn’t get to sleep for a while that day, and in my usual stubbornness I was determined not to let anyone see that I was feeling teary, but also just missing the ease of being able to call a friend to hang out or cry to someone who knows me and whom I am not shy in front of. I woke up that day and had a little cry to myself and was starting to feel really awful and so hot so I decided to go into work to at least be cool and be around people, I got in there and it was nice and I ended up skyping Liz for a few hours (thanks Liz :p ) and then going to dinner with most of the Battambang CCT crew who are super lovely for Nat’s B’day. After that I felt so much happier and appreciative and realised that I do have support both from home and here and I don’t need to be so stubborn.

This weekend we went to Siem Reap and had a lovely weekend J and now I am in Battambang ready to sleep and go back to work tomorrow. I feel so glad to be making friends here, the weekend in Siem reap was really lovely, and I really appreciated the luxury of nice food and a foot scrub and dancing and drinking and company of great people J Also staying in touch with people back home, I feel so lucky to have the support and love that I do, and I often find myself smiling or chatting away in my head to someone from Australia, and it means the world to be thought of by people so busy with life and so far away J

 (also sorry for all the unexplained medical stuff, I’v just written how I would talk and it’s just in there for anyone who’s interested but if you want to know more or it’s annoying just let me know.)

Xx

Starting work

So time seems to have flown a bit since I started here and I haven’t had much time to email or post (sorry mum!) but I will try and catch up a bit now…

The hospital that I’m working at was originally founded in 1997 by an Italian NGO called Emergency.  It was started to treat victims of war and landmines, so was set up as a surgical trauma hospital. As the war ended and now the amount of landmine injuries has thankfully decreased somewhat, the hospital continued treating trauma patients, the majority of which are from road traffic accidents, in particular motorbike accidents. As it no longer fit the description of what Emergency does and the government didn’t want to take it over the handa foundation took over the hospital in 2012, and that’s who I am working for now.

 The hospital has an ED, an OT which I don’t know much about yet, an ICU, a men’s surgical ward, a women and children’s ward, and a ward for patients with infections. There is also an outpatient medical clinic, a lab and they are currently building an endoscopy unit. For CT scans we send the patients to one of the clinics in the area.

We are also about to open a new wing which will have medical ICU patients and medical patients. As we start to bring medical patients into the hospital we are trying to do some teaching about medical patients and their needs, we are also trying to implement some of the structure and infrastructure and standards of the kind of hospitals that we have come from. This is a very interesting task and there are many challenges involved, not least of all my lack of khmer language skills (although I have my first lesson on Thursday!!).

 I feel funny being respected in this hospital and listened to by nurses with so much more experience than me, simply because I am white and ‘western’. I forgot to tuck my septum piercing away this morning for the first few hours and no one commented… I wonder what people think of me this funny western woman with no idea of khmer language or culture. I am really keen to learn more, to be able to talk to the nurses and patients and get a better feel for who they are and how they work.

So anyway, my role as I am learning, is to work with the existing ICU and the new medical/ICU wards, their NUMs and staff to implement new policy, start talking about nursing education and how we can get that going, try to fill any gaps in education with the staff, and assist the NUM’s to become NUM’s as this is a relatively new role here, as well as trying to create a culture of critical thinking, problem solving, self reflection and improvement and respect for one another.

This is all intensified I guess by the fact that almost everyone we are working with has lived though the khmer rouge, it’s hard to imagine the difference between the three young Australian and American nurses who I’m pretty sure all grew up in comfortable middle class ways and have only a few years each of in hospital clinical experience and our Khmer counterparts whose lives I don’t know much about yet.

I was pretty intimidated by the job when I first heard what it was, and rightfully I feel, I do not have the qualifications or experience to be doing this kind of thing, I know my knowledge is lacking and there is a lot I need to refresh and work on, but I think that the value I have is mainly in the fact that I have worked in well run, high standard, well resourced hospitals with a strong idea of professional nursing, and that experience is what I have to offer and try and teach about at the same time as hopefully learning some skills form the staff, and yea… working together I guess.

I decided to just be positive and do my best, I know many people who could do this job much better than me, but I am here and I am of no expense to the hospital, so I will just do my best! I have decided to just be positive and try things and believe in myself, I have had a lot of lovely feedback from my friends telling me that things like that I have value because I am level headed and listen to people, and so I am listening to them and trying to trust in myself and my ability to hopefully do a half decent job!

Sorry this is so long and scrappy! My head goes slightly at a million miles an hour with these long intermittent pauses, I have also been having fun making new friends, I went to Siem Reap for the weekend and love riding my bike around Battambang, especially on cool days with the wet season rains. It’s lovely staying with Nat, her house is lovely, and I miss and love you guys so much!

X

C

 

Travelling with my sister

So Keda and I actually travelled quite well together! I think we both had our misgivings about how we would go being such different people, but I found, stick us together with our packs and a tatty map and we quite happily bump along together. We both enjoyed Phnom Penh more than we thought we would, and neither of us were particularly smitten with the delights of Siem Reap, (The delights lessened further by suspecting that I might be a bit sick but feeling ok and going out only to realise that no, I need to sit down before I pass out/vomit and having to get some poor tuk tuk driver to drive me home).

Things got harder when we got to Battambang and it finally started to sink in that I am going to be living here for a time, and I had little idea of what I would be doing or if I was capable! Keda says I got more intense, I say she got more annoying :P

It was really lovely having Keda come and see the town and take me out for dinner J and squabble like siblings together, I think we both had a great time and when I put her hungover and bleary onto the bus this morning I realised I will miss her little chattery presence J

 

So here are some pictures of us having fun together :)

Awesome! swimming in the rain in a rooftop pool, look at our happy grins!!

(Words fail me trying to caption this...)

                                                                              

And you can check out Keda's version of events at  Keda's blog

Are you ready for my first Cambodia inspired joke!?

So Keda and I were enjoying the neon delights of Siem Reap's tourist bars last night and young Keda got herself rather inebriated....

This morning upon waking she asked me 'How did I get home last night?' to which I promptly replied,

'Don't worry Keda, I tuk tuk you home'

*Keda would like me to remind you this is a joke - all characters are fictional, all scenes entirely whimsical, any similarity you think this may bear to real-life experiences are ENTIRELY FIGMENTS OF YOUR IMAGINATION!

Free the Bears!

So I may have been a little dubious of the ‘free the bears’ day, thinking it might be some weird tourist focussed “volunteering” with the bears kinda situation, and in a way it was, but in a way I liked, I guess.

We got picked up in the morning by some of the keepers (and their dog Rosie! so nice to play with a puppie) and one other aussie girl and drove out to the sanctuary. It is in 25000ish hectares of protected forest, which also has enclosures run by the government for lots of other animals, monkeys, birds, elephants, lions etc. The bear section is run by the ‘free the bears’ charity which was founded by an Australian woman called Mary who saw something about bear bile farming on TV and decided to do something about it, eventually leading to the organisation today which has a few sanctuary’s across south east asia for bears rescued from bile farms, resteraunts (bear paw soup), dancing bears and those from the exotic pet trade.

                                                   

Currently they can’t re-release the bears as poachers trapped the only bears that they tried to release and one of the bears died of it’s injuries.

The aim of the “volunteer” program seems to be mainly to educate the “volunteers” about what free the bears does and to let us do a few activities related to the bears (like preparing feed balls, and hiding scatterfeed in the bears enclosures for them. It was pretty fun! I liked climbing around the enclosure hiding food and then watching them find it… but I think mainly this post should be cute bear pics so…

                                              delicious bear snacks...

             Keda throwing our newly made snacks to the bears!

                          Bear checking out the snacks :)

                                                      

I also got into a fight with a monkey! we were near the cage of these massive pythons and a friendly monkey came over to say hi, turns out the monkey was a little over friendly and some of the other people ran off screaming... I thought that the monkey would back off, me being much larger and scarier then it but apparently not, so I hissed at feinted towards it and it hissed and feinted towards me until I realised I was trapped between the python cage and a big rock... and the monkey was still hissing and making to attack me (I realise I am probably about to get bitten by said monkey and briefly regret not having got a rabies shot) and then one of the friendly people starts pegging sticks at the monkey until it backs off. My pride took a bit of a knock at loosing a battle of will with a monkey!

 

 

 

 hiding food for the scatterfeed

 

 

The bears finding the food we hid :)

 

And yea, this happened...

Choeng Ek Killing fields and S21 prison

*this could be triggering* – It’s about the Khmer rouge, torture, murder and genocide - I am so sorry if these things have touched your life.

We visited Cheong Ek Killing fields near Phnom Penh, and S21 the torture prison in Phnom Penh. It was an intense experience, and I’m not sure I can really articulate or understand the experience, but I will try to share how I felt.

The Killing fields when we got there were felt peaceful, there were tree’s and grass and butterflies flying around, It was fairly quiet. We got the headsets that tell you about the different parts of the site and walked around the area listening to the audioguide.

It’s so hard for me to imagine in anyway what happened there, especially to relate a site that felt so peaceful to such cruelty and suffering.

 I can’t relate to the experience in any way and I think I am a very experiential person or learner. To imagine what happened I feel like I use a part of my brain that imagines the imagery of a story I read.

Having been lucky enough to never really have had my life or the life of my family, friends, loved one’s threatened, I just cannot understand how horrific it must have felt, and still be for the people who suffered under the Khmer rouge, My sister realised while we were there that the regime occurred within her lifetime, so all of the people her age and older had lived through it. It is so recent still, It almost amazes me to see so many people living their lives in what looks like normality and to know that there must still be such trauma and pain present.

I like to believe that people are good, to give them the benefit of the doubt, despite knowing in my head that people commit awful atrocities against each other, I just can’t reconcile this with the truth that these sort of things happen everywhere and often, and often go unreported/noticed/mourned. I know I am lucky to be so naïve, to never have been faced with what a person can do to another.

How  can humanity encase such beauty, wonder, generosity and love and also such violence hatred, and brutality? And I suspect it’s not even always clear cut the differences, I don’t like to think of ‘good’ and ‘bad’ people, I think I have elements of both as do most people I suspect.  Are the people who worked in the Khmer rouge messed up, ill, evil, or were they terrified of what would happen to them if they didn’t obey? In which case who masterminded it? Are there single people to blame like Pol Pot, or Hitler who somehow made millions of people kill, and terrorise millions of others?

 Part of me doesn’t want to understand that brutality in a real sense.

We also visited the torture prison S21.

I don’t think I want to write about it. It was awful, people being absolutely destroyed in every sense of the word. It just makes me question how I see us human beings, I don’t know if I can fit these things into my worldview and still be hopeful and believe in myself and other people.

But does that disrespect the memory and experience of the millions of people throughout the world who have been faced with this sort of violence and terror firsthand?

I have no answers, this is my attempt to share how It felt.