week 1 in Cambodia

The thing that strikes me the most..... is how different life is here to Vietnam. I knew it would be different, but I thought, seeing as the countries are so close, and share some history / religious affiliations things would be similar.

Nope.

The next is the scale of poverty, and lack of education.

On our first day here we went out to the killing fields. It was horrifying. The area is really well designed for tourists to give the history while maintaining the respect for the people who were murdered there. You get an audio guide which includes stories of survivors.  It  was so intense, and traumatic that I became numb. I couldn't cry, just feel physically sick. And while it was a horrifying start to a Cambodian trip, it was also a very very important way to get an understanding of what has happened to the people here. Context for those who may not be aware of details......  Pol pot wanted the country to be a communist, agrarian society. He de-urbanized and forced people to work in mass farms. Often without enough food to survive, yet alone do that amount of physical labour. To regress the country more effectively education was more or less outlawed. All the educated, or progressive thinkers were killed. Literature was burned. Whole families were murdered - to prevent children from seeking revenge when they were older.

About a quarter of the population was killed. So when you think about the effects of killing the most educated, forward thinking, progressive 25% of a population..... it helps put into context why so many things that seem logical, and simple and easy - just don't happen now.

Kids playing and reading at the clinic

We also visited the national museum. Which is dedicated to more ancient history and has a lot of carvings and stone tablets. Amazing carvings, and it was nice that it was a much more positive place. I think it would easy for all museums to be taken over with Khmer Rouge information..... and there are enough killing fields and prisons to provide that!

Monday and we headed off to the clinic we will volunteer at!

This young girl appears to have cerebral Palsy.

This clinic is located in a slum about an hours tuk-tuk ride from Phnom Penh. It supplies free medical care for anyone who comes in. Most of the day there is a horde for random children in here playing. It makes it a little childcare-ish.... but, it means these kids aren't playing in filth water or piles of rubbish..... so it is probably a pretty good injury/ health prevention strategy!

We were hoping that the disabled kids in the area would be able to come in while we are here so we can try to do intensive work with them. There seem to be less than was first thought in the local area. So far at the clinic we have been working with the young girl who has CP. She actually gets around quite well considering her poor balance and contractures! but we are working on improving balance and hoping to do some writing and drawing next week.

We have also been seeing a teenage boy with cerebral palsy and working on strength and balance for standing transfers (he is in a wheelchair).

There is another 14 year old girl we see in hospital in Phnom Penh. She stepped on a landmine about a month ago. I need to confirm with the translators next visit.... but they seemed to say the landmine was right behind her own house. I had assumed that she was walking in the jungle, or an empty field. Not right in her own backyard! She has had both legs amputated below her knees. But thanks to Hoin, the organiser here in Cambodia, she was able to receive nine blood transfusions and is alive. We need to meet with the doctors and try to get her better pain killers. At present it seems like she is on paracetamol. Her mum said she is so skinny because the pain makes it hard for her to eat. And we really want to get her moving, get her doing exercises and strengthening her legs in preparation for (hopefully) getting prosthetic legs. But we need better pain killers if at rest it is so painful she can't eat!!


Back to the clinic:
The clinic provides an awesome service. They are able to give people free medications as well as clean and dress any wounds that people might have. This seems so simple, but in this filthy, hot, humid environment seemingly trivial cuts or scrapes or boils could so easily get really badly infected.

Kids reading books in Khmer and English

Because we aren't nurses, and the patient load wasn't so high that the nurse couldn't keep up - we haven't been doing that.... and it took us a couple of days to get our head around the place, and come up with plans for how we can be helpful!

We are trying to get the kids doing more productive things than playing with  blocks all day and so have set up desks in half of the waiting area where we can do English lessons and health promotion talks.The treatment area and not lockable cabinet of medications were all in the waiting room. Where kids are constantly hanging around reading books and playing. This seemed a bit - not private, to us (they did have a fabric screen to put up, but if anyone wanted help with private issues it would be obvious to everyone!) We spoke with the staff about reshuffling to make more space in the waiting area for the classroom..... and keep the medications and medical scissors etc. away from the kids!

The new classroom area 

The classroom area has desks and chairs that can be stacked together when not used to make more space. The other half of the room is open space and large chairs for people waiting to see the nurse.

new "medical" room

The new "medical room" is in the back (and a lockable) room. This means people can have some privacy, particularly if they need to talk about personal issues, or things that might make the kids be awfully kid-like, such as UTI's or sexual health. And I hate to think that people might avoid the clinic because of all the kids hanging around. But if you sent all the kids away they will be outside playing in garbage. Plus, at the moment the clinic isn't so busy, so at least the kids being here means the nurse / volunteers can give lessons, or teach health promotion things!
It also means that the medications and sharps are away from the kids, and away from anyone who might get tempted to have sticky fingers. After all, these people live in extremely dire circumstances, and if someone was starving, and walked past and noticed no one in the open waiting area at that point.... it could be tempting!

The only problem here is that the light isn't so great as in the waiting room. But they have a fairly bright fluro and a medical spotlight. We are going to try to get another light as well to fix that issue!

We also instigated a "any kids who come in the building must wash their hands immediately" rule. This has caught on and some of the older kids will now point out new arrivals and tell them to go wash! :)

We found a box of toothbrushes in individual bags with names on them. They obviously hadn't been used recently, turns out that's because the kids who own them don't come to the clinic anymore. Some might be at school more hours (a lot of kids do half days at school) and some might have moved away.
We sorted them out and are going to take them on our next walk through the town so that if we come across those kids / their families we can give them the toothbrush and some paste. They might not get used when the kids don't have anyone reminding and nagging them to brush, but they are a lot more likely to get use than if they sit in a box in the clinic! We are also planning to buy a bulk lot of toothbrushes for the kids who come now (and hopefully spares for new kids) and add daily tooth brushing to the daily handwashing routine. Hopefully we can slow some of the tooth rotting, and start some good habits! (anyone who would like to donate small change to the buying-toothbrushes-and-soap fund is more than welcome too!)

As soon as we made the "classroom" kids came and sat at the chairs looking attentive. Unfortunately there was a wedding being prepped across the road..... which means music being blasted at a teeth rattling volume. Preventing effective communication, or even effective thought! Nancye and I instead focused on planning what we will teach next week, how best to teach, and what / how to do some health promotion.

When we came back from the back room we discovered our model student happily writing on the board and teaching the other kids! We are going to use our little teacher's pet as our official helper. This doubles as us having a Khmer scribe, because I am never going to be able to write that beautiful, but complex looking script! Plus, it gives her a role as teacher (which she obviously loves) and which might slow down her yelling out of answers a little. She is actually comparatively quite good as English letters and basic words. And she is proud of that fact, so constantly yells the answer out before any of the other kids have even computed the question! Which is great for her..... but means the others just wait until she says the answer, then repeat it. She is obviously a great reader in Khmer as well. We are hoping that if we make games so the lessons are fun and provide a number of "teach yourself English for kids" type books, kids like her who are desperate to learn, might harass the nurse or the other staff who volunteer (local people) to run some simple English classes, or even classes in Khmer or math or anything!

The slum near the clinic.

Looking forward to getting some English lessons in next week, and slipping some translated "when we wash our hands" "why we wash our hands" type lessons in too!

We also went for a walk through the slum community. These houses are built over an open canal/drain. Which is full of garbage so floods the area and makes the whole place more of a filth-swamp. The nice clean wooden bridge you can see in the photo is brand new. I think they said it was donated by past volunteers, or maybe an NGO. Before it was built people had to just walk through the filth swamp of garbage, rotting food and I don't want to think what else! This is where the lack of education / forethought really strikes me. There is a few open fields near by, where the people who live in slightly nicer houses just across from this slum (so we assume they have a slightly better socioeconomic status/education) obviously walk out to throw their rubbish, and I think burn it regularly as well. The people living over the swamp just throw anything, plastic, food waste - probably human waste, out their doors and into the swamp. Which they then have to walk through. And which I have to assume must flood and wash into their own houses when it rains. The nurse said that they have spoken with people about not living in garbage - but I don't know if they spoke to everyone, and it would only work if everyone was on board. But it seems that lack the understand of why living in garbage is bad, and so can't be bothered to change. I know another past volunteer mustered local people to pick up garbage and clean up the area, but I don't know how  much for the wet filth-swamp garbage they cleaned up with their emu-parade.

some of the houses in this area

Friday the nurse does outreach to another slum community. This one actually is next to a rubbish dump. But when you look at how much rubbish is piled in/under their houses, compared to how clean the unlived in blocks of land next door are..... it is again obvious that that rubbish is all their own! The thing here that amazed me the most.... was learning that the people living next to this dump, pay rent!

 In this community the nurse visits a few people to check blood pressure and general health (I think this is of people she knows to be at risk). Then as they walk around anyone with cuts or sickness seeks them out for attention.

kids wanting to be photographed is pretty universal.
These girls kept shouting one more in Khmer.

They give out little baggies of medications, clean and disinfect any wounds and give people some supplies to re-dress the wound in the coming days (after all, they won't be back for a week!)

We busied ourselves entertaining the kids - taking photos and showing them themselves on the screen, and checking the kids out for any cuts or open sores that need attention. We did find one kids with what looked like burst (or about to burst) boils. but he was crying and curling up to avoid us getting to them to look/clean them. So the nurse was able to give his sister some anti-septic powder, betadine, and instructions so she can do it later.

Giving him painkillers and anti-septic cream
so he can re-dress the wound himself

The man pictured here came in with a large cut across his leg. Apparently it was done on broken glass. I really liked that all the kids stopped playing and came over to watch, so they were listening to the instructions (that I assume were about changing the dressing and keeping it dry and clean). I hope that it helps show the kids that when they huve cuts etc, they need to keep the filth-water out, and can come for treatment and medications.

view of another part of the slum

they seem to have amazingly tolerant cats here!