An infuriating logjam in the enlistment of vitally needed foreign qualified nurses for South Africa stands to be broken with the hiring of the dynamic rural health-worker recruitment NGO, Africa Health Placements (AHP) – but bureaucrats will need to add their own muscle to clear two vital obstructions.
The famously slow-moving SA Nursing Council (SANC) must streamline and simplify its cumbersome and outdated examination requirements (at least to bring them in line with those for foreign qualified doctors), and the government must urgently increase nursing accommodation in rural areas. With just these two key ‘logs’ moved, the hundreds of foreign qualified nurses who meet minimum local standards and annually knock on official and NGO doors, could begin pouring in to help in the important revitalisation of primary health care and delivery of the all-embracing nurse-dependent National Health Insurance (NHI). This is according to the CEO of AHP, Dr Paul Kornik, whose seven-year-old organisation has outstripped all government agencies and universities in identifying and placing healthcare workers in rural public sector posts. He doesn’t expect it to be smooth sailing given the endorsement needed from the various health departments, SANC requirements, finding the appropriate rural vacancy and securing a provincial job offer. However, AHP staffers are veterans at negotiating most of this territory on behalf of applicants.
Create a ‘non-exam track’ of properly qualified candidates
Kornik says if the SANC just emulates the Health Professions Council (HPCSA) in identifying countries whose medical qualifications match local requirements to create a ‘non-exam track’ category of applicants, the waiting times would immediately drop by six months and his strike rate would soar. ‘At present all foreign nurses fly here to write the exam and apply, fly back, wait … it’s time consuming and expensive, with no guaranteed outcome. Then there’s all the back and forth of documents for verification, especially when one vital piece of information is missing. If the nursing council just automated their application into a computerised form that doesn’t allow you to continue until all requirements are in, that would also speed up things dramatically.’ These bureaucratic and unnecessary ‘hoops’ were hugely off-putting for foreign qualified nurses, of whom there were many more than government departments and the nursing council seemed to realise. ‘Thousands of nurses have approached us to work here over the years, but most just lose interest when they see all the hassle. So far our focus been mainly on placing doctors in rural public sector facilities,’ he said. With a non-exam category of applicants, nurses from countries like the United States, Western Europe, Canada, Australia and New Zealand would immediately be available while those from countries where qualifications were not always up to local standards would appropriately be required to write the local exam. The AHP, in spite of its historical focus, has recruited 60 foreign qualified nurses, but it’s in the other healthcare fields that it has really shone. It has placed 2 600 healthcare workers in the public sector since 2005, 1 500 of them foreign qualified doctors. For doctors, this is more than the country’s combined annual university medical school output (a miniscule percentage of whom choose to ‘go rural’ after serving their internship and discharging their community service obligations).
The desperate need is best illustrated by the following facts. Nearly half of South Africa’s population lives in rural areas, where just 19% of the nation’s nurses work. According to the government’s White Paper on Human Resources for Health, nursing numbers dropped by 10 000 between 1996 and 2008 (nursing colleges closed in 2007, after which specialist nurse numbers plummeted even faster, especially in intensive care, advanced midwifery and psychiatry). The white paper reveals the current nursing workforce to be ageing, with 46% of nurses over 50 years old and 16% already at retirement age (60). Most worryingly, it says that just to sustain the current ratio of nurses-to-population, 51 200 nurses must qualify over the next decade, clearly an impossible task.
Health minister eager to support acceleration
Kornik said nurse accommodation was very thin on the rural ground while nurse salaries were much less competitive than those of doctors, two factors which if even partially addressed would make a rural nursing stint of one to three years for a foreigner far more attractive. He is optimistic that national health minister, Dr Aaron Motsoaledi, will move mountains to solve these two problems, given that doing so is vital to achieving his overall NHI goals. (The NHI plan requires 260 locally-hard-to-come-by specialist nurses to carry out three vital primary healthcare delivery objectives. These include, for each of the 52 health districts, the following: an advanced midwife, advanced paediatric nurse and an advanced primary health care nurse for the District Specialist Support Team, a professional nurse for the School Health Programme and a specialist primary health nurse for the municipal-ward-based Primary Health Care agency.)
The AHP collaboration with the Nursing Council comes in the form of a memorandum of understanding, signed in May this year. It will see a full-time AHP administrator seconded to the SANC’S foreign qualified nurse registration department. This person, with AHP staff backing, will screen applicants to ensure that only complete documentation is submitted to the SANC. Active recruitment starts within six months. Kornik is eagerly awaiting the new USAID/PEPFAR funding cycle which begins on 1 October to see how his expanded funding application (to include foreign nurse recruitment) pans out. In the meantime he’s slotting the nurse recruitment initiative into his overseas marketing and identifying the nursing needs of the worst-off rural hospitals so he can earmark and forewarn provinces willing and able to shell out the necessary salaries (not always a given). ‘We’ll be driven by the needs of the provincial departments of health and we’ll certainly concentrate on getting more senior and more specialised nurses to help out with on-site training. We’re most certainly not after economic migrants though we may help out some of the African nurses already here to secure permanent positions. We’re after people willing to contribute to the developing world for one to three years,’ Kornik said.
SA Nursing Council Registrar, Mr Tendani Mabuda, told journalists initially that the SANC and the AHP would form a management task team with two representatives from each party to ‘co-manage’ the implementation of the agreement. In spite of numerous attempts by Izindaba to contact Mabuda, he did not respond to the vexing question of streamlining foreign recruitment. The SANC’s media relations department said such complex matters were best dealt with by Mabuda.
Chris Batemanchrisb@hmpg.co.za
Figures from: Human Resources for Health for South Africa 2030. Draft HR Strategy for the Health Sector: 2012/13 – 2016/17. Consultation Document. August 2011. http://www.doh.gov.za/docs/stratdocs/2011/draftHRstrategy_Consultation.pdf
S Afr Med J 2012;102(9):723-724 .DOI:10.7196/SAMJ.6186
http://www.samj.org.za/index.php/samj/article/view/6186/4457
Monday 20 May 2013
Thursday 18 April 2013
Cape Town & Obstetrics
So..... we have arrived in beautiful South Africa and received into the waiting arms of our loving family. There is nothing quite as special as returning home!
What I have learnt so far from maternity statistics in South Africa has made me incredibly sad when I am not just hopping angry.
There is a 90% cesarean section rate in Cape Town within the private sector (can anyone say obstetric malpractice). I refuse to belive that all these women choose major adbominal surgery and accept all asociated risks with complete and ethical informed choice.
Within the public sector there is a 20% cesarean section rate wich is concidered normal in Europe, although the maternal and infant mortality rate is sky high.
In Africa:
280 000 women die annually during birth!
10 million die due to pregnancy, or due to post partum complications.
3 million newborns die annually, many from infections.
2.6 million stillborns annually.
So these issues flag up two huge healthcare needs in South Africa both envolving EDUCATION, EDUCATION, EDUCATION and RE-EDUCATION. Being just one intrepid midwife in a land as vast and diverse as you can imagine, I feel this not a burden but an opportunity to engineer change, to be part of progress and a future with better maternal and neonatal outcomes.
No-one disputes a woman's right to choose how to deliver her baby. However, making an informed choice regarding an elective cesarean section means taking an objective look at the risks. According to a study led by Alan T.N. Tita, assistant professor in the UAB Department of Obstetrics and Gynecology, "Women who choose to have their babies delivered via repeat cesarean at 37 or 38 weeks without a medical or obstetric indication, risk serious complications for their child."
Cesarean Section Neonatal Complications & Risks include:
Premature birth when the delivery date is not accurately calculated.
According to a recent study, cesarean section neonates may not have the same beneficial gut bacteria at birth as babies delivered naturally. This may cause immune related troubles to develop later in life.
Babies born by cesarean section are more likely to develop breathing problems like asthma and allergies later in life.
Cesarean section is known to raise a child's risk of diabetes by 20 percent.
Lower Apgar scores at birth.
Cesarean Section Maternal Complications & Risks include:
Major abdominal surgery.
Surgical wound complications such as adhesions that can cause bowel obstruction and chronic pain.
Resultant placenta accreta or percreta in subsequent pregnancies. This can result in complete hysterectomy to treat major haemorrhage after delivery of the placenta.
High risk of DVT - anti-thromboric medication should be prescribed, this is in the form of subcutaneous injections which sting and depending on risk may be required everyday for up to six weeks.
Loss of sensation at incision site.
Six weeks of no driving or lifting any weight heavier than the baby. In South Africa where nothing is accessible without a car this may lead to isolation and/or dpression.
May affect breastfeeding success.
May contribute to postnatal depression
May affect maternal-neonate bonding
Dramatically reduced incidence of skin to skin resulting in system and hormonal consequences both for the mother and neonate.
Monday 8 April 2013
Kindness
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| Postnatal home visits |
This journey has taught me to be still, to be grateful and to accept the tides that is our life paths. I have learnt about myself that perhaps I am not the spoilt princess I had thought and that I can be happy sleeping on the floor and that running water and electricity are not necessarily the trappings of a life fulfilled.
I have shared knowledge with the local midwives of Cambodia and in doing, have found a connectedness and camaraderie in woman-ship that has lit a fire in my heart. South Pacific Asia and the amazing, resilient women of Cambodia will always hold a very special place in my heart and I will carry with me, this experience, their beautiful smiles and wisdom until the end of my days.
It has been hard, it has been raw and at times I wasn't sure if I had what it took to make a difference, yet through this, through the struggle I found myself again. My strength, my gift, my faith...........
I bring merely kindness!
To leave behind fear, and have the courage to walk the road of ones hearts desire is no small task. The prayer I whisper to the wind, is that I may have the courage of my convictions to journey to a place were there is peace in my heart, love at my side, kindness on my lips and caring in my hands.
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| Beautiful midwives |
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To all my wonderful family, friends and husband: Your love, support and donations have brought education, medical supplies, sanitation and safe medical practice to some very remote rural areas of Cambodia. You should all feel very chuffed with yourselves for choosing this worthy cause and I want to again reassure you that 100% of your donations has gone directly to the cause.
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| Weighing the baby |
Birthday en-route
Up eeeeaaaarly to catch our flight from Phnom Penh to Singapore, wouldn't be so bad except we were all sleeping so badly with poor Emma suffering the worst. 5 hours a night was considered good and of course our last night in Phnom Penh was no exception.
The girls got me a beautiful hand made silver box from duty free for my birthday which was very sweet and unexpected. I love you guys, THANK YOU:-)
Arrived in Singapore too early to check into our hostel to we dumped out bags and went shopping which was fun. Singapore Slings at Raffles long bar, dinner at our street restaurant and dreams of an early night, but of course......no such luck. Group of very noisy boys kept us awake and then eeeeeeaaarly wake up to catch flight from Singapore to Heathrow were I finally made it into the waiting arms of my gorgeous, amazing husband and promptly burst into tears of exhaustion, happiness and relief. I had not fully realised how much I missed him........He is my centre, my love, my life, my guiding star without whom, non of this would have been possible, without whom, I could not be everything I can be and without whom, life would have no meaning of purpose. Thank you my love!
The girls got me a beautiful hand made silver box from duty free for my birthday which was very sweet and unexpected. I love you guys, THANK YOU:-)
Arrived in Singapore too early to check into our hostel to we dumped out bags and went shopping which was fun. Singapore Slings at Raffles long bar, dinner at our street restaurant and dreams of an early night, but of course......no such luck. Group of very noisy boys kept us awake and then eeeeeeaaarly wake up to catch flight from Singapore to Heathrow were I finally made it into the waiting arms of my gorgeous, amazing husband and promptly burst into tears of exhaustion, happiness and relief. I had not fully realised how much I missed him........He is my centre, my love, my life, my guiding star without whom, non of this would have been possible, without whom, I could not be everything I can be and without whom, life would have no meaning of purpose. Thank you my love!
Duped again
So....getting back to Phnom Penh
This time we though we would be very clever and procure our clever little selves a "barung bus" (bus for soft Westerners with mod cons like air con and a toilet. During our conversation with the travel agent, we learnt there are 3 choices:
1. A local bus (like we got before) noooooo thank you.
2. A VIP bus (air con, toilet, refreshments cart and non-stop)
3. A luxury bus (Wi Fi, air con, toilet, refreshments cart and non-stop)
Being very clever, and dead set against repeating our previous experience we decided to go for the VIP bus as Wi Fi is doge at the best of times and therefore deduced that paying and extra $7 would not be worth it.
Picked up from the hotel by mini bus and started thinking....."now this is more like it" until of course the minibus started picking up locals who got on the mini bus with their lunch. This consisted of a live chicken tide up with strips of plastic bags with chop sticks stuck on its back (well how do you suppose lunch would stay fresh in the stinking heat)?
Any-hoo, the bus did turn out to be air conditioned, however it it also made unscheduled stops to drop of and pick up passengers on the way which would not have been so bad if there was in fact a toilet and a refreshment cart. Refreshments turned out to be 500ml of water thrown at us on departure and that was all she wrote. Journey took 7.5 hours and wasn't so bad as we weren't melting. Sat next to a stinking German man who kept falling asleep all over me and his hair tickled my nose. So I was very mean and would sit forward quickly which would cause him to fall into my seat and wake him up for 10 mins at which time he would relocate himself into his designated space until our little game started all over again, and again, and again:-) quite entertaining and funny.
Arrived in Phnom Penh in a torrential down pore, left the girls huddling under a shop awning and made my way to the guest house solo as was popping for the loo. Got lost and tormented by naked teenagers dancing in the rain in the street Had to seek refuge in a shop as they got quite bold circling me and touching me despite my angry "no's".
Found the girls and the guest house in the end, watched the prostitutes from the balcony on the 3rd floor. I think the building across the street was a brothel. Must have been a slow night as we didn't see much of interest.
This time we though we would be very clever and procure our clever little selves a "barung bus" (bus for soft Westerners with mod cons like air con and a toilet. During our conversation with the travel agent, we learnt there are 3 choices:
1. A local bus (like we got before) noooooo thank you.
2. A VIP bus (air con, toilet, refreshments cart and non-stop)
3. A luxury bus (Wi Fi, air con, toilet, refreshments cart and non-stop)
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| Angie |
Picked up from the hotel by mini bus and started thinking....."now this is more like it" until of course the minibus started picking up locals who got on the mini bus with their lunch. This consisted of a live chicken tide up with strips of plastic bags with chop sticks stuck on its back (well how do you suppose lunch would stay fresh in the stinking heat)?
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| Lunch |
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| Emma |
Found the girls and the guest house in the end, watched the prostitutes from the balcony on the 3rd floor. I think the building across the street was a brothel. Must have been a slow night as we didn't see much of interest.
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| Travelling by Tuk Tuk to rural villages for postnatal home visits |
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| Back when Tuk Tuks were still a novelty:-) |
Tuesday 2 April 2013
Temples of Siem Reap
Siem Reap is beautiful, I'm so sad we do not have more time here.
Early morning excursion to the gorgeous temples.
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| Angkor Wat |
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| Bayon |
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| We decided to see Bayon by elephant - amazing, incredible, awesome I am so grateful, it felt like a spiritual experience |
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| Trees at Ta Promh |
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| Ta Promh - nature reclaiming the stones |
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| Ta Promh my very favourite temple |
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| Temple sculptures at Ta Promh Incidentally, this is were Tomb Raider was filmed. |
Travelling
Whole day travelling from Takeo to Siem Reap.
Taxi at 05.30: Takeo - Phnom Penh (2hrs)
Local bus 12.30: Phnom Penh - Siem Reap (7.5hrs of stinking hot, destroying travelling)
Bus dropped us off in the pitch dark, out of town, hounded by tuk, tuk drivers.
Ravenous, dehydrated.....beautiful hotel, with a pool:-)
Taxi at 05.30: Takeo - Phnom Penh (2hrs)
Local bus 12.30: Phnom Penh - Siem Reap (7.5hrs of stinking hot, destroying travelling)
Bus dropped us off in the pitch dark, out of town, hounded by tuk, tuk drivers.
Ravenous, dehydrated.....beautiful hotel, with a pool:-)
Monday 1 April 2013
A trip down memory lane.
Angies' s photos.
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| Our first speed boat trip to Koh Rong |
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| Beautiful Song Saa |
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| Food market - Takeo |
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| Museum on the way to Borie temples |
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| No comment |
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| Con (state appointed midwife), took me for a ride on her scooter |
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| Health centre, midwives office - waiting for a labourer |
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| Washing day |
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| Postnatal home visits |
On the move.
Nothing much going on.... visited two health centres today....
Hence, we are going to Siem Reap to look at Angkor Wat (temples) tomorrow, plan is to stay for 2 nights and then 1 night in Phnom Phen so that we can catch our early flight to Singapore on Friday.
Hence, we are going to Siem Reap to look at Angkor Wat (temples) tomorrow, plan is to stay for 2 nights and then 1 night in Phnom Phen so that we can catch our early flight to Singapore on Friday.
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| Health Centre midwives we visited today |
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| Interesting traffic today |
Saturday 30 March 2013
Sihanoukville
So we are now in Sihanoukville , the girls took a taxi down to meet me. We sat on the beach and drank and chatted all day.
In the evening we found a peace of paradise (it looked almost Mediterranean) and we sat outside under the twinkling lights, with the gentle lap of the crystal blue sea as music. Grant would have loved, loved, loved it and it made me miss him allot, bad, sad.
Drank stupid yet delicious cocktails, which I know gives me a banger of a headache, but what can you do.....when in Rome.
In the evening we found a peace of paradise (it looked almost Mediterranean) and we sat outside under the twinkling lights, with the gentle lap of the crystal blue sea as music. Grant would have loved, loved, loved it and it made me miss him allot, bad, sad.
Drank stupid yet delicious cocktails, which I know gives me a banger of a headache, but what can you do.....when in Rome.
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| Chamaap (midwives) enjoying some down time |
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| Sihanoukville |
Thursday 28 March 2013
"you come, you come"
Was awoken early to "emergence", "emergence", which I took to mean emergency. When I asked what had happened, the reply was only, "you come, you come". So off I went, galloping across the beach (I'm getting quite good at barreling into these unknown situations).
What I found was our beloved Nai ye (the local midwife) feeling very unwell with symptomatic hypertension. For those of you who don't know, by the time you feel unwell (headache, dizziness, blurred vision) with hypertension, you are in trouble. She took some anti-hypertensive drugs and then I waited the longest 20 mins of my life so far for them to start working. The pressure was so high for her little body that she burst the blood vessels in both eyes.
I decided to make her rest the whole day and sleep next to me at night, so I could keep a close eye on her.
I am so relieved to now be off the island, with access to hospital if I need it. Her blood pressure is now stable but she is still headachey & doest look 100% well to me.
We have been sitting on the mainland beach this morning drinking fruit shakes and having a massage (Nai ye's first time), I thought she could do with a bit of a treat and relax, she loved it:-)
Waiting for the other girls to meet up with me. Looking forward to bbq on the beach tonight.
PS: have advised her to go to the doctor but she doesn't want to and I don't blame her. I am just worried about cerebral haemorrhage, stroke, heart failure, dvt, etc.......aaaaarrrrh, shut up Western brain.
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| Sunset at Koh Rong |
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| Waterbuffelo |
Wednesday 27 March 2013
My beautiful island
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| Jetty off Koh Rong |
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| Song Saa from Koh Rong |
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| Entrance to staff compound |
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| Staff gym.....too hot, hot, hot |
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| Staff compound view from outside my room, a bit if alright hey:-) |
Up and Running
Hooooraaaay, Tabby is aliiiive. The managing director's wife has an iPad and although her charger didn't fit in dear Tabby the pug was usb, so I could use my charger with her plug and hey presto we have lift off.
So, not much going on still. Went to the village this morning and found an excited hub bub of bustling people. Turns out that an Italian aid NGO has landed on the island and was giving away free medicine. They are de-worming all the children and giving Hepatitis vaccinations, apparently they come every 6 months and do this.
Hence only 1 taker this morning. An old man with puss oozing out of his ear all nice, think and yellow. Poor thing must have had one hell of an ear infection. Anyway he wanted the barung (that's me) to look at it, which I did and promptly sent him to the NGO for antibiotics. To be honest the stuff we see here is so extreme, half the time I don't even know what I am looking at. The STDs don't look like anything I have seen before as often they have been left untreated for years and years. This is one incredible education I an getting here.
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| Museum on the way to temples |
Hence only 1 taker this morning. An old man with puss oozing out of his ear all nice, think and yellow. Poor thing must have had one hell of an ear infection. Anyway he wanted the barung (that's me) to look at it, which I did and promptly sent him to the NGO for antibiotics. To be honest the stuff we see here is so extreme, half the time I don't even know what I am looking at. The STDs don't look like anything I have seen before as often they have been left untreated for years and years. This is one incredible education I an getting here.
Tuesday 26 March 2013
Sardines and luxury
25.03.13
So, unfortunately my faithful Tabby has died, I hope and pray it is not a permanent death and with some tender ministering Tabby may be resurrected once more, but until such time, no more pictures I'm afraid.
So I left early morning on Monday and got a "taxi" with Nai ye the local midwife to the port, from were we hitched a ride on a speed boat to the private island and then took a slow staff boat from there to Koh Rong island.
The taxi rides are always entertaining and terrifying There were 8 of us in a car, we were lucky as we got to share the front seat, which although uncomfortable meant we didn't have people on our laps. About 20 mins into our journey the taxi driver decided he would stop as he could maybe squeeze a few more in, so we pulled over at a seemingly nondescript stop (later I learnt this was a cross roads leading to 4 majour destinations) here we waited for about 2 hours while he found some more sardines to pack in with us:-) When in Cambodia hey.....
Once nearly at our destination we were pulled over by the police (and rightly so really as we were waaaaay over capacity and the indicators on the car didn't work - although this doesn't really matter in Cambodia as they have a hooting system for overtaking and I notice allot of vehicles would fail a road worthy). Anyway, I'm thinking, oh my good golly, now we are going to miss our boat and are we going to end up in the slammer..... but of course our good ol driver had some bribery money ready (only 1500r, which is about 0.70p) and off we went with a wink and a smile.
On arrival at the beautiful Koh Rong, Nai ye said I should stay in the staff compound and she didn't have to ask me twice.......real running water, electricity and air con...........luxury. I do feel a bit of a stinky rat though as I know the other girls are boiling alive under the tin roof at the health center.
Alsolutley bugger nothing going on on the island, I think the health needs of the indigenous population has been dramatically overestimated. There are not that many poor people and those that are get a letter from the village chief confirming there financial situation at which point they are transported for free off the island and treated for free (well not free, a local NGO pays for it) at a hospital on the mainland. Most women ferry themselves a week or two before their due date to the mainland hospital and have no need of us. So.... I'm having a holiday for a few days, not so shabby I tell ya.
As I am not needed I have had some time to read. I devoured Somaly Mam's "The road of lost innocence" in one sitting. It you want an in depth understanding of human trafficking, the sex trade and what really is going on behind the beautiful smiles of the Cambodian people, this is the book for you.
So, unfortunately my faithful Tabby has died, I hope and pray it is not a permanent death and with some tender ministering Tabby may be resurrected once more, but until such time, no more pictures I'm afraid.
So I left early morning on Monday and got a "taxi" with Nai ye the local midwife to the port, from were we hitched a ride on a speed boat to the private island and then took a slow staff boat from there to Koh Rong island.
The taxi rides are always entertaining and terrifying There were 8 of us in a car, we were lucky as we got to share the front seat, which although uncomfortable meant we didn't have people on our laps. About 20 mins into our journey the taxi driver decided he would stop as he could maybe squeeze a few more in, so we pulled over at a seemingly nondescript stop (later I learnt this was a cross roads leading to 4 majour destinations) here we waited for about 2 hours while he found some more sardines to pack in with us:-) When in Cambodia hey.....
Once nearly at our destination we were pulled over by the police (and rightly so really as we were waaaaay over capacity and the indicators on the car didn't work - although this doesn't really matter in Cambodia as they have a hooting system for overtaking and I notice allot of vehicles would fail a road worthy). Anyway, I'm thinking, oh my good golly, now we are going to miss our boat and are we going to end up in the slammer..... but of course our good ol driver had some bribery money ready (only 1500r, which is about 0.70p) and off we went with a wink and a smile.
On arrival at the beautiful Koh Rong, Nai ye said I should stay in the staff compound and she didn't have to ask me twice.......real running water, electricity and air con...........luxury. I do feel a bit of a stinky rat though as I know the other girls are boiling alive under the tin roof at the health center.
Alsolutley bugger nothing going on on the island, I think the health needs of the indigenous population has been dramatically overestimated. There are not that many poor people and those that are get a letter from the village chief confirming there financial situation at which point they are transported for free off the island and treated for free (well not free, a local NGO pays for it) at a hospital on the mainland. Most women ferry themselves a week or two before their due date to the mainland hospital and have no need of us. So.... I'm having a holiday for a few days, not so shabby I tell ya.
As I am not needed I have had some time to read. I devoured Somaly Mam's "The road of lost innocence" in one sitting. It you want an in depth understanding of human trafficking, the sex trade and what really is going on behind the beautiful smiles of the Cambodian people, this is the book for you.
Sunday 24 March 2013
Killing Fields
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| A memorial of sculls from the mass graves (7 stories high). |
What a heavy lumpy throat day! At the killing fields we listened to the history and absolute horrors of the Khmer Rouge on head - sets.We then had a welcome escape by vanishing into the labyrinth of steaming, chaotic, stalls that is the Russian Market. Bartering is the name of the game, although I admit I am rubbish at it. Louise if you are reading this, you would be in your ELEMENT. Everything of course was "cheap cheap for you lady!' In the evening we went to the night market, which is the same sort of thing, just a bit smaller and whole lot cooler, with some live music and a surprising absence of white faces. Of course you do see the occasional disgusting old "barang" (that's what Cambodians call white people), with very your girls, and it just makes me want to cry.
I had not released that Pol Pot got a seat on the UN council for the 20 years after the genocide until his death! The fact that he enjoyed life with his family in American (funded by the UN) until a ripe old age is utterly repugnant to me. I thought the UN were the good guys......guess maybe I was wrong.We were going to go to the prison were the people were kept, tortured and forced to sign false confessions (S21) before being transported to the killing fields, but I just couldn't digest anymore - how selfish is that.
24.03.13 Private taxi back to Takeo, with air con!!!!! Pure luxury!
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| Bracelets left in memoriam by visitors to the killing fields. |
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| A Buddhist house for the lost souls of the killing fields |
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| Babies heads were smashed in against this tree and there lifeless bodies tossed in the mass grave alongside. This spot was the undoing of me. |
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| 1 of many mass graves. |
Friday 22 March 2013
Weddings and Roasting
Got invited to a wedding last night. They were very, very keen on getting us doing some dancing Kamer style, which is rather different from what we are used to, it was baking hot and we were sweating like pigs but they wouldn't let us sit down so eventually we had to make a break for it, I had to bolt like a frightened lamb, not very dignified but did the job..... very interesting experience. It is so nice to be treated so kindly in the village and be invited to all the special occasions.
Absolutely nothing going on at the health centre today, everybody at the wedding (they last for 2 days).
Went to do some home visits on the way to Phnom Penh, saw they lady I escorted to hospital, everybody is still very pleased with me and I felt quite the hero walking into their village.
Saw the lady with the prolonged second stage as well. Everybody well, although this woman was roasting herself and the baby. It was so hot I struggled to do the maternal and neonatal check. The local midwife was explaining to them how this particular practice can be harmful to the mother and baby due to excessive smoke inhalation but they were not having any of it.
Got another death ride in a "taxi" to Phnom Penh and then found a hotel on the fly. It has aircon which is bliss, what a treat for us.
Cambodian postpartum practices:
Cambodians believe that the woman's body becomes cold after giving birth. They take steps to heat up the body and prevent further cooling or deterioration. A woman is not to take a shower for a few days or a week after delivery, although she can take a sponge bath with warm water. Keeping the body covered from head to toe is important. Cold ice water offered post delivery in the hospital may be seen as unhealthy.
Often mothers lies on a bed above a fire with their babies; this is called ‘roasting’. The roasting starts immediately after delivery and normally takes at least a week to complete. Besides heating up the body, roasting is believed to prevent illnesses after the postpartum period.
A woman is also told to sit on a rock that has been heated in fire every morning, for up to three weeks postpartum. It is believed, as a Traditional Birth Attendant (TBA) told a client, “when a woman sits on the rock it prevents the uterus from coming out.”
It is also a common practice to have a fire-warmed rock on the abdomen. It is said to make the uterus shrink, and to prevent the sagging of the abdomen later.
Steaming is another postpartum practice. Steaming causes the mother to perspire which removes impurities. The steam is made by the boiling a mixture of herbs, usually in a clay pot. During or after the steaming, some women apply a pounded mixture of galangal root and/or turmeric root all over their bodies. (Galangal and turmeric are like ginger, and are ingredients for cooking) These practices prevent illnesses and improve the skin.
Although all this sounds ok, the fires are usually make from green wood as it is cheaper and so lots of babies die from smoke inhalation. The local midwives have also seen many bad burns from hot stones and roasting. As an alternative, we advise then on a healthy diet with an emphasis on ginger (so they still get the "hot") and plenty of rest, but some people still prefer to roast which is very frustrating for the local midwives.
Maybe I should have been a vet?
Clinic, clinic, clinic, hot, hot, hot.
Tried to buy some mange treatment from the "vet" to treat the village animals today. The vet doesnt seem to understand what I need, not that I would trust him anyway, his training was a whole1 month and he proudly displays his certificate on the wall.
He let me snoop in the drugs cupbourd but I dont know what I'm looking for, I found Iodine but most of the animals are so bad that they have weeping open wounds and I am worried that it will burn them.
Have bought spray bottle to apply mange treatment when I figure it out as the animals are feral or farm animals and I dont have the facility to dip them so will run around spraying them all as best I can, well....thats my plan any way.
Feeling better today, spider bite looks miraculously healed.
Blessings
Hot, hot, hot, I recon easy close of 40 degrees in the sun. Dusty, dusty, dirty, praying for rain. Sometimes the clouds come but no rain, they just tease me and move on.
Feeling super dodgy today, spider bight red and full of puss, no fever so will wait and see.
Clinic, clinic, clinic.
Emma doing night duty, so I am looking forward to a good sleep as it is impossible to sleep under the tin roof were we are staying during the day, its like a sauna.
All the midwives and local women who know are very concerned that my gorgeous Grant and I dont have a baby yet. Last night the lady who looks after us said that when I go home I will get pregnant and the baby will have the spirit of Cambodia. It was very strange and felt almost like a blessing and I felt so emotional. These women who have so little are so sweet to worry themselves with me.
Emma had two deliveries in the night....
Night Duty Adventures
18.03.13
First night shift, am on my own as now there are 3 of us at the health centre we are trying to spread out a bit. Am with midwives who dont speak any English. Our conversations include wild gesticulating, lots of laughing and giggling but its amazing how the language of birth is universal.
Am enscounsed at present under a barbie pink mozzie net, they are so sweet at looking after me
One labourer
Gravida: 1
Para: 0
Cervical dilatation: 4
Membrains: ruptured
Obs: stable although BP high 140/100 as she is in pain.
FHR: 134bpm no decels heard
And that was all she wrote untill it all went a bit crazy....
BP continued to rise, maternal complaints of epigastric pain, although only 1+ of protien. The local midwives decided to transfer the woman to hospital, and the family was very worried and granny was crying and asked me to go with them to the hospital. So off I go with emergency box in case of delivery in transit and jump into a taxi (a bit like some scap metal held together with tape) with a whole bunch of complete stranger who dont speak a word of English and we shoot of rattling towards to the nearest hospital wich is about 1.5 hours away.
Then it all became clear why the family was scared, the "hospital", is I guess third world, I dont even know how to descibe it. They made us wait outside untill money had exchanged hands, then we went into the maternity unit, which is dirty although looks ok. A very rough and horrible hospital midwife examined the women and then took her away into what looked like theater, I felt so responsible being the only qualified midwife escourt and worried about the attitude but I didn't know what to do, when I turned around and looked into the frighted faces of the family I knew I had to do something but wasn't exactly sure what, so I made a snap dicision and walked bold as brass into theater and said I am the womans midwife and I intended to stay with her. It turns out they were only doing an internal but so rough and it was very painful for the woman, I wante to slap that hospital midwife.
Then they said she would need a cesarean section, why exactly I still can not fathom, but before they do it they want money, the family were desperately scrabbling around trying to cobble together the funds and I could tell they didn't have it and thank goodness I had my wallet so I just paid it. They didn't ask me for money and were so so greatful and granny thanked me with such emmotion she nearly made me cry.
Apparently this is common practice in hospial and they wont give you your baby untill you pay up......it makes me so sad.
More chilled out rattle home and I dont know why but was amazed at the amount of sex workers on the street.
So, dear whoever is in charge of these things. Enough with the obstetric complications please, can I please do some nice normal midwifery now.....
Sunday 17 March 2013
Angkor Borei & Phnom Da
20km "motor boat" ride to Angkor Borei & Phnom Da along Canal 15. Skipper was a very nice homicidal duck killer and stopped at an archaeological museum on the way for us. When we were not running over the ducks that are farmed on the edge of the Canal, we had a super hot and sweaty time.
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| Angkor Borei |
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| For Mighty Mouse |
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| Angkor Borei temple steps |
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| Oooouuummmmmmm |
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| Cooling down |
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| Phnom Da |
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