Back together again

So here we are, all three of us together again for a weekend off in relative comfort in Takeo province.

Plans are to go to market to try and get some goodies for our loved ones back home.

For those of you who have been following my progress of the spot tracker, I apologise for the absence of updates, I have been having some trouble with it over last couple of days. I have put some fresh batteries in it and hopefully we will be up and running again soon.

The plans for next week are a bit tenuous at best, so will update as soon as I know.

Please, please, leave me comments on the blog or email me with any questions and I will do my best to answer or send pictures which may be sporadic as there is no amenities in the local villages were we work.

I am developing such a passion for South East Asia, I just cant wait for my amazing Grant to see it.

Where there is no doctor

Wating for delivery and thought I would articulate some of the things I have learnt from the amazing Cambodian midwives.

Fundal hight + adbo  circumference ÷ 4 = estimated fetal weight (amazingly accurate).

Hight measured in finger width between uterus and umbilicus = days post partum. Not palpable usually between day 7-10.

Worms from anus can enter vagina a burrow in, may cause some bleeding but not painful on V.E.

10iu Synto post miscarriage after 12 weeks gestation.

Viniger diluted 1 part to 3 parts water applied to cervix will show white spots in the presence of cervical cancer.

Synto IM can be given post physiological 3rd stage after 5th baby to prevent pph.

Press just above pubic bone and observe cord lengthening in 3rd stage. If retractes when pressure removed placenta not yet seperated. Otherwise seperation has occured.

Controlled  cord traction while external uetrine guarding can be preformed with physiological 3rd stage once seperation has occurred.

Synto given after physiological delivery of placenta to prevent retained placenta (very clever where there is no theater ans anesthesia).

If fundus is high post delivery, ask women to void. If fundus remain high post void, querie retained producs.

Papaya sap 3 teaspoons diluted in water can get rid of intestinal worms.

Strong garlic tea can get rif of pin worms.

Prolonged second stage is not an obstetric issue if fetal heart remains stable.

For prolonged second stage with acinclitic fetal head, tilt maternal pervis up for a couple of contractions to allow fetus to reposition.

Flying solo

What a crazy intense situation. Was so in love and horrified with my delivery.

Para: 0
Gravida: 1
Obs: stable
Fetal heart: 117-135bpm
Uneventful pregnancy

ARM on perineum, slow delivery of head, local midwife  showing me new techniques to prevent perineal tearing, although I'm not sure it helped as the women still had to be sutured for 2nd degree

This is the horrifying part, local midwife sutured without local anesthesia as the "pharamacy" was losed (at 15:00 on a Wednesday afternoon?)

During labour husbands support, feed and toilet their women with the support of what looks like all the grandmothers, mothers, aunties and female children. During the actual birth he is kicked out of the delivery room, while all the other reletives come in and out as they like. After the delivery he picks up his wife so tenderly and carries her to the post natal beds, so heartrenchingly sweet to watch.

As with the miscarriage, placenta and dirty linin is given back to father all jumbeled in a black back bag and shortly thereafter you will find him outside at the well hand washing the dirty linin... amazing.

These women are incredible they labour and give birth (called, crossing the river) in virtual silance and all just seem to do it, there is no vacume extraction, forceps or cesarean section here, you do it or you die and they do.....

Rumpea Meanchey Health Centre

Spent the day traveling from Koh Rong Island to Takeo province to visit rural health centre. Slow boat to Song Saa, speed boat to Sihnoukville, tuk - tuk to taxi rank, taxi to local midwives house in Takeo. Then tuk-tuk to rural health centre.

Hot, hot, hot and dusty. Ricw, rice, rice. Pigs heads, fish heads and chicken spines delicacy.

Staying ontop of someones house, we have electricity and water, but intresting squat toilets remain.

This place is going to eat me up and spit me out if I let it. A grandfather brought in a little 8 year old girl with vaginal bleeding and said an insect had done it. The midwives agree by consensus that she was raped, but nobody says anything and she got sent away will him again. Just looking into her beautiful and dead eyes I almost lost it, I had to go out and breath. We have been told this was the second case of child rape this week.

Awareness is building around child abuse and I have seen posters and stickers on taxis with a number you can call, but of course these are all in English, which is unhelpful as Cambodians speak Kamhir and most cannot read or write.

Waiting room

I love the strength and beauty of the women here, life and death exists hand in hand and spontaneous miscarriage is just a part of life. The midwifes in the health centre are quite scared and transfer allot of patients to the big hospital in Pnohm Penn, the local midwives from Life Options are trying to teach them kindness ( which I think is beautiful) and good techniques.

Local supertiction:
Roasting post partum
Mother spirit will take baby (baby will die) if you say baby ia beautiful
Sleeping with sharp knife of scissors next to baby to scare mother spirit away from baby.
Gosts

Helped with spontaneous miscarriage of 3 month old fetus, once delivered it had a big heamatoma of the left shoulder and the midwives told her the miscarriage was due to abdominal trauma and told us most likley from a fall out of a hammock.

Woman bring there own supplies to give birth with (sorongs, food, water) and are usually accompanied by a whole gaggle of aunties.

The miscarried fetus and products along with dirty linin are given to the women and they take it all away with them. This particular woman was pirexual at 39 degrees on initialinvestigation and so was given iv antibiotics and fluids as well as oral antibiotics and iron to take home.

One labourer at the moment, writing this as we wait for cervical dilation.
Obs: Stable
Possition:ROA
Engagement: 5/5
Parity:3
Age: 28
Fetal heart: heard and stable (local midwives do not listen in as there is nothing to be done if fetal distress is detected)

Health Centre

Midwives office

Pharmacy

Last post from Koh Rong Island

Took village kids snorkeling on a reef about 1 hour by boat, an amazing experience to watch them discover the under water world for the first time. People here mostly find it acceptable to through rubbish and human waste in the sea, so this was an ecology education program that we were so privilaged to be part of. After snorkeling we had the most delitious barbicued meat of some kind (best not to ask too many questions about what exactly you are eating) served in big leaves from the tree they were cooking under.

Super viscous sun here, got slightly toasted even through factor 50 sunscreen,  must remember to reaply more often.

40 min walk to backpakers on the beach for sundowners and another bbq. Loooong walk back through the jungle in the dark, but worth it - amazing dinner.

Leaving early tomorrow morning for the mainland, so on to more adventures. I have absolutly no idea what to expect but this is the way in Cambodia.

I feel so acutly acutly aware, that many people on Koh Rong island have never seen a white person and that mearly our presence here affects their society. There is a big drive to change mal practice, teach the children English,  for a better future and I wonder who decides what "better" is. At this point I have more questions than answers.

There is so much to report every day, that I just feel overwhelmed and don't know were to start.

Yesterday someone came to tell us that the woman who delivered felt like she was bleeding so we went sprinting through the jungle in the pouring tropical rain to help. Turns out she was fine so we stayed for quite a long time with her chatting and encouraging her to have some soup. This woman's husband died 3 weeks ago and her father hung himself the night before we arrived so she is feeling very vulnerable and worried about her ability to provide for her small children.

Since being on the island we have experienced a funeral, wedding and birth.

Koh Rong Island

This place is crazy beautiful, rural, 3rd word and raw. Raw being the best word I can use to describe it. The people are amazing, so happy and smily despite having what we in the west would call "nothing".

Huge problem with domestic violence, rape, untreated STD's, AIDS and TB. Very glad for my BCG vacination right now.

Been playing with the children and taught an English class tonight as the teacher didnt show up. Not quite sure how to do that in all fairnesss, so I just played games with them. Hence I now have a gaggle of little girls that follow me ever were and love to hold hands, so sweet.

Our first delivery in this brand new clinic which only opened on Monday went without a hitch despite this being the mother's 8th baby and her being very aenemic. The baby was gorgeous and was deliverd by the traditional birth attendant, who has some unusuall practices but it so lovely, I hope to learn allot from her while we are on the island.

Had a women come to see us with bacterial vaginosis, and she didn't ask for help, she just sat on the porch looking very poorly indeed. She has been treated with antibiotics, had a lie down for a bit and then wondered off back home, its all very informal. Cambodian people dont do mattresses, they pull them off the beds, so they just lie on mats on the bed, we think they think mattresses are too hot. Kids come and wonder around as well and we play with them. We have been told allot of them have never held a penil or crayon before, they love drawing and call us 'barang' which means white person.

We are sharing beds (this is the local way) and sleeping on the deck of the bungelo (dont know how else to describe it). Although this sounds a bit strange, the breez (if there is one will be welcome). Make-up is pointless as there is no mirror and it would probably just melt and slidw off your face anyway. We are fed three times a day by a lovley local lady who looks after us and we have rice, rice and more rice but I really like it. No electricity or running water which make ablutions challanges at times but actually its fine, im just really dirty. It looks like I am developing a tan but I suspect its just dirt.

The island as you can imagine is just beach sand which is great but its in everything as washing it off all the time is just a waste of water which is a very precious reaource here.

Lots of animals on the island including a pack of wild dogs covered in mange, even the chicken are infected and thread bare. Heards of wild water buffelo wander through through village and one scared the daylights out of me when we came through the trees and ended up ontop of them. Mozzies are bad but so far my citronella concoction seams to be keeping then away, although it seams anything else that is insecty and bights has had a little nibble and  these usualy hurt.

Im not sure what tomorrow will bring, we will do a post natal home visit for the woman who delivered today and then we will see. One thing I have learnt that in Cambodia plans and time never run according to schedule and the best this is to take things as they come. So..... I look forward to the adventure that is tomorrow.