I know, its been awhile. The last week and then some it has been a mix of work, sightseeing, exhaustion, and more work. Can I just go back to being a student again? Here I am again, in an all familiar setting, sitting on a bus going back to Phnom Penh only to drop off luggage and head in a taxi to the province of Koh Kong. To pass the time, I will try to recollect my past experiences from Pursat and Battambang as this was our first taste of what actually goes on in this little country that is called Cambodia. Well, here goes nothing..
The bus ride from Phnom Penh resembles every other bus ride; streets lined by too skinny cows, chickens, and roosters. Amongst the consistent flood water, there are shacks for houses, people laboring away in the rice fields that consume the landscape, even people fishing in the standing water for a tiny catch of the day. There are also dogs everywhere. Sometimes so broken that it breaks the dog lovers heart into shambles. Among most of these broken down villages that litter the side of the road, there are elaborate pagodas that differ greatly from their villages counterparts. These are the heart and glue of the tiny communities, the part that hold every palm tree constructed house and family together.
These same sights were all too familiar in Pursat. Pursat itself is a small community surrounded by many remote villages. The only thing that puts it on the map is the dam built by the Khmer Rouge that took the life of thousands and never worked. Seems to represent the whole idiotic ideology of Pol Pot, huh? Although the province is welcoming of foreigners, it is not likely to see another one in this area. On the other hand, I thinkour foreigner faces represent a level of stability for the community, since both Pursat and Battambang were not only hard hit by the civil war, but also one of the last areas in which Pol Pot still lead his regime despite opposing forces.
On arrival, we went straight to the RACHA office and were quickly sent out into the field. This began our trip to different water sanitiation facilities and maternal and child health clinics for specific villages. RACHA places emphasis on community based health care and build clinics in some of the most remote areas of Cambodia to promote maternal health and reduce maternal and child mortality. The water sanitation facilities, which you will hear me mention a couple times throughout this blog, offer 20L of drinkable water for 500 reil; the equivilant of around 12.5 cents. The local villagers come, fill up their water tubs, and take them back home to ensure safety, especially since in recent years there was a large Cholera outbreak in Pursat. There is not yet a delivery truck that can transport the water to the homes, but is in the future plans of these facilities.
Water sanitation facility
Water bottles for the families in the village
The health care clinics in Pursat were not bad but no where up to American standards. Since we are specifically looking at hygiene in these clinics, you have to rewire your brain to think what is acceptable here. Things that are not acceptable was the fact that there was no running water in the delivery room at the first clinic we visiting in Pursat. Also, lack of soap, clean beds, and poor disposal of bio-hazardous material is also not acceptable. Don't be quick to judge though. These are people whom many can't read or write and have very little training in terms of medical practice. There are no real doctors on staff, only midwifes and nurses. It truly is an infrastructure problem here in Cambodia. One lady told us a story about how one of the education trainers showed many men in a remote village how to put on a condom by using her own toe. Once they returned to the village, some of the men showed the new trainers how they had learned to put on a condom by actually placing it on their toe before they were involved in intercourse. Funny, of course, but it also reveals one of the many barriers of public health in these areas. Education is not only critical, but also allows for a sustainable environment in which each villager can have control over their own health. Granted, don't even get me started on the lack of access part...its a real doosey.
Health staff prepares a nurse for an immunization
We also stopped by a location in which the World Food Program handed out food to all pregnant mothers and children under the age of two. They had to learn how to treat their food properly before they were given it as well. The only problem with this program is that no one can assure the the food is really used for the small population it is inteaded for. It even sounded like it was rare that it actually did.
The women learning how to prepare food
The second day in Pursat was spent following a QI (quality improvement assessment) in another local remote village. Most of these health clinics were far away from the actual downtown area, not to mention an extremely bumpy and tretourous ride. Luckily, this day...the clinic was around the corner. We say there and watched, preformed our own mild assessment, took pictures, got bored, and finally were taken back to the headquarters just in time for a huge meeting...in Khmer. Luckily they had the best tiny little bananas I had ever had in my life. We stared aimlessly at the people we could not understand eating small bananas, jujubees, and fried plantains. Best way to make us happy, feed us. Especially fabulous little bananas. It is as simple as that.
The next day we stopped by a couple more health clinics and traveled to the Battambang province, more specifically, Bateam Meanchey. Being one of the more northern provinces, it was an area that was very hard hit by the Khmer Rouge. The town itself still had many bruises on the buildings showing the severity of the regime and how many of its reprecussions still remain today. This is seen through public health as well. Tuberculosis, for example, is a disease that is highly prevalent in Cambodia. The number one reason for this is the Khmer Rouge. With no medicine and too many people working, living, and suffering in the same place, TB spread like a wildfire and still remains one of the number one diseases in Cambodia today. Talk about public health in time of conflict...and in this case the aftermath as well.
The next morning we woke to attend a health facility launching for a health center that had set the standards of hygiene for all other clinics in the rural areas. We walked into a gigantic tent, sat down and ate our angel food cake muffin provided, and waited for the "party" to being. Again, the service was all in Khmer...so we sat there and our new friend Bona translated as much as he could while he could keep our ever shrinking attention span. After all the speeches concluded, including one for the deputy of the Ministry of Health, the actual man in charge of the health of Cambodia, we all went over to walk around the clinic and look at its spectacular hygiene. While standing our front, we saw the Minister of Health come around the corner and start making his way over to us with his huge posse surrounding him. Ruchi and I awkwardly started to get our of his way not realizing his intentions were to say hello to us. He said hello and thanked us for being there. We then watched the ribbon cutting ceremony and stood back to watch all the big wigs at RACHA and the Minister of Health take a picture, when we suddenly saw hands waving for us to come over. Although I don't have the picture (the other girls do), there we were, surrounded in the big wigs and smiling for hygiene in a community clinic. It was pretty cool. The deputy of health asked us jokingly if we wanted to go around to the other provinces with him, and we laughed and went on our way. Hot, sweaty, and pictured out, we left only to eat and start on our next journey to Siem Reap. Oh how the time flys by when you are having fun...or don't even know what day it is:).
Funding by USAID
MoH cutting the ribbon to the clinic
Us with our Battambang contact at the launching
Saying this, I am safe, making it, and still learning more than I could ever imagine. On the other hand, Siem Reap was a nice break from the provincial life...although a mind blowing experience that will forever weigh heavily on my heart. More to come soon...
The bus ride from Phnom Penh resembles every other bus ride; streets lined by too skinny cows, chickens, and roosters. Amongst the consistent flood water, there are shacks for houses, people laboring away in the rice fields that consume the landscape, even people fishing in the standing water for a tiny catch of the day. There are also dogs everywhere. Sometimes so broken that it breaks the dog lovers heart into shambles. Among most of these broken down villages that litter the side of the road, there are elaborate pagodas that differ greatly from their villages counterparts. These are the heart and glue of the tiny communities, the part that hold every palm tree constructed house and family together.
These same sights were all too familiar in Pursat. Pursat itself is a small community surrounded by many remote villages. The only thing that puts it on the map is the dam built by the Khmer Rouge that took the life of thousands and never worked. Seems to represent the whole idiotic ideology of Pol Pot, huh? Although the province is welcoming of foreigners, it is not likely to see another one in this area. On the other hand, I thinkour foreigner faces represent a level of stability for the community, since both Pursat and Battambang were not only hard hit by the civil war, but also one of the last areas in which Pol Pot still lead his regime despite opposing forces.
On arrival, we went straight to the RACHA office and were quickly sent out into the field. This began our trip to different water sanitiation facilities and maternal and child health clinics for specific villages. RACHA places emphasis on community based health care and build clinics in some of the most remote areas of Cambodia to promote maternal health and reduce maternal and child mortality. The water sanitation facilities, which you will hear me mention a couple times throughout this blog, offer 20L of drinkable water for 500 reil; the equivilant of around 12.5 cents. The local villagers come, fill up their water tubs, and take them back home to ensure safety, especially since in recent years there was a large Cholera outbreak in Pursat. There is not yet a delivery truck that can transport the water to the homes, but is in the future plans of these facilities.
Water sanitation facility
Water bottles for the families in the village
The health care clinics in Pursat were not bad but no where up to American standards. Since we are specifically looking at hygiene in these clinics, you have to rewire your brain to think what is acceptable here. Things that are not acceptable was the fact that there was no running water in the delivery room at the first clinic we visiting in Pursat. Also, lack of soap, clean beds, and poor disposal of bio-hazardous material is also not acceptable. Don't be quick to judge though. These are people whom many can't read or write and have very little training in terms of medical practice. There are no real doctors on staff, only midwifes and nurses. It truly is an infrastructure problem here in Cambodia. One lady told us a story about how one of the education trainers showed many men in a remote village how to put on a condom by using her own toe. Once they returned to the village, some of the men showed the new trainers how they had learned to put on a condom by actually placing it on their toe before they were involved in intercourse. Funny, of course, but it also reveals one of the many barriers of public health in these areas. Education is not only critical, but also allows for a sustainable environment in which each villager can have control over their own health. Granted, don't even get me started on the lack of access part...its a real doosey.
Health staff prepares a nurse for an immunization
We also stopped by a location in which the World Food Program handed out food to all pregnant mothers and children under the age of two. They had to learn how to treat their food properly before they were given it as well. The only problem with this program is that no one can assure the the food is really used for the small population it is inteaded for. It even sounded like it was rare that it actually did.
The women learning how to prepare food
The second day in Pursat was spent following a QI (quality improvement assessment) in another local remote village. Most of these health clinics were far away from the actual downtown area, not to mention an extremely bumpy and tretourous ride. Luckily, this day...the clinic was around the corner. We say there and watched, preformed our own mild assessment, took pictures, got bored, and finally were taken back to the headquarters just in time for a huge meeting...in Khmer. Luckily they had the best tiny little bananas I had ever had in my life. We stared aimlessly at the people we could not understand eating small bananas, jujubees, and fried plantains. Best way to make us happy, feed us. Especially fabulous little bananas. It is as simple as that.
The next day we stopped by a couple more health clinics and traveled to the Battambang province, more specifically, Bateam Meanchey. Being one of the more northern provinces, it was an area that was very hard hit by the Khmer Rouge. The town itself still had many bruises on the buildings showing the severity of the regime and how many of its reprecussions still remain today. This is seen through public health as well. Tuberculosis, for example, is a disease that is highly prevalent in Cambodia. The number one reason for this is the Khmer Rouge. With no medicine and too many people working, living, and suffering in the same place, TB spread like a wildfire and still remains one of the number one diseases in Cambodia today. Talk about public health in time of conflict...and in this case the aftermath as well.
The next morning we woke to attend a health facility launching for a health center that had set the standards of hygiene for all other clinics in the rural areas. We walked into a gigantic tent, sat down and ate our angel food cake muffin provided, and waited for the "party" to being. Again, the service was all in Khmer...so we sat there and our new friend Bona translated as much as he could while he could keep our ever shrinking attention span. After all the speeches concluded, including one for the deputy of the Ministry of Health, the actual man in charge of the health of Cambodia, we all went over to walk around the clinic and look at its spectacular hygiene. While standing our front, we saw the Minister of Health come around the corner and start making his way over to us with his huge posse surrounding him. Ruchi and I awkwardly started to get our of his way not realizing his intentions were to say hello to us. He said hello and thanked us for being there. We then watched the ribbon cutting ceremony and stood back to watch all the big wigs at RACHA and the Minister of Health take a picture, when we suddenly saw hands waving for us to come over. Although I don't have the picture (the other girls do), there we were, surrounded in the big wigs and smiling for hygiene in a community clinic. It was pretty cool. The deputy of health asked us jokingly if we wanted to go around to the other provinces with him, and we laughed and went on our way. Hot, sweaty, and pictured out, we left only to eat and start on our next journey to Siem Reap. Oh how the time flys by when you are having fun...or don't even know what day it is:).
Funding by USAID
MoH cutting the ribbon to the clinic
Us with our Battambang contact at the launching
Saying this, I am safe, making it, and still learning more than I could ever imagine. On the other hand, Siem Reap was a nice break from the provincial life...although a mind blowing experience that will forever weigh heavily on my heart. More to come soon...
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