The provincial town of Battambang retains some shadows of its French colonial past in a few preserved buildings and the remains of the fortifications of that period. We had come there, Oly and I, to represent VSO at the monthly meeting of Medicam, the umbrella organisation of health NGOs in Cambodia. The theme of the morning was Maternal and Child Health and I was able to give my first impressions and some lessons relating to the management of toxaemia in pregnancy and eclampsia, one of the 5 major killers of pregnant mothers.
Analysis of the 2010 maternity registers reveals 28 cases requiring urgent transfer from level 1 Thmar Puok hospital along the bumpy 50km road to Sisophon and the final 9km of tarmac for management and delivery in the level 3 facilities of Mongkul Borei. Level 3 includes the availability of blood transfusion and caesarean operation. Of these 28 women, 15 had severe pre-eclampsia, in fact 3 of them had seizures before they set off in the 4×4 ambulance. The distressing findings were that 11 of the 15 had seizures before they were through, there were delays of 2-3 days in several cases before they were delivered, and in only one case was caesarean employed. There are clearly issues around initial treatment, safe transfer, prompt delivery and the use of anaesthesia that need to be addressed and that is our next task. Interestingly the month of June saw the highest number of cases – in the UK we would notice the same thing, a cluster of patients would be admitted at the same time with this condition depending on changes in the weather. The roads here in June become mudbaths as many are flooded – the journey must be awful.
Whilst we were at the Provincial Health Department talking to the Medicam meeting, our VSO colleagues in the nearby Battambang hospital were in another meeting discussing the case of a 22-year-old mother who died with eclampsia last month partly because the staff were afraid to administer a general anaesthetic lest she die. The truth is that general anaesthesia will prevent seizures, and in most cases within 48 hours of the baby being born the patient will begin a process of rapid and complete recovery. That is why caesarean delivery has an important place in the care. We toured the hospital in the afternoon on a sweltering day, probably in the high thirties/low forties Celsius, and saw both the good and the bad of the health care system of Cambodia. We exchanged ideas and experience, and interacted with staff and patients as far as our communication skills would allow. We saw the new maternity wards and theatres with many smiling faces. We tried in vain to unblock the footprint toilet solid with faeces because the drains are inadequate. It needs a plumber and a builder to sort that one out.
The effects of a short night, the heat and dehydration were remedied by drinking 2 litres of fluid and we departed for a late afternoon bike ride to refresh after the long day. We followed the river bank unsurfaced road for a couple of km south enjoying the village life and the sights. One group of kids took our photograph with a broken mobile phone in simulation of tourists with their cameras. It was very funny. On the return journey it began raining and as usual the traffic speeded up as everyone scurried for shelter. It was then I had my first traffic accident, turning into the path of a moto driver who appeared from nowhere it seemed to me, collided and dumped me unceremoniously into the road. Fortunately I was none the worse and after proffering my apology and gathering my belongings, I retrieved the bicycle, replaced the chain which came off in the accident (I’m expert at that now) and waved good-bye to the spectators as I resumed my journey home. Oly and Sue made me wash the blood off my hand and apply some magical ointment, doctoring the doctor and making sure I wasn’t in shock. It was a shock but I wasn’t in it and I’m so thankful for my guardian angels; I do give them a hard time.
Saturday saw us off for the day exploring the countryside with our faithful tuk tuk driver David Beckham (his alias). He has learned so many idioms from a succession of British customers and we soon were to ‘hit the road jack’ or ‘hit the frogging toad’ as the Cockneys had taught him. We explored the riverside settlements for miles and miles (sounds better than km and km). We saw bamboo flowering (as it does once in 20-30 years in some cases) , peanuts growing (underground), papaya and grapes (above ground), custard apple, chilli, jack fruit and herbs for all manner of culinary and medicinal use. David was a mine of useful and local information. We played with a giant centipede and avoided its deadly bite (in our imagination), we tasted local wine, brandy and ginger cordial. Cuddled some beautiful puppies. And we rode on a makeshift train constructed by the enterprising locals to run for a few km on the disused railway. The bamboo train is far more exciting than the Bala Lake Railway. Trains run simultaneously in both directions on a single track without passing places.
As you fly along a foot above the rails, rattling and shaking with all the usual clackety-clack of a railway train with the wind in your face, the sight of an approaching train is at first rather terrifying until you realise that both will be able to stop and one will be dismantled and lifted off the track to allow the other to pass. Two travelling one after the other have an advantage because the single train will always be the one to leave the track. Each consists of two axles with flanged wheels, a flat-bed bamboo platform with wooden blocks beneath to sit on the axles and a small diesel engine with belt drive which slides back and forth on angle iron supports to tension or slacken the drive belt and control the forward motion. I never noticed how the driver braked. My eyes were glued on the track ahead. At the terminus (though we could have gone further) we were surrounded by enthusiastic children who wanted us to sit down in the makeshift cafe but we declined and made off down the railway track closely followed by the railway children. We chatted, took photos, made friends, were taken to see their home, their pig (named aptly ‘pig’) and their mother to whom we paid 5,000 Real for the photographs and Equity dues. The children were delighted as she handed each of them 1,000 Real and they dashed off to buy fruit drinks from the local stall.
The highlight of the day was to be the flight of the bats from their caves at dusk but before that we would visit another old temple site on top of a hill after first having our lunch and siesta in true Cambodian style. At Wat Banan we lounged in hammocks, read the Guardian, Cambodia Daily and Asia magazine; played Cambodian and International Chess; chatted, snoozed, ate our meal and then settled down to watch a thunderstorm which brought welcome relief from the heat of the day. The rain came down heavily but David said it was merely raining pups and kittens – obviously not as heavy as cats and dogs, or sticks and old ladies.
We waited and waited for the rain to cease, enjoying the relaxed afternoon and the cooler air. The rainfall waxed and waned responding to the cracks of thunder and the thatched roof demonstrated admirably its ability to shed whatever fell on it. As the light began to fade, long after we had given up on climbing the hill to the 11th century temple on top or visiting the caves to see the bats fly at dusk, Pete went to pay the bill. His antics as he attempted to climb the slope from our waterside stilted huts to the top of the bank created great hilarity until we realised that we faced the same muddy challenge and it also dawned on us that everyone else had left some long time ago perhaps because they were wiser and more experienced in rainy conditions then we were. The bamboo hand rail collapsed as Pete reached the top and he was handed a long-handled mattock to hammer the supporting post back into the ground. Balancing barefoot on the muddy slope and swinging a mattock at a wobbly target provided more entertainment, and at that point we abandoned our second game of chess, packed our bags and attempted the slippery slope for ourselves. Traversing to the left between the other huts and the steep bank seemed to offer better options but in the end it was sure-footed David who hauled us up from above, one by one. The mud oozed between our toes and stuck there, Oly’s shoes were overflowing with water but he doggedly put them on with his socks and clambered up easier than the barefoot barangs. Our hostess brought us a bucket of water to the tuk tuk and washed our feet – a generous, humble and poignant gesture for an Easter weekend.
Our journey back to Battambang was uneventful aside from the fact that it was still lightly raining, we were battered by flying bugs, driving through flood after flood and circumventing fallen trees – well, one fallen tree. Poor Pete on the moto following behind couldn’t see the road ahead and prepare for the hazards. Through the floods he was expecting all the time to fall into a pothole, and he was soaked from the spray by the time we arrived home safe and thankful. We paid David $5 each though he had asked only $4. He had looked after us well all day long.
An hour later – showered, changed and more suitably attired – we crossed the road to a bar for a beer and on the arrival of Oly and Sue by bike we walked a little down the road for a welcome meal, fried rice for me, my second rice meal, it’s so satisfying and two meals a day is quite enough here. Whatever the original plan had been for the evening – it had been kept secret to surprise us visitors to Battambang – was cancelled because of the storm, but we were happy and ready for bed by 10, a late night for all. Esther’s house had water on the kitchen and bedroom floors but the bed was dry. Poor Katie went home to find her mattress soaked and water coming through the ceiling in places – she had to sleep on her sofa. There’s work for the landlord to be done before rainy season and there are lessons for all about closing windows, moving the washing, watching the weather and reacting appropriately to the changes.
There’s also work for the medics to do before more patients die from eclampsia since the rainy season will see a large increase in cases…