My alarm woke me at 6 today, a most unusual occurrence since it’s usually the sounds from outdoors that rouse me and I rarely set the alarm, but last night I had a meal with two visitors to the hospital and was late to bed and today I had to meet them again at 7 for a lift to Phnom Penh.
Our visitors from RACHA (Reproductive & Child Health Alliance) and WHO (World Health Organization, though maybe you know that abbreviation already) spent two days in the area assessing teaching facilities for nurse midwives and hoping to observe midwifery practice in hospital and health clinic.
The hospital didn’t disappoint. Or perhaps it did…
There were two deliveries side by side allowing ample opportunity to see good and not so good practice, and to feed back to staff what they did well and what can be improved. Obstetrics concerns include prospective use of the partograph, recognition of fetal position, check for the second twin before injecting oxytocin and support of the uterus during cord traction. Paediatric issues include the use of rubber suction bulbs which cannot be adequately sterilised between uses, unnecessary suction and allowing babies to get cold because of the ceiling fan and the lack of a radiant heater over the baby during resuscitation, to list a few simple issues.
We had a lady with PET who was not showing symptoms requiring intervention yet who had an induced labour, received between 1 and 2 litres fluid iv when the ideal would be 500ml maximum in 24 hours, delivered undiagnosed premature twins at 30-32 weeks when thought to be 36 weeks and had no prenatal steroids. One twin died at delivery, perhaps the second twin because of the oxytocin issue I mentioned, though it only dawned on me now and I didn’t think to ask her which one had succumbed. The staff know about the kangaroo pouch method of keeping such babies in close contact with the mother to keep them warm but 12 hours later this was still not being done. I saw the method in use in Addis Ababa some years ago so it’s been around a good long time. I doubt the surviving twin will last for long.
We had another mother deliver a baby with bilateral facial cleft and cleft palate who, due to a misunderstanding that her first three babies had the same problem, received little information or help with breast-feeding and who could not unfortunately be sent directly with the baby to Siem Reap Hospital for children because she had a postpartum haemorrhage and was not yet fit to travel the 100km or so. The surgeons in Siem Reap have experience repairing hare lip and cleft palate.
So we had a lot to talk about over the meal last night and I set off on my journey today hoping to talk over the weekend with a VSO colleague in Kratie who is also a short-term Obstetric Advisor.
This evening I heard of a film being screened in a local cafe featuring child trafficking for sex and a local organization rescuing and caring for such unfortunate exploited children and I went along to see it. The problem is rife here and serious corruption at every level, personal involvement by powerful individuals and endemic use of brothels fosters this tragic activity from which so many rich and well-connected perpetrators escape unpunished and countless voiceless victims suffer on and on even if rescued. I was equally appalled and distressed by the stories I heard, and humbled and heartened by the women (and men) who are prepared to risk their own lives, reputations and even families, to do something about it. Mu Sochua is an opposition MP and Advocate for Human Rights in this area and features alongside Somaly Mam, herself a victim turned advocate in the film Red Light. I wish you could see it. They were both nominated for the Nobel Peace Prize. Sochua.wordpress.com is the relevant blog for those interested.
Returning to the VSO office for the night (we have several rooms here for volunteers coming to the capital) I was surprised to see a great deal of police activity outside. There were police cars, motorbikes (I counted 9 or 10 big white Hondas), black security cars, military and traffic police too. Not at the VSO office fortunately, but at the restaurant across the street which is an expensive and desirable venue for VIPs. It was difficult to determine what was going on but the possibilities include high level talks between Cambodia, Thailand and Asean representatives, over the border fighting this last week. A ceasefire is in place yet again but any manner of trivial event could spark further action and the locals in the troubled areas are not rushing back to their homes and villages until something more definite is in place. Soon after 9pm the police whistles, sirens and radios sprang into action as a motorcade formed, flanked by the white-uniformed police escorts, and swept off down the street amid flashing red lights of a different kind.