Happy Christmas everyone and a Healthy and Prosperous New Year!
I am home and back on line.
During the communications blackout I was busy in Battambang looking at the dossiers and registers in the biggest maternity department I’ve visited in Cambodia. By now it was possible to compare the practices and outcomes in 3 different provinces and one striking difference came to light. Battambang was the first place where Caesarean section was being done for fetal distress. This immediately calls into question the fetal heart rate monitoring practices in the other two Provincial Hospitals. Fetal distress is not being recognised because the heart rate in labour is not being heard often enough and clearly enough. So some babies are dying unnecessarily due to asphyxia before or soon after birth. Furthermore all the C-Sections for fetal distress in Battambang were done for rapid heart rates which is unusual since the more serious forms of fetal distress are associated with slow heart rates; so something else is going on that needs looking into.
Meanwhile we were given access to 2,500 maternity patient dossiers housed in a small building where they were stacked on the floor in monthly bundles, surrounded by rat droppings (though they had not started nesting in them yet) and at risk of flood damage. 90% of the C-Section dossiers were identified along with vaginal breech births, ventouse extraction records and many of the complicated cases – haemorrhage, stillbirth, eclampsia and the like. If I had been locked in that room and food pushed under the door for a month I would have had material to keep me working day and night without fear of boredom though I may have had to defend my meals from the rats.
The session with the maternity staff was all too short and the time to investigate and organise the conclusions beforehand abysmally lacking. Nevertheless the Chief of Department became very animated by the ‘Reasons for César’ data and took over the seminar to lecture his staff on absolute and relative reasons for C-Section and why they should not do operations for no very good indication. He thanked me most enthusiastically for this opportunity to address something very important to him and asked for the remainder of the data to be processed and sent to him before the end of December. That has happened although there is still a lot to do to prepare and present the final reports.
After the final debriefing session with the NGO in Phnom Penh I at last had time to address my email problems. After 4 hours of searching and deleting a particular rogue file (over 120 copies in several locations in my mailboxes and with the ISP) and after turning off a facility that saved a draft of the file every time it failed to send, I finally restored email to its normal function, though too late to update my Blog before departing PP on 12th December.
So I arrived here in the UK after the storms, to encounter warmer than usual December weather which gives me time to acclimatise. I’m still waking and rising at 5am (though I slept in today until 6.30) and working on the data, sending information back to Cambodia a bit at a time. The plans for New Year are changing. Ethiopia is no longer the next destination, rather a return to Cambodia seems more likely. We now have extended family there. I have been unofficially adopted as Daddy to Chan Leap, now aged 21 (whose father died when she was around 7), older brother to Mono (who is now 26) and friend to their mother, who all three travelled on one small motorbike for 2 and a half hours to say goodbye when I was due to leave Battambang. Now I have the delicate task of introducing my children to their new relations …