URC Retreat in MDK in pictures

Mysterious ectoplasm found in our hotel room in MDK - Who you gonna call?! The bathroom was worse but I'm not sure the world needs to see the photo with Janice & me in our nighties

Early morning 'hatt-prann'

MDK - Sunrise

Pete refereeing the BTB v PNH football match with an iron fist and a velvet glove

Team BTB Back row (left to right) Choeurn, Ratnana, Hun, Chheng,  Rady, Visal front row (left to right) Sovannra, Jon-dara, Bonsak, Kim-ann.

Cheerleading from the side lines - Janice and Naro

Time out for Chhorvoin who was feeling the heat, sitting in the shadows his shade of red is not adequately conveyed 

Left to right Darith, Rady, Ratana and in far distance Bonsak (all the URC boys I work with!)

Naro - sisters are doing it for themselves (but not sure the shoes were very suitable)

Post match euphoria BTB won 5 - 2 Winners prize 3 crates of beer. The match invasion by 2 of the PNH supporters who dragged the BTB keeper off the pitch hence resulting in one of PNH's goal, resulted in the supporters being red carded. Man of the match was Visal and not just because he looks good with his top off. Pete was a firm but fair referee who I am told gave PNH plenty of chances but they were less (how can I put this politely?) 'active'!

MDK sunset

Busra waterfall, traditional Phnong dress. I just love Chhorvoin's expression - the warrior staring out into the middle distance, cheers me up with every viewing. 

3 Surgeons and the grand son of a Proctologist

A month ago all the surgeons were ignoring me, yesterday the deputy surgeon (Dr S) invited me around his house for dinner. I would like to quote Bella from the Twilight movie - "your mood swings are giving me whiplash".

As most things in Cambodia have the tendency to do, a simple dinner invitation came a blog-able event.

The invitation - 5 pm at work and my phone rings with a unknown number. With no messaging service here call screening is less of an option so I answered;

Me - Hello

Caller - Hello - long pause

Me - Hello

Caller - Hello. I am Sokun

Me - Oh Hello

Caller - You come to dinner this evening

Me - Oh, OK - Erm, Where?

Caller - My house

Me - Where is your house?

Caller - 7 O'clock

Me - OK, where?

Caller - My House

Me - Where is your house?

Caller - 7 O'clock

Me - 7 O'clock, dinner, your house BUT where is your house?

Caller - Yes - hang up

R & J beamed at me - they seemed very excited that this heralded a level of acceptance in Cambodian culture & it was absolutely essential I attend. I just felt quite anxious.
But there was still the small inconvenience of not actually knowing where his house was. However R was very confident he knew the location as Dr S had been his teacher when he was a nursing student at BTB. He drew me a very detailed map, I don't think it is unfair to say that the Cambodians I've met (particularly tuk tuk drivers) are not the best at reading maps. My level of anxiety heightened.
Dr S rang me back, perhaps having realised I didn't know where he lived. To add further uncertainty to answering my phone he had used a different SIM card. My cultural norm is that multiple SIM card owners are drug dealers, just for clarity this is not the case here.
We established that I had been given directions to his house and dinner was at 7 pm at his house.
Before cycling across town to dinner I decided to drop in on Katie for a pre-dinner coaching. This inevitably involved G&Ts so by the time I went in search of P'tair Dr S I was feeling more relaxed and a little less inhibited.
Arriving to where R's directions led me it became apparent that they had been for Dr S's private clinic and NOT his house.
Dr S rang me but was speaking in very fast and unintelligible khmer then he hung up on me. I rang J who advised I ring R. R call screened me.
I began to wish I hadn't had 2 G&Ts as I had appeared to have lost the ability to cycle, problem solve, understand khmer or use my telephone. I waited.
At 7 30 pm I rang Dr S who told me to "Cham" - wait. I waited some more.
Eventually Dr S called back saying in khmer that he was parked outside Hotel Asia. My bike would not fit into his Micra so we parked it outside his private clinic (NOT his house).
All the way to his house I apologized profusely in khmer, english and french.
His house it transpired is 250m from my house.
Three very pissed off looking surgeons were sat in his front room waiting for the slightly inebriated english doctor whose school girl french has almost completely been replaced by khmer.
They were a delegation of french proctologists visiting BTB for a fortnight which explained why, since coming back from the retreat, all the doctors had started greeting me with "Bonjour! Ca va?"
One surgeon had worked in the states and had fantastic english - he had been coming to Cambodia since 1992 and was impressed by URCs renovation of the Surgical building, apparently before it had a moat of raw sewage. His only complaint was they need a better light.
They are operating in the dark is an expression you could possibly use in more than one way.
The other surgeon had english but like most french I have met wanted to make me suffer for being an island dwelling, arrogant, imperialist, xenophobe.
The third 'surgeon' looked very young and when I queried if they all worked together this caused much hilarity. He was in fact the grandson of a famous french proctologist - mais naturellement!
We proceeded to have a smorgasbord of cambodian cuisine - some a little tepid due to the rude, inebriated, ignorant, monolingual volunteer getting lost.
The women of the family knew their place & remained in the kitchen venturing out only to bring more delicious creations. (X-ref future blog yet to be titled)
Dr S looked at me meaningfully and in khmer explained that there was no alcohol in this house and we only were to drink water - the shame, I obviously smelt like a gin house.
The over-dinner conversation was conducted in a french mainly with some english translation from the kind proctologist and khmer between me and Dr S.
The moment the last dessert spoon had been put down Dr S leapt up with his car keys and we all piled into his 'other' car - an SUV of course for him to take us home. The whole event lasting easily under an hour.
I was reunited with my bicycle and then with less gin coursing through my veins I cycled back in the direction I had just been driven.
And that is the closest I get to a dinner party these days.

MDK Emergency Medic

Sat in the Green House restaurant in Sen Monorom after the first day at the URC retreat (a complete misnomer) I heard a sound you never want to hear - screeching brakes, a sickening thump and then the wailing of a mother.
My plate just cleared and second can of beer nearly completed my eyes met Janice's - apparently my face was a picture of resignation. "Esther - go!" she urged so I was quick off the starting blocks but already there was a large crowd of rubber-neckers - a favourite pass time in Cambodia. The URC maternal & neonatal health team were sitting at the table next to me so as I followed the mother, who had scooped up her child and was running up the main street to a near-by private clinic, I called for someone to help me translate.
The SUV with its drunk driver left the scene quicker than the rubberneckers did.
At the private clinic I found the girl already laid on a bed with the clinic doctor shoving a large glucose tablet in her mouth. I have heard of 'DEFG - don't ever forget glucose' in APLS circles, I just wasn't aware that is preceded ABC, or perhaps stuffing a large foreign body into a traumatized child's mouth is a method of obstructing their airway hence giving the healthcare professional something to do about 'A'.
I'm always sensitive to stepping on other doctors toes (I'm sure BTB would disagree!) so I asked one of the URC team to explain to the clinic doctor that I was an emergency physician from the UK & if he didn't mind could I help. He said he didn't mind as he threw the girl about like a rag doll - obviously  not too concerned about a possible c-spine fracture.
Exit stage left clinic doctor.
My paediatric emergency medicine kicked in as I disengaged the hysterical mother from her hysterical friends and phone, asking her instead to talk with her daughter. In my "unclear Khmer" (I quote my teacher) I asked the terrified little girl how old she was, was this her mummy and where did it hurt. It was either me or the glucose tablet but she calmed down quite quickly whilst I assessed ABC first (call me old fashioned!).
Having established that she had cleared her airway of the glucose tablet, had a normal respiratory & cardiovascular examination and with a quick check of her abdomen I was surprised to find she had no obvious serious injuries. I was about to start a full secondary survey when two things happened;
1) Janice (who all this time had been hiding behind the door frame) called out to me "Esther does this girl need a drip?" Now you could argue that in Cambodia everyone 'needs' a drip (it is a panacea) but on this occasion (as with most others) I did not feel it was necessary. The reason Janice was asking was that a disheveled woman had come into the 'resus' room holding a drip. On close inspection it became clear that she was in fact not a nurse but another clinic patient with an IV running who was just rubber necking.
2) Due to my brief distraction with the drip patient when I turned around to perform the rest of the secondary survey I discovered I had been pushed out by the mass of hysterical Cambodian women, two URC obstetricians and a VSO health management advisor who was at the head of the bed, asking the girl (in khmer) to wiggle her toes. I had a momentary lapse when I thought that perhaps an emergency medicine specialist with sub-speciality paediatric emergency medicine training may not be the most appropriate person to see a 7 year old girl who had just been hit by a SUV. (X-ref 'A*' blog)
The little girl by now was regaining her composure, sitting up she was pretty insistent that the only thing that really hurt was her left arm. All the joints were pointing in the right direction, there was no crepitus, she could move her arm well and all things neuro & vascular appeared in tact.
Mum was smiling and thanking me.
The little girl agilely leapt off the bed.
Clinic doctor entered stage left, "She's fine" he announced - on this occasion I was able to agree with a Cambodian doctors diagnosis.
I told her what a lucky girl she was. Walking back to the Green House it hit me I was feeling pretty lucky also. If she had have been seriously injured we were 7 hours from Phnom Penh and the nearest half decent trauma health facility. I began to miss the metropolis of BTB.
Sitting back down I ordered another beer but my sobering thoughts counteracted any anaesthetic effects I had desired from it.

A*

I am reliably informed by another NGO worker that the term 'expert' & 'expat' is commonly confused here in Cambodia. Who can blame them? There has been a tidal wave of international experts inundating Cambodia with 'good' advice for the past 30 years. Every expat seems to be an expert in something, the words sound similar - hey, it's an easy mistake to make if not without some sense of irony.

The NGO worker 'expert' complex is a difficult conundrum - to have knowledge and skills is of course essential requirement to capacity building but imparting this so that it will adapted and sustainable to a local context is certainly not as easy to achieve. In my experience a common defence mechanism for this challenge is to play your expert card with even more vigour.

There is an interesting book my sister lent me on helping by Edgar Schein (Helping: How to Offer, Give, and Receive Help) It discusses the power dynamic and 'one-upmanship' that is inherent in any helping relationship. It also describes 6 traps that helpers can fall in to;


1) Dispensing wisdom prematurely - thinking you know what help is needed or being asked for and leaping into advice giving when you really haven't a clue.

2) Meeting defensiveness with more pressure - "I don't think you understand my suggestion; let me explain again." I think it is fair to say we have all at some time said these words when in fact it was us that was missing the point.

3) Accepting the problem and over-reacting to the dependence - a common trap for 'experts' who can take over a clients problem without fully understanding the culture. Much of VSO pre-departure addresses this trap.

4) Giving support & reassurance - "Once the helper has expressed sympathy, it is difficult to get clients back on the hook to own the very problem that they may have created."

5) Resisting taking on the helper role - a subtle one, in an attempt to be objective & avoid traps 1 - 4 helpers are emotionally aloof which can then be interpreted as an unwillingness to get involved.

6) Stereotyping, a priori expectations, "counter-transference," and projections - Guilty as charged.

I found this book very insightful and useful in my current situation (thanks Sonia) & would recommend it to any professional or informal 'helper'. I wish I read it a year ago.

If you can get past the 6 traps and develop a functional equal helping relationship between helper & 'helpee', the next pitfall is believing that because you have a little knowledge on a subject, in comparison to the local vacuum, this somehow makes you an 'expert' in many other areas outside your original capacity building skill set. Believe me this happens a lot - to be respected, revered for your skills, having people in awe of your knowledge can be intoxicating (I am told - I think I've made it pretty clear in previous blogs this is certainly not my experience both here nor the UK!). In my opinion it is also bloody irresponsible with potentially disastrous consequences - I am an emergency specialist in the UK but I am NOT a Cambodian Emergency Specialist.

A friend of a friend overheard a conversation between two 'experts';
1st expert "What is your title?"
2nd expert "Senior expert"
1st expert "But you should be more than a senior expert, 'senior, expert-expert' perhaps?"

My suggestion after hearing this, based on how the UKs education system dealt with the increase in A grades at GSCE level, was from now to refer to all people who consider themselves to be 'senior expert-experts' as 'Expert A*'.

I however will be sticking to 'VSO medical advisor'.

The gift that keeps on giving

One of the outcomes from going back to the UK was the acquisition of gifts for the Cambodian community. Some of these were to reciprocate kindness & generosity, some were special requests from home and some were to overcome the logistical nightmare of the Cambodian postal system.

From the Barang community;

Peter had requested PG Tips (as many as I could carry!) - that's brand loyalty for you.

Andre wanted a photographic magazine in which one of his photos had been published. (https://www.facebook.com/photo.php?fbid=248747928514880&set=a.139655496090791.26531.100001390258071&type=1&theater)

Geordie's brother had a lens for his SLR camera which logistically would not desirable to send to Cambodia by post. The plan was to send it to my parent's house and add it to my ruck sack (7kg going home 22kg coming back!), unfortunately I forgot that G & I had arranged this (alcohol may have been involved) and hence my excitement on receiving a parcel rapidly dissolved into disappointment when I went to collect it from the post office. Geordie also got Mars bars - despite them being available in the miserable chinese shop for $1 - because he had previously given me a hard time for not getting my parents to bring out a huge Tesco shop of confectionary for the whole of BTB.

Janice had no requests but had previously bemoaned that she had never received any post at her P.O Box - I did point out to her that as only 2 people know the address this might be a contributing factor to the lack of post. So Janice's gift (or A* as I shall now call her - see future blog) was a parcel and letter to her BTB P.O Box.

Kristy's gift to me when she went back to Australia at Christmas was a Violet Crumble so I returned her kindness with mini eggs & 'lollies' as the aussies call them. A girl can not live on Nutella & chicken coated peanuts alone.

Katie (selfless & unassuming as ever) asked for nothing but got cheese - vacuumed packed, sealed in freezer bags and then secured in tupperware containers - lovingly carried in my hand luggage. She misses cheese more than I do. And of course crackers!

The Cambodians were less food orientated, after all they have rice - all culinary corners are already covered.

Rady wanted the English File intermediate work book & CD-ROM, after reading an email he sent me whilst I was in the UK I could see it would be money well spent. When I gave it to him I thought it was the wrong book as he had absolutely no response. My family (minus my mother) are olympic gold medalists in present appreciation - Sonia is by far the best. It turns out that Rady (like my Mother) is more of a slow burner when it comes to present appreciation. He kept the book all neat in its packaging for a whole day and only after much haranguing from me, unwrapped it - he didn't want to spoil its newness. When he discovered that the CD allowed him to register for free on-line learning resources he let out a stifled exclamation of joy - "The people at Oxford University Press are just so kind!"

Vibol - my trusty VA and best boy - got a book on Idioms. His english is excellent, he has a great sense of humour with a limitless supply of jokes, so I figured that as I have an uncontrollable compulsion to speak in idioms (only since working with people who have english as a second language) that this book would be the most useful gift for him. I think he would have preferred it if in the inscription I had written 'to my best-man' instead of 'boy' but as we have already established, I am too old to be his Bong-S'rey (big sister) so he can't have it both ways.

Sivhour - with the longest, shiniest, gorgeous hair got accessories from Clare's. Her response rivaled Rady's with a photo of them and wall post on Facebook as a show of gratitude.

Soyeth - my Khmer teacher - got hand cream as when ever she is holding my hands telling me how much she pities me, she then comments on how soft and smooth my hands are. I keep trying to tell her it is because I haven't done a proper days work in my life (and for god sake DONT pity me!) Perhaps the Clarins will be able to help reverse the evidence of her lifetime of hard work. I'm not sure the same can be said for my pitifulness.

Bonsak however wins in his response. Before I went home he had cheekily asked what I was going to bring him back as a gift then? I asked him if there was anything he wanted & he requested a football. He supports Arsenal, when I told him I support Liverpool he mocked me - my response was at least I had been to Liverpool - unkind but if you read on you will see that he gets his own back.
On my return to work, barely through the door, Bonsak cheekily asked where is his gift was then? I explained to him that in my country it is rude to ask where your present is and we generally wait to be given things. His response - perfect in every sense - was "In your country is it rude to ask for help as well?" - touche.

It got me thinking about a VSO video I watched during my pre-departure training. A volunteer is talking about how she responds when her partner organization staff ask her where is the money, the resources, the per diems, the gifts that they want NGOs to provide them. Her reply was "I'm your gift - my knowledge, my skills, my time - that's my gift to you."

I think Bonsak preferred his football and arsenal water bottle.

Capacity building by applied physics

According to wikipedia "In physics, a wormhole is a hypothetical topological feature of spacetime that would be, fundamentally, a "shortcut" through spacetime."
Today we found one in the paediatric ward or at least the nurses had. Every patient had a set of observations recorded for tomorrow morning at 6 am. Brian Cox would have wet himself.