Training for milliners in sharp safety

One of my favourite things about living in Asia is the crazy english translation errors or interpretations.

Inappropriate T-shirt slogans are quite high up on my list. Young cambodian teenage girls wearing a T-shirt declaring 'Save a virgin, do me instead', 'Fun me if you catch..', 'I do it on the first date' or 'work me as hard as you blow me baby' are always quite alarming.

Yes that's "Love is a blind whore with a mental disease and no sense of humour"

And "Rabbid Kitten" - why not?

This is the cover of a note book I bought in China - incomprehensible wisdom!

and the title of this blog - this is something that J asked a Cambodian to put into the work plan which should have read 'training for military nursing students on sharps safety'!

This is Cambodia!

I hear this particular phrase a lot but unfortunately it is very rarely the reply I was looking for.

Last week in response to me asking the same simple question via email on three consecutive occasions, which only required a straight forward 'yes/no' answer - I finally received a 'this is Cambodia' retort instead.

Infuriating is putting it too mildly.

As far am I am concerned there is only one question that justifies this as a reply which is "Where am I?"

But perhaps I am expecting too much, after all....this is Cambodia!

Pushing the boundaries....

I knew I'd probably pushed it too far when R (always high up on my favourite Cambodian list) said to me, after two young girls drove by on a moto & he nearly dislocated his atlanto-occipital joint so I'd given him a 'look' of disapproval - "Even my eyes aren't free anymore!"

Its fair to say that with the electric razor J bought him for his birthday & my constant one woman attempt to alter his attitude towards his wife, karaoke, beer girls & extra marital affairs, means that R has learnt to 'alter' his behaviour around us - I don't like to think of it as nagging but this is basically what my capacity building has become. But today he told me "When you go back to England the first thing I'm doing is getting a girlfriend & growing a beard!" The two may, however, be mutually exclusive but it remains perhaps a metaphor for what capacity building can sometimes feel like. The changes only seem to occur when you are around to witness them & when you are no longer here, then everything slips back to the way it was before you came.

But facial hair & pretty girls aside there are some changes that can extend beyond any NGO workers time here, which often involves opening peoples mind's to a different way of thinking. I don't have a hospital example of this yet but......

R, J & I were sat having coffee. R - always on a mission of self improvement, which is why I'm sure he secretly encourages my nagging - wanted to know why if he said "Get out!" to a foreigner in a car, that could be seen as rude. I was explaining to him that in Khmer it wasn't rude but in English such a paucity of words was abrupt & considered impolite. We would have to add context & lots more words for it to be considered polite e.g. "We have arrived now, would you please like to get out of the car?"

As another example I gave him asking for the bill. I explained in the UK one would wait to get eye contact with a waiter, this would involve changing your body language - sitting upright, turning your body slightly. When one got eye contact you can either do the international sign for bill (In Morocco I once got brought a pen & paper!) or signal for the waiter to come over & ask "Please can we have the bill?" - obviously if you are really English you'd say "I'm so sorry, may we have the bill please?"

R was completely disbelieving - it was culturally normal to sit quietly & not yell across a restaurant "Kit luy!" - "But how are you ever supposed to get the waiters attention?" he asked incredulously. The night before we had been at 'The forest' - an eating place on the Thai border & R had been yelling for a full minute to get service as well as waving his arms like a drowning man - "That was rude in your country?" he asked suspiciously.

He looked to J - his role model for almost 4 years now - "Really?" he begged. Resigned that I had brought it to this J responded' "Yes, really. Every time I shouted 'Kit luy' for the first 3 years here, I died a little bit inside!"

We then both hastily added that we weren't saying it was rude in the context of South East Asia, we were just giving an example of cultural differences & why sometimes, things translated from Khmer into English can seem abrupt or rude to foreigners. We weren't asking Asia to change, we were giving some one from Asia an idea of how it felt to be an outsider.

This clearly made no sense to R & he just shook his head at the idea of a restaurant full of English people all silently gesturing for the bill & saying 'sorry' a lot.

We finished preparing our teaching for the following day & when it came to get the bill & I sat up straight & twisted my body around to make eye contact with the waiter but R grabbed my arm "No! Let me do this!"

He made his eyes very wide, cowed his head down a little & stared meekly at the waiter who had his back to him & then whispered "Somtoh - Oan Som Kit Luy" - sorry little brother bill please. Not surprisingly there was no response so R repeated it in a hushed voice with a hand flapping gesture (pointing or beckoning with one finger is VERY rude here) - still the waiter hadn't heard him & remained with his back to him.

A diner on the other side of the restaurant however was following R's attempts to get the waiter's attention so took it upon himself to yell at the top of his voice "OAN, KIT LUY!!!" and then pointed to our table.

R looked triumphant, J & I remain pretty sure that if he had stuck at it he would have got the bill eventually.

Now when ever I make an attempt to get a waiter's attention R shakes his head sadly & says - so gentle & so polite - I think he is mocking me. Maybe the reality of it is I am being too gentle & polite with the hospital staff as well.

First day on the job

My new VA (#4) started work today, I was a little apprehensive about going to the wards after last week but braced myself, warning her it may not be pretty, then dived in regardless.

ICU medicine - the doctors were still only requesting white blood counts despite the introduction of a new form with a box for a full blood count. I was informed you don't need haemoglobin & platelets on a septic patient. However the same patient had been given 3 litres of IV fluid. Last week Dr ON was talking about shock index, this week Dr V, who was also at the American organised emergency care conference in Battambang last month, was treating patients with correct fluid management. I couldn't feel more ineffective if I had tried but as long as they begin to give appropriate fluids I genuinely don't care who persuades them - it just leaves me wondering what the hell am I doing here then?

Paediatrics - surprisingly, the 28 weeker who I thought wouldn't survive the weekend had survived. Mum was managing to express some milk for NG tube feeding, he was a little less jaundiced & the breathing was about the same - the breathing would have been a lot better I discovered if the doctor hadn't ordered the oxygen to be switched off. Apparently, the father relayed to me, the doctor told him that the baby would be able to suck if the oxygen was switched off, as it would make him stronger. I tried to explain that maybe he would have less work of breathing & apnoeas if he wasn't hypoxic but the father earnestly told me that he was going to follow what the doctor said - why not? No one else listens to me - I'm even beginning to doubt what I think myself!

Surgery - not so good. There was  huge crowd of people - you could call it a mob - stood outside the OPD/emergency room. At a glance I could see a boy laid out on the floor being bagged - it wasn't looking good. My VA looked horrified, she's an english literature student & dead children wasn't in the job description.

Then something very strange happened - one of the surgeons saw me & said "Esther - please help us", I actually got asked for help, which of course I did because its my job & I don't need to be asked (although its also nice to know that its been requested & not begrudgingly forced upon the helpee).

So what started as a uncoordinated resuscitation of a drowned child on the tiled floor in a pool of river water vomit ended up 30 minutes later as an intubated child on a bed having good quality chest compressions, NG tube inserted, IV access obtained & adrenaline given every 4 minutes. There was even a cylinder of oxygen wheeled into the room so that we weren't ventilating with air. The nurse who handed me the syringe of adrenaline was visibly upset, the doctor that had asked me to help was sweating from the exertion of CPR & I had the detached calmness I only ever feel during a well run resuscitation. Things were quiet, there was an absence of chaos.

I called R to help as my new VA was startled & not medical. When he arrived he wasn't really sure why I had called him, the nurse anaesthetist had secured the airway, my tutorial on correct chest compressions had paid off & my VA, on my instruction, was getting a history from the mother.

I then began the unenviable task of discussing stopping resuscitation with the Mother & the surgeon, in a second language - walking the surgeon through what I would say & then him translating it in Khmer to the Mother who after much insistence from me had been allowed in the same room as her son & to touch him. It is hard enough stopping resuscitation in front of parents but when there are 20 plus rubber neckers it is even worse. I am finding hugging bereaved mothers increasingly more difficult as the paediatric death count increases. The under 5 years mortality rate in Cambodia in 2010 was 51 out of 1000 children, currently I feel like I am seeing every one of them.

I told the nurse anaesthetist & head of the OR, respectively, that their airway management & chest compression were great, then I went to debrief with R & my VA over coffee. I've accepted that I may not ever get to work in the new ER but by God I will drink coffee in the new canteen.

R & I discussed compression to ventilation ratios, warming techniques, use of drugs other than adrenaline in cardiac arrest, the benefit of having oxygen & an emergency trolley in an emergency area....

My new VA's feedback was that the boy's Mother had told her she was grateful for my kindness & compassion and felt that everything that could be done, had been, to try & save her son.

I tried to reassure my VA that this was as bad as it got here & it wasn't the best start for her but it was at least a realistic one. Thankfully she only works mornings so wasn't with me for the second paediatric death of the day, this afternoon.

It remains to be seen if she will show up tomorrow morning for day 2. I have a feeling she is more resilient than me, so will be still here, fighting poverty & injustice, long after I have bailed out.

Reverie of the cat

I think I may have made my point about the challenges of working in a government referral hospital in Cambodia - so on a lighter note some pictorial musings from China....

This is the notebook that Suzi bought as her journal for China - Reverie of the cat, why not?

In a side room of the ICU in the hospital we visited in Zhangye there was a room full of these machines, head coolers - again why not?!

Karaoke is endemic in Asia but at least this one has had some thought put into its name

Surrounding the temple that houses the largest clay Buddha in China were many old beautiful houses, I think the Chupa Chups tin to catch rain water is a newer addition 

A highlight of our morning explorations were the exercise parks that could be found in many outside spaces. There would be a collection of old but ultra fit & toned people going through their early morning exercise regime. These people are making full use of the very popular, always a queue for it,  massage station.

Suzi emulating the 70 year old man before her on the monkey bars

A scary baby statue in water whose central water feature had no water in it. There were other scary baby statues but too scary for this forum

Road cleaner

On our rest day we visited the wetland park & Miss Du, our translator, got very excited about the prospect of a trip around the park in a pink golf cart. It was in fact an excellent visit with a Lady Gaga sound track

During rush hour pedestrians are physically restrained from jay-walking by a man in a high-vis jacket & a rope 

There's nothing like a sign that states the bleeding obvious....

....or is on a carpet in the lift to remind you which day of the week it is...

....or is not a cold warning....

.....or intrigues you to wonder what is the contents of its container...

....or insenses you at the suggestion that pregnant women shouldn't go on an escalator if not accompanied by an adult.....

...or makes you want to be part of the Family of Happiness (that sales underwear!).....

or just makes you NOT want to put its contents any where near your skin!

Great little shops

Just what I need for my bicycle seat back in Cambo

Every supermarket deep freeze section needs a fish bowl on it, especially if the contents of the freezer is fish

Morning exercises are often accompanied by morning out door radio listening & kite flying. If you anchor the kite to your bike you have both hands free for tai chi

Suzi 'Tango stretching' at my favourite exercise park

A circle of Chinese horoscope statues can also be used for exercise adjuncts

Suzi looking apprehensive before out 'pedicure' - it was good but didn't involve nail varnish or our feet much

Out favourite waitress who when we tried to tip we learnt that there is no tipping culture in China. But having our photos taken with her was culturally appropriate

When going 'solo', sans translator we tried to order beer so they helpfully brought us a menu all in Chinese characters & with no photos. Another we miss Miss Du moment. Not sure this photo captures the faux marble with sparkles table top - I loved this restaurant but we only had a warm beer despite their protests that we needed to eat

Suzi's wrist modeling the  lucky chinese horoscope bracelet (Suzi is a tiger, I'm an Ox but they didn't have one of those for me so I have a Rabbit instead!) & dragon boat festival band that Miss Du gave us as a leaving gift. I wear both mine fervently like the superstitious fool in need of a lucky break that I am.......