Seasons Greetings!

Today I wished the head doctor (Dr L) of ICU medicine a Happy Christmas!

He growled back that he was Buddhist.

I smiled sweetly and told him that never mind - I'm an atheist but I still celebrate Christmas.

Tomorrow I will celebrate New Years Eve.

January 23rd I'll celebrate Chinese New Year (year of the Dragon).

April 13th-16th I'll be celebrating Khmer New Year.

I like to keep my options open.

Perhaps I should be agnostic...

Missing you already...

Saying goodbye to another set of visitors set me thinking about how lucky I am but also how much I miss from home.

I miss people of course. 

My wonderful family & friends whose support keeps me here especially on the days that I really think I can't do it anymore. Having my sister, brother-in-law & 2 gorgeous nieces for 10 days over Christmas now means that I miss them even more acutely than before. Skype is great but you can't choreograph a synchronized swimming routine over Skype. Whatsapp is instant and you can share photos & videos but not a G&T or a dirty hot chocolate. When all else fails & its bad news there is always my Cambodian mobile but the reception is not so good which led me to believe the other day that it was my sister and not in fact my Grandmother who was gravely ill. 

I miss not being able to be an irritating medical relative. 

I miss being a good daughter, sister, grand daughter, auntie & friend (although my parents, sisters, grandmother, nieces & friends may argue I never have been).

I miss money. I miss not having to think about whether I can afford stuff. This can be something as small as a cinnamon roll or a decent cup of coffee.

I miss my camera - it was stolen on Christmas Eve. I miss not just being able to replace it and I miss all the photos on the memory card I will never get back.

I miss cheese - I REALLY MISS CHEESE. In all the lovely 5 star hotels my family stayed in over Christmas there was REAL cheese for breakfast. My continental breakfast feasts became the stuff of legend. Grace procured some swiss cheese, smuggled out in a napkin which I enjoyed last night with crackers but no red wine. Now I miss cheese....A LOT. (and WINE!).

I miss hugs.

I miss HUI.

I miss Waitrose - truth be told this should really be a lot nearer to the top of this list, in reality a half degree below people, is that wrong? Right or wrong I miss a middle class, overpriced, semi-ethical, elitist supermarket. There I've said it.

I miss duvets and down jackets - I miss layers, and knitwear and socks and all things snug & cosy. As the temperature here plummets to the low 20˚Cs I have worn socks once and added a blanket to my bed and on occasions even worn a fleece but it is hardly the winter that the UK had last year with an average temperature of -1˚C.

I miss baths (& Bath!).

I miss working in team (or working in a team where everyone can speak the same language - preferably my mother tongue).

I miss real clinical work. Talking to patients, putting them at ease, building rapport. The conversations you have with patients as you perform intimate or painful procedures on them are simply always lost in translation.

I will miss my computer when the heat, humidity & dust finally kills it.

If you are reading this - I miss not telling you this is how I am feeling right now, face to face.

I won't miss 2011 because I have 2012 and all that it has to bring just around the corner.....

Happy New Year!

A Christmas Quiz...

Merry Christmas everybody - where ever you are, what ever you are doing and who ever you are with - I hope you have a safe and festive time.

I am back to work - 'capacity building' in the tropics.

I have a little Christmas quiz for you, its guess the age of the group of people I am describing;

They are a group of 15 people who are coming to a training day. They are coming because they have been told to come and will get a $4 per diem if they attend the whole day.

The invitation says the start time is 8 am - 10 out of the 15 arrive after 8 30 am.

The first session is setting the ground rules - the first rule is that they want change the morning session end time from 12 to 11 am, this gives them a 3 hour instead of 2 hour lunch break. When the facilitator tries to negotiate that as they mostly arrived over half an hour late for the start of the session that perhaps they could compromise and stay until 11 30 am (their usual lunch break start time) - this suggestion is rejected.

The second ground rule to be set is that there should be no use of mobile phones - they reject this but say they will switch to silent-mode. The next 2 hours is a cacophony of various mobile phone ring tones and loud intrusive phone conversations.

When asked after a lecture if there is any questions one person asks why he doesn't have a free pen and only a free pencil in his free folder, this is the only question.

The snacks arrive, there is a stampede to the table even before the teaching session is over. The first people to arrive take plastic carrier bags and fill them up to the brim with snacks for themselves and then leave the teaching. The remaining people have a bottle of water and a small piece of fruit if they are quick enough.

At 11 01 everyone looks at the watches, starts to mumble and leaves; despite the fact there is a demonstration on how to deliver effective CPR still in progress.

They have in fairness been quite well behaved today so far.

Those of you who have children or work with children have an unfair advantage as you should be able to gauge which age-group demonstrate these types of behaviour.

A.The average age of this group of Doctors & Nurses is 40 years old.

PTC - an epic tale

It has been a while since I have properly put finger tips to keyboard. There are a multitude of reasons for this but PTC (primary trauma care) lends itself to a blog all to itself - it is an epic tale. It is a story of what I do here and of why so often this blog (to quote my friends husband) becomes a 'litany of despair' but it is also I hope a story of the reality of capacity building and the hard slog towards positive change.

It all started in May of this year when Sz an anaesthetist from Australia came to BTB to run an airway course. We got talking and before long she had recruited me to instruct on a PTC course she was planning in Siem Reap in September.

For the uninitiated, PTC is the developing worlds version of ATLS (Advanced Trauma Life Support) which in turn was created in the States after an orthopaedic surgeon crashed his plane with all his family in it and realized standards of care for trauma patients could probably bear some robust improvements. Cambodia's deaths due to trauma are double that of any other country in South East Asia so there is a strong argument for introducing PTC here.

The Course in Siem Reap was the first of its kind in Cambodia & the first 2 day course was instructed by Sz, me, another Australian Anaesthetist and a Filopino trauma surgeon. Then after a 1 day training the trainers course the second ever course was run by Cambodians - doctors and nurses that all work for the brilliant NGO hospital Angkor Hospital for Children and had been participants of the first course.

For a movement such as PTC to be incorporated into the medical culture it is important (I believe) for there to be ownership of the course my government hospital staff and to have their commitment - they after all will be treating the trauma patients, 17.8 per 10000 vehicles of which currently die. Because of this I asked if HS - the head surgeon of BTB Hospital; previously worked in NGO hospital and trained for 2 years as an orthopaedic surgeon in France - would be able to come on the Siem Reap course and then train as a trainer. This you would think would be an unremarkable feat - well I thought so, how wrong a girl can be.

So HS said he would come, he even at one point promised he would come. But I later learnt that a Cambodian promise is not quite the same thing as a european promise, actually I learnt this at 6 am whilst in PNH for my second language training. When I was told that Cambodia has an early culture I assumed it meant they came early for appointments (nothing could be further from the truth!), in fact it just means they are all just very early risers so phoning you, playing really loud music, banging very loud drums and delivering a huge bunch of bananas can all happen here before 6 am. HS in fairness to him only did the very former of this list of early morning activities, calling me with various excuses - one of which if I remember rightly was something to do with the dog eating his homework - for why he couldn't come to Siem Reap.

Having secured funding from URC for him to attend the PTC course to say I was mildly disappointed with him would be an understatement. In fact when I got back to BTB there was a 20 minute conversation with him which started with us eye to eye and ended with him slumped on his Moto dejected as I did a very good impersonation of a mother of a teenager. "I am very disappointed"  was mentioned, "you've let me down, the hospital down but most of all yourself down" may have been a sentiment expressed by me also. All the NGO doctors and nurses had told me that government staff would not engage in training, they had bet me that HS would not attend the course. I told him so and that he had proved them all right, I believed he had potential to be a great instructor and improve trauma care in Cambodia but was lacking any proof.

HS delegated Dr V to go in his place but only for the first course as a candidate and then the training the trainers course. This would all work out fine because Dr V would have to be an 'instructor candidate' on one course and we could plan for that course to be here next time in BTB.

Three days before the course started in Siem Reap Dr H from the URC office called me - he had concerns about Dr V going on the course, as he holds the URC purse strings I needed his approval before Dr V could go. Dr H's case was that Dr V already taught with another trauma organization and perhaps it would be better for HS to go seeming as he was an orthopaedic surgeon and head of service - like I hadn't thought of that!

Dr V loved the PTC course, he was engaged with the subject matter and the style of teaching was novel, so completely different from previous methods he'd been exposed to, he could see its worth and regretted not being able to stay to teach on the 2nd ever Cambodian PTC. He was motivated and excited to deliver the course as an instructor candidate in BTB so we set a date for 4 months time - the end of the year - we wanted to keep the momentum going.

I picked the one week in December that Dr V was available to teach, I requested URC to financially support the training (VSO don't pay per diem & BTB staff won't get out of bed for anything less - that's a whole other blog!) and put it into the work-plan. I tried to book a room at the hospital but was told it was too early (forward planning isn't big in Cambodia). I confirmed with the directors that this week would be a good time for the hospital and that they supported the principle of PTC. I confirmed that Sz, Drs Ch & P, N (see favourite Cambodians list) from AHC were available to teach. I double checked that the timing was good for the hospital, I triple checked and then I emailed Sz confirming the second week in December as a date for the third PTC course in Cambodia.

I attempted to mend my broken capacity building relationship with HS.

Nearer the time I tried to book the large hospital meeting room for training again and this time was told by the admin man that I could not have the room for 2 days as there may be more important meetings which have not been arranged yet BUT could be arranged.

I lost it.

I went to the deputy directors office and lost it with them. I spelt out to them that PTC was an internationally recognized trauma course, they had the first ever Cambodian government staff instructor candidate on their staff, he had gone to Siem Reap on their approval so he could train the rest of BTB staff, all the equipment for the course would be provided by URC & AHC, instructors had already bought their tickets from Australia (Sz and her trauma surgeon mate Sp - they were coming in their own time and at their own expense). Despite not having to travel anywhere, stay overnight away from home or even leave their workplace they were still getting a per diem (this is a whole other topic for discussion - don't get me started) and ALL that I was asking for was one room. It would seem that this was just too much.

They were perturbed - they had seen frustrated Esther quite a lot already - but never incandescent with rage Esther, so they rang the Director at home. He said - give her a room!

I had a meeting with the hospital (they were rejecting my work-plan but again that is another story and don't get me started) - the issue of staff attending training was raised. It was suggested that perhaps if the management team attended courses this would improve 'discipline'. Another suggestion floated was training should be held in hotels. I calmly countered this with the argument that I am VSO and don't have money for a hotel room and more importantly clinical teaching is best delivered in a clinical environment. I said I would ask URC about getting a hotel room (it sounds so sordid) for PTC but I already knew the answer. Jn (Hospital Improvement Team Leader URC) didn't dignify my email with a reply.

When I told them the answer was no (or technically silence) the hospital seemed to take it pretty well. They told me that there was a meeting planned for the second week in December but as it was later in the week it wouldn't affect my PTC plans.

Three weeks to D-day and I was away in Anlong Veng when I received a phone call from my VA - he sounded very worried. "Try to keep calm boss" he implored me. The hospital in their wisdom had booked a meeting during the course so we had no venue now for training. I remained calm - it was after all not my VA's problem although as he sagely told me "your problem becomes my problem boss!".

I was having my own 'issues' in Anlong Veng (another story for another time) so rang J (URC BTB hospital co-ordinator) who went with Jn to speak with the deputy director. They seemed to think it was a genuine mistake rather than my cynical interpretation that was just a device for getting a hotel room. Thankfully URC came to the rescue and we changed the course venue to the meeting room at the BTB URC office - I believe thats what is called a compromise.

The next hurdle was obtaining a list from the hospital of 20 participants. I met with HS and asked if he could provide a list - he gave me 3 names. What followed was a 1 hour negotiation to increase that number to 10 staff from the surgical ward, at this point I was beginning to think PTC was NEVER going to happen. Once again URC provided one third of the solution by placing 6 of their staff on the course so they could then train as instructors. I applied VSO's volunteer dimensions and problem solved by being flexible - I invited OPD staff and the deputy directors. HS's name was not on the list but I invited him anyway.

I organized all the equipment needed for the course. This is a very short sentence that fails to convey the enormity of that task.

I spoke again with HS - I explained I had invited him because I needed his support. He promised me he would come, I pointed out that I had previous experience of what his promise means. I reset my expectation to 'none'.

Monday evening before the PTC course on the Tuesday I felt immense anticipation and a little bit of dread.

HS came, I owed all the faculty a drink as I had lost my bet that he wouldn't attend. The hospital staff surpassed my expectations which I suppose as I had 'none' is not that hard. They were engaged, they supported each other, their post-test scores were double the pre-test and although HS is still not instructor potential material the head nurse was good & has now done the instructor training with 7 other potential instructors from URC.

Dr V was a star.

The highlight for me was playing the role of a pregnant trauma patient and being log rolled. The surgical nurse doing the scenario tried to do a rectal exam on me, when I moved my head to object the person holding it clamped down on it like vice to protect my c-spine. It was all very real for them (& me!) and that is why scenario teaching is such a powerful teaching method!

Obviously I was a useless co-ordinator, I didn't get the certificates right, I hadn't bought gifts for everyone and I wasn't to be trusted with even the simplest task - but hey this is Cambodia and feedback is always only of the negative variety. They just haven't had the 'how to give feedback lecture' yet...

November in Pictures or WPC long list...

When my folks came to visit and refused to go to the killing fields and S21 my carefully planned itinerary was thrown into disarray. Hence we spent a whole afternoon of 'acclimatization' - sat by the river in Phnom Penh people & boat watching.

Phnom Sampeau - incense

The flatness of Battambang province

Poppa-bear with wives number 2 & 3. He particularly like the arm holding and constant fanning but in balance decided to go home with his first wife.

Dried bananas & why travelers get sick

multi-coloured chickens - why not?

Tonle Sap lake - lots of water & sky

Parentals at Angkor Wat - my country, my beer...

Ta Prohm

Tomb raiders

The manic grin of a jet lagged, over heated mother who has had enough of seeing temples and reliefs of various hindu epic tales that all involve fantastical creatures and death by poles up ones bottom.

What the tomb raiders left...

A WPC possible entry

After beer for lunch and despite having last time sworn I would never go up any temple step's again (I couldn't walk for a week after) I found myself at East Mebon running up the steps like a mountain goat. Coming down as always was slightly more tricky.

Rubber plantation Kampong Cham province - all those lesson in geography 25 years ago about 'cash crops' suddenly make a lot sense. 

Fishing village - much chagrin from my mother that the sun was in the wrong place for photos

Sunrise over the Mekong 

Mondulkiri sunset - and my first experience of being too cold in Cambodia

Elephant Valley Project

http://www.elephantvalleyproject.org/ - check out the website - it is a great project and worth any donations you can spare.

Washing the elephants - an absolute highlight

Got to watch out for those flapping ears (elephant's ears not BFG!)

Sunset in the jungle

Washing at the waterfall

Second attempt of rice crop after flooding wiped out the first.

The parentals completely adapted to the habitat!

Welcome to Cambodia - we hope you enjoy your stay

More blog radio silence I’m afraid, this time because I have been acting as tour guide to my parents for the last 3 weeks.  They have now left and the consensus was that “a good time was had by all”. If capacity building doesn’t work out for me here perhaps I could establish a tour company instead.

A sample itinerary would be as follows and concentrates on using as many modes of transport as possible and purchasing many scarves;

Day 1 – Fly to PNH (mode of transport 1), parentals set the tone of visit by suggesting we start on the Angkor beer at 10am. Lazy jet lagged day with drinks and food at FCC. Icy-cold 5 star hotel accommodation.

Day 2 – PNH – tour guide has a meeting at URC office so clients go on a ‘walking tour’ to street 240 for start of scarf buying marathon. Visit Royal Palace, National museum and lunch at Daughters of Cambodia. Respect clients’ request to not go killing fields and S-21. Dinner at Ocean.

Day 3 – PNH – Boat trip to Mekong Island (mode of transport 2), lunch at Friends then walk along riverside (mode of transport 3). Dinner at Ngon.

Day 4 – Travel up to Battambang by private taxi  (mode of transport 4). Accommodation my salubrious house by Wat Sangker. Dinner at Flavours of India, pre-dinner drinks at Geordie’s Gallery.

Day 5 – BTB – Meeting at hospital so “acclimatization day” for clients. Happy hour at Café Eden & dinner White Rose.

Day 6 – BTB – Bamboo train & Phnom Sampeau with David by Tuk Tuk (mode of transport 5). Dinner at Chinese BBQ.

Day 7 – BTB – Trip to Banon and surrounding area (mushroom farm, vine yard). Happy hour & dinner at Bambu hotel.

Day 8 – BTB – Tour of BTB referral hospital and then Tuk Tuk trip to Ek Phnom district and ‘cottage industry’. Dinner at Bamboo Train Café and Circus show.

Day 9 – Travel to Siem Reap by Boat. Accommodation Smiley’s Guesthouse. Dinner at The Sugar Palm.

Day 10 – SR – Small circuit of Angkor Wat. Happy Hour and dinner at FCC.

Day 11 – SR – Grand circuit of Angkor Wat. Dinner Il Forno.

Day 12 – SR – Trip to Silk farm and markets. Cocktails at Elephant Bar & Dinner at Abacus.

Day 13 – Private taxi to Kampong Cham. Accommodation Mekong Hotel. Lunch at Lazy Daze, trip to Rubber Plantation, dinner at Mekong Crossing.

Day 14 – Bus to Sen Monorom (mode of transport 6). Accommodation Phanyro Guesthouse, dinner at The Greenhouse.

Day 15 – SM – Elephant Valley project for visit, dinner and accommodation (hammock).

Day 16 – SM – Travel back from EVP by moto (mode of transport 7). Rest day. Lunch at Chum Nor, dinner at Banana.

Day 17 – SM – Trip to waterfalls, coffee plantation and sea forest. 

Day 18 – Trip to Kratie by shared taxi/minibus (mode of transport 8). Accommodation You Hong, Dinner at Balcony bar.

Day 19 – K – Trip to Kampie and dolphin boat trip, tuk tuk ride to turtle conservation project. Accommodation & dinner at Balcony Bar.

Day 20 – K – Trip to Koh Trung, horse & cart  ride (mode of transport 9).  Lunch at Red Sun Falling. Afternoon trip to another Wat. Dinner and many drinks at Balcony Bar.

Day 21 – Trip back to PNH by shared taxi/minibus. Accommodation ridiculously overpriced 5 star hotel. Visit Wat Phnom. Dinner at Sovanna.

Day 22 – Fly out of PNH.

The cost of me organizing the tour, including all booking of accommodation, transport and meals and acting as a half-arsed interpreter is just the cost of all my lodging, transport & food. This I’m afraid will probably reduce the clients of my tour business to my family and possibly only my parents!

However the feedback from the tour has been good.

Ma Wilson’s top 5 highlights

1)   Boat trip from Siem Reap from Battambang through the floating villages on the Tonle Sap Lake

2)   The scenery – especially the paddy fields

3)   Balcony Bar in Kratie – sundowners and story telling on the terrace with Andrew (owner)

4)   Visiting silk farm in Siem Reap

5)   Seeing me – well she is my mother after all and clearly this should have been listed as #1

Poppa-Bear Wilson’s top 5 highlights

1)   Sweet and Sour Pork – White rose Battambang ranked first place with Balcony bar a close second and this is really his #1

2)   Trip with David the tuk tuk driver around Battambang to see local industry

3)   Having drinks and good conversation with various young female backpackers – Cat & Sarah I’d like to apologize for my father

4)   Mekong Island visit in PNH (before Mum bought the 14 scarves!)

5)   Visiting Banon Temple and obtaining two new wives

Tour guide’s top 5 highlights

1)   Washing the elephants at the Elephant Valley Project

2)   Staying in a 5 star hotel in Phnom Penh and using a duvet even with the AC switched off

3)   Horse and cart trip around Koh Trung & seeing a snake

4)   Breaking down in Tuk Tuk after seeing dolphins and entertaining local children for 2 hours

5)   Evening spent with Tania at Banana in Sen Monorom

There were however some complaints and annoyances;

1)   The Wat next door to my house caused unacceptable noise pollution with its new sound system at what was considered by my clients to be an antisocial hour.

2)   The shared taxi journey from Sen Monorom to Kratie with the 23 passengers and chickens was not appreciated as the ‘authentic Cambodian experience’ it was intended to be. However Pop Wilson regained his GSOH in time to enquire when we arrived in Kratie if it was Phnom Penh and where was the airport?

3)   The private taxi from Siem Reap to Kampong Cham was also not considered to be ideal by the clients who felt that the price and various requests to fit in ‘wives, mothers and sisters’ were both stretching the truth and taking the piss.

4)   The Mekong Hotel manager who tried to sell us shared taxi over a bus ticket wins the least liked Cambodian award. The two Australian women we met in Sen Monorom were less than impressed with paying more than a bus ticket to leave 4 hours earlier than the bus, have practically the same number of passengers as a bus which arrived at the same time in Sen Monorom despite the bus being an hour late. Gideon the tuk tuk driver won extra points for advising on the bus option and hence enters my top ranking Cambodian list.

5)   Sweating was an issue, however this has been a complaint from previous visitors. As this is the tropics, the management reserves right to ignore all sweat/heat related complaints.

6)   My clients were unsettled by the torture/khmer rouge routine at the circus. It was probably a good thing that I respected their request not to visit the Killing fields and S-21.

7)   Witnessed random animal & child cruelty unsettled my clients.

8)   The hospital visit was not ‘enjoyed’ but it was acknowledged that it would result in better understanding of my situation the next time I have a rant over skype.

9)   A series of emails from the UK caused a slight shadow over my holiday but as legal action is being threatened I shall remain cryptic.

The Kindness of Cambodians

I have a list - it is a list of my favourite Cambodians, sometimes when I am in a long and boring meeting, or having a day when some Cambodians are being less than kind, I play the game of trying to rank them. This is an impossible task because as previously discussed the good thing about Cambodia is you never know what it will throw at you next - so just when you have absolutely ranked one person as number one a outsider will do something spectacular and breath takingly kind which shoots them right up to pole position.

So in no particular order.

R is always high up. He is a doctor that works for URC - when the civil war was raging he worked in a hospital in Preah Vihear province - a khmer rouge stronghold, where the the only way to get in and out of the hospital was by plane (whilst being shot at). He is puzzled at the reluctance of hospital staff to take outsiders advice because in the 1990s he was happy to see any outsider brave enough to come to his hospital (MSF, Red Cross) and would welcome any advice they had to offer. Obviously things have changed. R is always high ranking on my list as he is one of the few Cambodians who has been openly cross with me (I think around sensitivities about his English - thanks UN for that - but I'll never be exactly sure), he has also told me what he thinks of me (mainly I am 'acceptable'!) and the only real difference between us is that I get to show my numerous frustrations and anger whereas R is imprisoned in the Cambodian hierarchy and saving face culture which means that when he snaps at me I could hug him. Last week he earned a medal of distinction for services to cheering up a disheveled capacity builder. I was in a meeting, before it had started I got cross, I went to leave, R intercepted me and calmed me down and made me stay, during the meeting he sat next to me - very close and leaning (a bit like our old Irish setter used to). Mid-meeting the obligatory snacks arrived - bananas wrapped in sticky rice and then a banana leaf and grilled - delicious. As I leaned over to take my second helping of delicious banana snack R whispered in my ear "you have me to thank for that - if you had stormed off in a huff then you would have missed out on the snacks" - very true and as I am sure you will agree nothing wrong with his sense of humour or english either!

Ry - another URC staff member - living proof that capacity building works although it doesn't necessarily mean they will stay in the Government system. Ry calls me "My doctor." He understands me when I attempt to speak khmer. He laughs (like a girl) at my jokes. He gives me hope that there are nurses here that care. He knows which part of the brain controls breathing. He calls J & G 'Mommy and Daddy' - his died when he was a teenager. J's job for 3 years now has been to capacity build him and mine appears to be to cheer him up by being silly.

S is my khmer teaching - previously blogged about. She tells me that she pities me (on a regular basis) which I have tried to explain is not so good but I think she only means it kindly. S has lots of advice about water, home security, food, how to work at the hospital, how to stop a nose bleed and other diverse and varied subjects. She gives advice (like her teaching) in an assertive and (as R describes me) aggressive manner. She tells me that I make her happy, grabs my cheeks and pinches them in a gesture of affection that makes my eyes water and I frequently get an urge to take her home.

Sk is a nurse that works in the hospital. On days when I am being particularly frustrated he would talk to me but in the absence of a translator I never really understood what he was trying to say. One particularly challenging morning I learnt that pii-bach-chet means stressed but other than that and sitting next to me at the presentation I went to (blog - living for the weekend) communication has been minimal. With V, my fantastic new VA, starting I have been able to have more in-depth conversations and so last week Sk told me not to take everything so personally. He could see it upset me when the nurses & doctors are rude or ignore me but through V he asked me to be patient and try not to take it as an insult. I was so stunned I had to ask V if he was translating or was that his own opinion. I was reassured that this was a direct translation and that it isn't just kind eyes that Sk has. I repaid him the nest day by telling him off for taking blood without washing his hands, re-capping a needle and not using gloves. The next day he told me - via my VA - that I looked beautiful. I replied - via my VA - that he could call me what he liked but I would still shout at him for re-capping a contaminated needle. Yesterday I saw him clutching his chest and a bag of GTN tablets - I only hope he is a victim of the some what questionable diagnostic and management skills here that I am meant to be capacity building.

Moto-driver - outside my house a man and his moto sits most days waiting for business. Every morning as I cycle to work he sits smoking his cigarette and gestures that I should get him to give me a lift. As I am already on a bicycle this causes him much hilarity. The highlight of this little daily exchange was a few weeks back when I came out of my house gates, crash helmet in hand and took him up on his offer of a lift to the bus station. He couldn't believe it and since this our morning exchange has been taken to a new level of hilarity and uncertainty.

N works for an NGO hospital and is a nurse. She is assertive, strong and feisty. I have spent time with her devising BLS courses and triage protocols but my respect and affection was cemented for her when I spent a week on a trauma course in Siem Reap. She ranks pretty high as the only Cambodian who I have told that I love! I suggested I should move in with her and she could be my Cambodian big sister (Bong S'rey) but she used some feeble excuse about her home being under 2 foot of water. In Siem Reap on the training the trainers course I gave a lecture on feedback. Now as I have previously mentioned positive feedback isn't a big (or any) part of Cambodian culture - so my suggestion that people need 5 bits of positive feedback before delivering 'constructive criticism' was a challenge. When practicing the new teaching techniques one instructor critiqued the teaching style and I critiqued the feedback given. When N gave feedback to one of the young male nurses she manages she was characteristically merciless & unforgiving. So this is the feedback I gave her, "N I really like and respect you, you are an excellent nurse, a natural teacher, professional, competent and committed but your feedback skills are useless!" I now find myself in meetings with her just putting up 5 fingers - her house, she tells me, remains flooded - funny that!

The entire family that run the Expresso Cafe - our friday evening haunt. The Dad is cute, the Mother is smiley, the daughter makes a wicked Pinu Caleda (sic), the sons have nice arms the grandson is gorgeous. When they increased their draft beer price to 75 cents they still give us, regulars, the old 50 cents price, you get free fruit platters and cakes, the people next door in the seeing hands massage place get concerned if I am sat alone and chat away to me in khmer - what's not to like?

Mr L runs the Cafe across the road from my house where there is the Thursday night film club, he is a natural host. When in passing I mentioned the rain had been so heavy that my roof had leaked he immediately wanted to go and speak with my landlady. I had to explain to him that talking about the weather was to an english person what asking you "where you go/been?" and "have you eaten rice/" is to a Cambodian for conversational tactics. When Mr L tells stories he does actions - I guess this makes him a natural children's TV presenter as well.

P from URC office is the cleaner, she has no english so helps with my mission to speak good khmer, but with the help of S I have conveyed the idea that P, S & I should have a girly session and all go to get our nails done together at the market. P brings the snacks and drinks to all the URC meetings and training events at the hospital. URC snacks are great, I think this may be one of the reasons I like her so much!

D the tuk tuk driver was immediately notable to Katie & I by his good english and non-hassling approach to acquiring customers. He has a fine collection of rhyming cockney slang that various tourists have taught him. He loves playing chess so when ever you are off doing something and come back to the tuk tuk you will always find him either near by watching a game or beating someone at chess. He is kind to children and tourists. He does a great trick with a seed pod and his brother has just taught him a new one with a piece of string. When you ask him how much? he always responds - what ever you think - which is working out quite well for him especially now my parents are visiting. He'll have that new tuk tuk very soon at this rate.

So I am in double figures and still could list the two great paediatricians from Siem Reap, the lady from the bicycle shed at the hospital, the giggling waitresses at the Gecko Cafe, the capitol bus station man, the anonymous woman that intercepted me at work about a skirt incident, allowing me to go home to change before an important meeting. The list goes on.....

I will continue to rank and re-hash the list to keep the positive thoughts going when the lower list ranking Cambodians are giving me a hard time and I am not feeling the love so much.

Remember to chew...

Today is blog action day and the topic is food, hence I am spoilt for choice as to what to write about.
I could discuss all the food that I love here and how long the gratification lasts after consuming certain comfort food stuffs (for the record dumplings from the noodle shop are pretty high up the gratification scale lasting a good 7 hours at least and thats with out the garlic repeating).
Equally I could talk about all the food that I crave or have fantasies about, better still the welfare packages I have received from home (and Australia) that even reminded me of things I had forgotten to miss (dorset cereal, tim tams, peppermint tea, green & black Maya Gold chocolate - the list is endless).
There is at least a whole blog on cooking with just a wok and a skillet with no sharp knives at your disposal.
I could discuss the recent floods in Cambodia and the destroyed rice harvest and threatened food shortage. Or the malnourishment wing of the paediatric ward and the shock of seeing a severe marasmus infant. Or how you feed yourself on less than $2 a day (not very well but two thirds of Cambodians have no choice).
But I am going to keep it short, sweet, tenuously connected to food and of course medical.....
Every morning there is a hospital meeting where new patient admissions, deaths and any other current management problems are discussed. Occasionally something is brought up that reminds you why you attend these meetings, despite the hours of 'ot mean' - 'don't have' conversations you have had to sit through.
Last Friday was one of those days, there had been a death on one of the wards and as my new VA translated the conversation I realized that going back to basics was going to need to be a lot more basic than I had bargained for.
The patient admitted to the ward the previous afternoon had choked to death on their evening meal; none of the nurses had known what to do, the doctor had taken 30 minutes to arrive by which time the patient had asphyxiated.
So I was left considering this scenario - you are Cambodian, you get sick, the traditional khmer medicine doesn't work, you are able to afford transport to the local hospital, you either can pay the user fee or have a letter to prove that you are poor so can have the UF paid for you, you are well enough that you don't die waiting for some kind of medical attention, you survive whatever medical attention or inattention you receive and you can either afford to buy food or receive the rice soup provided by the hospital. But then when you choke on your food in hospital nobody knows what to do. The irony of it is you will have probably spent most of your life hungry or working all day every day just to put some food in your belly so that one day it will go down the wrong tube and no-one will have any of the training or skills to help you.
This week I go to a fellow VSO volunteer's hospital to conduct some emergency triage assessment and treatment training, the week after we have a basic life support course in my hospital - both involve choking algorithms. It seems so basic but then again it is the simple things that save lives.
Capacity building is an expensive and slow process but ultimately I still believe it to be the most sustainable way of improving peoples lives and in the words of Student Community Action's motto (circa 1990s) "If you are not part of the solution, you are part of the problem". Although I'm learning it is possible you can be both!
Happy world food day - remember to chew......

Patience is a virtue...

A conversation I had with a Cambodian colleague resonated with me after certain events this week.

Dr C (x-ref 'suffering doesn't have to be fun bit it helps') works for an NGO hospital and also trains government staff at a hospital which he affectionately refers to as a 'hot spot'. Dr C is an excellent physician, would have preferred to studied english literature & be a teacher and is Cambodian. Sharing the common ground of us both being doctors that 'advise' in government hospital 'hot spots' I find myself looking to him for guidance to navigate these stormy waters.

The last time we met, a few weeks ago, I asked him how is was going at his 'hot spot' - he grimaced and told me it had been going quite well but 3 months ago something had happened to rock the boat. One of the nurses from the government hospital had applied for and got a job at the NGO hospital Dr C works for. This had caused a degree of consternation among the staff at 'hot spot' and one person in particular who felt that the NGO were deliberately poaching their good staff.

Now Dr C had been given fore-warning of this impending mutiny so the next time he visited 'hot spot' he was prepared. He told me that just looking at the disgruntled government doctors face and could tell that he still was angry at him & the NGO - so he did what any self respecting Cambodian would do - he saved face and ignored it.

My western sensibilities twitched at this - surely if someone had an issue with you, you would address it, confront them, put matters right, straighten out any misunderstanding, not allow matters to spiral out of control, fix the problem, find the solution etc. etc. etc........

Dr C went on to tell me that on returning the following month he found that the disgruntled individual was still angry with him and continued to ignore him. However other staff were still receptive so he carried on his course and continued saving face.

At this point in the conversation I expressed my desire that if I was him I would have to sort out the problem directly. He frowned at me then smiled pitifully. "Esther" he reassured me, "If this month there is still a problem I will talk to the hospital director and arrange a meeting."

"But it already been 3 months!" I exclaimed impatiently.

This is when I was educated in the virtue of patience. Dr C explained to me that if a person is angry the best thing to do is to just wait until they had calmed down, have had time to reflect and came to their own conclusion that it wasn't Dr C's fault the nurse had left. Addressing the problem head on would only lead to cross words which then can't be retracted. Dr C knows that he isn't responsible for the nurse leaving and with the disgruntled person in such a state of anger any conversation about it would just be fruitless.

"Sometimes Esther the best action is inaction - you should be patient." I was wisely told.

So this week after a rocky start I have decided to take Dr C's advice. I am going to sit back, keep my mouth shut, wait to see what happens, float rudderless and just try to be patient.....


n.b all boat references are subconscious and most likely due to Battambang's water festival.

The unbearable lightness of volunteering

The pinnacle of good emergency medicine & post resuscitation care -  ICU - my goal!

So I have reached the 6 month mark of my time here (8 months in Cambodia in total) and now is about the time that it is anticipated for volunteers to experience the "6 month dip." If my current mood is anything to go by I think that the 'dip' they refer to is probably born out of an overwhelming sense of futility, bubbling up of 6 months worth of frustration and the dawning realization that volunteerism is not valued or worse still completely worthless.

Now most people (not all) come out the other side of this dip and have long and fulfilled lives in international development but whilst I am in it I think it is probably worth exploring why it happens and what it means about us (as volunteers) and them (the reluctant recipients of our capacity building).

I came to the conclusion that people do not value things that are for free at about exactly the same time that a friend messaged me words of encouragement and support. It was powerfully well timed, his response to my exclamation of futility clarified I think the root of the problem. 

He works in Africa and empathized with my experience of not feeling valued by doctors or nurses that we  work with. He wisely told me to concentrate on the patients - the small child or parent - who are more likely to see the value of a competent, trained and caring health care professional. It got me thinking, we had worked together in the NHS -universal free health care - how the fact that something is free impacts on it's perceived worth. Patients do not directly pay for their health care in the UK and there is a high expectation of the right to have free health care and often a failure to value or see the true worth of something as precious as the NHS. As a salaried doctor in the NHS, although I believed in a patient centered approach and got much of my job satisfaction from my interactions with patients, many of my feelings of value or worth around my job came from the committed team of hospital staff that I worked with. The patients and relatives were why we were all there but their taxes paid my (overpaid) wages as they often like to remind us and I had to get accustomed to frequently failing to meet their expectations. The dynamics of private health care are of course different, when you are paying directly (not through taxes) for health care you value it more because it has a tangible worth. Having worked in countries where there is not free health care it always frustrates me how undervalued the NHS is and how the better something is the less people seem to appreciate it.

So value & worth - how do you get it? From my limited experience here it would seem that you have to earn lots of money overseas and then come out on short visits only. This way you are seen as a revered expert and very much valued. If you can not speak the language, make no attempt to understand the culture or context and ignore local experts this seems to be even more effective. 

Giving up a well paid job to come here for 26 months as a volunteer - well that's just madness and at best deserves sympathy and at worst contempt. My favourite piece of advice was from a colleague who works for my partner NGO - he told me not long into my placement here sincerely and with no malice intended, "Thank you for coming Esther, we really appreciate it, but there is absolutely nothing you can do here."

I sometimes think that if my hospital had to contribute to my living allowance, as they do in other countries, perhaps they would value me a little more. I'm not saying that they would listen to me or even take any of my advice but maybe there would be a sense of ownership and they may even consider letting me into the room. Currently I am left standing out in the rain wondering whether the plans for the new Emergency Room will ever be shared with me or if being a specialist in emergency medicine means anything at all because the moment I gave up my job in the NHS it appears I was rendered completely useless. 

And as for the reluctant recipients of my capacity building - they would just like lots of money and resources and not to have their knowledge challenged by training or for me to ask any difficult or awkward questions.

So why do I even need to feel there is a sense of value or worth to what I do? Maybe I'll leave that one as a rhetorical question for you.... 

The reality of Emergency Medicine in Cambodia - my starting point!

Siem Reap - Floating Village

Long time, no blog.

Jean arrived from the UK on the 8th and I have been too busy with this volunteering lark and host anxiety to blog. But now I find myself sat in Siem Reap waiting to see if a tuk tuk can get through the Tonle Sap (quite literally) and get us to our bus to PNH.

It has been a pretty full on couple of weeks with much non-volunteer dining out and excursions whilst still 'working full time'. The rainy season has really stepped up a notch hence the flooding and as Jean exclaimed the other day - she is having a "tropical nightmare". I am thankful that it has actually been quite cool for her because her 'nightmare' alludes to the heat and sweating which could be a lot worse if it wasn't constantly raining.

Last Sunday we caught the boat from BTB to Siem Reap - a 7 hour journey that could have only been improved by being 3 hours shorter. It was an eventful trip with many branches whacking the face episodes (me) and a boat attempting to pick up someone from a little boat and crashing into a tree with a wasp nest in it resulting in many wasp sting episodes (Jean). Ironically I found the existence of the people in the floating villages of the Tonle Sap lake very claustrophobic - water, water everywhere etc and no dry land - now I am in Siem reap which due to the Tonle Sap bursting its banks is also a floating village. As I waded back from Angkor Hospital for Children last night to the Guest House I felt the same claustrophobia rising in my chest. At least the floating villagers have boats - I am trying not to think about what is in the thigh high water but can't stop thinking about hook worm, leptospirosis, faeces and other badness. This anxiety stems from having an open would on my foot from a previous bicycle versus moto incident where my foot came off the worse. I have had an offer of amputation from one of the surgeons from BTB which I was hoping would not be necessary but after a day of flies eating it, then wading through raw sewage maybe I will have to take the winking surgeon up on his offer.

Jean was in Siem reap to spend three of the days in the rain seeing temples - wading at some points in thigh high water to reach temples that had no entry. The day after she visited Banteay Srei the road flooded and nearly 200 tourists were air-lifted out back to Siem Reap - I think 9 Cambodians have already died so far in this months flooding.

I have been having a drier and less dramatic week teaching on a Primary Trauma Care course - the first of its kind in Cambodia. It was a great injection of motivation, well timed for my 6 month dip. Suzi was the course director - an Australian anaesthetist with Cambodian heritage and she had press ganged another anaesthetist from Australia (Sathi) and a tiny trauma surgeon from the Philippines (Jovy) but also working in Oz to come along. Between them they had many years of international health experience and really buoyed my spirits - who knows perhaps my 2 years here may even end up being meaningful. Sathi told me a great story of going to Mongolia for 3 years and seeing no changes, just as his group decided to give up they received an email from the hospital in Mongolia to say that they had reviewed there mortality statistics from the last 3 years and could see that since introducing a recovery room the number of surgical deaths had more than halved. I have said it before and no doubt I will say many more times but capacity building is a slow and time consuming business but eventually there are results - that's what I have to keep telling myself.

The first course we instructed and then we trained 10 of the participants to be instructors including a surgeon from BTB. They then went on to train on a second course - by friday we were all entirely broken so wading home through raw sewage was just what I needed. Never has a trip to the beach been more needed. In reality Jean & I know that we will be sat in the rain playing yahtzee and backgammon in Kep whilst I eat crab to Jeans disgust. Although it is probably worth noting that sea-food hating-Jean ate fermented fish (Prahok) and liked it but she is quick to note that it was in a dish and 'not in isolation'.
So the question remains - will our tuk tuk driver a) turn up at 11 30 and then b) be able to get us to the bus station or c) will there even be a bus.

When I left home last weekend I knew I had forgotten something....I should have brought a boat.

Tonle Sap Lake - Water-world

Siem Reap - floating village - town centre

Bonsak & Chheng modelling the cambodian turn-up

Human mannequins

Haircuts & primates

I am down in Phnom Penh for a fortnight of language training and the theme so far is primates & hair.

The VSO office has moved to near the Olympic stadium and it was with much excitement & anticipation that I discovered there is a brand new multi-plex cinema nearby at the city mall, the first in Cambodia. For $4 Lou, Katie & myself spent 2 hours stepping out of life in Cambodia and into the first world one of suspension of reality. We went to watch Rise (or return as I keep referring to it) of the Planet of the Apes. It was a near religious experience with Lou filling up with tears at the sight of popcorn. The film was good but from my Bangkok experience I know that it could have been dreadful (Insidious) and a good time would still have been had by all. It is with mixed emotions that I look forward to going back to see Harry Potter - final installment - in 3-D, my first 3-D experience but I have been corrupted by Dr K's opinion on that one.

Then on Friday night a group of us went to see a performance of the traditional monkey dance with a contemporary twist. Seven traditionally trained khmer dancers have spent hours watching video footage of monkeys and choreographed a performance loosely based on the original moves of the monkey dance. It was absolutely fantastic and we were all blown away by their athleticism and convincing monkey moves (better than ROTPOTA and free!). Very tempted to return next friday for a repeat viewing.

Then there was the small matter of 6 months with no hair cut that needed to be addressed so abandoning the attempts to fill my head with new khmer words or even remember the ones I should still know from 4 months ago, I went in search of a hairdresser.

Now it is important to note that I have been going to the same hair dresser for nearly the last 20 years - Clive. I can count on one hand the number of times I have confronted my trust and control issues and allowed someone else to cut my hair instead - 1) As an expedition medic in Namibia -  Kelly - who was a journalist with a hairdressing past. 2) Twice in my 2 years I lived in Australia - Kylie - who also introduced me to the controversial area of highlights. 3) Lou - 4 months ago in a hotel room in Kampong Cham who I reluctantly accepted a 'trim' from.

London is the salon that many VSO and ex-VSO volunteers have recommended so I looked down the barrel of the prospect of wearing a hat for the next 3 months and made the leap of faith. This was especially brave as Janice had been there last week for a trim and now her hair is so short she can't tie it up. If you can try to imagine going to have your hair cut with no language to really explain what style you want - feel my fear!

On arrival I was sat down and a nice lady promptly squirted shampoo on my hair and started to lather up as I sat upright in the chair vaguely bemused and wondering where the sink was. What followed was a 20 minute head, neck and back massage with an awful lot of lather. Then just when I was beginning to get quite concerned about the prospect of the lady pouring water all over me whilst I sat in the chair and getting soaking wet, I was move to the back room where I discovered there were in fact more traditional reclining chairs and sinks. Further head massaging ensued, complementary ice tea was supped.

Back to the chair where the surly, mute hairdresser - the complete antithesis of Clive - came up to me with the one word question 'short?'. I anxiously tried to explain the concept of a trim and the need to be able to tie my hair up and the end of the shearing (in khm-english and international sign language). With no further discourse he than began to hack - due to his semi-blunt scissors rather than any lack of skill - at my locks. It was when he began to drag the scissors down from my roots to tips that I started to get really quite concerned. We (hairdresser & recipient) both became quite distracted by a wealthy couple  bringing their spoilt toddler in for a trim and both ended up watching as the child was with much distraction and semi-constraint techniques cornered into having a haircut. It would appear that the staff in London can cut hair on a moving target (toddler's hairdresser) and with out actually looking at what they are doing (my hairdresser).

My shoulder length hair (eek!) was then blow dried and for the first time in 6 months the hair on the nape of my neck was briefly dry. Just to make the point surly-silent hairdresser pulled my hair up to demonstrate that it could still (barely) be tied up then he walked off. End of haircut!

To be fair I would have paid the $9 purely for the head and neck massage.

So it is with shorter hair I continue to struggle with learning khmer despite the apparent lobotomy of my language centre and deal with the encroaching damp and moldiness of my guest house room. Yesterday I discovered my bag, birkenstocks and purse were all covered in a thick layer of green mold - so I guess if I get a strep throat I can always just lick them for a cure.

On learning a new language

When I first arrived in Cambodia I had 5 weeks of language lessons as part of in country training. Every day for 6 days a week we all cycled to class every afternoon and had 4 hours of khmer lessons. Every morning I would sit with my books at the Mekong Crossing Cafe having a long breakfast & try to make the words and grammar from the previous days lesson stick. The lessons were interrupted by a one week placement visit and it was horrifying to discover how much could be forgotten in 7 days. So having learnt the valuable lesson that speaking a new language takes a lot of hard work and study I promptly did no study for the first couple of months when settling into to life in Cambodia.

When my impotence at being unable to express myself reached a peak and my vocabulary was at an all time low, I arranged a lesson once a week with a grade 12 student who wanted to practice his english and earn some pocket money. I dutifully bought the grade one khmer book and set about trying to learn to read and write as well as speak and understand spoken khmer.

So once a week in my lunch time I meet up with Kosar and we attempt to go through the book. This however presented a few issues;
1) He has very poor english and is very keen to practice his english language skills and for me to help him with his homework.
2) He isn't a teacher & has no teaching ability - he is still a student himself.
3) Khmer has 33 consonants and 25 vowels (but the sound of these vowels changes with 'long or short sounds' making the grand total of approximately 50 vowels!), is not a roman alphabet and has sounds that my mouth have never articulated before.
4) Kosar expected me to read, write & speak all of these letters after the first one hour lesson.
5) I am not a very good student.
6) Despite my many previous academic successes he still manages to make me feel like an absolute idiot every week.

However he gets to practice english and earn some money I didn't really feel I could stop the lessons just because I wasn't learning any khmer.

J's Landlady is a physic teacher at the university and had taken it upon herself to start to teach G (J's husband) khmer every day at his home. She had also expressed an interest to teach other barangs khmer so G, acting as her agent, hooked her up with me and 5 other VSO volunteers. She managed to slot me into her busy schedule on weekend afternoons and for the last few weekends I have been getting into a routine of lessons with her. She is a teacher, she speaks some english and good french. However the lessons are still not straight forward khmer lessons and there are in fact three levels to them.

1) I learn khmer - the vowels all sound the same to me, there is no pattern to what sound is made when you attach them to a consonant, I can't remember how to write them one week to the next and I can't remember any words. The words I do remember I don't appear to be able to say in a way that a native speaker can understand and I still can't understand spoken khmer. Admittedly I am not speaking khmer all day every day and I am not studying every day so this may explain the slow progress.

2) Soyeth - or the landlady as she is referred to in VSO circles - really wants to improve her english. She is also widowed and her only son is studying in France so she has confessed she just enjoys the company and now she is busy teaching us all she feels less lonely. So most of the lesson involves us speaking in khmer-english and being distracted by talking about life, love and death. There has been plenty of laughter & tears, once she even leaned over and pinched my cheek. I have taught her to say "I need a wee". Its all good.

3) The landlady refers to me as 'the doctor' and a large part of the lesson involves a medical consultation. It started off with me offering her some paracetamol, graduated on to me seeing where she had 'traditional khmer medicine' - coining, her body was covered in deep purple bruises. Then last weekend she pulled out a blood pressure machine from her bag and we had a 30 minute consultation which included us both taking our blood pressures. I was laughing so much the machine kept 'error' messaging and she told me off for talking. This weekend I had to fill out a blood request form for her and then review the results and she brought all her medical notes which I had to review in a combination of french, english and vietnamese. When I had my last bout of gastro she even rubbed tiger balm on my back & stomach - there wasn't even a placebo effect.

What can I say other than it is a mutually beneficial arrangement.

Still I am not sure how the words I am learning from the grade one book are going to enrich my conversational khmer both at work and socially. It leads one to ponder what the creators of the book were thinking that Cambodian children of 5 years old need to learn, clearly that it is more useful to learn words never, ever used in common parlance.

Here's a challenge for you - make a commonly spoken sentence with the following words:-
Sowee Bai - to eat - used only when referring to the King eating
Dam Srie - the stalk of a rice plant
Kam plung kie - trigger of gun
Kai-ping-bo-row-my - full moon
Dow - to mark, to pinpoint, to suspect, to guess correctly
Kat-sigh-bow - to cut a symbolic ribbon
Dom-die - ball of earth
Harl - to fly (birds only)
Cham char - a type of tree
Kah - dry/dry up (but not any of the examples I offered in a sample sentence. As it turned out it is specifically used for when you are boiling water with something else in it - like a carrot!!!!)
Bay - to carry lovingly (this can not be used your smart phone!)
Bar bow - to rebel, to revolt, to riot (actually thanks to UK current affairs & BBC website I was able to make a sentence with this one)
Lay lar - desperately or uselessly
Sor char char - to interrogate
Lay loh -  playful or frivolous (OK, that describes me perfectly especially when in a khmer lesson)

My two favourite sentences that appear in the book are:-

Grandchild Chom sucks the breast of sister Pye - Breast is best after all but the public health campaign never specified whose - oh actually it did - MOTHERS breast! I guess we haven't learnt the consonant 'Mo' yet so M'dai - mother wasn't an option in this sentence.

Do not pull the trigger of the gun! Cambodian history has seeped into the grade one khmer exercise book - there is nothing left to say.