Resilience - a study

As my ma would say, it's been 'what I call' one of those weeks; 

Easter Sunday spent chocolate-less ironically planning BLS training, resurrection of sorts. 

Giardia that kept me awake for 3 nights and exhausted various hotel rooms of toilet paper.
No solids (food as well as stools!) for 48 hours broken only by spending $2.50 on a bar of diary
milk from the local garage. I'm holding on to the promise of 5kg average weight loss (from
giardia not cadburys).

Arguments with drunken hotel owners about being put in a $13 room not $6, (NO AC
PLEASE!!) not one I would have imagined 6 months ago. Resulting in me feigning leaving the
hotel while thousands of miles away my entire family patiently wait after their Easter egg hunt
to skype me and wondering what is keeping me.

Bus breaking down for one hour because it had run out of petrol (who would think about petrol
when providing a transport service?), with the nearest toilet not fit for the purpose, 
(I am pretty tolerant in the  toilet department but this one defies description in this forum). 

Ants in my sealed muesli, I mean if they can get into sealed new packaging what chance do
any of us stand once the damn thing is opened? (no really I ask you!) This I think really got me,
I mean, even Muesli isn't sacred! My Cambodian colleagues inform me that I must build little
food moats, excellent somewhere for the Aedes to breed in then give me Dengue.

Various attempts to collect the correct health data for DFID donors resulting in the Hospital
Administration refusing to deal with me anymore, good work Wilson. And I am funded by URC 
anyway, now Alanis Morrisette that is bloody ironic.

Failure to fill out an expenses form correctly despite the tutorage of two experienced VSO-ers,
although this I am led to believe is standard procedure - it totals after all only quarter of my 
monthly allowance so I will just have to resort to eating the ants!

House flooding with the first big rains - definitely standard round these parts.

Staying in one place for too long in 40+ heat so that I actually slipped on a pool of my own
sweat on my tiled veranda floor - this experience was very special and also explains why I
haven't voided for the last 36 hours!

The Hotel next door realising they were provided free wi-fi so stopping it but replacing it with
late night rave music, excellent exchange.

The cold realisation that the Parcel with all my remaining 'summer' clothes which was posted a
month ago has indeed gone missing and facing the grim reality of having one pair of trousers
and 3 work tops to last me for the next 2 years. You really shouldn't put all your clothes in one
parcel, I see that now, I am learning and growing.

Another month of the rent failing to cover the mortgage due to 'essential' renovations on a flat
I lived in perfectly well only 3 months ago and where I never had ants in my muesli, skidded
on my own sweat and only ever had the occasional flood certainly never tropical storm related. 

But I've been informed by another seasoned VSO-er this is the difficult bedding in period that
requires and tests ones resilience.

Yep - this resilience thing certainly requires humour and a lot of grinning and bearing it. 

So I did a little internet search to find inspiration or at least some cliches.

I'm off to bed now and will just have to try again tomorrow........

You all know that I have been sustained throughout my life by three saving graces - my family, my friends, and a faith in the power of resilience and hope. These graces have carried me through difficult times and they have brought more joy to the good times than I ever could have imagined.

• Author: Elizabeth Edwards

Humor is just another defense against the universe.

• Author: Mel Brooks

A Sense of humor can help you overlook the unattractive, tolerate the unpleasant, cope with the unexpected and smile through the unbearable.

• Author: Moshe Waldoks

I haven't failed. I've identified 10,000 ways this doesn’t work.

• Author: Thomas Edison

You desire to know the art of living, my friend? It is contained in one phrase: make use of suffering.

• Author: Henri Frederic Amiel, philosopher and writer (1821-1881)

That which does not destroy, strengthens.

• Author: Friedrich Nietzsche

Inside of a ring or out, ain't nothing wrong with going down. It's staying down that's wrong.

• Author: Muhammad Ali

Man never made any material as resilient as the human spirit.

• Author: Bern William

“Happiness is not a goal; it is a by-product.”

Eleanor Roosevelt quote “Women are like teabags. We don't know our true strength until we are in hot water!”  Eleanor Roosevelt quote

"Courage doesn't always roar. Sometimes courage is the little voice at the end of the day that says I'll try again tomorrow. "
— Mary Anne Radmacher

Little Italy

What I really need to blog about is the three hospital visits I made this week and show you all some photos because my words wont do it justice, but what I feel compelled to tell you about is what I did last night. this is mainly because it is so far the most un-Cambodian experience I've had and involved cheese.

EM works for the German NGO - GIZ (I know but I don't think the German's get it!) at the Hospital and yesterday morning she invited me to a dinner party at the Emergency Hospital's house. As I had a fellow VSO-er staying at my house I initially said no as I had to be the hostess with the most-est but fortunately EM talked me out of such fool-hardiness. So leaving my guest to fend for himself I accepted an invite and now things will never be the same again.

The emergency hospital is an NGO that provides health care for trauma victims of war and as Battambang Province has more than it's fair share of land mines it is a well placed facility. The international staff are Italian and Swiss and when I arrived at their staff house the skies had opening and lightening was flashing simultaneously with it's accompanying claps of thunder, the high walled gated property looked all very gothic.

Inside I was given an emergency hospital T-shirt as after only 1 minute in the tropical "shower" I was completely saturated and looked like a stray dog. There then followed a procession of elegant beautiful continental types who apparently repel water.

We proceeded to have an italian meal - so 2 hours of conversation and pre-dinner snacks (popcorn, bread and REAL CHEESE) and then pasta and salad and fish amok and REAL red wine. By this time the fact that Adrian had borrowed my keys and couldn't get into my house was a minor concern as I had eaten REAL cheese and was drinking REAL red wine.

Then the puddings arrived - I THOUGHT I HAD DIED AND GONE TO HEAVEN. Pudding just isn't a concept I entertain anymore, an ice-cream when in Siem Reap from the Blue Pumpkin will be as pudding-like as I get. But last night there was fruit salad, creme caramel, panna cotta, CHOCOLATE MOUSE, ginger cookies, creme brulee and REAL expresso.

We all sat around a huge table passing food along like a corny pasta sauce advert, the conversation was in italian, german, french and english, the wine was REAL. (Sarah Andersson if you are reading this it evoked strong memories of your wedding). Seriously I could have cried with happiness.

And it isn't the expat experience so common to asia which normally involves bars and sex-pats or such seediness that it makes you ashamed to be european or be in the company of other Barangs. It was a little piece of Europe that felt like a favourite pair of shoes - easy to slip into and VERY comfortable.

So with my spirits re-charged I can continue in my world of south east asia with all its challenges and tribulations and equally great food (although Le Villa's chocolate mouse is truly awesome) and know that I have to return the emergency T-shirt and this is my 'get out of jail free' card for another evening when I haven't eaten REAL cheese for a while......

Not until every last health care facility has been visited will I rest....

Long time, no blog.

So much to say so little battery power on my lap top.

Since blogging last I have been back to Phnom Penh less than a week after moving to my placement. Attended a URC meeting on BLS training and against all my pre-departure training said the words "this is all wrong", not very participatory of me I know but I like to think I enabled the Paediatrician sat next to me to voice his assent and re-work the whole training tool. Next week when we pilot it will be the proof of the pudding.

Then it was back home where on my first outing on the surrounding 11th century hindu temple I received instant karma for joking with a fellow volunteers VA and sustained a sprained ankle. I went down like a sack of potatoes and received very little sympathy from the onlooking stall holders who were quick to comment that last week a Barang had done exactly the same think and sustained a serious head injury.

I followed my own advice and found that resting, elevation and ice really are quite effective. The wound to my right thumb however I am waiting to turn into a tropical ulcer, go gangrenous and drop off!

Another trip to Louise's hospital so when I get the daily lunchtime debrief from her I can visualise the hospital with no sinks or sanitation, 1 hour of red dust road from asphalt and 50 mobile phone shops in the village.

Then it was Khmer New Year so after a whole week and a half in BB most of it spent elsewhere or on a capitol bus I was off on holiday. This time to Siem Reap where I am proud to say I succeeded in visiting NO Wats. The combination of a swollen, painful ankle and 40 + C heat made Angkor Wat the least attractive option.

Siem Reap however is clearly not in Cambodia and I actually experienced reverse culture shock but a glass of red wine and some mexican cuisine helped. Interesting fact, Siem Reap is the poorest province in Cambodia and none of the tourist dollars from the Angkor Wat park go to Cambodia.

Only one day back from holidays and I sit in another lonely hotel, this time in Sisophon, with trips to two hospitals planned in the next couple of days. Dr L, chief doctor of ITU Medicine ward, looked at me bemused when I told him that I was off on another tour of healthcare facilities of Cambodia. I have told him that when I have visited every hospital in Cambodia I will come back to his and do the job I was sent here to do.

Today we saw a man together on the ward round, my limited khmer helped me to understand he had headache and fever. From the end of the bed Dr L demonstrated the clinical signs of meningitis. Then with 4 people holding down the patient, 15 more watching from various ward portals he did the fastest LP I have every seen especially as it was on a patient writhing in pain. This was all facilitated by the absence of lignocaine or aseptic technique.

Seeming the last LP I tried to do at home I failed after 3 attempts I was humbled by his proficiency, "I've done a few" was his modest response. Can I really teach these guys anything about practicing medicine in a resource poor, tropical setting?

So that is where I am at.

I'll keep you updated if my thumb drops off or there is a health care facility I fail to visit.

Medical Culture Shock

I sit and type from my lonely hotel room in Pursat, a trip to Bakan Hospital down and a meeting in Phnom Penh to come. It has given me the free time and the headspace to reflect on my first few days in work.

I have written a list of questions from first impressions that I'd like to explore more with the URC doctors and find some answers. It looks something like this;

If a patient with a GCS of 4/15 isn't an emergency that warrants a bedside blood glucose, who does?

How can you determine if a patient is anaemic and the cause of anaemia with only a haematocrit, when the lab definitely does Hb & MCV (I've checked!)?

Why have none of the patients had observations for the ward round and why are the charts filled in retrospectively at the end of the shift?

Why are there no drug charts and why do nurses transcribe the prescription everyday instead?

Why does everyone wear a paper mask and surely washing them can't be good?!

Why does every patient get a IV cannula and fluids except when they are in septic shock?

What the hell am I doing here and what can I possibly do to make things different?

visual gag - worth repeating

I found myself today sat in a clinic case review questioning the difference between decorticate and decerebrate posturing, what is in my head was different than the powerpoint presentation. When I questioned it afterwards I was told it was right because it was off the internet, I knew it wasn't but the medical culture shock has triggered a whole new level of self doubt in me.

And by culture shock I mean nearly stepping on an enormous black scorpion on the ICU medicine ward round, hospitals with no essential drugs list but TVs in every staff room, sinks installed to improve infection control being stolen at the weekend, beds with no mattresses (BYO mat), intermittent Xray & USS services, mixed gender wards with no screens and audience through window, patient presented to me with set of incomplete blood results but no history, examination or management plan.... oh you know what I mean, it is all a little bit different here!

But before you all think you've won your bet and I'm coming home early I should add it's all a brilliant adventure and certainly never ever dull. When in the UK do you have a working lunch where the food provided is rice with ginger as a vegetable, guess the chicken body part and blood balls? Exactly, wouldn't swap it for the world.

Can I add as a post script that I LOVE it when a Cambodian finds out you speak a little bit of khmer, they are soooooooo happy and although they want to practice their english with you they insist that you speak back to them only in khmer, truly I LOVE that. What a warm (in many senses of the word), friendly, beautiful, crazy place this is and it is home for the next 2 years.

Toto - I have a feeling we are not in Kansas anymore

Katie - taking the second lock-out from her flat all in her stride

So we have left the bubble of security that was in-country training, and what I have discovered is we may have thought we were acclimatized but that was just all a delusion.

It all started on Saturday with a 5 am start to pack up from the programme office. Some of us had been sensible and got to bed before 1 am on Friday night!

Katie & I set off at 6 30 am to catch the bus to our new home with the pick up truck with all our worldly possessions on the back and Scott, Sonia & Peter crushed into passenger seats. Katie & I actually had a civilised journey up with laan krong capitol, air-con, leg space, snacks and 6 hours of dry paddy fields and palms burnt into my minds eye. We even arrived in plenty of time to collect keys and have a smoothie. I bought a dongle to secure the intravenous drip of internet required to keep me in protai Kampuchea and then the real VSO experience started....

The pick-up successfully delivered to my place and then the great lock/key debacle began. It started with us being unable to even get into Katie's compound front gate and then another 20 minutes to get into her house's front door with it's dodgy padlock. After a successful unpack, Katie & I retreated to the Bamboo train opposite my place for an ice cold lime juice & soda. Then the heat began. April is meant to be the hottest month here and it certainly felt that way as we sweated quietly into our sodas.

It was some time after this I discovered my dongle doesn't work in my house, probably the enormous Spring Park Hotel blocking any signal. Internet withdrawal commenced.....

We went into the market to practice out khmer to buy Katie a new lock, it took several attempts, then on return to Katie's house we discovered she had locked the front door but didn't appear to have a key to open it. 30 minutes of sweating, failed attempts with a hair grip and quiet resignation commenced. "How come it wasn't this hard for the last 2 months?" we asked ourselves whilst blinded by the sweat pouring into our eyes.

The Wat's plinky-plonky music that Katie had initially told me was relaxing proved not to be so much the case for the 4 am wake up call.

I promised no further bite photos so I'll spare you all the 50+ bites on both my arms which have been confidently diagnosed today as bed-bug bites - well my mum always used to tell me to mind them. An interesting conversation with my land-lady via my VA awaits tomorrow. How do you say "please fumigate my house and burn my mattress" in khmer?

It's way too hot to scrub my house of all the dirt and dust just yet - I've already decided the cobwebs can stay - I need all the help with pest control that I can get and spiders are suddenly my new best friends.

My VSO bicycle is called Nala, Katie's old language training bike that she rejected for very good reasons as it turned out. I picked it because it was orange not because of the absence of brakes, the punctured back tyre, the perished back tyre or the slipping chain. An orange bike will only take you so far.... a swap is imminent as after a 45 minute walk in the hot season of the tropics to work, a bike is now considered more essential to me that the internet.

And then it was our first day at work - then the fun really began. I was surprised by a warm welcome from the surgical team and a request for my expert opinion. The surgical SHOs in the UK may think my opinion isn't worth much but in Cambodia they are clearly very desperate.

So this week I will be heading to Bakan Hospital to see how it's done there with URC doctor D, then going back to Phnom Penh for a BLS meeting on Friday, can't escape the bloody place. Apparently it's chest compressions first for all ages according to the American resus council, you go away from clinical medicine for 2 months and it all changes....

Any insider resus knowledge before Friday's meeting will be gladly received....

Below is the sign that's outside the Admin block at work, it may well be a sign for what I am currently looking for....