I know it is not buddhist but I love my laptop

OK, so I am having to be fast with this one before my computer decides to randomly caps lock certain keys or better still as it has for the last 5 days just lock me out completely sending me to laptop-less purgatory and I can assure you it is not very nice there.

I've had a particularly great week involving the happy co-incidence of having no money until pay day and contracting gastroenteritis. Happy not because of the 3 days spent literally bed (and bathroom) bound, unable to tolerate fluids with a disconcerting lack of appetite, but good because not leaving your bed for 3 days and ingesting nothing but oral rehydration solution is a great way to save money and lose weight.

If this all goes ransom letter-esque like the last blog you will know that my window of laptop good luck has closed.

So other reasons for a great week - playing the glad game here - are are follows;

Pete shared with me his iPod movies, which in the absence of a laptop and the ability to sit on my sofa and watch bad TV, have kept me sane. I particularly like the fact that they are all the movies that Mark Kermode HATES so I would never have gone to see at the cinema and he's right they are all bloody awful!

I'm $1000 up in the virtual world of my ipod solitaire game.

I saw a great documentary on discovery channel about how to survive a terrorist attack in a shopping mall. Mind you I work with plenty of people who could probably give me some pretty good survival tips also.

I've caught up on my radio lab podcasts.

At the M&M meeting that happened in my absence - my absence was noted by one of the Doctors I work with and he said "we have Esther working along side us now and we should utilise her expertise when she is here"!!! Meanwhile I was on the loo wondering if I'd ever be able to get off it.

Katie brought me loo rolls around to my house when I ran out, she left them outside my door so I felt like a villager from Eyam in the middle ages. Just needed a dish of vinegar or a fast flowing brook.

With out the internet I have read more books.

When there was a massive tropical storm at around home time on Friday I was in bed so didn't get wet cycling home.

The cambodian weight loss plan continues.......

Further blogs are dependent on this weeks trip to PNH where I will hopefully fix myself and the laptop and if the laptop isn't fixable at least unlike me we can buy a new one.

WarninG This BloG conTains very liTTle humour

In CamBodia "Every year, nearly 2,100 women and adolescent girls die from complications from pregnancy, childbirth and induced abortion and a further 80,000 suffer associated injuries such as prolapse of the womb, infection leading to infertility and chronic pain. Many pregnancies are unwanted and more than a third of women who die from pregnancy related causes die from unsafe abortions."


FirsTly I have To apologize for my The rained on macBook ThaT currenTly has caplocks sTuck on The TGB%_ keys, so This will make TypinG and readinG This BloG more challenGinG Than usual.


Secondly This BloG will conTain very liTTle humour as There isn'T very much ThaT is funny aBouT maTernal morTaliTy.


VSO's currenT counTry sTraTeGic plan for HealTh concenTraTes on MaTernal & child healTh, BuT as a URC funded volunTeer my role was To work in a HospiTal as an EmerGency physician To help Build capaciTy and develop emerGency and urGenT care as parT of a BiGGer MoH plan To creaTe a 'model hospiTal'. This week The Grim realiTy of CamBodia's maTernal morTaliTy sTaTisTics was BrouGhT home To me, iT is a BiTTer pill To swallow.


I've saT in morBidiTy and morTaliTy meeTinGs and heard aBouT women and BaBies dyinG as a resulT of pre_eclampsia and I've visiTed oTher hospiTals and seen The resulTs of unsafe aBorTion BuT This week iT was BrouGhT home as I had To waTch a 21 year old Girl slowly Go inTo mulTi_orGan failure and sTand By unaBle To alTer her very sad demise.


I've Been away from The hospiTal for a forTniGhT due To various meeTinGs and CME workshops and Bank holidays and my first morninG Back aT work was a slap in The face. I woke up ouT of sorTs; my lefT ankle conTinues To cause me pain, iT is Twice The size of The riGhT and now I have piTTinG oedema in The fooT, iT is 6 weeks since I sprained iT and The heaT and humidiTy is conspirinG To prevenT The swellinG from ever GoinG down. I also had manaGed To convince my self I have melanoma (I may sTill have as The nearesT VSO TrusTed dermaToloGisT is in Thailand) so when I arrived in work I was feelinG self aBsorBed and disTracTed. 


Janice inTersecTed me To Tell me ThaT Mr SoTha, chief nurse, was concerned aBouT a Girl on maTerniTy and could I Go over and have a look aT her. So Gary & I seT off TO The maTerniTy ICU noT enTirely prepared for whaT we would find There.


The healTh care professionals readinG This will undersTand when I say ThaT as soon as I walked in The room I knew This Girl was GoinG To die. From The end of The Bed I could see she had DIC (a comBinaTion of sepsis and haemorrhaGe and consequenTinG massive Blood Transfusion had depleTed her of cloTTinG facTors and plaTeleTs and TriGGered a chain reacTion of consumpTion of The remaininG cloTTinG facTors), she had acidosis _ acid Blood (proBaBly as a resulT of a lacTic acid from prolonGed shock and ureamia from renal failure), she had pulmonary oedema (fluid on her lunGs), she was in kidney failure and had only produced 100mls of urine in The lasT 12 hours.


On furTher examinaTion her Thready femoral pulse was 120 and her hearT raTe was over 200 (noT sure if The TachyarryThmia was due To jusT her decompensaTed shock or exacerBaTed By The dopamine ThaT was BeinG run ThrouGh aT a unknown raTe sTraiGhT from The BaG, no such luxury of syrinGe driver or pump), There wasn'T an ECG moniTor or 12 lead, neiTher was There a nurse or a docTor in The room wiTh her. 


The midwives didn'T seem TO wanT To Be in The room wiTh her, do her oBservaTions, Give her pain relief, do an accuraTe fluid Balance, adminisTer anTiBioTics, remove The Blood soaked sheeT she lay on, clean her up or inserT IV access. However They didn'T appear Too happy wiTh Gary & I aTTempTinG To do any of Those ThinGs eiTher.


Our presence prompTed The arrival of nurse anaesthetist, head of O&G, medical ICU docTor and hospiTal direcTor. IT was Too laTe and % (five!) hours laTer she died, The midwife ThaT performed The unsafe aBorTion has Been arresTed and I can'T GeT The imaGe of her askinG 'when can I Go home?' ouT of my head.


Now when I'm Told ThaT The reason DocTors and Nurses don'T do Their joB here is Because They aren'T paid enouGh I find iT very hard To keep my cool.


Of course money is an issue and healTh care professionals deserve a livinG waGe BuT if money was The only issue ThaT would mean ThaT The exTenT ThaT sTaff care and Their work eThic would improve as They wenT up The pay scale, I'm preTTy sure ThaT is noT The case. Any aTTempT To arGue The poinT or suGGesT There are also oTher causes for The varyinG sTandards of care in GovernmenT hospiTals is meT wiTh "Your side (ie BaranGs/NGOs) always say iT isn'T jusT aBouT money". 


I Bumped inTo The hospiTal direcTor who saT for 90 minuTes lisTeninG To my 'panyahaas and com niTs' (proBlems & ideas) Then announced he was "oT_kom_lanG" = Tired. He aGreed There were proBlems, liked my ideas BuT aT The end of The day he wanTed To know how does one Go aBouT chanGinG individual's Behaviour and insTiTuTional workinG culTure. 


Any suGGesTions on a posT card please?

This is The anGkorian BridGe near Lou's villaGe and Behind is The sTorm we GoT cauGhT on The moTo. I have a feelinG There may Be plenTy more metaphorical, as well as liTeral, sTorms Before This 2 years is up!

10 hour Journey from hell....

There are some days when the only thing that keeps you going is knowing that what is happening to you is blog gold, Friday was another one of those days.

Lou met me in Siem Reap on Thursday night and the plan was to bus it over to Kratie the following day to visit Gill and the river dolphins. As we were staying in my (formerly) favourite guest house we thought for the extra dollar, which we'd pay in tuk tuk fare anyway to get to the out of town bus station, we may as well just buy our tickets there at the guest house - this was our first mistake that resulted in a domino effect and resulted in an 'interesting' journey.

The following morning we were cheerfully told by the (formerly) lovely guest house staff that they didn't have the paper bus tickets but the receipt they gave us would get us on the bus - we shrugged, 'ok' we thought after all this is Cambodia.

All was boding well for us as the transfer mini-bus arrived dead on time but then things started to unravel as it spent the next one and a half hours quartering the small area of Siem Reap town in an apparently uncoordinated and random fashion. This was punctuated by Louise jumping out at every stop to visit the toilets of various hotels and guest houses and under-toned by my increasing transport related anxiety. The American in his cowboy hat talking in a loud and mis-informed manner about road trauma in the states compared to south east asia and how all safety precautions (e.g. safety belts, crash helmets, drink driving and speeding laws) made absolutely no difference, helped to distract me a little from the fact that we now 30 minutes late for our bus.

Meanwhile the Australian couple and their 9 year old son who had thought they were going to Laos and had been up since 4am waiting for their overbooked bus, now had no clue to where they were heading, were also helping to calm my missing a bus related anxiety.

The next circle of hell involved the man at the bus station refusing to acknowledge the receipt as a valid ticket, whilst 'noompang' man tried to sell us bread refusing to understand 'NO!' in a multitude of languages and decibels. As ticket man shouted at us, Lou smiled and I calmly and assertively told him not to shout at us because although I understood he must feel frustrated and angry, so were we, but we weren't the ones shouting. Years of dealing with angry patients and relatives has built up my expertise for this one moment of Cambodian transport tension conflict resolution.

After various attempts at ringing said guest house, in Phnom Penh first (less helpful) then Siem Reap, the ticket man finally got the confirmation that we had paid and weren't pulling a backpackers fast one. As we climbed on board with one last 'NO!' to noompang man the ticket collector muttered something about 'this will get you out of Siem Reap but not as far as Kratie...trouble....grumble, grumble, grumble' then he disappeared with our only proof that we had paid for a bus tickets.

The Australians were now feeling a whole lot better about their situation thanks to us.

We then had the joy of sitting in the back seat literally on top of the bus engine, with the hot air from it being blown up at our legs and the AC failing in any way to counteract this. This was for the 6 hour journey to Kampong Cham which was helpfully broken up by the repeated attempts of driver's best boy/ticket collector to collect our bus tickets. It would seem that we couldn't say "we don't have them, it was a receipt which the man at Siem Reap bus station took from off us" in khmer/english/english-khmer/sign language/interpretive dance, enough times for him. Each time Lou's smile got wider and my clipped ultra-polite but assertive response got shorter.

We arrived in Kampong Cham and had the bizarre experience (mentioned in previous blog) of being recognised (this time through a bus window) by Gideon the tuk tuk driver. We waved madly as he had a simultaneous double take and then carried on through KC feeling rather proud of ourselves that we appeared to be on a direct bus to Kratie and all transport related troubles were behind us.

This was short lived and the other side of the Spean Kizuna we were kicked off the bus by the side of the road with our equally screwed commonwealth brethren.

"Where is you ticket?" - by now my response was well rehearsed. When we were told we couldn't go any further without a ticket I changed my tactics.

Conversation carried out on side of road in midday sun somewhere in Kampong Cham province;
Me "do you live in Kampong Cham?"
Obstructive bus man (suspiciously)"yes"
Me "Are you married?"
Obstructive bus man "yes,"(clearly worried now about my motives) "why?"
Me "Well if you can't get through (to formerly favourite guest house in Siem Reap) we will just have to stay at your house and your wife can cook for us!"

This appeared to work because after jokingly (I hope) giving me a machete to use the next time I went back to my (formerly) favourite guest house he also relented and let us on the connecting bus muttering 'we can sort this out once you are on the bus'. We never did.

Now to say that the second bus had been overbooked would be an understatement. The australian family and Lou were squeezed on without even have the customary plastic stools to sit on in the aisle. I was told by the driver on numerous occasions as I stood out side sweating and watching our bags fail to be loaded, that I was "too big" for his bus. After the 10th time I had to explain to him that calling someone fat once in my culture is generally considered rude but ten times is unacceptable. This prompted me to be ushered on to take pride of place on a rice sack by the driver's side with a further 4 people standing in the stair well of the bus exit beside me.

As I sat with my left armpit being skewered by a Buddha statue, my face squashed against the windscreen unable to avoid witnessing every overtaking near miss and corner taken too fast, the gear stick digging into me with every gear change and being deafened by Khmer Karaoke I thought to myself, "Esther, this is blog gold".

With each unscheduled stop passengers alighted until it was just me the big, fat barang sat up front on the rice sack, who was without a seat. This was made even more entertaining by the fact that every time someone alighted I had to get off the bus (because of my hugeness blocking the whole exit) which invariably involved me banging my head, dropping my helmet, falling down the steps etc, much to the merriment of the slapstick fans in the front 4 rows. The Mr Bean they showed later on the bus didn't even get the laughs I got on that journey. Also as a result of my repeated humiliation, mine and the bus drivers relationship was thawing. When he took my crash helmet off me and put it on his head and I responded 'You need it with your driving', I really felt we were getting somewhere.

Two hours into the journey and a seat finally became available, well half a seat, so for a further hour I sat with one cheek perched on the edge of a seat, the rest of which that was accommodating a father, son and luggage. The khmer girls opposite commandeered my iPod so I spent a good half hour attached by headphones to them whilst they dictated the playlist.

I finally revolted and guessing we were close to Kratie, due to the bus drivers increasing speed and sharpness of corner taking, made a bid for another seat. Hence I spent a total of 15 minutes of an $11 journey in an AC comfortable bus seat - not bad for a 10 and a half hour bus trip!

We arrived in time for beers by the Mekong watching the sun set and the bus driver even held my shoulder and thanked me very much (I presume for all free entertainment)!

The endangered river dolphins were awesome, Kratie has a decaying charm which I love and you can't beat the Mekong river for beer and sunsets but none of these are the blog gold of that 10 hour journey from hell.

Going Tropo...

This Blog is as requested by Kirsa and clarification for Sarah A.

Now I'm not sure if you can 'go tropo' outside of Australian and if not then I may well be the first recorded case of it. If people aren't aware of this particular aussie expression the definition is as follows;

'Going Troppo' is an exclusively Australian slang term for 'going crazy'. The popular understanding about it's origin is that it comes from stories of the tropical heat in the northern parts of Australia driving people crazy.'


It isn't really that hot so I'm not sure what can explain my current behaviour and mood. It may well all have begun when I went to see the circus at Battambang run by a french NGO originating from the Thai refugee camps, teaching circus skills to traumatised young people post Pol Pot. If you wanted to see the perfection of the male form it isn't a bad place to start. 


Or maybe it was the next evening at dinner when Katie and I had a 30 minute conversation about the arms of our waiter.


Perhaps it was exacerbated by the cross sector meeting when the only skills the rest of the volunteers wanted from Gary & I was first aid training - I had to gently break it to them I can't even put on a high arm sling or finger dressing (Ex-work colleagues will attest to this!). The best part of this was the minutes of the meeting recording that all Gary and I had to offer the rest of the group was ;-)


Then the north west meeting of health volunteers revealed that I am in fact funded by the empire & regularly go to visit the death star. It was a fabulous welcome and I must remember that particular technique for the next new intake of volunteers.


Lou & I stayed at Pete's house in Preah Net Preah for the meeting and it is possible the Raid frenzy on the female rain insects he executed and my subsequent Raid induced 24 hour sore throat and headache may well have contributed to the tropo going-ness.


It may well have been ill advised to skip an evening meal the following day in favour of sitting on Lou's balcony drinking beer/gin/rice-wine-cough-medicine-type-thing whilst watching a distant epic tropical storm.


The next mornings bed bound state due to alcohol/dehydration related vertigo spent watching Mad Men which induced nausea with its smoking in every scene surely hasn't helped.


Getting caught in a tropical storm whilst pillion on Lou's bike has to have contributed to going tropo. After all being painfully lashed by a huge drops of warm stinging rain from dark culumonimbus clouds, lightening striking all around, wet through to the bone and strong gusts of wind threatening to wipe us out - well that is tropical.


Then the back to back viewing of the Bourne Trilogy which Lou and I undertook on Saturday night really wasn't healthy, but it has left us both with a healthy appreciation of Matt Damon's shoulders. 


The Dopamine training meeting I attended on Monday at Angkor Children's Hospital sent me reeling into tropo-ness. My use of words will fail to describe how a meeting in which you are the only Barang makes one feel, but the swings are long and deep. There is genuine warmth and kindness from the Cambodians who work for my partner NGO but this is dove-tailed with unintentional exclusion, my utter incomprehension of khmer and sometimes just their plain ignoring of me, I haven't quite got it all fathomed. So I went walking in another tropical thunder storm in an attempt to post Lou's VA job adverts around Siem Reap and to see if I could make my mood swings any worse. I succeeded!


The last two days I've been in a CME workshop in Siem Reap and have had the highs of wearing headphones with realtime translation feeling like a UN delegate, moments of real hope, bizarre conversations of a most personal nature, my name called out in the street (The second time this has happened since arriving, both times URC staff - they get around and are friendly - the unexpectedness of being recognized and greeted in a foreign land lifts my spirits every-time and takes me right back to a boat trip in Sri Lanka), impenetrable surgical doctors calling me by first name and smiling at me, meeting experienced (and quite good looking) health development workers who have words of encouragement and wisdom, and as with all URC events great snacks.


Then without warning tears of frustration will well up and an overwhelming sense of "What the...." hits me. It is one thing knowing what you think you can do and another to actually do it, let alone for it to then be effective and sustainable.


During a lapse in translation and a lack of french or english power point slides I entertained myself by doing a participatory exercise in which I was the only participant. I sat and brain stormed, thought showered, whatever, a list that answered the question "Good Medical Practice is supported by what?"


Do it yourself - I got 2 sides of A4 ranging from GMC licensing and revalidation to protected study time and budget, as big as DoH policies, targets and guidelines to as small as internet in the workplace and one to one shop floor teaching and supervision. And the real downer is here in Cambodia they don't have even one of the things I (and no doubt you) listed. 
So when I'm starting to get frustrated I shall remind myself that my work ethic and professional culture come with a whole array of props that until this point I had totally taken for granted.

I don't want to go troppo but I also don't want to lose the ability to get impassioned and animated about the things that I believe matter. Its a fine balance but 3 showers a day and an air fan are helping....and Matt Damon's shoulders of course!