Thursday, June 24, 2010

World Cup fever, Cambodian-style

It’s June, it’s the World Cup, and the dusty streets of Sisophon are, well, exactly as they were before.

Whilst the eyes of the world are on South Africa, the sporting preference of our average Khmer punter remains resolutely fixed on volleyball, cockfighting and flipflop pétanque.
But last Saturday all this started to change…

VSO are supporting the campaign, inspired by the historic first World Cup on African soil, and the conference of world leaders shortly afterwards. The campaign’s aim is simple: ‘education for all’. Shockingly, 73 million children in poor countries in Africa and Asia still don’t have access to a basic education. The campaign calls on leaders from developed nations to keep their promises on aid and for developing nations to invest in education.

I thought it might be a nice idea if we could arrange a football match in Sisophon to support the campaign, raising awareness of the message and gathering signatures. I figured it would be an even better plan to disappear to the other side of the country and persuade Jen, a young and enthusiastic education volunteer, to arrange the match whilst I was away. To my surprise she agreed, and set to work with gusto. After all, how difficult can it be to arrange a little kick around?

Well firstly, permission was needed to play on the main pitch in the town, a scruffy patch of land with branches lashed together as goalposts and a surface as smooth as national route 16 (that’s the bumpy dirt track to Thmar Puok). And we are also keen to leave something sustainable after the match is over – perhaps some new goalposts and nets.

The initial response is dispiriting – it appears that the ground has been sold by the local authority to a bank for development (scandalous, though I fear such shameful sell-outs aren’t limited to this country). And we learn that half the volunteer community – the Peace Corps, so the younger, fitter half– are off to Angkor Wat that weekend and can’t play.

But things improve – the director calls back to say he has spoken to the bank manager, we can play on the pitch, and he positively insists on having new goalposts – hurrah!

The opposition are the Provincial Office of Education, who boast a thriving sports department, so our rag-bag bunch of volunteers and local staff are a little intimidated. We arrange a practice match for 8am the day before, when it will be relatively cool. No-one turns up of course, and actually we didn’t actually have a ball, but we do manage to find each other for some ‘team-building and tactical analysis’ over omelettes in a local café. Later in the morning we even make it onto the pitch, having bought said ball, just in time to allow a group of laughing children to run rings round us.

In the afternoon I link with a local Khmer worker, Samut, who gives me an object lesson in how to get things sorted, Cambodian-style. New goalposts are manufactured and erected within hours. Sand to improve the penalty areas arrives within just 15 minutes of being ordered. The education department magic up some chalk to paint new lines. Alison even persuades some kids to pick up litter. The prejudice of many westerners is that Cambodians tend, frankly, to be lazy – they can certainly sleep at the drop of a pointy hat - but when they decide to do something, it happens at amazing speed. It’s impressive and frankly rather bewildering.

So, just a week after the initial idea was floated, the big day arrives! The education department are at it early: by 7am they have set up a tent, public address system, rows of red plastic chairs, and a range of banners (even if they miss the point a bit, focussing on the dire consequences of drug-taking). A parcel arrives from VSO with t-shirts for the teams and 20 footballs as raffle prizes. There’s even an ‘ice cream van’ (frozen condensed-milk on sticks from a tuc-tuc).

The arts school opposite arrive with a traditional band, and Paul, a volunteer music teacher, appears with his trumpet and serenades us with God Save Our Queen and The Great Escape. Kids from the school pack the touch line, and players bow to the respected guests. We even have a proper ref and try that thing where everyone shakes hands with everyone else. It doesn’t quite work as we don’t know when to stop shaking hands, but it’s a nice idea.

And then we’re off! To be honest the actual standard of the football itself is pretty modest – the opposition turns out to be of a certain age (and weight), and the VSO select team were clearly not selected for anything as logical as having played football before. But it’s great fun, hundreds of supporters and music, laughter, clapping and shouting from all around the ground.

So what did all this achieve?
* The 'Education for All' message was presented to hundreds of people in Sisophon, and we got an outstanding 340 signatures for the education petition (perhaps helped by the persuasive power of 20 footballs being raffled off at the same time)
* Relationships with the Provincial Office of Education were developed greatly, very good news for education volunteers in the province
* VSO enjoyed excellent publicity - the t-shirts and banner were prominently displayed, the footballs were very much appreciated, and volunteers from different programme areas (education and health) showed we can work really well together on a joint project
* The users of the football pitch - local kids and the Sisophon City team, now have a much better pitch, with litter cleared, sand laid and new goalposts and nets, which will be a lasting legacy of the event. I also hope that by encouraging the community to use the land, it more likely to remain there for them to use it, not to be taken over by another bloody bank
* And all of us had a great time
* And we won 6-4, with Oly Shipp the hatrick hero – result!

Wednesday, June 23, 2010

I want to ride my bicycle...

The transport revolution is two-wheeled, and Asia is the hub. I love cycling here, and it’s still by far the best form of travel. Today, however, was not my finest hour in the saddle.

I should have read the signs. With admirable gusto for a Monday morning I stride to work to start writing the report of our recent hospital assessment. My nurse colleague is delayed as there are no taxis – one comes along in a few hours so no panic. Happily the electricity seems to be working, so we do get going on the computer before it’s noodles and pumpkin time.

On our return from lunch we realise the power is a cruel hoax – the mains is actually off, it's just that the emergency generator is on to fan the visit of a city guest. As soon as his Lexus hits the dirt road the power is back off and our computing stalls. This of course also means that the wards have no power either; their needs are well down the hierarchy.

Several sweet coffees and immeasurable hanging about later we find another taxi to take us 50kms south to the larger sister hospital at Mongkul Barey to give ourselves a fighting chance for the next day. The bus is no longer an option: until a few months ago there was a once-a-day service, but then it mysteriously ceased and nobody seems to know why. Improving public transport is not yet a priority here.

So this morning I jump on a bike and potter along the couple of kilometres to the office. Not so fast! As I trundle along there’s a sinking realisation that the road is bumpy even by local standards – I have a puncture.

Fortunately there are plenty of repair shops, though in my hour of need they seem to all specialise in motos. But some friendly men in the market direct me to a little bike-fixing shack – in fact they even chase after me when I walk past it thinking it must be a derelict tractor store.

Now these guys are good, they can fix anything, so I’m confident I won’t wait long. The repair man is at least 107 years old but gets to work on my inner tube with youthful zest.

The first challenge is to inflate it to find the puncture. This is not so easy when VSO issue you with 1978 model Chinese rustbuckets whose valves have never been seen south of Laos. But the enterprising bikeman opens up his box of bits and builds a new pump from a wedge of plastic, a handful of nuts, a pin, some duct tape and the remains of his thumbnail.

This is not a quick process, but time is not a priority here. I bite my lip as other customers pitch up and he breaks off to pump tyres and grease wheels before sidling back to my job. I get this often: for example, once persuaded into a shared taxi, the driver thinks nothing of leaving you for an hour or so, before setting off in the wrong direction so he can first discuss the price of rice with his second cousin. And the trundling bus to Phnom Penh doesn't have to take all day, if we don't stop every hour for rice / toilets / greetings to the local peasantry. My time is not of value here – I need to chill and go with it.

So I’m happy that in less than an hour and only a few near-misses later the special pump is working. The innertube inflates to reveal a gaping hole. Of course at this point I would happily have just bought a new tube and been on my way, but they are much less wasteful here. Instead he winds the rubber around a metal cylinder, sands the puncture area with a rough-edged toilet-roll, applies tar, sets it alight (maybe he just escaped from Battambang circus?), blows on it, applies a patch, bashes it with the metal fork - and it’s mended.

Unfortunately it’s not that simple; on re-inflation the tyre promptly goes flat again – there must be a second puncture. At this point his 112 year old sister takes over. The process is repeated, with minor adaptations: she prefers a large candle for the fire trick, and decides that the best thing is to create a new valve made to superior Cambodian specifications.

I take deep breaths, and distract myself from the ticking clock and growing mountains of work which await me by trying to dissuade the bikeman’s great great granddaughter from her poking fingers in spokes game. Someone has to do it - interventions by the Cambodian Health and Safety Executive or Child Protection Unit are unlikely.

Eventually the job is done – at barely two hours, this must be the QuickFit of the east. And guess how much it costs? Well, would you believe it, the guy won’t take a cent. I argue hard until he takes a miserly 2,000 riels, less than half a dollar. I leave marvelling at both the ingenuity and the generosity my Cambodian hosts.

So finally I can get to work. I whizz along to the hospital, enjoying the whistling wind whisper through my hair as only cyclists can. Except that, sadly, it’s not the wind (and certainly not my hair), it’s the unmistakable hissing of a rapidly deflating back tyre...

Monday, June 7, 2010

Hospital Spot Check!

This has been my best week in Cambodia. And also the worst.

When the Director of the modest provincial hospital at Thmar Pouk asked me and Alison, the VSO nursing advisor, to spend the week with the Head of Nursing assessing the quality of the hospital, we were thrilled. This was our chance to get beyond the polite smiles and find out what care patients get here, and agree ways to make it better. Best of all, we were invited in.

After a breakfast of bananas – unfortunately bread supplies don’t often make it to this village – we step out to learn our first lesson: don’t start the morning after a monsoon, as the dust track becomes a treacherous, slippery mudbath. We should also have avoided the period after two of my translator’s piglets died. But Cambodia has a way helping you find calm and balance, and the happy singing of a little boy minding his grazing cows on the temple island got our visit off to a positive start.

Which was just as well, as I made the mistake of starting the inspection the litter-strewn grounds and deeply unpleasant wash blocks. No visit to the gents should leave you with this mixture of nausea and bafflement:

* Are these toilets clean?” “No they are very dirty” We agree!

* Yes, they are rather - when were they last cleaned?” “They are cleaned every day” “So this colourful crust and interesting aroma developed just this morning?”. Sarcasm doesn’t translate well.

* Ok, how often are they cleaned with bleach and a mop?” “Twice a month” “So when was this particular toilet last cleaned with bleach and a mop?” “Maybe last year?” Logical deduction not a strongpoint either.

* Different tack: “How could we make these toilets cleaner?” “We must teach patients to stop making them dirty”.

* Last try: “Who is responsible for keeping these toilets clean?” “That man sleeping in the hammock under the tamarind tree” “Is he tired from all the cleaning he does?” “No, he runs the hospital fruit and cigarette stall”. Nobody said this was going to be easy.

Things get better – both the hospital wells are broken, but there is hope that someone somewhere might know how to fix them – and even better, we think we know a donor who will pay for it.

Electricity also sparks debate: the hospital supply is unreliable , but it’s not a problem as there isn’t much equipment needing it. But hang on! Maybe the reason we don’t have much electrical kit is that we haven’t secured reliable power. I can’t help thinking that the Khmer language’s lack of a future tense may limit forward thinking.

It’s a baking hot day, and many patients are visibly uncomfortable. Happily all the wards have ceiling fans. Less happily, not a single one is on. All broken? Not at all - it’s just that electricity is “too expensive” (admittedly it does cost three times more here than in the provincial town). So the patients sweat and suffer, and everyone just accepts this, and my blood is coming to the boil...

I have a similar puzzlement when talking with patients - no matter how many times we ask what we can do to improve their experience, the only answer we get is ‘I want to be better so I can get back to my ricefield’. Necessary, of course, but sufficient?

Bless those midwives! Just as I am despairing, the serious matron shows me her spotless, well stocked and immaculately organised delivery suite. And rewards me with a rare smile. What's more, happy days, I have discovered that the hospital has a room with air conditioning!

And whilst the paediatric ward is a little rough round the edges, the bang and clatter outside remind us that a new one is being built. I have no idea why the US Army’s Corps of Engineers Pacific Command agreed to fund this, but we are happily accepting their generosity. I’m confident we are getting better value from their money than some of the usual things on their shopping list.

Outside, cheerful children clamber around the nearby playground – but on closer inspection we had to persuade them to leave, as the equipment was jaw-droppingly dangerous. Think of a slide which is so rusty it resembles a cheese-grater. Another one for our action plan –who might like to donate a new playground?

The medical ward is the busiest in the hospital, yet two of the three staff rostored to work have ‘popped out for a couple of hours’. Unfortunately they are rumbled as our inspection takes longer than that, and the story is modified– they are at a wedding and “may be drunk”. Understatement of the year. Meanwhile my blood pressure mounts again when I uncover old, bloodied swabs in the nursing trolley – and further when the discovery is met with a shrug. Meanwhile Alison finds that patients’ temperature, blood pressure and respiratory rate are neatly recorded for today. And tomorrow. “They can predict them” explained our translator. My esteemed nursing colleague did not concur. At least the drip stands are were not being used to dry fish today – I guess that’s progress?

The final ward has only one patient, a poor, emaciated woman – unbelievably she’s only 27. She knows she has TB, but we’re not sure that she really understands that the red crosses throughout her notes indicate she is also HIV positive. We ask if she is getting enough food, and she tells us she has no relatives to cook for her – only her young son. He’s the happy boy looking after the cows.

At the following day’s morning meeting, the Director harangues staff, who all intently study their flip-flops. We’re not entirely sure what is being said, but the word ‘worry’ is repeated, and we assume some details of our findings have already been shared – oh dear. After a sustained period of finger-wagging the Director fixes me with his gaze and my translator explains the big concern – cleanliness? drug supplies? staffing? financial irregularities? – so much choice. But no! - apparently the real anxiety is that they understand that the poor white man can’t find bread in the market, so they are arranging for the hospital ambulance to deliver me some regular supplies. It’s so sweet, unexpected, surreal, I don’t know what to think...

This week was just the start of course. We’ll now spend the next fortnight with the Head Nurse, discussing what we observed with each ward and department , and agreeing what they will do to make things better – and how we can help. The real crunch will come in August when we do it all over again – and hopefully find that standards are improving. I’m not sure if we’ll have working wells, functioning fans or decent documentation by then – and the poor lady with TB and her happy singing son may no longer be with us – but at least I may be enjoying my daily bread.