Infection Control Drive!

Just why are we doing this again?

A perfectly normal question once you’re past the initial, enthusiastic stage of any project.

On this occasion I was talking to myself – muttering probably – though I did aim the question later at both my colleague Alison and my long-suffering meant-to-be-on-holiday parents.

We were helping to clean the wards at Thmar Puok hospital, part of our infection control drive.

So the answer’s clear, right? I mean, you don’t really need to ask why you’d want to control infections. It’s blindingly obvious - nobody wants to be contaminated, least of all weaker, more vulnerable people in hospital - so limiting bugs is what us managerial bullshit speakers term a no-brainer, no?

Well yes… but somehow out here it’s not as simple as that. The staff claimed to know all about the importance of infection control and how to do it. In fact, when we tried to do a quick refresher on the basics, eyes were rolled and we were grumblingly accused of ‘trying to teach crocodiles to swim’ (Cambodia grandmas don’t go in for egg-sucking).

Yet even a cursory tour of the wards showed a yawning chasm between theory and practice. Dirty doesn’t get near. I tour the wards every day, and was ashamed I’d put up with the filth for so long. Shit stuck to beds was probably the worst, but other lowlights included needles tossed aside, decomposing food stuffed into note trays and decades worth of accumulated grime, blood and worse under every bed, behind every cupboard and inside every drawer.

So however self-evident the need, the wards hadn’t had a proper clean for ages. So why were we doing this… now?

One answer is that we, the outside volunteers who like ‘nice clean western wards’, had asked to (albeit a rather insistent, toddler-after-a-lollipop request) – and our hosts were too polite to refuse. In fairness we planned the event together with the hospital’s head nurse, and timed it for the dry, quiet run up to Khmer new year, which also happens to be a traditional time for ‘spring cleaning’.

But we did have another, stronger reason – the Ministry of Health had laid down numerous standards, including levels of cleanliness, and were coming to assess how we matched up. The following week.

Somehow bigwigs from the capital focused minds in a way that even the whiff of festering wards hadn’t. And so we were permitted to start a clean of the whole hospital that morning, starting with the Medicine ward.

Breakfast was a nervous affair. What’s the worst that could happen? asked Alison. Well, for a start they’ll find some reason why today isn’t a good day to clean, and it’ll likely go downhill from there, I replied. I’m not really a morning person.

The doctor in charge of Medicine greeted us warmly. Just one thing - today’s not really a great day to clean because… So far, so predictable. I wasn’t in a mood for negotiating, and risked a bullish approach of ‘We’ve got to do it now. And your boss agrees’. He gave way with remarkable good grace. Maybe he knew what was under the dressing trolley.

So we started dragging beds outside, which had an amazing effect - suddenly the huddled nurses were all too happy to carry them outside. And then the main toy came out: the hose! Never has so much fun been had outside of a karaoke bar - the boys were positively wrestling it out of each others hands.

To our shame we rather forgot the patients in all this. Admittedly those who could walk had seen the inevitable and retreated to the relative safety of the cooking area. But two poor souls remained: a man bent double with abdominal pain, and a wafer-thin lady in the terminal stages of AIDS-related illness. The doctor wisely transferred the man, and it fell to Alison, my visiting mum, me and a passing relative to carry her to safety, each holding a corner of her wicker mat - the nurses were still having far too much fun with the hosepipe!

But in fairness the staff - particularly the cleaners - were doing a great job at scrubbing the floors, walls and even ceiling. Strangely though, there was much less enthusiasm for cleaning beds. And when I asked them to help me to paint, they point-blank refused. To this day I don’t know why: there must be something in the hierarchy which makes it ok to brush floors, but beyond the pale to brush paint. Some things I guess I’ll just never understand. Fortunately a placatory call to the hospital director broke the deadlock, with an agreement to pay a labourer to paint beds if we cleaned them and provided paint. Good deal!

In fact the painting was key. Some volunteers back away from helping to decorate their hospitals, feeling that it literally ‘paints over the cracks’ and gives a false impression of cleanliness which leads to apathy. I take the point, but disagree. In practical terms dirt shows up much more easily on white walls, and is easier to clean from freshly sanded and painted surfaces. And boy does a row of beautifully painted beds lift a place! The Medical ward in particular was completely transformed - to my eyes at least, by the end of the day it really looked quite beautiful.

A week later, the men from the ministry are in full swing, and the hospital is looking spick and span. One of my favourite moments of my whole year here happened this morning. The once recalcitrant medicine doctor skipped past announcing that he was on the way to collect some health education posters to decorate his newly cleaned walls. Wow!

Sustainability, of course, is the goal, and it remains to be seen whether the staff actively keep their wards clean, or passively allow the dust, dirt and other unmentionables to return. I’m an optimist, and really believe that now we have helped them see things can be better, they will improve even further.

That’s why we were doing it.