A new life?

Between us, Katja and I volunteered for over 4 years in Cambodia.  We wanted to do something, however modest, to help people less fortunate than ourselves to have new, better lives.

Fine words, but not always easy in practice! 

In my remote village of Thmar Puok, the director asked me to help breathe new life into his hospital, which had gently drifted since it was cobbled together in the aftermath of the Khmer Rouge nearly 30 years ago.  

I offered to help them to improve the care they offered to patients by using a quality improvement system in their ward or department.  Happily, the tool we used was not imposed by well-meaning outsiders, but was developed by Cambodians themselves and agreed by their own Ministry of Health.  And it wasn’t me doing the assessing – rather, I helped ward chiefs to score their own area against a detailed list of good practice. 

Another benefit of this approach is that - unusually for hospitals - we could actually measure improvements.  We agreed the present situation for equipment, documentation, hygiene, and patients’ views of their care.  These scores could be compared over time, or at one point between wards (healthy competition!).  Where scores were high we gave praise, and where not we focused on improving things - a manager’s dream!

It wasn’t perfect:  some of the scoring was strange, like getting hygiene points simply for toilets being unlocked, or for having a ward free of motorbikes.  And some staff ‘played the system’ - from giving their ward a rare clean just before the inspectors arrived, to making up documentation such as vital signs and medical notes in retrospect (it’s called fraud where I come from).

But if staff were playing, so were we - it was a ‘percentage game’, with at least some of the improvements made in advance of the assessment continuing afterwards.  Some things just dropped back to their original level - even basics like turning up for work, wearing uniform and washing hands.  Yet my heart leaps when I still hear doctors explaining diagnoses and proposed treatments.  And many of the issues which affect patients most - hygiene, nutrition, medication, finances - continue to be discussed in wonderful staff-led carer education sessions, which continue every Tuesday morning.

I would have preferred that staff enhanced care through a sense of empathy or professional pride.  But if in fact they made things better because they liked to get points, look good or avoid getting into trouble – well, so be it.  The fact is, things still improved for patients.

Appropriately for our planned renaissance, the best progress was in obstetrics. The midwives were the most receptive of all staff, and this year they agreed to be assessed against tougher (‘level 2’) standards.  They did really well – despite having a shabby old ward they kept it clean, maintained decent records, and gave a good quality of care to mothers and their newborn babies.

This was particularly pleasing as maternal health is (in theory at least) the key focus for all VSO health volunteers in Cambodia.  And it is richly symbolic:  if the whole aim was to give new hope and new life to the poorest people in a poor country, what better way than helping to bring babies into the world with more chance of a better life than their mum?

So, after two years, our thoughts also turned towards new lives, this time our own.  Katja returned first to the UK, to continue the theme of re-birth by starting two years further training to be a midwife herself.  The main reason she gives for taking on this tough extra study is not just that she loves babies, but also that she feels this is the best way she can help poor people in the future.  Now you can see why I admire her so much!

And for me too a new life was beckoning:  the prospect of discovering Oxford, possibly changing job or even career.  Importantly, I also hoped I would have a novel perspective on things – a better work-life balance, a calmer outlook, a clearer focus on what is important.  And, of course, I would be setting up home with the new love of my life - a wonderful, totally unexpected bonus of volunteering!

And so to my punchline.  At this point I had planned to make a happy announcement – of one more new life. 

Around a month before she returned to start studying, Katja and I found that she was pregnant.  We were so happy and excited – this really did mean that a new life would await us back in the UK. 

I couldn’t believe it:  “I’m going to be a daddy!” I chanted.  The thrill of the return home was enhanced by debating when and how to make the announcement, where to live, what marque of superbuggy to covet.  Most difficult of all was names.  Oliver was firmly at number one in the UK baby charts: what good taste parents have.  And these days there is also the issue of the surname, which presented a unique challenge for us – would we really risk condemning our offspring to a life of ridicule by imposing the easily mispronounced ‘Horsch-Shipp’?

But it wasn’t to be.  Sadly, after three months Katja rang me distraught to say she’d had a heavy bleed.  After dashing to the emergency obsterics unit and a further scan it was confirmed she had suffered a miscarriage. 

As suddenly as it had started, our dream was over.  Of course I rushed home, and am writing this in the day unit at Oxford’s John Radcliffe hospital, waiting for Katja to return from her operation, a coldly clinical ‘evacuation of retained products of conception’.  The physical evidence will soon be gone, and all that will remain are our dreams of what might have been.

It would always have taken us time for us to adjust to our return in the UK.  Now, with this wretched, unexpected twist, it may take even longer.  But I honestly feel that if we can survive two years in the most rural corners of a developing country, then we will have the strength to recover and move on. 

Just as we tried to give help and hope of a better future to others in Cambodia, I believe that we too will enjoy and embrace our new life.