Cambodia

Articles / Volunteer Evaluations

	I have just had an amazing weekend with the rest of the Outreach International volunteers in Kep and Rabbit Island. White sandy beaches, eating lovely fresh sea food, swimming, sunbating, playing Volleyball and drinking far too much. Think i did really well with the other volunteers as they are all really lovely and much fun was had. Im now halfway through the trip which i cant believe. Im going to do a presentation with Alison the other occupational therapist volunteer to the Physio Congress. We are hoping that they will come away with a better idea of what an OT is and how they can develop OT principals into their practice, we shall see! Ive been spending lots of time in the community recently which has given me a great chance to see more of the rural countryside as well as get involved with patients who are unable to get to our clinic. It involves many hours on a motorbike, ferry journies and varying weather conditions. Ive been involved in treating Srtoke patients, children with Cerebral Palsay and traumatic brain injuries. the challenge is even bigger when the patients are in their own homes and are unable to get to the clinics so have to rely on their family giving the treatment that we ask them to. with no welfare system and limited funding there is no other choice. I went to a muslim area the other day to see a lady who had given birth 3 years ago and ended up with general weakness and lower limb spasticity - something i have never come accross before coming to Cambodia (i saw one lady in the clinic with similar presentation). I'll be the first to admit that i wasn't sure we could do much for her due to the length of time she had been affected. It took us 3 hours to get the the house and the roads were awful. on arrival she was reluctant to come and see us because her family had shaved her head - they thought that because she had been so unwell for a long time her hair may be the cause. She was really self conscious about it, not helped by the horriffic achne she had also. eventually she came out and we talked to her about practicing walking within her house to build confidence and encouraged her family not to put too much pressure on her t go outside walking on uneven ground and feeling so self conscious - i then turned around and realised that 24 people from neighbouring houses had come to watch. I dont think that will help with her self confidence! they had never seen a westerner before and were amazed at my skin colour and by "big western nose"! if i didnt come with a complex i'll sure leave with one! Ive had a few days off in the last week and with 3 other volunteers went to Siem Reap to visit the Temples. It was amazing and worth seeing but i struggled to cope with how touristy it was. you could have been in any country with everything westernised. I missed my little town and simple life in Kratie. Im going to stay in Phnom Penh for the water festival wihich is the biggest festival of the Khmer year and attracts 2million visitors to the city - it will be mayhem! lots of boat races to see so should be fun. So, ive been here in kratie for about 2 weeks and am starting to settle in. the weather has been crazy as we are getting the edge of the typhoon from the Philippeans so mental rain storms then glorious sunshine. My role at work is starting to fall into place and i have a few projects on the go including creating a leaflet about having a stroke for patients (this is in line with the very limited health knowledge of the general population and specific treatment according to cambodian health care), making equipement e.g. a commode out of nothing - good job i was a scout! and also suggesting that home visits for some patient should be completed prior to discharge from the clinic rather than a month later. Things have to be made really simple here not because they staff dont have the skills or experties but because there is no welfare system or government run health care so unless its easy for them to follow it wont be sustained. the staff here are also worried as Veterans International will be taken over by the government in 2 years time so their salaries will drop to $60 a month. I had a day in the community and was on a moto in the hot sun but enjoyed seeing the local houses. Climbing up ladders to get into the house, sitting on ants nests, trying to treat patients with family and visitors interupting. there is no stress here and if it takes 2 hours to treat someone then thats what happens! my house is still good and luckily being on stilts not affected by the floods. luckily the landlord speaks french so im able to communicate with him. his daughter is getting married in nov and im hoping to get invited! there was a little festival in Kratie last sunday which was really nice. everyone from the town came to celebrate the end of the rainy season - ironically at about 8pm torrential rain started!! it was fun with lost of popcorn and beer and local teenagers who thought it was funny to light rockets next to westerners legs! no one was hurt luckily. I went for food at my boss's house with some other colleagues, they were impressed with my drinking ability and the food was amazing. it was noodles and intestine, lovely!! the funniest thing was that my boss decided he was hot and stripped to his boxers for the rest of the eve. very normal thing to do here aparantly! the people here are amazing and very friendly. we cycled to Kampie 16km along the Mekong and all the kids ran out their houses to shout hello. hoping to see the dolphins this weekend. Well ive finally arrived in Kratie and its beautiful, its quiet and safe and has some colonial buildings remaining. very few people speak english and they trade mainly in reil rather than dollars like in phnom penh. im writing this from the VI rehab clinic which is inside Kratie referral hospital. the hospital is amazing, nothing like NHS hospitals! there are cows chickens and dogs roaming around, the wards are in separate little buildings, the patients and ther families stay and wash in a big water pool opposite the clinic. the mattresses and beds are very basic, windows open all the time, drip stands are made of a wooden pole. i will never complain about the nhs facilities again (OK i might once im back!) the rehab clinic is unique! it has a big open space with a variety of surfaces for practicing walking on, a climbing frame that the amputees are sent ope once their prosthesis is fitted. there is one big therapy plinth that 3 or 4 patients sit on at one time and everyone watches everyone elses therapy and gives their input. their children and families are involved and often a khmer therapist will walk off to do something else, answer a phone etc during treatment. the facilities are basic but the staff are brilliant. the patients are there from 7:30 am till about 4 and get seen when they can be and maybe more than once. i have found a house here too, didnt really know what to expect but its huge, has 3 bedrooms, balcony, kitchen with stove and fridge (thats not standard) and a nice big living room with leather sofa and tv/dvd. ill be living there with Des the physio for the first 5 weeks then am on my own. plenty of space for visitors and parties!.

• Updates from Rebecca Lambert

	It was great to have an insight from a previous volunteer at the interview as we could ask them specific questions prior to committing to a project. Hearing accounts from the previous volunteers on the information day was also useful. We were really excited about the project after the day in London! Now that we have completed and adored a project ourselves we understand Hannah's enormous enthusiasm! If you would like us to share our tremendous experiences with possible future volunteers, we are available (and very keen) to provide information to students at Universities/Colleges in Edinburgh. Some of the prosthetists and orthotists had an excellent knowledge base. We therefore had great opportunities to learn from the locals as well as them learning from us. We felt that we received the perfect amount of information about Prey Veng as a town and about the general experience that we should expect from the project. If too much information is provided then the sense of the project being an adventure and a challenge could be lost. It was fascinating to have so many unexpected experiences whilst we were out there. Advice to Future Volunteers 3 months passed so quickly. If you have the time, a longer project would be even more enjoyable. Clothing-not too many light coloured clothes as they get grubby really quickly and can only be washed by hand. Read up on cultural differences especially appropriate clothing and relationship issues with the locals. It was a good suggestion of James and Hannah to read about Cambodia before heading out there. Reading whilst living within the country was even better as you could imagine the scenes of the book with true images. Visiting Tuol Sleng and the Killing fields is a must. I'd recommend visiting them on different days as they are both pretty distressing experiences. However, really try to visit as they provide a rapid learning curve of Cambodia's history. We found it really interesting to catch up with other volunteers throughout the project to find out what they are up to. Visiting other centres was also interesting and recommended. If you are working in Phnom Penh make sure you take the opportunity to visit the volunteers working in the provinces. It is a fantastic chance to see provincial life when visiting a volunteer who is living within the community rather than just visiting an area as a traveller. If you get the opportunity, live with a local family. We wish we'd done it for the entire project. The locals have such a beautiful nature and are so welcoming. You learn a lot about true Khmer living! Keep your phrase book on you, especially if you are working in the provinces. Lack of menus in two out of the three restaurants meant it was well used – thanks Hannah! You helped us get fed each night with that little green book! Also, on the topic of language, if you are in the provinces try asking the local monks if they would like to teach you Khmer. They are very patient teachers. David prepared a book with information about living in Prey Veng. Please can future volunteers continue to add to it? – share your experiences so the volunteers after you don't miss out on any experiences. Travel after your project. Discover the Khmer's neighbours. It is fascinating to compare their cultures. Most importantly, make the most of every opportunity presented to you during the project... and, although you don't need us to tell you… have a superb time!

• Evaluation by David Roberts and Hannah Francescon

	What is a typical day like on your project? I spend the mornings at Calmette hospital in Phnom Penh where I am supervising and training local physio's completing an upgrade training course. We are working on the stroke ward and see a variety of patients, 2 or 3 in the morning and go through the neuro assessment and treatment for each patient. I have had 1,2 or 3 physio's with me at one time (there are 12 completing the upgrade course at the moment). We work with the patients by their hospital beds, as there is no gym available. We have one wheelchair that we can borrow for treatment but no other equipment available to use at the hospital. We have worked with a variety of patients and their relatives including stroke patients and traumatic head injuries. They are all really motivated and appreciate any help we can provide. In the afternoons I am at Kien Kleang rehab centre in Phnom Penh supervising the same physio's. We are working with a variety of disabled children including cerebral palsy, polio and clubfoot. We complete the assessment and follow-up treatment and advice for families and work closely with the prosthetists / orthotists to provide splints and seating systems as needed, and also with the maintenance department for standing frames. What have been the most memorable things on your project so far? Working with all the local physio's. They are all really keen to learn new skills and adapt existing ones. I have definitely learnt a lot from them too. Helping a child with cerebral palsy to walk which he had never done before. Working with a stroke patient over several weeks at Calmette hospital who was unable to sit independently initially and he walked with assistance when he went home. Another patient who had had a head injury from a moto accident who made great improvements in just a few days. The children at the rehab centre that we have treated. They all have such complex difficulties but are so happy. The fact that the children are so happy with just the minimal of things - a lot of them don't have any toys. They are so excited by new toys and the simplest toys are so interesting to them. My moto rides to and from work are always memorable! What are the most challenging things? The language difficulties i.e. that I speak very little Khmer. I found it really daunting to start with and really appreciate how patients must feel in the UK that are unable to speak English (and I'm not even a patient out here!). Now I've learnt a bit of Khmer though which I am really enjoying and find it a lot easier! The different way of working. There is no equipment at the hospital so you really have to improvise. At the rehab centre there is more equipment available but it is still quite limited and basic. The heat! Its really difficult working in 40 degrees heat! The lack of space at the hospital and that patients stay in hospital for a short period of time i.e. due to lack of money (they have to pay for treatment) so a lot of the time don't receive all the treatment they need. The slower pace of work out here. Why did you choose to take a break from working? I had gone straight from school to university and straight into a job without a break so I really wanted to take a break. I didn't just want to go travelling for 6 months and wanted to do something worthwhile to me and my career. Luckily South Birmingham Primary Care Trust where I work, have allowed me to take 6 months off my Senior 2 job so I could do this. I recommence work in Birmingham in October 2006. I really appreciate it! I have always had an interest in amputees, paediatrics and neuro. I was initially drawn to the project because of my interest in amputees but it turns out that isn't a part of my project! I love working with the kids and the adult neuro patients out here and think it will really benefit my future work as a physio. I have also wanted to go to Cambodia for a while since my holiday in Vietnam and couldn't believe my luck when a project was available in the country so I could volunteer as a physio as well as see the country. Why did you choose Outreach International? I literally typed in to google  physio in Cambodia" and came up with Outreach International. I read more about the project and it really appealed to me. Also I wanted to go with an organisation rather than on my own so that I had some support out here. How has the project helped you so far? Developed my skills as a physio in a variety of areas. Developed my ability to adapt treatment to a number of different settings. Expanded my experience with different conditions such as polio and clubfoot. Developed my communication skills - ability to explain ideas in simple terms for the local physios, due to the language. Gained an understanding of the cultural differences in Cambodia. Having the opportunity and ability to live in a different country. Meeting new people and visiting a number of great places. Developed my assessment skills - I am unable to understand the language a lot of the time so just spend a lot of time observing patients and I really think my assessment skills have improved as a result. Facing many challenges in the country which has definitely made me stronger! Do you have any future plans in the UK or overseas yet? I will return to work for South Birmingham PCT in October to continue my Senior 2 rotational job and hope to stay there for a while! I will definitely plan more travelling for the future as I love it so much and think you can learn a great deal from it. What kind of person would enjoy the project that you are doing? What kind of background should they have? I think anyone who is outgoing and would like a challenge and change of working environment. The physio projects change a lot so it is difficult to say how much experience you would need. For my project you would need at least 2 years because you are training other physios and need some experience from the UK. If you have less experience then it would be more challenging but it depends what you would do and I hope they would try to find the right project for the individual. You can gain so much from working in a different place that I would recommend it to anyone! What are your top tips for someone wanting to perhaps take a career break or break after studying to volunteer? Really think about whether it is what you want to do - as it's not all easy! Discuss it with your manager first! Really think about the money as I found it a lot of hard work raising all the money that I needed for the project (over £3,000 pounds) and also how you will be volunteering when out here i.e. not getting paid (I have had to put my mortgage on hold for 6 months!) Really think about where you would like to go as I think you can gain different things depending on where you go.

• Evaluation by Sally Cox

	Outreach Prior to Departure Outreach provided a good introduction sheet to surviving in Cambodia with some useful hints and tips. The contact email addresses were also useful, especially preparing me for Kratie. I would have liked a bit more information back from the project so I could have really prepared for the project. For future physiotherapists and OTs it would be useful for the project to send an outline of objectives and some details on the types of patients they are going to be treating; this will allow the physio to prepare themselves in advance and bring any relevant references with them. The pre-departure briefing was informative and it was great to talk to past volunteers. Outreach in Cambodia As soon as I arrived in Cambodia I felt I was supported by Hannah, as she met me at the airport, sorted me out with accommodation and once the other volunteers arrived gave us a thorough induction including do's and don'ts. Hannah remained a good source of contact throughout the project, making sure she contacted us on a weekly to fortnightly basis. We had a good induction from the project in Phnom Penh and had a look round Kien Kleng. It was nice to meet some of the managers and get a better idea of how the organisation is run. We spent the rest of the week on our projects with a view to having a handover from the previous volunteers. In theory this is a very good idea, however the previous volunteers in Kratie were on holiday in Laos for the whole week so we received no handover. I think it is essential for some sort of handover between volunteers (whether it is verbal or written), otherwise patients and staff do not progress in their training or English. We have decided to develop a handover pack for Kratie with a basic introduction to Kratie and the centre. The pack will include a detailed handover on the level English each member of staff is on. I think future volunteers should be encouraged to continue with this pack as a handover reference for this site. The Khmer New Year got in the way with some of the Khmer language lessons. However Hannah managed to organize quite a few and they were invaluable. We also end up having some really good lessons from our site manager, but these obviously depended on how busy he was. I think that it would always be useful to have formal lessons during the first few weeks. The guidance that Hannah provided in finding additional lessons in the provinces was also invaluable. The Project I regard the project as an excellent organisation. The staff were extremely welcoming and were always willing to sort out any problems for us such as sorting out maintenance etc. We had a quick induction on arrival where we were shown around the centre, but it did take a few weeks to work out exactly how the centre was organized and what we would be doing there. I think a bit more of an understanding into the project and its function and funding would be very useful for future volunteers before arriving on the project. Things are so different in Cambodia. I really cannot over estimate this. I was however given a few objectives to achieve and set more for myself as time went on. The initial 3 day, physiotherapy induction at Kien Kleang was useful, and they provided an excellent information folder for reference. The project very generously provided funding for me to attend 2 courses which were both very good. I recommend that future physiotherapy volunteers attend the courses, including any arts and crafts ones as they will probably find themselves taking part in these sessions when they are at the centre. I am very grateful for the time I have spent volunteering for this project, I have learnt a great deal over the last 3 months and hope I have made a good contribution to the centre at Kratie. Above all else I loved the country and the people and could not have done this without Outreach International.

• Evaluation by Hannah Parsons