Help Me Build a Cambodian Library

Wednesday, March 12, 2014

I have been here in Cambodia working with my community for over a year and a half. In this post, I begin a new project; one that I hope you can help me with.

Peace Corps volunteer Rich Durnan with students at the Roh Minh High School, Takeo Provence, CambodiaUPDATE!
The grant for this project has been fully funded thank to your generous donations, thank you! If you wish to support other projects like this please visit the Cambodia Volunteer Projects site here.

A few months ago, I was approached by Samon, one of the schoolteachers at my village’s high school with a request to help the school. Although I have not been doing any work with the school, word made it to them that I was helping the community through the health center. Samon told me that the school director wanted to know if I could help the school too.

 “What do you need?” I asked.

“We need books for our library” he said.

Library room at the Roh Minh High School, Takeo Provence, Cambodia
This is the current library.

Roh Minh, Takeo Provence, Cambodia

Outdated Library text books in CambodiaThe high school has 1,157 students enrolled in grades 7 – 12. Currently, the book collection consists of 340 outdated Ministry of Education texts, and a handful of Khmer language reading books stored on a few decapitated bookshelves. There are no visual resources, reference, fiction, or non-fiction books. Children in the school here are expected to learn using only a single textbook. I cannot imagine if my school had been like this. In order for children to become independent readers, effective communicators, and lifelong learners, they need to practice reading, and have exposure to a variety of texts. However, this school’s limited financial resources prohibit expanding their book collection on their own.

I think in the US, we take reading and books for granted. I know I do. When I grew up, my parents read books to me, and later when I learned to read myself, there were always books available to me. If I want to read a book now, I just go get one. I buy one from the store, or borrow one from my local library. None of these options are available to any one in my village. Reading for pleasure is really just not an option. Can you imagine your life, or your child’s life without books?

students at the Roh Minh High School, Takeo Provence, Cambodia

Books to someone who knows nothing of the world beyond the bounds of their families rice fields will be invaluable. Books can provide an opportunity for students to improve their reading skills and vocabulary. Additionally, exposure to the greater world through the gift of reading can empower students, and help them realize their potential for successful futures.

Library room at the Roh Minh High School, Takeo Provence, Cambodia
My intent is to build up the school’s library. I want to provide them with reading materials, and a safe space to learn. I will renovate the space, and most importantly purchase a variety of age-appropriate reading materials, in both English and Khmer. These new resources will support the opportunity to expand upon the Ministry of Education’s curriculum, and encourage extracurricular reading.  A selection of reference materials, new curriculum-based resources, visual materials such as posters and world maps, and a selection of fiction and non-fiction novels will allow the students access to information beyond the bounds of their school textbooks. It will enable and promote the simple practice of independent daily reading through which they can learn. Access to reading materials will benefit the teachers as well providing them with resources to improve their own knowledge, and supplement their class curriculum.

I need to raise $780 for the purchase of the new library resources. If you would like to help support this effort and the students of my community, please donate to this project. All donations are US tax deductible.

UPDATE!
The grant for this project has been fully funded thank to your generous donations, so the link above is no longer active, thank you! If you wish to support other projects like this please visit the Cambodia Volunteer Projects site here.

students at the Roh Minh High School, Takeo Provence, Cambodia
On behalf of the students, thanks for your help creating this opportunity for independent study, pleasure reading, and instilling motivation to continue the pursuit of education.

Putting My Design Skills to Work

Tuesday, January 7, 2014

Over the last year and a half here in Cambodia, I have worked on several projects that are not specifically for my community, but rather aim to help my fellow PCVs,  members of  their communities, and strengthen the PC Cambodia  program. I thought in this post, as sort of a year-end review, I would share with you some of this work. As you will see, I have been putting my writing, organizational, and design sills to work here in Cambodia.

The Chewy Pong Reference

chewy-pong-coverOne of the first projects I became involved in when I arrived was Chewy Pong. “Chewy Pong” is Khmer language equivalent of  “HELP ME!”. The Chewy Pong Reference is like a first aid manual, but much more (how could I resist getting involved in it?). Chewy Pong was conceptualized and first drafted by several K5 PCVs that arrived a year ahead of me.

Chewy Pong is a bilingual medical reference written by PCVs for PCVs to be utilized at their health centers and in their communities. The purpose of Chewy Pong is to provide medical and first aid information specific to Cambodian health centers to help PCVs build rapport, trust, and capacity in their health centers. It uses very simple vocabulary and does not require a PCV to have a medical background to use it.

A team of us new K6 volunteers was formed and we worked with the old volunteers, redrafted, and expanded the reference. Drawing on my years of experience with emergency medicine as a Paramedic, I headed the effort as chief editor, writing several new sections, and creating the design and layout for the second edition.

Pages form Chewy PongYou can read more about Cewy Pong here.

The CHE Curriculum Toolkits

CHE Curriculum Toolkit Cover CollageMany volunteers worked on this huge project. There are now 5 Community Health Education (CHE) Curriculum Toolkits establishing a series of resource books with technical information, lessons, and language related to CHE primary assignments, and the Cambodia CHE Project Framework. Although designed as a resource for CHE PCVs, these Toolkits are great resources for all PCVs in Cambodia that want to include health education in their work.

 Work began on this project in December 2012, and took almost a year to complete. Each toolkit contains complete lesson resources to encourage good teaching methodology with participatory activities and a comprehensive  appendix with complete teaching tools and handouts. The lessons are designed for capacity building in community members, and can be used as a resource for PCV Training.

Each toolkit is laid out in the same format presenting the following:

  • CHE Curriculum toolkit orginizationBasic and Advanced Information
  • Technical Vocabulary (with English transliteration and Khmer text)
  • Learning Activities with Discussion Questions (transliterated and in Khmer text)
  • Activity Resources containing:
    • Illustrations / Visuals
    • Case Studies in English and Khmer
    • Lesson Activity Card Sorts
    • Transliterated Materials
    • And more

 I assisted with editing and did the design and layout of all 5 of the toolkits. I also co-authored the Non Communicable Diseases (NCD), Sexual Reproductive Health (SRH), and Water Sanitation and Hygiene (WASH) Toolkits. The WASH I piloted using all it’s activities in my Samrong Diarrhea prevention project.

Pages-from-WASH-Book You can read more about the CHE Curriculum Toolkits here.

The Small Grants Guide

Small-Grant-Guide-CoverI serve on the Cambodia post’s Small Grant Committee. Resembling a grant writer, my duties are to support, and advocate on the behalf of PCV small grant applicants with regards to the grant type selection, planning, writing, the application process, and grant management, helping to ensure successful awarding of funding to support PCV projects.

Available to PCVs is a thick intimidating manual that has all the requirements for this process. No one ever reads it, and most PCVs don’t even know it exists. The committee agreed that an abridged version, focusing on the common questions, pitfalls, and post specific requirements would be good to have. I wrote and designed it.

Pages-from-Small-Grant-GuideIf you are inclined to support PCV Cambodia projects, grants needing funding will appear  here, (search for Cambodia).

The Create Cambodia Toolkit

Create-Cambodia-Toolkit-CoverThe Create Cambodia Youth Arts Festival is an annual art education event for Cambodian 10th, 11th, & 12th grade students, run by PCVs. It provides students with formal art education, and an opportunity to showcase their talents via exhibition or performance. A team of volunteers created an arts curriculum to support this event, and asked me to do the design and layout for it.
Pages-from-Create-Cambodia-Toolkit
If you want to learn more about this event, visit the Create Cambodia Web site and blog here.

The Art Olympics Toolkit

Art-Olympics-Toolkit-CoverThe Art Olympics is a project that provides basic visual arts education to primary and secondary students through local art clubs. It also has a comprehensive art curriculum created by PCVs, and I was asked to compile it into a toolkit. Thus the Art Olympics Toolkit; second edition was born.

Pages-from-Art-Olympics-Toolkit
You can learn more about The Art Olympics Project here.

The Science Lab Toolkit

Science-Toolkit-CoverCurrently, I am working with two other volunteers to create a Science Lab Toolkit. This project compiles a series of science-based lessons surrounding currently unused science equipment at the Cambodian school where my friend Evan teaches. Again, I am helping by doing the design and layout for the toolkit.

Pages-from-Science-Toolkit

A Resource Web Site for My Fellow Volunteers

One of the shared frustrations many of the Volunteers and I have here in Cambodia is a lack of access to ideas and resources for projects or the frustration of constantly reinventing the same project. We all have our primary projects; mine for instance is teaching at my health center, or teaching in the surrounding villages like I am doing with the Samrong Village Diarrhea Prevention Project. Then we have our secondary projects. These can be anything else we are asked to do, such as projects based on specific needs identified in our communities, or elsewhere ,outside our primary work. A lot of great ideas and projects exist that Volunteers are doing, or have done in the past. How great would it be if a single place existed to find everything a volunteer needed to do one of these numerous projects?

Say hello to the PC Cambodia Secondary Projects web site!

http://pccambodiaprojects.wordpress.com/
My friend Sean started this idea as a Facebook group, and when I teamed up with him, it quickly blossomed into a full-blown categorized and searchable web based resource site. I put my years of web design experience to use and built the PC Secondary Projects web site. This site is intended to be a forum for ideas, inspiration, discussion, and the sharing of resources for secondary projects. It is a place where PCVs can submit projects if they have them. Alternatively, they can search for ideas if they need one. On the site, they can find files, photos, and tools, or share their ideas supporting each other making the design and application of secondary projects a little easier.

If you have nothing else to do today, feel free to click over to the site and see some of the great things are being done here in Cambodia.

Breaking the Fecal-Oral-Cycle with a Fly Trap

Monday, January 6, 2014

Helping Break the Fecal-Oral-Cycle

FlyIf you have ever been to Cambodia, you are probably aware there are a lot of flies here. Flies are a significant contributor to the fecal-oral-cycle, which is the fancy term for how bacteria from feces gets into peoples bodies causing diarrhea and other illness. Basically, with regard to flies, it works like this.
  1. Fecal-Oral-Cycle ChartPeople defecate out in the open
  2. Flies land on the feces and pick up bacteria and viruses
  3. Flies land on peoples food contaminating the food
  4. People eat the contaminated food and get sick

Ideally, if we stop people defecating in the open, we could make a tremendous improvement to the general health of people in Cambodia. However, breaking the fecal-oral-cycle at the fly level can also be a significant help. Recently, I tried to do just this on a small scale.

Sry Thom, building a fly trap from a plastic bottle in a village food shop. The trap is to be used in trapping flies as part of an effort to break the fecal-oral-cycle in which flies contaminate food causing illness, Takeo Provence, CambodiaMy host family sister Thome runs a small community store in front of our house, which is behind my health center. She sells snacks to all the kids, and other goods one might need last minute, much like a corner convenience store. She also cooks and serves breakfast, lunch, and dinner. We get a lot of patients and the neighborhood folks eating here. There is never a shortage of flies buzzing about, and they really bug me. Sry Thom, building a fly trap from a plastic bottle in a village food shop. The trap is to be used in trapping flies as part of an effort to break the fecal-oral-cycle in which flies contaminate food causing illness, Takeo Provence, Cambodia

I did this fly trap building project with her as we spoke about the fecal-oral cycle and the role flies play in it. Now the shop has several of these traps hanging over the tables and food preparation area catching flies all day. We found putting a little Red Bull or one of the other super sweet energy drinks available here in the trap as bait works great. Sry Thom, building a fly trap from a plastic bottle in a village food shop. The trap is to be used in trapping flies as part of an effort to break the fecal-oral-cycle in which flies contaminate food causing illness, Takeo Provence, Cambodia

Flies trapped in a bottle fly trapPatients from the health center and folks from the neighborhood that stop in to the shop often comment on the traps filled with dead and dying flies. Thome enthusiastically explains what they are for, and how they work. Everyone agrees they are a good idea. I hope I will be seeing traps like these popping up all around my community.



Give it a Try

How to Build a Fly Trap out of a Common Water Bottle to Help Break the Fecal-Oral-Cycle

  1. Cut the top off the bottle, just below the point the neck begins to taper
  2. Cut the bottom off the bottle, making sure there is enough room to invert the top section of the bottle into the bottom
  3. Flip the bottom piece over and insert top piece into it, creating a contained funnel
  4. Use tape or staples to fasten the two pieces (if needed)
  5. Make two holes towards the open side of the trap and tie the string through them
  6. To set up, fill the trap with sugar water and hang from a branch or post and flies will enter through the funnel but will be unable to escape
  7. To dispose of dead flies, fill with water, remove top section, and dump out contents
Illustration showing how to make a fly trap from a plastic bottle

Postcard from Cambodia: Rabbit Island Relaxation

Tuesday, November 26, 2013

Rabbit Island Relaxation

While its winter at home in the US, Cambodia offers endless summer. Rabbit Island is off the Cambodian southern coast town of Kep and offers quiet relaxation and a weekend get away for me from my Cambodian village.

Postcard From Cambodia: Raindrops on a Bananna Leaf

Thursday, October 24, 2013

Rain drops on a banana leaf, Tani Village, Kampot Provence, Cambodia
Raindrops on a Banana Leaf
Tani Village, Kampot Provence, Cambodia

Camp BREW (Boys Respecting Empowered Women)

Thursday, October 3, 2013

Group Photo from camp BREW (Boys Respecting

On September 27th, 28th, and 29th, several of the English Teacher Peace Corps Volunteers (PCVs) from Takeo and Kampot provinces, and their Cambodian teacher counterparts, invited 50 high school aged boys for a three-day Camp BREW (Boys Respecting Empowered Women). It’s a camp focusing on topics related to health, career planning, gender issues, and community engagement. These are topics generally misunderstood or overlooked in the public schools. Camp BREW allows attendees to be exposed to and discuss these topics in a safe environment, while they gain knowledge and skills in areas needed to succeed after graduation. It also allows a rare opportunity for Cambodian students from different provinces to meet and exchange ideas on how to better their communities. There is a similar all girls event put on by PCVs called Camp GLOW (Girls Leading Our World).

Group Photo from camp BREW (Boys Respecting

Sokhom Kourn translates for me during my alcohol use lessons

I was invited to teach a health related section at the camp. One of my secondary projects here is working with several other health volunteers to create a series of curriculum toolkits containing lessons on health topics. This was a great opportunity for me to pilot several of these lessons.

I presented on substance abuse, in particular alcohol use, a topic I consider very important here in Cambodia, and completely overlooked in the schools. 54% of Cambodians report having used alcohol in the last 30 days and men are 10 times more likely than women to heavily use alcohol. Cambodia currently has no minimum drinking age, and although they do have a blood alcohol limit for driving, it is not enforced. Alcohol is uncontrolled and can be obtained any place and by any one regardless of age. The only barrier to obtaining alcohol in Cambodia is money. There is tremendous peer pressure to drink alcohol, especially amongst men,  which usually manifests in the form of binge drinking. A common phrase in Cambodia is “Drink to get drunk, and if you are not getting drunk, then why drink?”

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo Cambodia

With the help of a wonderful teacher Sokhom Kourn as my translator, my presentation began with a quick basic anatomy and physiology lesson explaining how alcohol is processed and its effects on the body.

Then, I led a discussion on the consequences of intoxication. We explored the ways that alcohol can affect many aspects of our lives such as financially, our health through harm to our health through disease as well as through accidents and increased risk for sexually transmitted diseases, and socially through our relationships including increased domestic violence.

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo Cambodia

Group Photo from camp BREW (Boys Respecting I had the students play a spoon game. In this game, they close their eyes and spin 10 or 20 times to get dizzy. Then I ask them to walk a straight line balancing an egg on a spoon. The idea is to illustrate how alcohol alters our consciousness and coordination preventing us from doing tasks we normally can do effortlessly. The boys loved this, and they easily made the connection on their own to driving drunk. Road accidents are the number one killer in Cambodia, and alcohol accounts for more than half of traffic fatalities.

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo Cambodia

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo CambodiaMy presentation concluded with having the boys write a list of all the things they think they are good at. Anything could be on their list. Then I divided the boys into smaller groups, and had them create lists of things that they could do better together as a group. After the groups presented their lists, I guided them to see that as individuals, they have many strengths, and as a group, they have even greater strength to accomplish things in their lives. The intent was to foster greater confidence and self esteem, two qualities important to combating peer pressure. We finished with a discussion of peer pressure and its role in the abuse of alcohol.

Evan Cobb a Peace Corps Volunteer and co organizer teaching students at camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys focused on building leadership skills, raising awareness on issues of health and gender and allowed for a rare opportunity for Cambodian students from different provinces to meet and exchange ideas on how to better their communities, Takeo Cambodia
Other topics covered in sessions over the course of the camp were study skills, reproductive health and sexually transmitted diseases, domestic violence prevention and prostitution, what it means to be a man, playing sports, and how to plan for your future.

Statue by the sea side in Kep, Cambodia

The camp culminated in a field trip to the southern Cambodian beach town Kep.

Cambodian youth enjoying a crab feast at the beach in Kep part of Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys focused on building leadership skills, raising awareness on issues of health and gender and allowed for a rare opportunity for Cambodian students from different provinces to meet and exchange ideas on how to better their communities, Kep Cambodia
Here we purchased 30 Kilograms of fresh blue crabs and had them cooked up for us along with fresh fish squid, and shrimp for a seafood smorgasbord. Many of the students had never seen the ocean let alone eaten this kind of food. They were all thrilled.

Evan Miller and Andrew Smith enjoying a crab feast at the beach in Kep part of Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys focused on building leadership skills, raising awareness on issues of health and gender and allowed for a rare opportunity for Cambodian students from different provinces to meet and exchange ideas on how to better their communities, Kep Cambodia
So were the teachers.

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo Cambodia
Cambodian youth enjoying soccer at the beach in Kep part of Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys focused on building leadership skills, raising awareness on issues of health and gender and allowed for a rare opportunity for Cambodian students from different provinces to meet and exchange ideas on how to better their communities, Kep Cambodia

After lunch, we played soccer on the beach and swam in the ocean.

Camp BREW (Boys Respecting Empowered Women) educational camp for cambodian boys, Takeo Cambodia
… and of course took a nap.

Operation Pacific Angel 13-5

Wednesday, October 2, 2013

Operation Pacific Angel 13-5 US air force and Cambodian Royal Armed Forces group hoto

In August, the US Marines were at my health center doing great work.  On September 9th, 16 US Air Force airmen and 20 Royal Cambodian Armed Forces (RCAF) security personnel and engineers arrived and began work side by side at my health center. Operation Pacific Angel is a recurring joint/combined humanitarian assistance mission sponsored by US Pacific Command (USPACOM) designed to bring humanitarian civic assistance and civil-military operations to areas in need in the Pacific region, like Cambodia. The project builds medical and civil assistance capacity. I was made aware of this opportunity through the US Embassy. I spoke with my health center staff about it, and after identifying some relevant needs, I wrote a proposal to the US embassy. My health center was chosen along with two others to be a part of this Pacific Angel project.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
One of the bigger goals of this operation is to visibly express the Unites States’ commitment to Cambodia and demonstrate their continuing resolve to support international disaster and humanitarian relief efforts in the Asian region. At the local level, however the impact to my community is enormous. It brought a $35,000 upgrade to the infrastructure of my health center, improving resources and capacity to the community far beyond anything that they or I could have done on our own.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia

On August 5th, members of the Pacific Angel Team toured my site to look at the proposed work. The scope of the work was large enough that  and bids were collected to have some of the work done by a private Cambodian contractor. 

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
On August 29th, the private Cambodian contract crew arrived and work began. As all this unfolded I felt a lot like a contractor. My years of construction experience came into play. I was constantly running around acting a liason between the health center, contractors, vendors, and military personnel.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, CambodiaUpgrades to the facility included refurbishing 4 bathrooms (above), pumping 10 septic tanks, building a new larger septic tank, replacing sewer lines, and installing new handwashing sinks in several of the buildings.

The electrical service to the facility, which previously was a maze of twisted spliced wires, was entirely replaced. New poles were set with new service wire to each building meaning if a slice or wire broke it now would no longer cut electricity to the whole facility beyond the break.. Tying all the buildings into the generator was now possible providing ensured power during the frequent black outs the community suffers.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia All the buildings received attention form the electricians. Light fixtures, switches, and fans were repaired or replaced. Two old air conditioners that were installed by another foreign aid project, but never worked were repaired. 

It was great to see the US and Cambodian forces working side by side learning from each other.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia Airmen Lance Speed (above) worked with an interpreter to diagram and teach a Cambodian counterpart a more efficient way to wire light fixtures that uses less of the costly wire.

Lance’s Air National Guard unit from Idaho sponsors Cambodia, and this is his second operation in the country.

Even the local kids (left with lance) were learning and lending a hand to help out.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
The patient rooms god a good cleaning when ceramic tile was added to the walls. The tile provides a much more sanitary environment that stays cleaner for the patients.

kitchenComp
The kitchen shack was totally rebuilt providing a more sanitary place to prepare patient meals and storage.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, CambodiaMy health center delivers about 30 babies a month. Disposal of the afterbirth is the responsibility of the family. Until now that meant they either took it home in a plastic bag or buried it behind the delivery building. This project brought the construction of a new bio-hazard incinerator where patients can now burn the afterbirth.

Patients bathe with water from a cistern at the Roh Minh Health Center, Roh Minh, Ko Andet District, Takeo Provence, Cambodia This is our new patient shower (right). This was another project started by an NGO that was never finished. Our inpatients typically have family stay with them for overnight stays. If they bathe while here, they have to bathe outside next to the well and drinking water (right below). Now they at least have the option to use an actual shower.

Honestly I am not sure how well this will go over as most of the patients have never seen or used a shower. But at least they now have the option.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Above is a new red roof awning that was built over the walkway connecting two of the buildings. I call area the IV garden because of the numerous patients who often rest at the picnic tables here with their IVs. This was something the staff particularly wanted built.

IVGarden-Comp
It provides shelter from the sun on the hot days and from the monsoon rains this time of year for the staff when transporting patients and supplies back and forth between the buildings. It also made a great place to stage the patients while their rooms were being tiled. (above before and after look at the IV Garden)

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
The oldest building received the most work. This building received a new roof, celing, windows, electrical, and was totally gutted reconfiguring the rooms.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
A new infectious disease ward room for tuberculosis patients, staff rooms, and a cleaning supplies room were created. Before the health center occupied this building, it was a theater. So this remodel has not only updated the building, it has improved the efficiency of its use and patient flow dramatically.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Because the bulk of this Pacific Angels operation’s work was done at my health center, it was also chosen as the site for the final closing ceremony. The ceremony afforded an opportunity for the health center staff, and US and Cambodian forces to hang out a bit and enjoy a catered lunch togehter.

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Speeches were made, certificates and gifts of appreciation were exchanged. Generals, Majors, community dignitaries, and the Cambodian and US press were on hand. You can read two of the stories written about this operation here on the Pacific Air Forces web site and here in the Cambodian Herald

US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Beyond the obvious physical upgrades to the facility, there is and indirect benefit to my community equally as important. The work done here has been very visible. The community is talking about it, and I think it has added a lot of credibility to the health center. I think it has increased confidence and trust in the government health care system, US Air Force airmen and Royal Cambodian Armed Forces (RCAF) work side by side at the health center.in Roh Minh, Koh Andet District, Takeo Provence, Cambodiawhich is lacking generally, and will encourage people to seek care at the health center. It has also made the staff think a little bit more about their efficiency. With the reconfiguration of the one buildings in particular, the staff has improved the efficiency of the way they utilize space, and work with patients.

For me, this was a very rewarding project. I am happy I was able to facilitate it all happening. As with the Marines in August, I think I was valuable in making sure the needs of both the health center and the military personnel were met. Additionally, I think I was able to facilitate a greater cultural understanding on each side between the Americans and Cambodians.

NRichinUniformCambodiao, I did not join the Royal Cambodian Armed Forces, but the Military Police whom I got to know over the weeks while they stayed guarding the health center really wanted to see me in their uniform. It could use a little letting out.

The Marines Have Landed; Cambodia MEDEX 13.2

Wednesday, August 14, 2013

3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE)
On August 12th, 13th, and 14th, thirteen members of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, spent time with me, and the staff of my health center. They came on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange or SMEE as they like to call it. Since the Marine Corps do not actually have medical personnel, most of our guests are actually Sailors assigned to the Marines from the US Navy. It was a pleasant surprise for me to learn the US military does this kind of humanitarian work.

MEDEX ShirtFor the Marines, the purpose of their Cambodian MEDEX 13.2 is to improve interoperability, increase local medical capability and capacity, and foster goodwill while developing a medical needs assessment to plan for future exercises within this region. For my Health Center staff, it is an opportunity to share with them how the medical system works here in Cambodia, and to learn some new skills from the Marines. This opportunity came through the US Embassy who contacted all the Peace Corps Volunteers in my province. I responded with a proposal and after a site visit they selected my health center for the exercise.

Opening ceremony
Throughout the event, I acted as the liaison between the health center and the Marines. Although the Marines brought very good Khmer translators, I was often able to better clarify information flowing in both directions interpreting the cross cultural and medical perspectives needed for both the Marines, the Khmer translators, and Cambodian staff.

Group tour of health center
3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) touring the Roh Minh, Koh Andet District, Takeo Provence, CambodiaOn the morning of day one, I made introductions and gave a tour of or facility to the Marines. During the tour, I told the marines about the services we offer, and they observed the staff work, while learning about the resources my health center has, and does not have. I think the most telling comment came from one of the corpsmen who said to me, “wow, and I thought we had to work with a minimum of equipment under hard conditions”.

Angela Dougherty, Critical Care Nurse part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, CambodiaCritical Care Nurse Angela visits with a new born baby born just a few hours earlier.

After the tour, with the help of the two excellent translators the Marines brought, I facilitated a meeting with the Marine officers and my HC Director, Dr. Sera. We identified areas of medical knowledge both wanted to share and learn about. Prior to their arrival, I had spent a fair amount of time working with Lt. LaBarbera, the Company Commander coordinating and formulating a schedule, but after an on the ground look at the health center and a chance to meet with the staff, we chose to make some adjustments. Throughout this whole event, I was very impressed with the Marines willingness and flexibility to adjust the schedule.

Dr. Joe a dentist speaking about dental exam and proper care to the staff of the health center as part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Dr. Joe a dentist speaking about dental exam and proper care to the staff of the health center as part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject MatAfter Lunch, Dr. Grant the dentist gave a presentation on dental assessment. In my community, there is absolutely no dental care. This means there is very limited and incorrect basic knowledge, and no preventative check-ups. If you have a problem here, unless you can afford to go the provincial capital or Phnom Penh, you just suffer until your teeth fall out.

Health center staff listening to presentations by the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
The staff showed real interest in this presentation and asked a lot of questions. It also became clear that simple things, like how to properly brush your teeth, are things they did not know. When Dr. Grant was finished, I suggested if time permitted, he should speak again tomorrow and give a proper brushing demonstration.

Health center staff listening to presentations by the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet Di
The second presentation of the day was from Critical Care Nurse Dougherty on teamwork. For the Cambodian staff this is a brand new concept. It was a shortened presentation as the staff honestly seemed a bit bewildered and confused by the concepts. Structured teamwork with predefined roles in a crisis is just not common here, and I think the presented concepts were too abstract and un-relatable.

Emergency room doctor Lawrence teaching trauma assessment, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Emergency room doctor Lawrence teaching trauma assessment, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, CambodiaDr. Decker, an Emergency Room Physician presented next on trauma assessment. This subject is particularly valuable for the staff to learn. As a former medic, I am acutely aware through observation of the lack of knowledge the staff here has about even the basics of treating traumatic injuries. I asked Dr. Lawrence to keep to the basics, which he did presenting the introductory course they give to the Marines for field trauma assessment, stabilization, and transport. The HC staff really seemed interested, and it gave me the idea to follow this up later as a practical session.

3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) collectign information about the staff and facili
Day two started with the Marines doing a more formal inventory of the hospitals resources. They took a closer look at equipment, procedures, and spoke with the staff in each department about what resources they have, is broken, or is lacking.

Dr. Joe a dentist speaking about dental exam and proper care to the staff of the health center as part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Dr. Joe a dentist demonstrates proper brushing technique the staff of the health center as part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, CambodiaDr. Grant presented on proper tooth brushing in the afternoon. I had a stash of toothbrushes I collected from the freebees given in hotel rooms, and we passed them out as Dr. Joe spoke and showed proper brushing technique. I encouraged Dr. Grant to emphasize the need to get the young children brushing. A common belief in Cambodia is that children do not need to brush because they have baby teeth, which just fall out any way. When I told this to Dr. Grant, he was shocked.

Nary Ly is a Cambodian who achieved her PHD in the US, and now works for the US Naval Medical Research Unit (NAMRU) in Cambodia.speaking on recognizing and how to properly handle two respiratory infectious diseases that have been a problems here; severe acute respiratory syndrome (SARS) and "bird flu" or A(H5N1) a subtype of the influenza A virus. part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
Nary Ly is a Cambodian who achieved her PHD in the US, and now works for the US Naval Medical Research Unit (NAMRU) here in Cambodia. She spoke on recognizing and proper treatment for two respiratory infectious diseases that have been a problems here, severe acute respiratory syndrome (SARS) and “bird flu” or A(H5N1) a subtype of the influenza A virus.

Dr. Lawrence spaerking about non-surgical approaches to birth complications, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, CambodiaHealth center staff listening to presentations by the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, CambodiaDr. Decker finished the day with part one of a talk on non-surgical approaches to birth complications. Childbirth is one of my health centers primary services. Although we provide a higher level of care than many Cambodian health centers, they are not equipped or staffed to handle all problems, so this presentation was of great interest for them. Typically when a problematic delivery is recognized the patient is transferred in our ambulance to the referral hospital in Kirivong. This presentation focused on what to do when there is not time to send a patient on this 45-minute trip.

In the morning of day three, I joined the Marines on a tour of the Referral Hospital in Kirivong. They were interested in learning what the next higher level of care here in Cambodia is like, and what services and equipment they provide. In the afternoon, we heard part two of the non-surgical approaches to birth complications, and then it was my staff’s turn to present.

Health Center midwives demonstrating their technique for child birth when a patient has eclampsia, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
I did not want this event to be a one-way exchange of knowledge, so I arranged for our midwives to show the Marines how they  handle a delivery. This was really fun. The Staff was reluctant at first. They told me they feel that the Americans know more than they do. However, in fact, this is not at all the case. As a field medical unit, delivering babies is not what these military doctors, nurses, and corpsmen do on a daily basis. The midwives at my health center however actually do. They deliver an average of 30 babies a month. So, we all piled into the delivery room, and the Midwives put on an excellent presentation. That’s my host family sister Theray a senior Midwife on the left above and playing patient below.

Health Center midwives demonstrating their technique for child birth when a patient has eclampsia, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
They did a role-play, and acted out how they handle a delivery complication known as eclampsia. Eclampsia is an acute and life-threatening complication of pregnancy in which the delivering mother has seizures. It was great to get everyone out of their seats, have a reverse flow of information, and see them all laughing together having fun.

Health Center midwives role playing neonatel resucitation during child birth , part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange

Health Center midwives role playing neonatel resucitation during child birth , part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert ExchangeThis led into a second role-play in which Nurse Dougherty led the Cambodian staff through a role-play on neonatal resuscitation. The staff loved it when one of the male corpsmen was volunteered as the expecting mother. I was proud when it was obvious that most of the information presented, the midwives already new. The big take away for the staff was really how she had them working together as a team, understanding the need to prepare for the worst in advance, and the need to practice.

Trauma assessment nd stabilization drill with the health center staff, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exch
The teamwork. preparation, and practice concepts were carried forward in our last activity. I gathered everyone at the primary treatment area and asked Dr. Decker to run through a real time demonstration of the trauma assessment presentation he had made.

Trauma assessment nd stabilization drill with the health center staff, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exch
I then partnered our HC staff with the Marines, and had them do the drill shadowed by the Doctor and corpsmen. I wanted the staff to do this exercise and experience how important it is to have leadership, predefined roles, and see how drilling together bonds them into an efficient team in which everyone knows what to do in a crisis situation. This is exactly the approach to training I used for years as an EMT instructor.

Rich Durnan leading a Trauma assessment and stabilization drill with the health center staff, part of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exch
Finally, the HC staff did the drill on their own several times. It was super fun for everyone. Like me, Cambodians generally seem to be better hands on learners, and I think that doing this really sold the concepts of teamwork that were so intangible in Nurse Dougherty’s presentation the day before. As a follow up, I asked the staff what their thoughts on doing this drill are. They said they liked it and it was not hard. Dr. Sera, the health center director told me that he wants me to do drills like this with the staff every week.

Closing ceremony and certificate presentation at the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
No event in Cambodia would be complete without a closing ceremony. Dr. Sera made a formal thank you, and the Marines presented him and the health center with a framed copy of the group photo you see at the top of this post. Staff members also each received a certificate for their participation.

Closing ceremony and certificate presentation at the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
The hope is for the Marines to return at some point in the future, further build capacity at this health center, and serve the community with a MEDEX treatment clinic. It would be great if it happens, but already I think the primary goals of increasing local medical capability and capacity, and fostering goodwill have been achieved. Additionally, I think this has been a great cooperative effort between two US agencies, the US armed forces, and the Peace Corpse.

The staff getting photos with Lt Joe Labarbara of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange (SMEE) at the Roh Minh, Koh Andet District, Takeo Provence, Cambodia
The young women on staff getting their picture with the hansom Lt. Joe.

Sanitation Workshop

Tuesday, August 6, 2013

a 10 % bleach solution in a spray bottle for sanitizing surfaces in the health center, CambodiaIn an effort to promote good sanitation in my health center, I have been communicating messages on proper cleaning technique to my health center staff. For months now I have been promoting the use of a 10% bleach solution as a basic cleaning agent. This is a solution recommended by the US Center for Disease Control (CDC) and adopted by most health facilities in the US. Currently when cleaning occurs however, I only see moping of the floors, and it is done intermittently with only water, or water and laundry soap. I see no wiping down of surfaces before or between patients, and often see the floor, beds, and other surfaces covered with a multitude of bodily fluids.

I have had many conversations with Dr. Sera the Health Center Director about the need for more frequent cleaning and the need for using bleach. He recognizes this as a need, and expresses support for the idea, yet little has come of it. The idea of more frequent and thorough cleaning has been slow to catch on. I often hear from him (this is a paraphrase), “yes, I tell the cleaners, but they do not make much money, so what can I do?” This is a common truth in Cambodia, and it is a barrier to change. The two cleaners here, who are responsible for  cleaning 6 buildings and maintaining the grounds make about eighty dollars a month.

A few weeks ago, I was helping a mother in the exam room and her baby urinated all over the bed. Children here rarely wear diapers. There was nothing to clean it up with, and no one even seemed to notice. The next patient just came in and sat on the wet bed. The next day I brought in a rag and spray bottle I filled with the 10% bleach solution I had been talking about. I started using it between each patient to wipe down the bed.

Consultation nurse Saran cleans using a 10 % bleach solution in a spray bottle for sanitizing surfaces in the health center, Cambodia
That afternoon the Consultation Nurse Saran (above) I often work with, who is also the Assistant Health Center Director, asked me if I could get more bottles so he could have one in every room. Of course I said. My take away from this experience is that people respond slowly to spoken ideas here, but when they see or can experience an idea, it is easier to absorb. I am actually very much the same way.

Health Center staff learning how to make a 10%bleach solution for sanitation.

The next week after some slightly more aggressive prompting, I finally got the health center to buy some spray bottles and bleach. I held a small staff training workshop focusing efforts on how to mix and clean with the bleach solution. I focused the effort on the cleaning staff who have no medical training and little knowledge of disease and infection. Some of the key medical staff attended as well. We talked about why they need to use this solution, either from the spray bottle, or mixed in a bucket for mopping, whenever there is blood, urine, feces, or any other bodily fluid present. We talked a bit about infectious disease, its transmission, and the role proper cleaning with bleach plays in keeping the staff and patients healthy. I also stressed the importance of using Universal Precautions, such as gloves, masks, wearing their uniforms, and washing hands.

I still don’t see bleach is being used as often as it should, but it is getting used. It will clearly take time to create this new habit. I guess that is one good reason I will be here for another 13 months.

Election Day

Sunday, July 28, 2013

Today is Election Day in Cambodia. It is the country’s fifth general election since 1993, when the United Nations helped stage the nation’s first free polls since the 1975-79 genocidal rule of the Khmer Rouge and a subsequent period of civil war and one-party rule.

Fingers marked as a confirmation of voting in the Cambodian general election Takeo Provence, Cambodia

All of us volunteers were instructed to stay at home for our safety, which I did, but saw no problems in my village.  I will not make any commentaries or speak at all about the politics surrounding this election. There is plenty to be read on the Internet if you are interested. However, I did want to share the above picture of my family members that proudly voted today, and have the fingers to prove it.