A new life?
on Oly's Cambodia Blog (Cambodia), 14/Sep/2011 22:06, 34 days ago
Betweenus, Katja and I volunteered for over 4 years in Cambodia.  We wanted to do something, howevermodest, to help people less fortunate than ourselves to have new, better lives.Finewords, but not always easy in practice! Inmy remote village of Thmar Puok, the director asked me to help breathe new lifeinto his hospital, which had gently drifted since it was cobbled together inthe aftermath of the Khmer Rouge nearly 30 years ago.  I offered to help them to improve the care they offered topatients by using a quality improvement system in their ward ordepartment. Happily,the tool we used was not imposed by well-meaning outsiders, but was developedby 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 ofgood practice. Anotherbenefit of this approach is that - unusually for hospitals - we could actuallymeasure improvements.  We agreedthe present situation for equipment, documentation, hygiene, and patients’views of their care.  These scorescould be compared over time, or at one point between wards (healthycompetition!).  Where scores werehigh we gave praise, and where not we focused on improving things - a manager’sdream!Itwasn’t perfect:  some of thescoring was strange, like getting hygiene points simply for toilets beingunlocked, or for having a ward free of motorbikes.  And some staff‘played the system’ - from giving their warda rare clean just before the inspectors arrived, to making up documentationsuch as vital signs and medical notes in retrospect (it’s called fraud where Icome from).Butif staff were playing, so were we - it was a‘percentage game’, with at leastsome of the improvements made in advance of the assessment continuingafterwards.  Some thingsjust dropped back to their original level - even basics like turning up forwork, 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 wonderfulstaff-led carer education sessions, which continue every Tuesday morning.Iwould have preferred that staff enhanced care through a sense of empathy orprofessional pride.  But if in factthey made things better because they liked to get points, look good or avoidgetting into trouble– well, so be it. The fact is, things still improved for patients.Appropriatelyfor our planned renaissance, the best progress was in obstetrics. The midwiveswere the most receptive of all staff, and this year they agreed to be assessedagainst tougher (‘level 2’) standards. They did really well– despite having a shabby old ward they kept itclean, maintained decent records, and gave a good quality of care to mothersand their newborn babies.Thiswas particularly pleasing as maternal health is (in theory at least) the keyfocus 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 thepoorest people in a poor country, what better way than helping to bring babiesinto 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 ourown.  Katja returned first to theUK, to continue the theme of re-birth by starting two years further training tobe a midwife herself.  The mainreason she gives for taking on this tough extra study is not just that sheloves babies, but also that she feels this is the best way she can help poorpeople in the future.  Now you cansee why I admire her so much!Andfor me too a new life was beckoning: the prospect of discovering Oxford, possibly changing job or evencareer.  Importantly, I also hopedI would have a novel perspective on things– a better work-life balance, acalmer outlook, a clearer focus on what is important.  And, of course, I would be setting up home with the new loveof my life - a wonderful, totally unexpected bonus of volunteering!Andso to my punchline.  At this pointI had planned to make a happy announcement– of one more new life. Arounda month before she returned to start studying, Katja and I found that she waspregnant.  We were so happy andexcited– this really did mean that a new life would await us back in the UK. Icouldn’t believe it: “I’m going tobe a daddy!” I chanted.  The thrillof the return home was enhanced by debating when and how to make theannouncement, where to live, what marque of superbuggy to covet.  Most difficult of all was names.  Oliver was firmly at number one in theUK baby charts: what good taste parents have.  And these days there is also the issue of the surname, whichpresented a unique challenge for us– would we really risk condemning ouroffspring to a life of ridicule by imposing the easily mispronounced ‘Horsch-Shipp’?Butit wasn’t to be.  Sadly, afterthree months Katja rang me distraught to say she’d had a heavy bleed.  After dashing to the emergencyobsterics unit and a further scan it was confirmed she had suffered amiscarriage. Assuddenly as it had started, our dream was over.  Of course I rushed home, and am writing this in the day unitat Oxford’s John Radcliffe hospital, waiting for Katja to return from heroperation, a coldly clinical ‘evacuation of retained products ofconception’.  The physical evidencewill soon be gone, and all that will remain are our dreams of what might havebeen.Itwould always have taken us time for us to adjust to our return in the UK.  Now, with this wretched, unexpected twist, it maytake even longer.  But I honestlyfeel that if we can survive two years in the most rural corners of a developingcountry, then we will have the strength to recover and move on. Justas we tried to give help and hope of a better future to others in Cambodia, Ibelieve that we too will enjoy and embrace our new life.