Life with the elephants and refugees from Myanmar

In northern Thailand refugees from Myanmar (formerly Burma), a country but a Sorng-taa-ou ride away, are at significant risk of trafficking.

 

Many people associate trafficking exclusively with sex-trafficking but that is just one part of the exploitation and abuse that can occur in this region and others around the world. We must not forget that a significant number of people the world over are trafficked for forced labour, domestic servitude, forced marriages and for other economic, and non-economic, reasons as well as for sex.

 

The presence of dispute in Myanmar so close to this region of Thailand means that people who are displaced from their homes or who are without money or who are separated from families can all be exploited by unscrupulous people unless strategies are put in place to protect, empower and educate them. Added to this are the hill tribes people with their traditional cultures whose traditions and potentially children, without protection, will disappear. These marginalised ethnic minority people live in villages far from Thailand’s urban centres. Isolated and remote, they often lack clean water, electricity and access to healthcare and education.

 

This week I’ve been joined by Den Carter, SicKids Head of Communications (for the avoidance of doubt, at personal expense) where we have been learning about strategies to protect vulnerable children and women from exploitation as well as learning about eco-tourism and how responsible visitors can help enhance the lives of the ethnic minority women, the hill tribes people and the elephants in association with whom they live.

 

We’re staying in a project that is set up to empower, employ and educate Burmese refugees. The project, which is a social development organisation, provides a safe-house, free education and paid vocational training for ethnic minority women at risk of trafficking. The mission of the project is to help these women – all of whom have fled ethnic persecution, political unrest and violent disputes in Myanmar – into the rapidly growing hospitality industry here in northern Thailand. The women learn to read and write, catering, how to manage a guest house and English.

 

The project supports an organisation called Daughters Rising that aims to prevent trafficking and exploitation through empowerment, employment and education.

 

By empowering at-risk girls through free education, they learn computer skills, confidence, women’s rights and health in a peer-support environment. Staying in school results in more earning power and the possibility to provide a better scaffold for the rest of the community to avoid the exploitation, abuse and trafficking that would otherwise prey upon them.

 

By employing women artisans through a community development shop and by buying their handmade crafts at a fair price, with investment of the proceeds back into the next generation of young women, their communities can develop and still maintain the all-important traditional roots that might other wise be snatched away.

 

By educating at-risk populations about the signs and dangers of trafficking, through out-reach programmes, and by using social media to raise awareness of trafficking here and throughout the world, it is hoped that, over time, the combination of efforts will enable these wonderful communities, with a rich history and fantastic diversity, to flourish safely once more.

 

The project also shares property with a Thai family-owned elephant camp where a family of 12 elephants live in the jungle around us. Sadly, the growth in elephant tourism often fails to foster a sense of mutual understanding and respect between elephants and humans – instead focussing on “elephant chair riding” and “elephant shows”.

 

What we’ve been doing is very different.

Grandma

 

We awoke at 06:00 to be down by the river by 06:30 for a walk into the Jungle with the elephants. Actually, that’s not quite true – we awoke at 1am, 3am, 4.16am and countless other times where I couldn’t face looking at the clock, to the sound of a somewhat time-confused rooster, but that was all put behind me once I met Watermelon (aged 2 years and 5 months), her Mother (aged 27 years), her Grandmother (aged 45 years) and her cousin, Dee-Dee (aged 5 years).

DeeDee

We spend the day in an early morning walk, with the elephants, through the mist rising out of the Jungle then went down to the river with them as they bathed (and bathed us too!). After a hearty local Thai breakfast we hiked up into the Jungle with one of the local people who took great delight in showing us his village and the traditions that stem from it – including cooking us a really lovely lunch over a campfire. In the afternoon we floated gently back down the river, on bamboo rafts, where we were able to spend the time before dinner with Dee-Dee who was playing in the river. An all together memorable experience and so much better than the bus loads of tourists who, throughout the day, have sadly turned up for painful metal chair-rides on the back of these poor elephants.

Nellie Track

By staying here in this project we’ve been able to spend the days getting to know these beautiful animals in a respectful and positive way. These animals would not survive in the wild on their own at the moment – at risk of poaching for their ivory and capture by people who would exploit them, for the present time they are safer living here in this camp in the forest. By bathing with them in the river, by sitting quietly with them watching them go about their daily business in the bamboo scrub and forest around us and by only riding them bareback through the jungle, and only then if they are content to do so, I’ve seen how intelligent these animals are and how, with the right interaction with humans, they have nothing to be afraid of and, although I am no vet, appear to positively enjoy the attention, the space and the interaction in measured doses.

AGR and Nellie.jpg

All too often elephants in this area are subjected to bull hooks, heavy metal chairs, painful tusk removal and a 14 hour workday parading tourists around. With little time to eat, baking hot conditions, and exhausting hours, this cannot be a good life for these wonderful animals.

 

Elephants are forced to live like this because of the tourism industry’s demand for cheap rides and photo opportunities but by changing the demand the abuse can be ended.

Vista

The project here aims to create a peaceful home for the elephants where they spend their days grazing in the bamboo forest, cooling down with baths in the river and going for leisurely walks in the jungle. It aims to change the tourist demand for cruel and outdated elephant exploitation so that the animals can, once again, be fully respected as the wise and graceful pachyderms that they are.

 

The striking similarities between the fate of the elephants a few metres away from where I’m sat typing this in my tree house and the fate that would have faced the women who are a few metres the other side of that tree house are not lost on me. I can’t help but think of the similarities between the project needed to change the way that communities and visitors here view elephants, and the project needed both here and back at home in the UK to change the way that communities view children and young people who live within them.

 

Projects like this one that I’m staying at will genuinely help to empower and educate people who would otherwise have an almost certain fate including trafficking and exploitation.

English Lesson

I only hope that the fate of the elephants can also be secured in the future so that these intelligent, majestic and beautiful creatures can live the long lives they were intended to live, content in their natural surroundings, with mutual respect and understanding between them, their mahoots and the other humans that might come into contact with them.

Myanmar

With big smiles from our host Nookun (who came here from Myanmar 8 weeks ago) and snorts (at least I think they were snorts) from the elephants in the darkness behind me, I bid you good night!

 

Life on the Beach: To some people this beach is an idyllic place to sit and watch the sun go down. To others it is their home.

“Working with vulnerable children, youth, their families and their community”

That is the new strapline that the Board of M’Lop Tapang approved today. It was a great honour for me when I was asked to be a member of the Board of Directors of this social development organisation as the work that they do in terms of education, social care, healthcare and child protection is amazing.

The Board meeting was an opportunity for us to review progress over the last six months and to plan out the coming year for the organisation.

I’m going to use this article to highlight some of the work that M’Lop Tapang has been doing recently.

The organisation was originally set up to work with street-living and street-working children in Southern Cambodia many of whom lived on streets and beaches around Sihanoukville, at risk of adverse health and abuse of all types.

Sunset photo

Over the past 12 years the organisation has transformed the lives of children, young people and families in the Sihanoukville area to give them all a better start in life, better education, better health, better employment options and better protection from harm.

Summary of activities

M’Lop Tapang works with over 4500 vulnerable children & young people and over 1500 families in Cambodia.

Outreach programme

Between January & October 2015 the M’Lop Tapang outreach programme supported 2729 children and young people and 1530 families.

Education

Between January & October 2015 M’Lop Tapang reached 2230 children and young people through educational programmes. 440 children & young people now participate in arts activities and over 300 engage in organised sports activities.

Healthcare

Between January & October 2015 M’Lop Tapang’s fantastic medical team delivered care to 4258 children and 549 adults. The outreach team have provided 1464 treatments during their visits to rural and urban communities.

Night shelters

Between January & October 2015 M’Lop Tapang has had 39 boys and 27 girls using their night shelters. These are children who would otherwise have slept on a street or beach or who would have been subject to all forms of abuse overnight.

Child Safe

M’Lop Tapang has trained and certified 997 ChildSafe members. I really want a ChildSafeUK pilot to happen!

Vocational training

100% of the students in the vocational training programmes secure employment – this is a fantastic achievement!

Prisons

M’Lop Tapang works with around 200 children and young people who are in prisons in Southern Cambodia. The health problems for them are significant and there has to be a better way of rehabilitating these young people, some of whom even officials acknowledge are innocent of the crimes they are accused of, other than incarceration.

Colleagues

There are 195 Khmer staff colleagues and 3 foreign/international colleagues working at M’Lop Tapang:

Staff

The achievements of all of these individuals, and collectively as a team, are stunning.

It was during the Board meeting that news of the awful attacks in Paris started to come through. News of attacks in a Cambodian restaurant in Paris and of the atrocities that had taken place overnight were the source of reflection and concern from Board members.

FRANCE

I don’t intend to turn this into a political blog but I will say this:

The devastating attacks and terrible loss of life in Paris, and also in other parts of the world, have no place in our global society. It is education, mutual respect and acceptance of our multi-faceted society that have the greatest chance of changing our communities so that people can live together in peace and understanding. I am saddened by the terrible loss of life in Paris and elsewhere. That is not how human beings, wherever they exist and whatever their beliefs, should behave and such violence can only be destructive to society, including the society that those people who carry out such attrocities are seeking to achieve. My thoughts are with all of those caught up in recent attacks, their families and their friends.

Following the Board meeting the members of the Board and Senior Staff of M’Lop Tapang had lunch at the Holy Cow restaurant after which some members of the Board went back up to Phnom Penh (5.5 to 6.5 hours away by bus) and I joined the Founding member of M’Lop Tapang, Maggie Eno MBE, and one of the other Board members, to watch the sun set over Otres Beach.

Sunset Three       Sunset Two

To some people this beach is an idyllic place to sit and watch the sun go down. To others it is their home.

The work of M’Lop Tapang is making real improvements to the lives of children, young people and their families who live in poverty, live on the streets or live on the beaches in this part of Cambodia. I can’t wait to get back here again to see the progress that I know will have occurred and to follow up the amazingly resilient children who I have seen in clinic, and on outreach visits, this week.

Good night!

Life on the Tracks

This morning was a very difficult morning in clinic. I spent the majority of the morning advocating on behalf of a very young child, with significant developmental delay, who I think is likely to have been sexually abused.

The law in Cambodia requires a forensic examination to take place in a public hospital and any other doctor’s report is not accepted as evidence of abuse by a Court. For the little child I saw this morning, that meant visits to two further healthcare facilities after having seen me, the Advanced Nurse Practitioner and the Head of Child Protection in our clinic this morning.

Cases like the one I saw today are very difficult to deal with here. We know that disabled children are at least three times more likely to be abused than children who do not have disabilities and here in Cambodia there are horrific stories of abuse occurring in sleeping patches on streets (where those people who do not have a home often rest). Children who have gross motor delay and cannot mobilise themselves can sometimes be left unattended by their parent(s) whilst they go off to try and make money. There is a significant alcohol addiction problem throughout the community and reports of serious domestic violence are common.

All of these factors compound to place children and young people living in and around those situations at significant risk of abuse of all types including trafficking, exploitation, physical abuse, neglect, emotional abuse and sexual abuse. Just like my patient this morning.

Once a plan had been put into place to treat this child and to ensure the necessary child protection measures were used, I spent the rest of the morning in a research meeting and writing referral letters and case summaries for patients I’ve seen this week. I’m looking forward to getting updates during our monthly Skype clinics when I get back to the UK.

The Medical Team here are simply fantastic. I absolutely love working with them as their thirst for knowledge and their enthusiasm for teaching makes this partnership we have set up a truly bi-directional one.

This afternoon I joined the Outreach Team’s mobile medical clinic to Pepper Farm. A lovely sounding place, one might imagine, but the appealing name is far from the reality that met us when we arrived. The small farming community is located right next to a railway line and has limited access to clean water with makeshift housing.

I don’t think I’ve ever been as hot (or sweaty!) in a clinic before and astute readers will realise that this necessitated a quick costume change between patients!

Life on the TracksOutreach Bus

There are significant health problems here – in both children and adults – and because it is far from the urban centre, with no transport links (the railway doesn’t count as the trains don’t stop!) the community relies heavily on visits from the mobile medical team and the mobile teachers who set up a pop-up school on a tarpaulin on the grass beside the railway.

After a comedy entrance by me – almost falling through a wooden platform that partially collapsed underneath me (to the entertainment of the villagers who had gathered) – we set to work assessing the children who were brought to see us near where the school was being held. We opened the clinic on a raised platform beside the railway track and managed to see a couple of patients before a, thankfully short-lived, storm arrived and deposited a large quantity of water from the sky. Better known as it chucked it down.

OUTREACH ANDREW

The medical team are used to such changes in weather and before more than a few drops of water had landed on us the entire clinic was moved into the doorway of a house where the community, who wanted to be seen by the medical team, all gathered.

I met an absolutely amazing group of people this afternoon. What is strikingly clear is the social support that this community give to each other. I saw dedicated parents and grandparents who wanted the best for their children, and each other, and joined together as like-minded people to help each other in any way that they could.

The children’s clinic rapidly turned into an afternoon education session – high blood pressure in adults, type II diabetes mellitus, respiratory illnesses and a number of other conditions were all talked about in the group that had formed in the doorway and I got a real sense that the people there wanted to know as much as they could about the different diseases that might affect them, and their children, and what they could do about these. The Advanced Nurse Practitioner who leads the medical team at M’Lop Tapang is really skilled at engaging the community in exactly the right way to give the information they want and to do this in a kind but firm way. Encouraging people to be empowered to do everything they can to look after themselves, and to prevent illness development or progression is crucially important when there is a lack of easily accessible healthcare.

Happy Women

As each child was seen and assessed the children moved back to the lesson with their teachers – including an impromptu Physical Education lesson (of balancing techniques – using the railway line as bars). Thank goodness the village elders knew the train timetable!

With a lack of access to many investigations, it is traditional medical skills that have to be relied on here (proper histories and as good as an examination as is possible given the environmental limitations) rather than fancy tests.

Outreach TeamYellow Andrew

About 50 metres from the railway line, the other side of some trees, the farming community blends seamlessly into a quiet beach, with houses set amongst the trees. A walk along the beach and back through the housing area showed me how the community have had to adapt to their lack of a readily available source of clean water and how everyone has had to work together to build houses that have the best possible chance of withstanding the rainy season – although I suspect that M’Lop Tapang will be busy repairing roofs again next year before the rains arrive once more!

This evening, back in Sihanoukville, we held a dinner to thank the Team Leaders at M’Lop Tapang for their work over the last six months and I had an opportunity to socialise with the other Board Members in preparation for our Board of Directors meeting tomorrow.

You can see a few more photographs from today and this evening on Twitter so do click through to these links (and follow both @DrAndrewRowland and @SicKidsUK) to see more:

https://twitter.com/DrAndrewRowland

https://twitter.com/SicKidsUK

The food was lovely and made even better by the fact that it is a training restaurant where students from M’Lop Tapang and elsewhere in Sihanoukville town undertake a professional catering training course to equip them with skills that will be useful to them in the future (both domestically and in seeking employment within the catering and hospitality industry).

I’m now back where I am staying – just about used to the heat but still thankful for a fan!

It is time for sleep now before tomorrow’s Board Meeting so I’ll leave you with a picture of the beach beside the farming community I visited today…

Sunset Boat

…and I’ll say, Good Night!

Where would you go if you had nowhere else to go?

A situation that people would not voluntarily place themselves in.

Children and young people who live in areas remote from the town often don’t engage with education even if transport were to be provided for them. That is where the outreach education team comes into its own. Mobile in a camper van the M’Lop Tapang education team can access the jungle areas set away from the town where children living in the remote village communities can access an education without needing to get to the main centre.

Jungle School

A similar system exists for those children and young people who are living in urban areas and either can’t or won’t engage with the schools that are provided in the town. These children and young people are often living in desperately poor conditions and by the very nature of their living conditions are at risk of all sorts of harm – from poor education to poor health and from malnutrition to sexual and other violence against them.

The outreach school provides an education for these children; an education that is so important to the future development of the society in which they live and will live. As the late Nelson Mandela said, “education is the most powerful weapon you can use to change the world“.

IMG_9897

The children living in these and other communities around Sihanoukville are at high risk of turning to drug abuse or alcohol abuse – often as a means of survival or as part of an exploitative situation.

If you were a young child that had become addicted to drugs, or who had been given or taken drugs and were in a situation where you did not know what to do, what would you do? A difficult question to answer I suspect as the reality-changing substances that some children and young people are addicted to here distort logical thinking so even if you believe now that you know what you would do, the tables might be turned in a very different situation.

If you had run away from an abusive situation, or you were homeless or you were without a family and you needed help, what would you do?

If you were unnecessarily ashamed about the sexual and other violence that had happened to you and you had nobody to talk to, what would you do?

If you were a child and found yourself alone on the streets or beaches at night and had no one to turn to, what would you do?

Where would you go if you had nowhere else to go?

Very soon, children and young people around Sihanoukville will have even more safe places that they can go to for help, rest, hygiene and care. The system of night-shelters where children and young people can just turn up to and receive a friendly smile, a caring and empathetic welcome and the care and attention that they need, will soon be expanded thanks to donations given to M’Lop Tapang.

Night shelterArts Centre

The last time I was here in May 2015 the foundations had just been laid out for the new night shelter, and it is great to see the walls and building now appearing, directly opposite a new building that is to become the arts and entertainment education centre. This new shelter will not only provide a safe haven for children and young people in times of desperate need, but the staff will be able to identify who might need significantly more support and who might benefit from many of the other free services that M’Lop Tapang offers in its main and other centres. When I come again next May I’m hoping the centres will be open and operational, which should be possible provided the building works get completed before the wet season starts again.

Of course it is not just girls that are at risk of abuse and exploitation so the night shelters will have different floors for boys and girls. Sadly the abuse of boys is something that not everyone believes in or understands and the work that has been done here in Cambodia shows that the abuse of boys is far higher than has often been recognised in the past.

After a long day in the clinic today helping the team to write the first ever M’Lop Tapang local guide to the recognition and management of common childhood conditions in South West Cambodia, I had a lovely vegetarian dinner with an experienced researcher, Jarrett Davis, and the co-ordinator and founder of M’Lop Tapang, Maggie Eno MBE. We’ve been able to plan the next phase of a piece of work looking at the specific vulnerabilities of children and young people on the beaches of South West Cambodia and we’ll be meeting early tomorrow morning for a research seminar with some of the key staff at M’Lop Tapang.

Tomorrow afternoon I’ll be kicking off my flip-flops and putting on my hiking shoes to go out with the outreach team to a rural farming community to provide health care and advice to the children and young people, and families, who are living there and who may not have yet accessed the services in Sihanoukville itself, rather like those in this photo that we are calling “Girl Power”.

In Cambodia it is often the women who play the kay role in raising their children and taking care of their family. These women live in a remote and rural location, far away from clinics and schools, so they have an even greater responsibility to ensure their families are safe and well.

Girl Power

In a country where poverty, ill health and domestic violence are prevalent, it is vital that women and children are empowered with knowledge and confidence to ensure their families grow up feeling healthy, safe and happy.

Good night!

What do you do when a blue child walks into your clinic?

That was the problem that faced me as I sat in my clinic room at M’Lop Tapang in Cambodia today. An easy question for a Paediatric Emergency Medicine doctor you would think except not so easy to deal with here in Cambodia – especially as the child had, apparently, been blue for the last seven years.

With the loudest murmurs and most striking cardiac signs I have seen for the last 13 years, and with no access to any imaging or ultrasound machine in the clinic, I only had my clinical history and examination skills to rely on to make a diagnosis. The history was, as is common here, somewhat limited as the patient attended alone, with only the clinic and education teams to help provide the information that parent(s) usually would have done.

With a likely diagnosis of Tetralogy of Fallot, the most difficult task of the day was to work out what supportive treatment can be given in Cambodia when if the same child had presented in the UK the diagnosis would have been very likely picked up antenatally on scans or, if not, very soon after birth and certainly not seven years later. The main treatment for this condition is cardiac surgery soon after birth, or in infancy, depending on the scale of the cardiac lesion.

I was thankful that M’Lop Tapang have a dedicated and empathetic health and social care team who can support this child (photo not shown to protect confidentiality) and their family from now on. The surgery that would have been carried out in the UK is simply not available here. I don’t think I need to go into detail here about what that means for this particular child in the future except to say that there are a very large number of acute and chronic conditions in childhood with a mortality rate here significantly higher than in the UK and for the children with very serious life limiting conditions one of the most important interventions is working out who can have treatment and for whom a supportive and palliative management plan is more appropriate or the only possible course of action.

The clinical team are superb to work with here at M’Lop Tapang. Efficiently run and spotlessly clean there has been a stream of patients queuing at the door to be seen today. Some were acute unselected cases and some were specifically brought back for me to review or provide a second opinion on:

Clinic

Smiles all round during a consultation in clinic in Cambodia

It has been immensely satisfying to see a group of patients today who I last saw in May 2015. The intensive management plans that were put into place for the children with developmental delay have had striking results in under six months. From being unable to sit unsupported at the age of five years, one child can now weightbear and take a few steps with support. From having no head control and severe hypotonic at the age of eight years, another child can now sit by herself without support with independent head control. These amazing results, and a whole file of others, would not have been possible without intensive work from the Special Needs Team and Medical Team under the watchful eye of the Medical Team Manager – an Advanced Nurse Practitioner from Cambodia whom the University of Salford has recognised with the award of an Honorary Lecturer appointment.

The new guidelines for the management of acute and chronic asthma are going really well and will be further enhanced by the generous donation of some volumatic spacers by the Director of Nursing of our new charity, SicKids.

Ra

Senior Nurse Ra with one of the donated Volumatic Spacers

Work hasn’t stopped now the clinic is over; I’ve just had a quick dinner in the training restaurant and as soon as I’ve finished this update I’ve got to write some referral letters for the children I’ve seen in the clinic today who will need to travel up to the capital, Phnom Penh, or even further up to Siem Reap, for tertiary management of their conditions.

Except I won’t be able to do that until the lights come back on as we’ve just had a power cut and I’m now sat in complete darkness, with only my back-lit keyboard for light, waiting to see if the back-up generator kicks in. If not it will be a long evening…!

So for now, I’ll say រាត្រីសួស្តី.

Good night!

Outreach clinics in Cambodia

This week I’m heading back to Cambodia to M’Lop Tapang where I’ll be undertaking some clinics in the health centre, outreach clinics in the jungle, holding some research seminars and taking part in the Board of Directors meeting.

It is Independence Day in Cambodia today and I’m sat at Manchester Airport waiting for my (long) flight to Phnom Penh via Doha and Ho Chi Minh.

Cambodia Flag

I’ve got a suitcase full of guidelines printed off ready to work with the team in the health centre in Cambodia to turn them into things that are suitable to use in a healthcare system that is desperately short of resources.

We have been working with the team at M’Lop Tapang all of this year and holding regular, monthly Skype clinics which have served two purposes: bilateral exchange of education as well as support for the difficult cases that the staff have been dealing with.

Some people think that the partnership that we have set up between my Trust, my University and the social development organisation in Cambodia is a uni-directional partnership. They couldn’t be more wrong. We have a fantastic amount to learn from the health and social care staff in Cambodia, whether it is how to better recognise the children who have suffered from, and are at risk, of child sexual exploitation or how to implement guidelines in a lean way in a resource poor environment, with rapid results. Supporting the fantastic health and social care staff in Cambodia is professionally very satisfying and I’ve seen at first hand how the introduction of simple, Cambodian-specific guidelines for common conditions, such as Asthma, can have striking, and super fast, results for the children and young people they are applied to.

The launch of my our charity, SicKids, now registered with the Charity Commission will help to support work with the health team in Cambodia (all of whom are working tirelessly to improve the situation for children and young people in the South West of the country), as well as supporting more local projects in the North West of England.

SicKids is currently trying to raise money to further develop the monthly Skype clinics with the team in Cambodia and to be able to provide a Sensory Room to help support the health and development of children and young people with learning difficulties, disabilities and developmental delay.

If you think you could help us this Christmas, have a look at this link to see how you can provide support without any additional cost to yourself:

http://www.easyfundraising.org.uk/causes/sickids/?t=Easyfundraising-li&v=a&u=V6RWKU&=

Alternatively, if you would like to make a donation to our work, please have a look here.

http://sickids.co.uk/projects-2.html

Its time to board now, so I’ll hopefully be send a few updates or tweets during the week.

I can’t wait to get started as soon as I arrive!

Clinic