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!
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.
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.
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.
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:
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…
…and I’ll say, Good Night!