Author: Angela

Volunteering with Speech Therapy Cambodia

When we first realised that we were actually going to do this trip I decided that I’d really like to visit some overseas Speech & Language Therapist (SLT) departments or volunteer my services somewhere along the way.

If you don’t know me then my ‘day job’ is as an Adult SLT working with people with Motor Neuron Disease (MND) and other progressive neurological conditions, as a clinical educator for SLT students and as Adult SLT Team Lead in my local hospital trust.

I knew it was important to think carefully about the reasons for volunteering, the impact and the sustainability of the volunteer person/project. Will volunteering give me a warm glow but actually have little impact on the people for whom I’m volunteering? Will there be sustainability in my involvement that will lead to long term change well after I’ve finished? If not then really I shouldn’t do it.

I had followed with interest on Twitter a Specialist SLT from Manchester who volunteered for an American Non-Governmental Organisation (NGO) working in Cambodia called Speech Therapy Cambodia (STC). She and her colleagues had carried out some training there and the focus of the NGO’s work was adult dysphagia (swallowing difficulties) – just my area of expertise.

I contacted STC, explained I was planning a trip and I would be in their area in about October or November 2019 and offered to do anything (within reason!) that would make an impact. I was really pleased that we were able to come up with a plan for a two week period involving giving lectures on ‘MND and Dysphagia’ as part of the hospital’s continuing professional development (CPD) and contributing to clinical education/competency development.

I wrote my presentation whilst we were in Vancouver and Hong Kong, and skyped with Annie and Paula, the overseas SLTs employed by STC, for revisions to ensure it was pitched at the right level and culturally sensitive. I only did a four day week for the two weeks so I didn’t feel too guilty about leaving the kids and Mike to their own devices.

It was really interesting to learn about the aims of the charity – to train Cambodian healthcare professionals (at present Doctors, Nurses and Physiotherapists) in dysphagia management at the three public hospitals in Phnom Penh, with the ultimate aims of developing a University level Speech & Language Therapy course in Cambodia to train local staff and to develop the job structures within the health system.

I shadowed Annie and Paula in the hospitals, observing supervision of their dysphagia practitioners, had many interesting discussions on the topics of clinical education and competencies, and presented on MND and Dysphagia management at all three hospitals.

The STC Assistant Veasna provided the logistics for the sessions (challenging!) and I also worked with their amazing Cambodian translator Sophy (and had some lovely lunches with her too). She translated all my slides into Cambodian and provided on the spot translation during the lectures.

I really enjoyed my two weeks there. I was really nervous on my first day and before my first presentation – which I think was a good thing. I was out of my comfort zone but it all worked out well in the end! The warm glow is certainly there.

I’d be lying if I said I didn’t do it for myself as well as part of taking a career break was to do things that I’ve been wanting to do but never usually have the time. I also benefited with some unanticipated CPD of my own as I got some practise in interpreting some specialist assessments (FEES) that we don’t have at my hospital.

Being able to contribute to professional CPD in the three public hospitals was my main impact focus before I went and that was successful with great engagement from a range of professionals. 85 attendees in total which logistically was a good number to reach there!

Equally important though turned out to be learning enough about the STC service to be able to contribute to planning ahead for clinical education and supervision, focusing priorities and really looking at practical ideas of sustainability and promoting the Cambodian service development.

I’m going to keep involved as part of a professional network being an ongoing resource for clinical or service queries and help develop competencies appropriate to the setting and level of skills being developed.

Many thanks to Speech Therapy Cambodia for the opportunity!

Hello Cambodia!

Today we left Chau Doc took a boat to Cambodia!

We were picked up from our hotel by cycle tuktuk to take us to the river where we caught our speed boat.

It was a fairly short journey to the border post where we first had to go through the Vietnamese border controls, then back on the boat for 5 minutes and then through the Cambodian border controls.

It sounds quick but all in all it took a couple of hours to get through.

Following this we spent another couple of hours on the boat until we reached Phnom Penh, the capital of Cambodia.

I wasn’t well that day and it was a bit of an ordeal for me, though I think the others quite liked the experience.

It was noticeably hotter when we got onto dry land and we had to drag our luggage up a long pier following a taxi man who had our biggest case – “follow that man Sam” I said!

It was lovely to finally reach our first stop, the Blue Corner Hotel.

Cai Rang floating market

Dawn was breaking as Mum (aka Kate, aka Grandma) and I got up extremely early one morning to meet Toby our guide who had come to take us to the floating market.

We walked through the town at 5.45am down to the river passing groups of exercisers on the park and early morning traders on the streets.

We met with our boat driver Miss Truc (pronouced ‘djuk’). It was a picturesque scene with the rising sun, passing by the water hyacinths floating in the Mekong River during our 40 minute ride to the markets.

Miss Truc created various items for us along the way using natural plant materials and shaping them into grasshopper and flower rings, bracelets and crowns! We’ve managed to send some of them home.

Farmers bring their produce to the markets and live on boats to sell it all, staying until all their goods have been sold. This could be for several months whilst the whole family live on the boats. Their boat is also their market stall.

To advertise what they are selling they put their product on a stick high above the boat – so if there are bananas above the boat then that is what they sell. Often there is more than one item shown, so it looks a little like a kebab sticking up made of sweet potato, pineapple or cabbage etc!

The market is open 24 hours a day but is busiest early in the morning.

There are smaller boats that sail around with items such as rice, coffee, and toiletries for the boat people to buy what they need.

We then sailed down a small canal off the river and Toby took us for a walk alongside the river to a noodle factory. We got to see how the local noodles are made and how colours are added to them (add beetroot to make red noodles, baby jackfruit to make orange, and bamda leaf to make green).

We then went to a local cafe on the canal for a traditional Vietnamese breakfast of pho (it was still only about 8am by this point!).

A very interesting morning!

10 days in hospital

Warning – not a light and airy post!

Martha’s skin condition got worse overnight and by the morning more skin had peeled from her face and torso with some areas crusting over. We were increasingly worried now at the rate of change and went straight to a pharmacist first thing as planned and then almost straight on to a doctors from there.

There are many doctor’s practices in Hong Kong and you can make an appointment on the day and pay per session. On arrival they found that Martha now had a temperature and the doctor definitely felt we should go straight to one of the hospitals for further tests.

We hopped in a taxi and went to the closest private hospital – St Paul’s Hospital – with a letter from the doctor. The set up is that you get a clinic appointment, and then the doctor will refer you on to specialists or admit you to the inpatient wards if you need to. Again, it is a pay per session system, but fairly easy to navigate.

We were seen very quickly by a generalist doctor and then by a paediatric specialist who both agreed that Martha needed to be seen at the public hospital – St Mary’s Hospital. Apparently this is a centre of excellence for skin infections so would be the best place for her to be treated. We were getting so worried about her, especially when they mentioned toxic shock syndrome as a possible diagnosis.

At this point we realised we should inform the insurance company about the medical situation and Mike was on the phone to them literally during the taxi ride over and when we were booking in at the A&E reception.

Martha’s skin was visibly worsening each hour so when we arrived at St Mary’s we were once again seen very quickly by numerous doctors, and then admitted to the paediatric ward for IV antibiotic treatment.

The thing I remember most from this day’s events was how quickly the infection progressed. By the evening Martha was in the isolation ward starting her treatment.

Only one parent was allowed in with her at once, and poor Sam wasn’t allowed in at all. I stayed the first 48 hours until there were signs of improvement and then Mike and I took it in turns to stay with her. I won’t post any photos of her but at her worst she couldn’t open her mouth or her eyes.

We passed the time by reading Harry Potter aloud to her, and that was the best thing we could have done. Once she’d had 48 hours of IV antibiotics and fluids she had definitely perked up but it would be another week of treatment before we got her home. The entire top layer of Martha’s skin had come off by the time she had completely recovered.

She’d had a bad streptococcus and staphylcoccus infection but overall Martha responded to treatment quickly – she was able to tolerate oral antibiotics after 4 days on the IV antibiotics and was moved to the general children’s ward. By then she had progressed to reading the 2nd Harry Potter by herself and was feeling much better. Martha coped amazingly well with being in hospital, in a different country, with different languages spoken.

We had been due to go to China two days after Martha was admitted but it wasn’t to be, so no Great Wall of China for us after all. In between all the worry Mike managed to find us a place to stay for two weeks instead in Causeway Bay, and our local travel agents at home (Destinations) managed to change our round the world ticket at the last moment – many thanks!

Sam was amazing throughout this time, very calm and patient. He had to sit for hours outside the ward, and never got to see Martha, though the last few days she was in she could get out of bed and wave to him from her 7th floor window when he got off the bus.

Whilst Martha was in hospital I was asked if I would help with the final year medical students exams which I was happy to do. I enjoy working with students and it took my mind off worrying. Five nervous students came in one after another and each was able to elicit pertinent case history information leading to a possible diagnosis.

They were all kind, respectful and professional, and all this in their 2nd or 3rd language – very impressive! Through discussing the case history so much I realised that we might never know exactly when the bugs got introduced into Martha’s system. It could have been an infected insect bite in her armpit or from the sea/beach into another open cut. It has made me a little bit paranoid about cuts and scrapes ever since, and we get through a lot of Germolene and plasters!

I was impressed with the Hong Kong health system, it certainly made Martha better again – but I did miss being home with the NHS.

After 10 days in hospital Martha was discharged with an oral antibiotic course to complete and a week’s worth of creams for her poor skin. I’m pleased to report that she is now fully recovered!

Illness

We’d hoped Martha would be feeling better when she awoke on Sunday but she didn’t.

She didn’t have a temperature but was itchy and part of her skin had peeled under her eye, as if it had washed off with tears. I’m posting this picture of the early signs of her illness so if it ever happens to anyone else it might help with earlier recognition.

I didn’t have a clue what it might be, we were racking our brains to link it to something that had happened recently – possibly an insect bite in her armpit on Wednesday evening for which she’d taken some Piriton, maybe sunburn without us realising before we left Canada.

We kept looking up online health sites such as The NHS website, wondering if a soothing cream or an antibiotic cream would help and wanted to ask a pharmacist.

Yesterday Mike hadn’t managed to get to a pharmacy from the hotel due to a protest march near by, and then today when we did get there we found out that the pharmacists don’t work on Sundays.

If we’d been at home we would have rung the NHS 111 service for advice and they may have directed us to the out of hours GP service at this point. I did wish I was back home with all the support of the NHS around us.

I investigated the Hong Kong health system and found that we could pay for a family practice doctor’s appointment locally – we decided that we would visit the pharmacist first thing and then see a doctor in the morning.

Sunset at Kitsilano

Cousin Shirley took us to Granville Island where we caught the last serving in the food market and had an evening walk around the island. On the way back through Kitsilano we saw an incredible sunset.

  • Silo Giants, Granville Island
  • Looking along False Creek
  • Sunset over Kitsilano