Friday, 11 December 2015

Nursing in Siem Reap: Mountains, zip-lines and giant buddha statues

COUNTRY: Cambodia
PROJECT: Nursing - Murdoch University
WRITTEN BY: Melissa Williams and Peter Footer

So here we all are – we have made it to the end of week two of our International Placement. Well done to everyone involved – the very important support crew back home in Australia, our amazing preceptors in Cambodia, our Siem Reap based partners and translators, and most importantly our little team of Aussie nursing students here in Siem Reap.

Sou Sdei and Ter nak sok sa bay te? (hello and how are you?)

Last weekend we took a trip to Phnom Kulen National Park. We set off in our van with our trusty transport driver and translator and began our journey to the top of the mountain. Kulin Mountain is 487 metres high and the summit has only been able to be reached by car since 1999. This is when a private businessman built the current winding road up to the summit. This same businessman now charges US$20 per foreign visitor to use said road – hence I suspect he has well and truly made his money back (plus some) by now. The journey to the top takes at least 2 hours and due to the narrowness of the road, it is only possible to ascend prior to 11am and descend after midday – it seems some logical order does exist in this beautiful country.

Kulen Mountain is situated in the north-eastern corner of the Angkor Complex and is considered to be the most sacred mountain in Cambodia by the Khmer people. It is said that this is where King Jayavaraman II declared himself as god king and announced independence from Java in 802 AD. Even at the top of a mountain of this size and ruggedness there are the remains of 56 Angkorian temples – most in bad condition, however one remains named Hahendrapura. We were a little templed–out by this stage, after our epic day visiting temples on Thursday, so we opted to travel to the summit of the mountain to visit a Buddha Pagoda. It contains an 8-metre long reclining Buddha statue, carved into a sandstone block dating back to the 16th century. In Australia I highly doubt you would be allowed to get anywhere near to such an amazing piece of history, however in this neck of the woods there is a boardwalk built around the statue, and worshipers rub Buddha and leave offerings.

Following this, we travelled a short distance back down the mountain to a river where there are carvings dating back to 12th century AD. It was then that monks carried heavy carving tools up these hills to carve the thousand Lingas and other bas-relief images of Hindu gods and goddesses into the riverbed and surrounding rock face’s. The carvings are known as Lingas and are phallic symbols, and the flow of the river over them sanctifies the water. This sanctified water continues down the Kbal Spean River through Angkor Wat and eventually becomes a tributary feeding into Tonle Sap Lake, Cambodia’s biggest lake.

After this we travelled a little further down the mountain to Kulen Waterfall. What an amazing place to visit, with many Monk, tourist and local doing the same thing on this day. Following a very steep decent down stairs that would hardly qualify in Australia, we reached a beautiful bathing spot where a few of the crew stripped down to their shorts and t-shirts (no bathing suits here sorry) and enjoyed the refreshing fresh flowing sanctified water. Meanwhile myself and another crew member basked and frolicked on the big granite boulders admiring the beautiful scenery and hundreds of butterflies that were sipping on the minerals found in the waterfall.

After the cool off we headed back up the many, many, many stairs where we sat in a quaint little pagoda and were served a fresh home cooked meal. You see, in Cambodia, you blink and then all of a sudden there is a feast fit for a king placed in front of you for you to enjoy.

Following our busy weekend we commenced week two by integrating with some of the local population on the outskirts of Siem Reap as we began working in both Regional Hospital Station 4 and the Bakong Health Clinic. The group was split into two with one group spending the majority of this week at the hospital and the other at the clinic.

At the hospital there were approximately 15 in-patients. Due to the difference in roles and standards between Cambodian and Australian nurses, it is not appropriate for us to administer medication, however following on from the Doctor’s rounds our preceptor wasted no time identifying plenty of opportunities to put our assessment skills to the test on very willing and interested patients. Nursing care in Australia is very different compared to what occurs in this Cambodian hospital, in particular the patients’ family room in with them and take care of all their cooking, cleaning and ADL (activities of daily living) needs.

Due to the rooming in of families, by the end of the week we had a gaggle of gorgeous children following our every move as they became more confident with our presence. As part of our health education aims, we used impromptu opportunities to teach these children hand-washing skills and continued to teach them basic English words. We also gave them some balls to play with and taught them to catch (with their eyes open) and we even showed them how to play a new game – Tunnelball. Highlights at the hospital included a neurologically deteriorating patient whom through our fundraising efforts could be sent to a private clinic to receive a much need diagnostic CT scan, as well as an emergency admission who had been hit by a car. We also completed assessments on patients with heart valve deficiency, pneumonia, alcohol withdrawal, abdominal illness and diabetes.

Meanwhile, Peter one of the members in the group working at the clinic had this to say about his teams’ week…Working in the clinic has been a great experience full of opportunities to experience cultural exchange from both sides. With fewer resources in comparison to Australia, extremely competent nurses run the medical team. The clinic operates similarly to both an Australian General Practice and an Emergency Department, with one ambulance to transfer patients if an emergency occurs. The clinic offers a great opportunity to demonstrate nursing assessments to other staff as well as primary health care such as dental and hand hygiene. Highlights include experiencing a newborn assessment, the diagnoses and treatment of Tuberculosis and teaching children how to brush teeth.

Everyday we are taken on a much-needed rest for lunch and an afternoon siesta. This two hour break is commonplace in Cambodia (needed to deal with the stifling humidity) and most of the clinic staff use this time to go home and cook themselves lunch. After lunch the clinic spends most of its time preparing for the next day, and with very few patients attending in the afternoons, we generally use this time as an opportunity to present case studies and assessments to each other as way to continue our education.

During our down time, Siem Reap offers many things to do – from temples to pubs. One personal highlight for me this week was flying 50 meters high in the air with the zip–line company Flight of the Gibbons. Although rather expensive at US$120 – and we did not actually see a gibbon – the experience was exhilarating, offering a break from the organised chaos of traffic and markets that is in the city area.

So that sees the end of week two and it is hard to believe that this time next week our job here will be done and we will be reunited with our beautiful families and friends. So, until then…

Le Hi and Ah Kun Chrian (goodbye, and thank you very much).

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