COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Nutrition
WRITTEN BY: Kirsten Swan
Last weekend was quite eventful: most of the group visited Phnom Penh, while some of us stayed here in Siem Reap to visit the Wat Preah Prom Rath Pagoda, enjoyed a village cooking class and participated in a traditional Khmer pottery lesson.
It was fantastic to learn some delicious traditional Khmer dishes which incorporated some techniques many often take for granted in Australia (utilising gadgets to do the labour), making a curry paste with a mortar and pestle and creating a coconut and black sesame tuile on a hot flat iron followed by hand-rolling/curling to make pretty shapes. We found this lesson very interesting: adding to our understanding of Khmer cuisine and culture, as we were also taken to a village family home, where we were taught about some of the common ingredients and crops, customs and cooking methods (this was valuable, to assist us in ensuring our recommendations to patients are appropriate).
Our placement fell on the Water Festival celebratory public-holiday period (24 to 26 November 2015) so we had a very short working week, working Monday and Friday only. We left for our respective sites and, similar to late last week, we found that due to the Water Festival many patients did not present for their appointments or to the walk-in clinics.
We have noted that the clinical presentation at the CDA has been a mixture of newly diagnosed and chronic type 2 diabetes patients – often with comorbidities, mostly frequent hypoglycaemic episodes, hypertension and peripheral vascular damage. Many of the people presenting to the diabetes clinic have been older than 50 years of age. We have been careful to make sure our recommendations are cost effective and meaningful to the patient.
These recommendations have commonly included:
• Discouragement of salt/MSG in cooking (utilising spices and herbs as a replacement), in light of management of hypertension. Decreasing amounts of oil utilised for cooking; promotion of olive oil and canola oil as healthier oils for heart health, instead of vegetable oil blends or other fats that may contain atherorgenic properties.
• Increasing meat/fish/vegetable portion in meals (for fibre, satiety and protein)
• Up to one small bowl(approximately 1 metric cup) of rice/noodle at each meal (many patients were eating much more than this!) to aid in ensuring even carbohydrate distribution across the day
• Consumption of regular meals (fruit, nuts, eggs as snacks) for glycaemic control and sustained energy for working
• If patients are to be exercising, they are to try and carry some quick-acting carbohydrate with them or have a small snack prior to going (in light of increased risk of hypoglycaemia)
We have also spent time developing some sustainable resources for the CDA, when the clinics are not-so-busy: in collaboration with the physiotherapy students, we developed a diabetes management booklet which encompasses physical activity and healthy eating, as well as some informative posters which incorporate dietary messages regarding the management of hypertension and diabetes (these are focused on improving staff knowledge).
Throughout our home visits at the MHDC, we have been presented with a number of challenges and a broad range of interesting conditions. Some of these challenges have included patient’s lack of access to a clean water supply, financial constraints which place burden on the ability to afford fresh healthy food and inability to safely store fresh food due to living situation. This has meant our health messages have been very basic and incorporated how to keep food and water safe, hand and dental hygiene as well as adapted simple nutrition messages. Due to the broad range of conditions we have seen, our nutrition messages have been ranged from how to incorporate a high-energy high-protein diet (for malnourished patients), to eating for health during pregnancy, as well as how to manage conditions such as diabetes, hypertension, heart failure and stroke.
We have also noted that on home visits, many people are anxious to eat vegetables from the market, as they believe it is unsafe to consume the chemicals used to keep them fresh during transport, we have therefore reinforced food safety messages such as washing food in filtered or boiled water before cooking, and to ensure food is cooked all the way through to ensure any harmful organisms are killed.
At the school visits in the mornings we have been focusing on simple health promotion messages:
• Grains and cereals for energy to play and focus
• Proteins for growth, repair and strength to play and work
• Dairy, leafy greens and fish for healthy bones and dental health
• Fruit and vegetables for keeping well, skin, hair and eye health
• Exercise for overall health, strength, focus and fun
The afternoons we have spent practising English with the students and playing games such as ‘duck, duck goose’ and ‘what’s the time Mr Wolf’. We have generally been asking what aspect of English they would like to practice and their response is usually animals, numbers and body parts. To conclude each English lesson the kids love to play ‘hangman’.
The first day of the Water Festival we joined Cath and Lesley for an afternoon tour of the floating villages of Lake Tonle Sap, this was amazing to see and learn about another interesting way of life in Cambodia. It was a great effort to get the boat out of the mooring: we were bogged in the sandbank on the way out and nearly on the way back in.
Our skilled, young drivers managed to get us out of trouble both times, despite damaging a propeller connection in the process (which I’m sure would be promptly fixed for the next day!) We saw everything from floating grocery stores, chicken coops to fish and crocodile farms. Our guide explained that there are three poverty levels: the highest are likely to be “middle men” who sell food, and the lowest being those who directly catch the food, he also noted that solar panels and car batteries are utilised to power black and white televisions in many of the village homes. It was also interesting the find out that the water people use to bath, swim and go to the toilet in, is the same as what they use to drink and cook with. We were lucky enough to get the chance to ride in some questionable-looking canoes, which provided us with an opportunity to gain a closer look at the village homes, which these families move 3 times per year!
As part of the Water Festival (Bon Om Touk) celebration along the Siem Reap river, engaging in lots of dancing to some traditional music ranging from slow progressive music where you dance in a circle, to very rhythmic fast-paced music. We walked along the river after having devoured a fantastic $1 tapas menu from Sonia Moria hotel, finding food and promotional stalls as well as watching the children float tributes in the water, it was great to see. Some of the traditions surrounding the Water Festival were explained to us including meaning behind the gifts given to the Monks and the Pagoda, as well as the tributes placed along the water and traditional celebratory events such as Bandaet Pratip and Sampeah Preah Khae. We tried some Ak Ambok, which was tasty but a little too dry without the coconut and banana. Overall, it was a lovely experience to be in Siem Reap for Bon Om Touk.
It is a fantastic compliment when, after only three weeks here, some local store owners commend our Khmer accents, asking how long we have lived here! We are looking forward to our final week here, and will be very sad to leave.
