Final Bittersweet days in Cambodia

After a fantastic break in Siem Reap, everyone returned to Phnom Penh ready to complete the last week of clinic to the best of their ability. With only two days remaining at the PIO school and with many students feeling unwell or run down, we really had to come together as a team to complete as many students as possible in our short time. At the completion of our week at PIO, we had seen over 280 students.

It was incredible to see the fantastic effects of SDF (silver fluoride) during this time, with the students who were in year 3 or above, having minimal caries and evident areas of arrested caries as a result of their six monthly fluoride applications and regular screening. It was so encouraging to see that the efforts of the One2One charitable trust and Dr. Bethy’s PhD research was really benefiting the children in this area and those attending PIO.

To complete our placement at the school, each child was provided with a toothbrush, a tube of toothpaste and a bar of soap. As we handed these out through several classes, the children were overjoyed to be receiving something that they could call their own. It was a sad goodbye on this day, as we had all began really enjoying visiting the beautiful children who attended PIO.

The following day we began our three-day rural placement. Once again the Phnom Penh traffic was a huge shock to us, as it took 2 hours to travel just 40kms to ‘Le Refuge’ in Oudong. 

The bus arrived at a beautiful garden, where children were playing on the grass or on the playground. We were greeted by Dr Saram, the founder of ‘Le Refuge’, who gave us a tour and explained to us how the place began. Dr Saram lost his wife and children during the Khmer Rouge genocide in the 80’s, he was shot in the neck as he made his escape to the Thailand border. He miraculously survived and migrated to France, where he studied to become a heart surgeon. After living in France for some time, Dr Saram returned to his home nation to give back to his people. He moved to Phnom Penh and started working in a hospital, before noticing that many of his patients were from the region of Oudong. This motivated him to open an out-patient clinic in Oudong, so his patients did not have to stay in Phnom Penh far away from their families and homes during their recovery time.

With funding from his friends and colleagues in France, he continued expanding ‘Le Refuge’ to house up to 25 children who did not have parents or whose parents had moved for work. He provides these children with shelter, clothing, education and food. He also provides every child in Oudong lunch three times a week. 

Through the ten years of ‘Le Refuge’ it had expanded to also include a dental clinic and optometry clinic. As dentists from Phnom Penh only regularly visit on weekends to volunteer at ‘Le Refuge’ the children were rarely seen, as they would be working or helping their parents. Dr Saram’s story was truly inspirational, and we all felt motivated to see the children of Oudong as they had no access to dental care.

The next three days we screened 80 children at ‘Le Refuge’, providing fluoride applications and fissure sealants. It was quite challenging, with so many children to see in only three days, we really had to come together as a team to practice efficiently in this fast paced clinic with minimal supplies. 

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Days were long, having 11 hour days from the time we would leave the hotel to the time we would return home, and our energy levels were running low, however our motivation was high. Knowing these children’s access to care was rare, we all came together to help each other and work harder when students were unwell. It did become overwhelming at stages, when we couldn’t address the child’s immediate needs, such as pain. With the healing process being delayed due to the humidity, deciduous teeth would not be extracted unless it was necessary. While also focusing on long term preventive treatment, it did not provide us with that immediate reward. However, having applied over 200 fissure sealants and fluoride applications at Oudong, it was reassuring to know that we potentially saved 100’s of permanent teeth for the children in this area. 

After our final day at Oudong on Friday, we travelled to our Farewell dinner at FCC, a beautiful restaurant overlooking the Tonlé Sap and Mekong rivers. We shared a three course meal with three of the dental students that helped us throughout our Antipodeans placement and with our in-country partner Linda. We all exchanged gifts during our meals and exchanged stories of our experiences throughout the two and a half weeks together. It was a fantastic evening and a bittersweet end to an amazing trip.

We were all excited to head home to our families and friends but we were also very upset that the amazing experience was coming to an end. It was reassuring to know that we accomplished so much in our time in Cambodia and made a difference to almost 400 children’s lives. 18 days had flown past so quickly but it was incredible how many experiences we squeezed into our short time in Cambodia.
   

Welcome to Cambodia! Oral health placement

Walking out of the Phnom Penh International Airport at 6:30pm, a gush of 29°C heat and humidity swept over us! ‘Welcome to Cambodia’ our tour guide said as we climbed on the bus.

As we began our slow journey, the incredible amount of vehicles, scooters and tuk-tuks on the roads was overwhelming. There are so many vehicles on Phnom Penh roads that a 10km trip from the airport to our hotel took us an hour! During this trip, our tour guide explained the culture and surroundings of Phnom Penh, she explained just how poor so many Cambodians are, with the average person surviving on only $1 a day. As we arrived to our home for the next 18 days and most of us were feeling quite miserable about the circumstances of the people here, feeling as though there wasn’t much hope. 

  

The following morning, we visited ‘Friends International’ a Non-Government Organisation (NGO) that is involved in keeping children safe and encouraging education and business within Cambodia, and preventing young and old from being involved in begging, drugs, sex trafficking and homelessness. It also supports businesses that hire marginalized youth and encourage education and employment within this sub-population. 

They provided us with an educational seminar on the ‘Child Safe Movement’ and how to prevent tourism that encourages the abuse of children. We then visited the public and private dental universities of Phnom Penh. It was incredible to see how similar both universities were to home! It was impressive to see how thorough the courses are in Cambodia. Both private and public universities had a dental clinic where the public could come receive dental treatment pricing from $1. The students also have the option to provide free treatment to individuals who seem incredibly poor and require treatment.

We all felt a lot more hope after this day, seeing how many NGO’s and individuals are motivated to encourage healthy safe environments for children and to encourage safe work for everyone within the community. The Universities provided hope, seeing how dedicated and motivated students were to make a change in their community and provide incredible, vital care in their home town. 

 The third day we had tours of the Palace, the genocide museum and the killing fields. This day was emotionally draining for everyone on the trip. It’s truly heartbreaking to see how much the people of Cambodia have faced with throughout the past 50 years, and how difficult it has been to rebuild from this. With so many fundamental issues still not having been resolved within the community, it seems difficult to address dental concerns.

Access to electricity, access to clean water, basic personal hygiene, rubbish collection and public bins are still not available throughout the whole of Cambodia. Issues such as water fluoridation and tooth brushing cannot be solved when basic human needs have not been met for everyone. On our tuk-tuk home, a few of us were waving to a child who was in the car next to us. When the cute boy broke into laughter, all his upper front teeth had decay.

This was quite a shock to us at the time as this would be a rare sight in Australia. However for a child in Cambodia, by the age of 6 the average DMFT score is 9. This means that on average, by the age of 6 a child will have 9 decayed, missing or filled teeth, being almost half the teeth that they would have by this age. 

We spent the next four days at PIO (People Improvement Organisation) School that was built along a rubbish dump to support families and educate children in this area, who had turned to picking rubbish out of the dump to support themselves. In conjunction with One2One Charitable Trust, we were providing silver diamond fluoride (SDF) to the deep pits and fissures of every child within the school, while also providing ART restorations and fissure seals to high risk patients.

There are 500 children within the school that require their 6 monthly SDF application, and we are trying to get through as many as we can within our 6 days at this clinic. Having four make-shift dental chairs, using tables and chairs to create our own clinic, it was quite demanding. With no triplex, suction, light or access to all our usual equipment or materials, working within these conditions really encourages team work and being versatile.

Making our own cotton pellets from cotton balls, creating our own autoclave with a pressure cooker for sterilising, manually writing down computer notes before entering them into the computer as quick as we can with the slow Wi-Fi access, working in teams of three with one person holding the flash-light and using bins for spit buckets are only a few of the changes to our usual luxurious dental clinics. Being within these clinics really makes you appreciate just how privileged we are, and after day one we were all wishing we had our dental chairs with suction and the triplex back!  

The children, however, make every hot day rewarding, and their beautiful personalities motivated us to complete each day. By the end of the week we were all ready for our three day trip to Siem Reap to explore more of Cambodia’s history.

What I got out of my Antipodeans' Unibreak

An appreciation for my life 
I always knew we had it good in Australia, but coming back from Cambodia made me reflect on exactly how good we do have it. We are so lucky to have a government that supports health and education. Having an education is something that is truly valuable and can never be taken away from you. I realised just how fortunate we are to have access to education and have a government that supports this. I came back a more peaceful, grateful and tolerant person.

Having a government and system that upholds the rule of law is something most Australians would definitely take for granted. Having been exposed to Cambodians who have had their land taken from them and their houses bulldozed by the government with little to no compensation is devastating and a reality we will likely never face in Australia. Practicing as a lawyer in Australia is much easier and much more supported by resources, education and without the uphill battle against a corrupt system. Working in the legal system in Cambodia taught me to appreciate the Australian legal system and the value of foreign aid. 

The confidence to travel 
This trip has given me the confidence to travel the world, even on my own. Traveling overseas, somewhere you have never been with a group of people you have never met was a new and overwhelming experience. It taught me that I am much more capable on my own than I realised and that the world is my oyster! I am more eager than ever to experience the world and even go to places I previously never would have considered.

You only get out of life what you put in 
Yes, this is a cliché quote you would see on a fridge magnet or bumper sticker. And yes, this was stressed to us before we left, but I didn’t really think about it until I was almost finished my first week of placement. I noticed that those of us who enjoyed the experience the most were the ones who put everything in, who asked questions, who engaged with locals and who were optimistic and open- minded. Those who arrived with preconceptions or expectations were quickly disappointed and this tended to leave a bad taste for the rest of their trip. Going into any experience, particularly one that involved work, travel or both, it is so important not to have any expectations before hand and to just dive in! I would much rather leave exhausted than with regrets of what I should have done or said. I have always been a fairly optimistic and open-minded person but this trip showed me why this is so important to take things as they come and embrace every opportunity life throws your way.

A Day in The Life of a Law Student in Cambodia

COUNTRY: Cambodia
PROGRAM: Faculty Placement
PROJECT: Law
WRITTEN BY: Lauren Cutuli

A typical working day starts around 7am with breakfast at your hotel, followed by the bus, which takes students to their designated legal NGO for the day. We would usually spend the morning in court, either the Extraordinary Chambers in the Courts of Cambodia (ECCC), the Trial Court or the Appeals Court. At the ECCC the court provides headphones that translate Khmer to English, however in the Trials, Supreme and Appeals Court you will need a translator who is usually the staff member with the best English. 

Lunch breaks are quite long in Cambodia, around 2-3 hours! During this time some staff members will have a siesta in the office, but we would use this time to have a walk around the streets and explore. We are provided with a packed lunch but can opt to eat out which we did do several days. 

After lunch we would either have a briefing about the court and justice system in Cambodia or attend a meeting with a prosecutor, NGO or community group that provides support to clients. We were very lucky that these meetings were arranged for us to be able to ask questions and we were surprised with the honesty of their answers. Many lawyers and professionals are interested in the Australian legal system so we would also share the differences between our systems and even voice our concerns for the Cambodian legal industry.

A days work will finish somewhere between 4pm and 5:30pm, at which time our driver returns us to our hotel where we would meet with the other students on our trip to discuss our days and our plans for the evening. Depending on how early we have to be awake the next day we will all have a drink at the rooftop bar at our hotel and head out to dinner. Dinner is usually a traditional rice, noodle, soup or curry dish and, if we can fit it in, deep-fried ice cream or Nutella crepes! 

Weekends are ours to plan as we please, but we will usually always fit in a trip to one of the local markets, a tourist attraction and a big night out!

What you should know before your Antips trip!

Expect to be challenged 
For many who have never been to Southeast Asia, this trip was an eye-opener. So expect a bustling, busy city with many things to do and see, but also poverty. This may be confronting for some, but use it as a reflection to realise how lucky we are in Australia. Despite the conditions here, the locals are very friendly and happy and if you wave and smile, they will return the gesture with the biggest smile you have ever seen- especially the children.

Expect to get sick 
I am not saying it is inevitable, but expect to. That way there is no disappointment when you are and you have come prepared. Pack paracetamol, stomach flu medications, any vitamins to keep you going (I brought zinc!) and if you need to, any antihistamines or cold and flu medication you usually reach for. Within the first 4 days here in Phnom Penh, 9 out of 11 of us fell ill with stomach bugs. For those affected it was not ideal so definitely be aware of this when eating out and drinking. In saying that, the food is amazing and there are plenty of restaurants to eat at so don’t hold back. Just be careful to only drink bottled water and plenty of it!

Expect to make friends 
I was so preoccupied with the trip and working abroad that I forgot I was going to be experiencing this with a group of likeminded students. The friends I have made have definitely been one of my favourite parts of this experience so far. Remember, you are not alone and if you are feeling homesick, uneasy, or anxious it is likely that so are some of your fellow travellers so support each other. If you don’t know anyone going on your trip, don’t worry. I only knew of one other person before going and by the second day I had private jokes with everyone! You are in a group of likeminded, adventurous people so making friends is easy and will make your experience even better.

Top tips: 

• The environment here is very different to Australia so make sure you pack accordingly. Dress conservatively but also bring some casual clothes to wear on weekends away or out to dinner with the group. One of the things I regret most was packing too conservatively and being very hot. While it is recommended to respect the culture and wear clothes that sit below the knee and cover the shoulders, it is fine to wear shorts or skirts that are at the knee or just above.
• Bring USD. There is no need to bring Cambodia Riel as Cambodians prefer USD. I would recommend bringing several hundred USD and then taking more out at an ATM if needed. You will most likely have a safe box in your hotel room to store your cash but check beforehand.
   
• Bring a small bag that is secure. Be aware that pickpocketing is rife here in Cambodia so keep your belongings secure when walking the streets and do not bring your passport or large amounts of cash with you unless it is required.

Top Five Things I Got Out of My Antipodeans Abroad Unibreak in Cambodia

PROGRAM: UniBreak
PROJECT: Teaching
WRITTEN BY: Tianna Killoran

As we start to pack our bags and fly back home today (here's to hoping it all fits!), I've been doing some thinking about the amazing opportunity I have had on this trip and all the wonderful things I have gained from it. Here's my top five.

1. A New Perspective on Life
I have gained a whole new perspective on the way I see myself, schooling and our place in the world. It was just an inspiring and humbling experience to see everything in Cambodia, including the history of where they have come from and that they have such incredible resilience and have really progressed so far.

2. A Better Understanding of Responsible Tourism
A new understanding of my impact as a tourist and what responsible tourism really means. I am incredibly grateful for the ConCERT responsible tourism training course that we completed! I think that for me as well, the idea of volunteering and immersing yourself in the community really gives you an in-depth view into the country and its people, rather than just being a tourist which could sometimes give you a superficial view of the place.

3. Becoming a More Flexible Teacher
I have discovered a new level of flexibility in teaching and really teaching for the students that you have. I thought I was a flexible teacher, but many times I had an idea in my head of how the lesson was going to look and sound like and due to the language and cultural barriers, sometimes it was way different! But that's not a bad thing, I just had to frequently remind myself that I was here to learn.

4. More Appreciation for How Lucky Australians Are
A greater concept of the amazing opportunities we have in Australia and how lucky we are. But also on the other hand, a stronger understanding of the importance for education for all children, all over the world, despite the different barriers that may be in place.

5. New Friends!
A whole new group of friends, both in our UniBreak group and in Cambodia! The people here are the loveliest, happiest, and kindest people you will ever meet.

Must-Do's in Phnom Penh From Newcastle Nursing

PROGRAM: UniBreak Groups
PROJECT: University of Newcastle Nursing Placement
WRITTEN BY: Molly Batinic

Last week in Cambodia, and we have ticked almost everything off of our bucket lists, plus some. We not only saw the last of the kids at PIO and started work at a new school, we also took our long weekend as an opportunity to explore Siem Reap … And it was worth every minute! The top 5 must-do’s of the week are almost all in this incredible city. 

 First of all, no one can miss the chance to see Angkor Wat, more specifically, at sunrise. From the history, to the beauty of this famous landmark, it was a fantastic way to start our Siem Reap adventure. After a long day of exploring that and many more temples, we decided to hit up Pub Street. And yes, it is exactly as the name suggests. We ate delicious food and danced the night away with both locals and tourists on our first night away from Phnom Penh. However, after an excellent, but long first day there, it was time to relax and enjoy the beautiful scenery of the Kulen Mountains. This involved three different stops on our tour, including a visit to the big Buddha, a hike along the underwater carvings river and finally a swim in the ever so enchanting waterfalls. It was simply magnificent! Next on the list is a visit to the Kantha Bopha Children's Hospital for an amazing and eye-opening Saturday night. Due to this chain of hospitals in Cambodia, millions of children’s lives have been saved that would not have without sufficient treatment.

And finally, our last to do for this week is based in Phnom Penh, however it is most certainly not for everyone. As we have been enjoying supporting the many dining-for-a-cause restaurants in Cambodia, we decided to continue this and have dinner at ‘Dine in the Dark.’ The idea is to be placed in the same shoes as a visually impaired local and eat a 3-course meal whilst having no idea of what you're actually eating. Like I said, it's definitely not for everyone. However, it was a great experience and although not all agreed, some of us girls would most certainly go back again.

Now onto the work part … We didn't quite manage to get through all of the 500+ kids at PIO, but we came extremely close and a everyone put in a huge effort. Although, our last day at the school was a bittersweet one and a few sneaky tears were shed whilst saying goodbye to all of these delightful children. But lucky for us, we were onto a new a school, where the children were just as wonderful. Chibodia is an afternoon school where children from the countryside can go to learn English, sewing and computers. We did basic health checks here, as well as educating the children about proper hygiene standards, which they absolutely loved! On our own time, some of us girls also visited a school in which one of our translators volunteers for, which teaches English and computers on an island just outside of Phnom Penh. It is called the Coconut School and it has changed the lives of many children and broadened their minds and futures, which will indefinitely change the future of Cambodia for the better.

We now have one more school to attend and get through as many kids there as possible, before we say our final goodbyes and leave this incredible country. You could say, we are feeling quite sad about this prospect already!

The Best Places To Hang Out in Siem Reap

PROGRAM: UniBreak
PROJECT: Teaching
WRITTEN BY: Tianna Killoran

After spending a few weeks here and being faced with a crazy amount of choices for places to eat, we’ve finally settled on a few of our favourites.

Sister Srey Café 
200 Pokambor Street, Riverside, near the Old Market 

A beautiful café run by two Australian sisters that makes the best coffee around! Their food is brilliant, all of the staff are very friendly, and there's always some chilled out music. If that weren’t enough, we've all found that Sister Srey has a mind for supporting sustainability in the local community. They hire local Khmer staff and then train them in English and Hospitality, whilst also maintaining support for other local projects and donating a percentage of their funds. We’ve been back now a few times. You'll usually find us there on weekends or for a sneaky breakfast some days before school!

Temple Bar 
Pub Street 
This place is basically the best on Pub Street! They have three floors, with a restaurant, a balcony restaurant and a sky lounge with beanbags and a big water feature. Either way, they're the best to either chill out or party on a Saturday night. Tonnes of cheap cocktails and really good food! There's another Temple Bar on the other side of the river too, which is much quieter if you're not up for the bustle of Pub Street.

Soria Moria 
Wat Bo Road, Siem Reap 
$1 tapas and cocktails on Wednesday nights: that's really all there is to say! They serve Western and Khmer food and it's all good! Soria Moria also supports responsible tourism and employs local individuals with the aim of equipping them with work skills.

Charlies
98 Hospital Street 
We have all dropped into Charlies a few times now, but it's our plan to spend the day there on Australia Day! They'll be playing triple j’s Hottest 100. They're always playing really great music and lots of sports, plus they serve Khmer food and some other favourites like potato skins, nachos, and chicken wings! 

For Life
The Lane close to Ms. Wong 
Thank you Antipodeans! This place is where our lunches during the week are organised and it is honestly the best food. We are always given an array of different dishes (a good way to try all the different Khmer food) and it's always delicious. The people there are so friendly and we look forward to lunch there each day. It's a bit of a hidden gem, but definitely worth it.

Newcastle Nursing Settle Into Life in Phnom Penh

COUNTRY: Cambodia
PROGRAM: UniBreak Groups
PROJECT: University of Newcastle Nursing Placement
WRITTEN BY: Molly Batinic

Six strangers travelled together to Phnom Penh and luckily, so far so good. The traffic is chaotic, the language is unknown and the culture is immensely different. For the first couple of days we were thrown straight into the culture and sights of beautiful Cambodia before starting our work at the health clinic.

This epic adventure that was enabled by Antipodeans Abroad has influenced us to do other charitable activities whilst here. On day two, we decided that lunch at Friends was a must-do. Friends employs disadvantaged youth to get them off the streets, and teaches them vital cooking skills so they can have a brighter, happier future. This vibrant restaurant not only encourages hope for these children, but also has a positive environment and incredible food.

Many of the must-sees of Phnom Penh were checked off of our bucket list in these days. This includes visiting the S21 jail where the Khmer Rouge genocide took place during the 1970’s, wiping out 3 million Cambodians in just over 3 years. The Palace was also another wonderful sight to see, and was such a shock to see how much respect and devotion was still directed towards Buddhism and their King.

A sunset cruise is also a must-do if you are looking for a peaceful end to the day – a serenity-filled dinner. Whilst in Phnom Penh, it’s also fantastic to experience the bustling markets. Barter with the locals and shop till you drop, whilst spending little amounts of money on clothing, paintings, ornaments and everything in between. Lastly, if living on the edge is your style, jump on a cyclo-bike and rush through the city streets. You will support a local charity, whilst maneuver crazily through the traffic to get to around the city.

After exploring, we were ready to immerse ourselves in the clinics.

The alarm buzzed at 5.30am on Wednesday morning, and we dressed in our scrubs and got ready to tackle the busy day ahead. We were faced with many challenges and our worlds were put into perspective. From the poor working conditions, to the extreme health conditions, we were feeling overwhelmed by what we came across. Basic health checks in our country seem like so little, but to these children they were so much more. We set up stations to include eye checks, ear checks, skin and hair integrity, height/weight and temperature, vital signs, as well as dental interventions and quality of life questionnaires. By the end of the afternoon, we had our routine down-pat and established rapport and trust with the children. The day drew to a close and we were feeling both exhausted and excited for the many days to come.

30 children assessed, only 470 to go. Wish us luck!

A Day in the Life of A Volunteer Teacher in Cambodia

PROGRAM: UniBreak
PROJECT: Teaching
WRITTEN BY: Tianna Killoran

This week we have all started to settle into our place here in Siem Reap! The streets are starting to become familiar and we can actually get around! Pub Street and the markets all around town are fast becoming our favourite places to hang out. We have gotten into a routine with our classrooms and we love it!

6:30am: Wake up bright and early, ready for the day. We enjoy breakfast together in the hotel, which often includes an array of traditional Western and Khmer foods. I love having the fried noodles for breakfast! Our in-country coordinator always checks up on us in the morning to make sure everything is going smoothly.

8:00am: We ride off in our tuk tuks to get to school! Sometimes it's a bit of a bumpy ride, but mostly it's fine. We love really getting to see the villages around Siem Reap on our way there, which really gives us a view of how our students live, many of whom come from very poor families.

9:00-11:00am: In each session, we have an English language lesson and then a topic lesson. I mostly help my teacher with speaking and pronunciation in the English lesson, while I get to take the class for the topic lesson. The students usually have lots of energy and are always smiling and laughing. They'll also jump at any opportunity to do some skipping! We also get to teach maths and art in our lessons, with games on Fridays.

11:00am-1pm: We usually go out to lunch with the other teachers. The place next to our school makes the most amazing iced tea and iced coffees. They’re only 50c, so now we get why all the teachers go nuts for them!

1:00-4:00pm: English language and topic again. This time we can repeat the lesson and everyone can correct the mistakes made in the day’s first lesson.

4:00pm: After getting home, a lot of us make sure our plans for the next day are all in order. We can pick up plenty of supplies around town if we need them.

6:00pm Most of our nights are spent exploring the streets and walking around the markets. We always find somewhere new and interesting to eat.

Other tidbits: We spent our last weekend getting up at the crack of dawn to see the Angkor Wat temples and then also went around to Angkor Thom and Ta Prohm with our tour guide. He filled us in on so much of the history of these places. Angkor Wat was just breathtaking and so magnificent. The intricate carvings and statues situated within the vast history of the Angkor Empire were amazing sights. Some of us even went back to Angkor Wat at sunset the next day, and it was just as good the second time around.

Teaching Week One – Adventures in Siem Reap

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Teaching
WRITTEN BY: Tianna Killoran

Well it has already been three days that we’ve spent in Siem Reap, and it feels like it's been an age. There's so much to do and we have all just been busy, busy, busy!

After arriving – overtired and jet lagged – to the airport, we were all picked up by our lovely in-country team. As we drove around the streets, they pointed out to us all the different landmarks along the way. After a refresh at the hotel, we went to lunch and got a tour around the main parts of town. We were all in awe of how different it was! Motorbikes and tuk-tuks everywhere, markets selling everything you can imagine … even the power lines are different! We had a special welcome dinner at Amazon Angkor, where we got to watch traditional Khmer dancing. The female dancers were so poised and precise – it was just beautiful! My favourite was the coconut dance, which is normally performed at weddings. It was just so happy.

Our second day kicked off with an orientation visit to our school, Grace House, which we will start at on Monday. Four of us are at Grace House, with the rest of our group of thirteen are split between schools. The schools were very relaxed, with chickens roaming around and open-plan classrooms all over the place. We are all so very excited to start teaching at our schools next week, so more to come on that! After another delicious lunch, myself and a few other girls went exploring the markets. I'm not used to haggling, so it was tough trying to get a good deal. Some of us are really getting the hang of it though.

We had a cultural lesson and a language lesson in the afternoon, which very much helps with saying ‘tay or kun’ (no thank you) to all the tuk-tuk drivers.
Hopefully we’ll be visiting Angkor Wat over the weekend and filling having all kinds of adventures before we start at school on Monday!

Discovering Amazing Angkor Wat and New Insights into Nursing

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Wollongong Nursing
WRITTEN BY: Ashton Reid

Week two has been just as challenging and exciting as week one. It marked the end of our first clinic rotations. It was really good to swap clinics between the two groups because it allowed us to see both different perspectives and how the two clinics worked – including their similarities and differences.

This week Krabei Riel clinic gave us a taste of midwifery and with our supervisor's help, we were able to do plenty of antenatal care with the mothers. For both clinics, immunising children was a big job with lots of families bringing their babies into be immunised first thing in the morning.

Throughout week two, we were all given the chance to look at the clinic pharmacy and observe medication dispensing. It was interesting to see the differences pharmacy practice between Cambodia compared to Australia.

On Thursday we were given the day off and all trekked by tuk tuk to the temples around Angkor Wat. The architecture and history behind all the various temples was amazing and so interesting as some were both Hindu and Buddhist temples. It is so easy to see how they became a wonder of the natural world.

Friday was our last day of practical, and lots of hugs and tears were shed. We invited everyone out for our last team dinner so a lot of the staff from the clinics came as well as our interpreters and drivers. It was really nice to sit down and talk to them about their lives more and the two weeks that we had all shared together.

It is easy to say that we all had an amazing time in Cambodia, and have learnt so much not only about nursing skills but also about the inter-personal skills that need to be engaged in with a patient to provide excellent primary health care, and person-centred care.

Discovering Cambodia's spectacular water festival

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.

Giving back to the community in Siem Reap

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Physiotherapy
WRITTEN BY: Jess Garner

Week 3

We have now surpassed the halfway mark, and are at the end of our third week here in beautiful Cambodia. Most of this week was spent partaking in the annual water festival that ran from Tuesday to Thursday. The usually quiet river was inundated with boats racing down the river, and people from all around flooded the streets. It turns out nobody knows quite how to party like Cambodians! The number of street vendors seemed to triple almost overnight, fireworks went off daily, and once dusk hit the pubs exploded and people were dancing in the streets (us included!). We did manage to get a few days of placement in as well however, and met with patients Monday and Friday.

Mr. C, an elderly gentleman who had had a trans tibial below knee amputation (due to an accident with a land mine during his time in the army, kindly volunteered to be our first patient (and model!) for the home exercise program for the physical rehab centre (PRC). These exercises included hip, leg, arm and core strengthening. Although most of the amputees assessed at the PRC are highly functional, we believe this will be beneficial to new patients, as well as help maintain the strength and prevent secondary complications in current patients also.

At the CDA, the main focus was again assessment, exercise prescription and education. Patients were willing to sit and talk with us briefly after their CDA appointment concluded, where we determined main physical limitations, and prescribed exercise based on findings. Like at PRC, a variety of conditions were seen, ranging from patella femoral pain to stroke. All received education about how nutrition and exercise can help with the management of their diabetes. A lot of patients had little understanding of their diabetes, or how diet and exercise could help, and were quite grateful to learn more. We then tailored exercises to suit each patient. For Mr. T for example, we gave a variety of upper limb reach to grasp exercises, as he had suffered a stroke one year previously, and mainly had difficulty with his right arm.

At the school, the guys started teaching the kids some basic anatomy and assessments. They got the kids to trace the outline of their hands on paper, then draw in the bones, so they could start to have more idea of what the body is made of. A lesson on pulse taking was also included, and the kids learnt how to measure their heart rate before and after exercise, and why it is good for you. We also played games, such as handball, in order to help with basic developmental motor skills.

At the military clinic, patients that had previously been referred from the home visits had started arriving. A surprising amount of problems reported turned out to be related to back or neck pain, and where we could we implemented a variety of treatment options, including massage, trigger point and combine and repeated movement patterns to help elevate pain and improve functional and quality of life where possible.

All up, I feel that although we are all getting so much out of this experience, we are hopefully giving a little back as well, and helping patients to manage their conditions in order to get the best outcomes possible.

Discovering what really makes a person happy in Cambodia

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Nutrition
WRITTEN BY: Kirsten Swan

After spending the first few days getting orientated and preparing ourselves (and resources) for our various projects, we were invited to participate in the World Diabetes Day awareness walk around Siem Reap on Saturday 14th November. We opted in, as we deemed this to be a great opportunity to raise awareness about a highly prevalent illness in Cambodia, as well as a pretty special experience to participate in World Diabetes day in a country other than Australia.

We woke early Sunday morning (4.30am) to be greeted at the hotel by our Angkor Wat tour leader. We departed to watch the sunrise over the temples, and spent most of the day enjoying a bicycle tour of the temples. This was a fantastic, active way to engage with the history and beauty of these cultural monuments. The rain clouds, while crowding our sunrise photos made for a refreshing shower during our ride through the bush. It was a great tour that provided us with bike hire, tasty snacks, a complimentary breakfast with all the trimmings as well as a delicious sit-down lunch in a small surrounding marketplace (this was well welcomed after how far we had ridden).
Monday marked the beginning of week two, our placement rotations at the Cambodian Diabetes Association (CDA) and Military Handicap and Development Centre (MHDC). We started conducting MHDC home visits, health education and English lessons at a local school, as well as individual consultation with patients at the CDA.

We quickly found that many presenting patients at the CDA were diagnosed as either Pre-diabetic or Diabetic, commonly with a number of comorbidities, such as hypertension and chronic pain. We also discovered that one of the most common ingredients that the patients cook with is MSG (Bchan), to add a savoury taste to their foods; this is high in sodium, which is known to increase the risk of hypertension if eaten frequently. We incorporated this into our patient education to discourage the use of salt and MSG as flavourings, providing other appropriate alternatives. This information proved to be well received by many people, who were unaware of the health effects of some aspects their diet, they were very thankful and enthusiastic to improve their health through nutrition and exercise.

We all really enjoyed visiting the school and teaching the children about healthy eating, personal hygiene (oral and hand hygiene) as well as how exercise can benefit our health. We also taught some English lessons in the afternoons. We found that playing a number of games utilising flash cards, colourful fruit/ vegetable toys as well as true and false questions worked well to engage with the students of varying age. We also established that the children loved playing the games “Hangman”, “Fruit salad” and “What’s the time, Mr Wolf”, as shown by their high levels of excitement. They were so clever and often didn’t require much explanation, mainly some visual demonstration to copy, we found their capacity to interpret and comprehend amazing!

The home visits were fantastic for us to learn how resourceful people become when faced with adversity. It was, at times, distressing to see the difficulties some families are faced with living with very limited resources and suffering from complex conditions with extremely limited health support. We aimed to provide these families with some basic public health education, as well as some practical exercises and nutrition advice to help improve their conditions and health status. It was eye opening to comprehend the way these families live, they were welcoming and were more than happy to invite us into their home and allow us to assess them. It was inspiring to see how happy these families are, emphasising that wealth is not a prerequisite for happiness.

We are feeling settled into life in Siem Reap, have found a few favourite cafés and are looking forward to a couple of days off.

Week Two in Cambodia: Challenges, dances and learning about prosthetics

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Physiotherapy
WRITTEN BY: Jess Garner

Week 2

Week one flew past, and before we knew it we were heading into our second week, where the real challenges began! Our first? The dreaded, yet also expected ‘travellers gut’ (maybe the street food wasn’t the best life decision after all). However, after a few good doses of our new best friend ‘Buscopan’ we were feeling slightly less green, and keen to get back to it. Our newly formed ‘PhysioTribe’ headed out to the location sites, with Chiefs Cath and a Clint leading the way!

The diabetes association was an exciting new location that had previously had little physiotherapy input, so Beth, Eddie and Ari had to figure out exactly how and where to see patients. One of the first challenges they faced was lack of space. Before long though, there was a physio and nutrition section being set up in the waiting room. This turned out to be an ideal spot, as the girls could grab patients whilst they were waiting for medications, or after they were done, and give advice on exercise and nutrition.

At the rehab centre Bee, Tiara, Libby and I learnt a lot about how the prosthetics were made, and had exposure to conditions rarely seen in Australia, such as polio and congenital amputations. I think we were all amazed with the patients. During our assessments, we learned that they could do most ADLs with relative ease, with their main complaint being that they required a new prosthesis. We struggled a little on how best to help, but came up with the idea of a basic home exercise handout, with the hope that it will help patients learn and remember the exercises prescribed by the physio.

At the military clinic the others managed to successfully sweat their way through outpatients, home visits and school sessions. Being a more rural area, a lot of the patients in clinic and at home had long and complex case histories, but with little access to adequate treatment. This was especially hard, and at times the group felt rather helpless. A referral system was set up so that patients seen at home that required further assessment could be seen in clinic too.

At the school, the guys managed to improve on their very stylish dance moves, and taught the kids some games from back home they could play to keep active. Apparently “What's the time mister wolf?” was the winner, hands down! And of course, us being physio students and all we just had to add the old anatomically correct "head and shoulders, knees and toes" routine. Overall, it's been a tough, yet equally amazing week. Looking forward to heading to our new sites for the next two weeks and learning as much as possible, but for now, PhysioTribe out!

Rice, Rice, Baby: First week of the nutrition placement in Siem Reap

COUNTRY: Cambodia
PROGRAM: UniBreak
PROJECT: Nutrition
WRITTEN BY: Kirsten Swan

Week 1

Well, what a whirlwind our first week has been! We met at Sydney International airport on Monday morning feeling slightly nervous but also super excited for the trip. This was calmed by a smooth flight and some friendly banter on the way. Once we arrived in Siem Reap, we were greeted on the tarmac by some humid winds and after a relatively smooth transition through customs and border control (the friendliness of Cambodian people was already evident), our minds were again put at ease by prompt/reliable wifi connection. After a short drive through the city we strolled into our hotel as expected, at 9.30pm. We checked in and went to bed straight away, we were already tired and with a big week of orientation ahead, deemed this as quite important.

We spent the first two days getting to know some Khmer language basics, and our fabulous interpreters, as well as walking around the town centre and familiarising ourselves with the location. Clearly we weren’t so great at learning the language, and the local Cambodians (who are happy to help us with corrections) are still laughing us at. It was definitely an eye opener walking around town in the traffic, with a mixture of tuk-tuks, rickshaws, cars, trucks and bikes all weaving past us on busy narrow streets. It was a great experience to do the ConCERT training in child protection, helping us to further understand Cambodian history, our roles and the importance of child protection in Cambodia, as well as contextualise the differences in culture of our two countries.

Thursday saw us being introduced to our project sites: the Cambodian Diabetes Association (CDA), Military Handicap and Development Centre (MHDC). We were officially welcomed by the Vice Chief and board of MHDC and given a tour of the facilities and schools which we will be based, this was quite rural and everyone is looking forward to all aspects of our role with this organisation. Professor Lim Keuky and his team greeted us at the Cambodian Diabetes Association. This excited many of us, as we had previously been told Professor Keuky would be away on business for our placement. He was keen for us to take a hands-on approach within the service as young health professionals as well as looking forward to our development of some appropriate sustainable resources. We were also eager to participate in World Diabetes Day 2015 (Saturday 14th November 2015) as part of the CDA group, which we were invited to join.

On Friday we conducted a local market tour in order to help us understand the Cambodian food system better and ultimately gain clarification on some uncertainties we had, including; Cambodian staple foods, price, portion sizes as well as traditional cooking methods. This proved a very satisfying venture, as we learnt that most of the Cambodian meals are predominantly rice, noodles, rice-based cakes, vegetables and some protein. We got to try many of these foods, and we particularly enjoyed the rice and coconut waffle. This visit to the market also reinforced to us of the resourcefulness of the Cambodian’s way of producing food products: there is minimal wastage of meat/protein components of the meal (all parts of the animal are eaten – head, tongue, gut, hock, etc) and also much of traditional Cambodian carbohydrate sources are made from rice rather than wheat, like we are used to. We also found a few vegetables/herbs we have never eaten or even seen before which was great!

After a long day of eating and planning our education session/resources, we decided to seek some relaxation in taking a local yoga class which was a lovely way to finish the week, followed by a Western dinner at a local café (we were all craving some fresh salad). Can’t wait to see what week two brings!