I have now been in my VSO placement for two months, working as a hospital management adviser at two referral hospitals in the north west Cambodian province of Banteay Meanchey.
During this time, I have been carrying out a rudimentary assessment of the hospitals' management capacity and capability. I have gathered information through discussions with staff and patients, my own observations, statistical returns to the ministry of health, and reading available documentation, including annual quality evaluation reports.
The hospitals are at different levels of development and therefore have different needs. My assessment of their management support needs will form the basis of my work plan, to be agreed between the partner hospitals, VSO and myself after three months in the placement.
Lay of the land
Travel between the hospitals is a challenge in itself. It involves a journey to Sisophon town on the back of a moto (motorcycle taxi) and then a 40km taxi ride over unmade road that will flood severely in the wet season. The taxi system in Cambodia is an experience: drivers cram as many people as possible into the car, often including a passenger sitting between the driver and the driver's door and working the clutch! My presence in a taxi is cause of much discussion and intrigue among the other passengers, especially when I respond to them in Khmer.
Mongkol Borei referral hospital is the main provincial hospital serving Banteay Meanchey province. It was built in the 1950s and has seen a lot of action over the years, through the Khmer Rouge era and then the civil war in the 1980s. The hospital is quality assessed annually and achieves a level three (the highest level for a referral hospital in Cambodia).
The director, Dr Sereywitchouk, manages the hospital as well as being a busy surgeon. He has amazing leadership skills and has provided a sense of direction for the organisation, secured the respect and loyalty of his staff, and achieved demonstrable improvements in the quality of healthcare at his hospital.
A new building was donated to the hospital by the Japanese government and opened in May 2007. VSO management advisers have been supporting the hospital's management team throughout the development of the new build.
The new hospital's modern surgical and operating facilities, emergency care and facilities for maternity care bring huge benefits, including improved patient experience and staff motivation. The major challenges facing the hospital now are ongoing maintenance and the costs of new equipment, especially when the guarantee expired this March.
Thmar Pouk referral hospital is around 50km from the main provincial town of Sisophon. It is a level one referral hospital serving a rural, mainly poor, agricultural community. The hospital was developed following the end of civil unrest that lasted up to the late 1990s in some parts of Cambodia, including Thmar Pouk.
The hospital has poor infrastructure, lacking basic amenities such as running water and electricity. Water is bought from a water seller, who draws it from a communal pond. At night, electricity is provided from a generator. Some of the most basic drugs, supplies and equipment are not always available, limiting the care staff can provide. However, despite the difficult circumstances in which they work, the hospital staff do a good job. Most doctors and nurses at the hospital trained in the refugee camps in Thailand and have recently been retrained either in Phnom Penh or Battambang.
Both hospitals challenge a lot of what I take for granted working in the NHS in England - free access for all at the point of delivery, relative uniformity of care standards, and a well-developed public health system.
It is distressing to see people admitted to hospital with conditions and injuries that simple public health interventions could prevent. For example, very few people wear motorbike helmets, yet with faster roads being developed and increased use of cars and motorbikes, road traffic accidents are starting to account for a large percentage of all accidents and deaths in Cambodia.
However, my life here is not all about work and I have taken every opportunity to get out and about at weekends. Cambodia has a great stretch of relatively unspoiled coastline in the south. I have also exploited the large network of unmade roads and tracks to go mountain biking with friends and colleagues. This is a great way to visit more remote villages and communities and to let off some steam and get some exercise.
Thmar Pouk referral hospital
What is VSO?
VSO is an international development charity that works through professional volunteers who live and work at the heart of communities in 34 countries around the world. Working in partnership with local colleagues, they share their skills and expertise to help find long-term solutions to poverty.
The charity recruits skilled and experienced professionals from a wide range of backgrounds, including health, education and business. Health management professionals are needed to develop hospital management systems through staff development, budget planning and resource management, particularly in Cambodia.
VSO volunteers usually have a professional qualification in their field, as well as a minimum of at least two years' experience. As well as professional skills, they must have the right personal qualities, which include confidence, flexibility and the ability to work effectively with others. Volunteer placements can last from two weeks to two years, with shorter-term assignments aimed at those with a high level of experience.
In return, VSO offers a comprehensive volunteer package including return flights, basic accommodation, a local living allowance, national insurance contributions for the period of service (or country equivalent), insurance, comprehensive pre-departure and in-country training, as well as support from a dedicated VSO team on the ground.
For more information, visit www.vso.org.uk