The first trimester 2023 has been a busy one for The Lake Clinic Cambodia. The Tonle Sap Lake is always a challenging environment in which to work. Once a reliable ebb and flow of water into Tonle Sap Lake is a thing the past. The rapid lowering of water levels in the lake makes transporting clinical staff and supplies very much an heroic adventure on a weekly basis.
We persist.
Clinics Held: 108 Clinical Cases: 7,587 Health Education: 3,991
Dental Cases: 560 Oral Health Education: 3,902 Antenatal Care: 76
Birth Spacing: 117 Eye Care: 413 Vaccinations: 3,019 - including 2,801 COVID-19
Mental Health: 73 counseling sessions Hospital Referrals: 16
The Tonle Sap Lake...the entire Mekong Delta is facing the "perfect storm" of changing weather patterns combined with the already constructed 160 hydroelectric dams along the Mekong and its tributaries -- more than 200 are planned! The Lake was once home to more than 2,000 species of fish, and many of those were migratory and relied upon the five, distinct pulses of floods to bring them from the Mekong, up the Tonle Sap River to the Tonle Sap Lake where they would spawn in its flooded forests. Where just a few years ago the lake's peak level would be 16 or 17 meters deep, this past season saw only a 7 meter rise.
This is a disaster in the making. More than 1.5 million people depend upon the lake's fisheries for their livlihoods as well as a source of much needed protein. The connection between an economy and health needs should be obvious.
As this year closes we need to acknowledge both our accomplishments and a return to a post-Covid normalcy. This "normalcy" is best illustrated by our calendar being filled with volunteers, both new and returning ones.
CLINICAL ACTIVITIES THROUGH 9 DECEMBER 2022
OUTREACH ACTIVITIES THROUGH 9 DECEMBER 2022
We have been busy. In addition to our core programming of providing free healthcare and and health education as well as community health and homecare, The Lake Clinic has expanded its scope of care to include a concentrations on Domestic Violence and COVID-19 vaccinations.
The Lake Clinic has partnered with The Department of Women's Affairs, The Cambodian Women's Crisis Center as well as local government and law enforcement agencies in order to address a sadly growing problem. Domestic violence, whether it was targetted to the spouse or the children - usually both - has historically been ignored by law enforcement and considered a "personal, family matter." TLC has worked for many years in an attempt to bring this mental health issue to the attention of those with the authority to actively take a role in solving some of these problems.
In the beginning we sought to empower women to feel free to talk about this issue. In some individual cases we had success with our direct intervention, but all too often we were met with frustration as many men were intractable; they felt free of any consequences. With the very public backing of the local authorities we are seeing our efforts supported and making a difference.
In July of this year TLC was approached by the Provincial Departments of Health in both Kompong Thom and Siem Reap Provinces to partner with them in the distribution of COVID-19 vaccines. This is a great honor for The Lake Clinic as we are the only provider other than the government (Military and Ministry of Health) to be trusted to undertake this responsibility. So now, in addition to the "routine" vaccinations that we offer to our patients we can now add Astra-Zeneca, Moderna and Pfizer vaccines.
Clinical to date:
Outreach to date:
Thank you for your continued support.
~Jon
Commentary
For two, very long years The Lake Clinic-Cambodia has been living and working midst a global pandemic. With the start of 2022 we, in Cambodia, have seen a “return to normal”. No clinics needed to be canceled due to “cluster infections”, or fear of “community spread”.
So far, this has been a very good year.
Clinical Activities:
Clinics Held: 79
Patients: 1,448 women; 907 children 15 y.o. and younger, 491 men, and 34 Home-Care visits for the elderly and handicapped.
Total Medical Cases: 5,287
Total Services: 14,130. That includes:
2,830 Health Education,
2,828 Oral Health Education,
74 Dental,
119 Antenatal Care,
103 Birth Spacing (condom, IUD, implants and The Pill),
1,971 Birth Spacing Education for men and women,
156 Eye Care,
548 Vaccinations,
19 Mental Health visits,
and 15 Hospital/Specialist Referrals.
(PHOTO1)
Schools are in session
With schools in Cambodia now open with in-class learning, TLC’s Outreach Team, along with our clinicians are now able to provide health screening and health education to school children on the Tonle Sap Lake and the Steung Sen River.
(PHOTO2)
International Volunteers
With an easing of travel restrictions TLC has once again become available to medical volunteers. Drs. Helle and Erland of Norway decided to spend their honeymoon with The Lake Clinic. Their arrival via Singapore on 17 December. They stayed with us through the end of March.
(PHOTO3)
Focus on Outreach
As part of our on-going “Healthy Community Program” TLC’s Outreach Team engages in a number of projects all linked with the purpose to empower women through education and peer-to-peer support. Our Outreach Team also continues its “Children at Risk” project by going home to home each year to survey the nutritional status of children under 5 years of age, and then to follow-up on those children most at risk for malnutrition and its consequences.
(PHOTO4)
TLC’s Nary works with a Mothers Club to teach the care and feeding of infants-specifically the importance of breast feeding in the first six months.
In this 1st Quarter 9 such gatherings have taken place as communities leave the need for “social distancing” behind.
Children at Risk, or CAR, is an extremely important project that identifies children whose biometrics show them to be small for their age due to malnutrition and in danger of a lifetime of stunted growth and possibly cognitive impairments. In this 1st Quarter there has been 371 such measurements and follow-up visits conducted.
(PHOTO5)
Above, TLC’s Outreach Director, Kolyan, discusses a care plan for an undernourished young girl who is being provided with a high calorie, high vitamin supplement. Fourteen years ago, when TLC first started to work on the Tonle Sap Lake fully two-thirds of the children under 5 years of age were clinically malnourished, and one-third of those suffered from stunting and would never recover. A newer and more dynamic strategy is showing much improvement.
Clean Water is essential to good health and hygiene. TLC’s approach is to work directly with mothers and girls to set up bio-sand filters; teach their proper use, and to follow-up with those mothers and girls to encourage their use and to troubleshoot any problems that may exist.
(PHOTO6)
Biosand filters are provided on request by the family, and in Quarter One the Outreach Team has set up 189 new filters. By involving the women in the process of setting up and later troubleshooting, TLC brings the woman’s role in providing for the family to the forefront. We have seen the utilization of these filters increase dramatically as a result.
(PHOTO7)
Whether floating on the lake, or alongside the Steung Sen River, Home Gardens have become an essential source of additional nutrition due to the declining fish catch throughout the Tonle Sap basin.
TLC’s Outreach Team strongly encourages families, particularly the mothers, to try. TLC will provide the education as well as the seeds, and sometimes the tools necessary.
451 new gardens, both floating and land-based have been created across the nine villages on the Tonle Sap and along the sides of the Steung Sen River.
(PHOTO8)
In these first three months of 2022 there have been 992 Home Visits to meet the villagers face to face and to assess their needs for any of TLC’s services from clinical to other Outreach activities.
(PHOTO9)
Such meetings within the home, whether it is a planned follow-up or just a seemingly random visit goes a long way to establishing trust between the villagers and TLC. The Outreach Team will use these visits as an opportunity to learn what a family’s concerns might be, and to provide health teaching as well referral to the host of TLC’s services.
Mental Health: Because of their unparalleled access to the homes of the villagers our Outreach Team is a source of referral to our Mental Health project that in this first quarter saw 19 counseling/clinical visits.
Domestic Violence
(PHOTO)
“DM” is a huge problem in Cambodia, and on the lake where homes are small and there is no escape for its victims, TLC’s Outreach Team has been trained by the Cambodian Women’s Crisis Center to recognize DM in the families they meet, and to refer those families to our Mental Health project.
One More Number from Outreach:
Fifty classes covering such topics as healthy relationships, conflict resolution, good nutrition and communication skills were held as part of our Teen Education project. No photo is available.
In closing.
(PHOTO10)
It takes a special kind of person to work with TLC.
Links:
Life, for all of us, has been challenging throughout 2021. Remarkably Cambodia had been spared the worst of the COVID pandemic in 2020 in terms of illness and its burden on health resources, but the economic impact on tourism has been felt throughout the country. However, beginning in February of 2021, Cambodia had its first "surge" of infections and community spread and The Lake Clinic had to suspend services from 31 May through 25 June because of a nationwide ban on travel. We also had to stop working from 5-16 July as some of our clinical staff had "close contact" with a COVID-patient that required all staff to self-isolate at our homes for 10 days.
Even with these challenges our Clinical Teams were able to provide the following services:
1 January - 15 December, 2021
Educational Services Provided:
Sub-services:
Our dedicated Outreach Team of midwives and nurses provided the following:
Children at Risk (CAR)
Clean Water
Family Nutritions
Mental Health
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