Good Morning Friends and Family from Phnom Penh,
It 8:45AM Wednesday here and I have a great deal of work to do before Saturday when I catch the 7:45AM bus on Giant Ibis bus lines to Kampot, Cambodia, about a 4 hour bus ride away. Kampot, Cambodia is on the SW coastal area of Cambodia and a place my husband I hold very dear. It is where I worked and we lived for 10 months during my time a US Fulbright Scholar 2013-2014.
So, why am I here in Cambodia this time for 2 weeks? Unfortunately, due to COVID and some personal situations (my mom's illness and another foot surgery for me), there was a 5 year gap between visits in 2016 and my return in 2023. Nursing education is relational, so last summer, while I worked on part of a WHO sponsored project with the Ministry of Health (thanks to a grant from the University of Florida for my expenses), I also sought to rebuild relationships and assess the current state of nursing in Cambodia in a post-COVID world. The project did not go as anticipated, due to the lack of some critical data and conflict on what the end goals should look like, so with my husband's support, I have returned with the intention of wrapping up that project as well as determining the status of future work in Cambodia.
My trip here this time is different than last summer in that the majority of the trip is self-funded (further detail below). Yep. Actually, across the 10 trips that I've made to Cambodia, I've received some level of support for just 4 of them. The rest of the time House of Reed has foot the bill. That is something we have to consider given our ages and that one day we will retire and need to be fiscally responsible for that future. So, here are some lessons that I believe are worth sharing if you are interested in international nursing.
Lesson #1- Unless you are working for an international NGO, have a grant, work for the US State Department or the US Department of Defense, there are very few revenue lines that will support a nurse working internationally in a low-income country. There are high- income countries that will hire RNs from the US and in some settings, it is a rather lucrative career opportunity.
I remember back in 1988 when I first taught at our College of Nursing, I was asked to vote on providing funding to a faculty member whose body of research was in Scandanavia. The vote was to provide something like $250, which even back then was a drop in the bucket for an international trip! I naively asked what the faculty member was going to do about funding the remainder of the trip and the response was If you want to make it happen, you will pay for it. As the young mother of two little ones at the time, I could not even begin to comprehend personally funding such a trip. Now? I get it. You either really want to do this type of work or you make other choices. We each have our own walk and there are seasons in life. My life in my 20's and 30's was not one that would have fit well with international work, but now, it does.
In the effort to be transparent, the cost of our 8 weeks this summer is $16,250. Additionally, Vin University (Hanoi, Vietnam) is providing me with air fare from Cambodia to Vietnam and then housing and in-country taxi service for 6 weeks while I collaborate with them. Air fare from the US to SE Asia alone is costing us $8,800. We have made the decision that we cannot spend this level of personal funds again.
Lesson #2- You have to decide if you are commiting to an area for the long-haul or if your skill set is best used in one or more short-term trips in different countries/ areas or with different organizations. As previously noted, nursing education is very relational. It took me 2 trips and 5 years before I was able to secure a volunteer opening to teach at a nursing school during my 3rd trip. Cambodian nursing program administrators could not believe that I didn't have some personal financial motive for teaching. It was through the introduction of another US nurse working in Cambodia that opened that door for me and Gabi will always have my heart and gratitude.
My husband I decided that Cambodia is where we wanted to make a long-term impact as educators. The benefit of developing in-country relationships is that I don't have to come here as part of an organization. I reach out to the people I know, tell them when I am available, and we work out a body of work. I have developed a positive reputation that has been a long time in development and required patience and flexibility.
Lesson #3- Know when to cash in your chips and walk away, believing that you have done the best that you can do, but the project or your body of work has come to an end. I share the following with true grief in my heart and my eyes brimming with tears as I write this because I really love this country; however, this is likely my last trip to Cambodia for the foreseeable future. I believe projects must be sustainable and demonstrate traction. Unfortunately, I have come to the decision that my work here is like throwing buckets of sand into a sink hole, expecting my actions to fill the hole. Now, I know that I have made a difference in the lives of individual Cambodian nurses here. I have directly taught over 800 nursing/midwifery students and 100 professional nurses over the years. Plus, the English Medical Terminology course that I designed back in 2014 is now a part of the Cambodia's national nursing curriculum. So, I am proud of the work that I have accomplished. It goes back to funding and demonstrating traction. Personally and Nationally. Personally, we cannot keep spending these large sums of money to travel here when there are no long-term funding options available to us, despite our reputations and demonstrated commitment, as well as to what end? When we leave, what has changed on a broader scale? It is important to me and to my husband that we are contributing to a larger picture, a unified goal (traction).
Nationally- It is difficult to unpack this topic further as I never, ever wish to disappoint my Cambodian colleagues. But what if dozens or hundreds of individuals had buckets and were also throwing sand into a sink hole. While it would take time, that hole would fill. What I am seeing in Cambodia is the country's officials wanting one thing without the structured effort, long-term planning, and necessary funding to support its development and implementation. I've been told that Cambodian officials want their nurses to be eligible to take the NCLEX exam; however, English is not a required language. Taking English Medical Terminology is not enough. There are wonderful donations of textbooks made every year to Cambodian nursing programs, but the majority of nursing students cannot use them because they cannot read/ speak English. There are no textbooks in Khmer (Cambodia's language) for the students leaving Cambodian students lagging behind their global counterparts.
I know amazing Cambodian nurses and look forward to the day that the Cambodian nursing profession successfully advocates for the necessary changes across all levels of education so that Cambodia can become a significant partner in the ASEAN (Association of SE Asian Nations) and global nursing community. As for now, I am making the most of my time here.... and making memories.
Wishing everyone peace,
Karen
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