Angkor Hospital for Children (AHC) is the only children’s facility in Cambodia. Nurses from all programs in Cambodia come to AHC for pediatric training.
I hope to assist the hospital's mission of providing high quality pediatric care.
During my trip I will teach nurses in a busy outpatient clinic the principles of triage and management of common pediatric complaints to allow more severely ill children quicker access to physician care and disposition of milder complaints.
I will also teach senior nurses in the hospital interactive lecturing and precepting techniques, which will give them the tools to further train mentees. I am slated to give lectures on pain and pediatric heart problems.
This is not my first medical mission. I have previously visited Peru, Bhutan, Gaza and West Bank Palestine in a similar role.
I was assigned to teach outpatient nurses, who function in a quasi NP capacity at this busy children’s hospital. I also worked as a provider for cardiology and general urgent care patients when they were short-staffed.
The most interesting experience was the week I spent at AHC’s rural satellite clinic. They had 15 inpatient pediatric beds filled with babies with respiratory illness, sepsis and omphalitis (infection of umbilical cord in newborns). They also had two emergency beds, and 5 newborn ICU beds. Their small clinic area was soon full beyond capacity every morning with dehydrated kids getting IV boluses, asthmatics getting treatments and many febrile babies. The experienced nurses would assess and manage these patients including hydrating with IV fluids (without IV pumps), antibiotics and some other medications. Then suddenly a motor bike would pull up with a semiconscious child who had fallen from a tree. The nurses would mobilize and perform a nearly perfect trauma resuscitation with IVs, Cervical spine immobilization, and splints, to ready the child for transfer to a city hospital where CT scan was available. Next, a seizing 4 year old boy, tied to his mother’s back as she peddled her bike, was brought in. Again the team responded with valium, IV’s and respiratory care. This child had been bitten by a dog one month ago. Now he was now seizing and drooling with rabies encephalitis, a fatal disease. In Cambodia, dogs are not vaccinated, so children have to be after a bite from a strange dog. Sadly, this boy was not brought in for the 4 shot series in time. Then an alarm rings and 3 nurses and a resident run to the neighboring adult hospital for a distressed newborn in the Delivery room.
As I shadowed various outpatient nurses to observe their clinical decision making and nursing skills, I saw many with impressive knowledge and skills. Honestly, I quickly decided I had as much to learn from many AHC staff as I had to offer. The hospital has adopted the World Health Organization’s Emergency triage, assessment and treatment (ETAT) guidelines, as well as the Integrated Management of Childhood Illnesses guidelines (ICMI). These guidelines allow nurses to diagnose and treat common childhood ailments. I noted however, considerable variability of assessment skills and knowledge of the treatment guidelines. Although the hospital wants nurses to use the guidelines to help manage their daily volume of 500 outpatients per day, some nurses only took vital signs and then referred the patients to wait for the pediatric residents or interns. There was also a lot of variability and perhaps futility in the approach to the many malnourished children.
The outpatient department did not have a formal training program. New outpatient nurses were oriented and taught on the job. My job was to supplement nursing education with PowerPoint presentations on various topics. It took 3 weeks for me to realize that I should have aligned my presentations with the ICMI guidelines. The hospital did request that I talk about how to precept junior nurses and best PowerPoint presentation techniques which Tatum Korim, kindly helped me ahead of time with this. I also gave lectures on cardiac, respiratory, hematological and infectious conditions and assessment. Since I have worked in Pediatric Cardiology I connected with the pediatric cardiology fellow who kindly let me attend his clinics. I saw many kids who never received the sorts of childhood surgeries or simple medical treatments they would have received in the US. Now they were disabled by heart failure, cyanosis or coronary aneurysm.
I gave lectures 1-2 times a day in English to the nurses or pediatric residents and medical students in English. The staff was supposed to be fluent in English to work at this hospital but of course that varied. I used Mr. Google to put lovey Kmer script titles in my slides. This provoked much humor as Mr. Google was always wrong. I interrupted my lectures a lot by asking my audience questions about how they handled various situations or as part of case scenarios. The staff were very willing to struggle with English to answer me and we ended up often having great fun. I found the hospital staff always kind, friendly and generous. In my final week they took turns bringing me delicious Kmer food to try everyday.
There were areas I saw for improvement at AHC, but mostly I was very impressed and come back with renewed admiration for our international nursing colleagues who do so much is such difficult circumstances. I come back very proud to be a nurse among these nurses and very aware of the privileges we have here in the US.
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Health Volunteers Overseas is a nonprofit organization working to improve global health through the education, training and professional development of the local health workforce in resource-scarce countries. Visit www.hvousa.org to learn more
