Since December 2009, a group of nurses, physicians and therapists from Children’s Hospital Boston has dedicated themselves to setting up a “Sister PICU” (pediatric intensive care unit) program between Children’s and the National Pediatric Hospital (NPH) in Phnom Penh, Cambodia. Read about the C4C team–named for their Cans for Care fundraising efforts–here, then read the first in a series of posts from Maureen Hillier and Kim Cox, two Children’s nurses who are spending the next two weeks 9,000 miles away, in Phnom Penh.
After breakfast, Kim and I are greeted by Soupna, the driver who takes us to the hospital via tuck tuck—a three-wheeled cross between a motorcycle and a taxi. It’s 85 degrees and very humid. I’m still amazed that I haven’t seen any accidents here with how people drive. There are thousands of mopeds or “motos” mixed in with some cars and occasional bicycles, but there don’t appear to be any “rules of the road.” If there’s no room on the street, just take the moto onto the sidewalk! A moto made for one often carries three or four—babies and toddlers included. Except for the driver, no one’s expected to wear a helmet.
I should have worn sunglasses today to shield my eyes from all of the dust. In fact, it’s common for Cambodians to wear masks while driving their motos because of the dust. It’s a strange sight—moto drivers wearing blue surgical masks while whizzing along at warp speed!
We arrive at the twelve-bed PICU a little after 8 a.m. to find a team of doctors and nurses trying to figure out how to manage a nine-month-old baby in severe respiratory failure and on a ventilator. The baby boy is extremely thin and likely underfed. Milk is too expensive, so I suspect he’s been fed only rice water. As a result, his electrolytes are abnormal. With gentle guidance we suggest that the baby was in need of sedation to help him breathe a little easier. This is common practice in western PICU’s such as ours back home in Boston. After a while, the doctors agree, and by the time we leave, the baby’s vital signs start to improve and he can rest. The other child on the unit is a 12-year-old boy with meningitis who only wakes up to urinate into an empty water bottle his mother provides. I guess that’s what happens when you don’t have access to anti-nausea medicine and can only receive IV fluids for a month. I was surprised to learn that nurses in Cambodia don’t change diapers or give sponge baths to patients. This is a task left to the parents. Only one bed sheet is provided per hospitalization, and no diapers—parents need to provide their own.
Kim and I will continue to assess and teach the nurses about the appropriate size of blood pressure cuffs, assessing IV sites regularly (we found a bad IV infiltrate of Dopamine) and appropriate suctioning techniques. We saw a baby’s heart rate dropped to a sustained 60 beats per minute during suctioning—no one noticed. On a positive note, the past measures created by our Cans for Care team have been successfully maintained! Each child has an emergency equipment checklist at their bedside. The code med list and dosages are commonly referred to and the emergency cart is being checked on a daily basis. Since Kim was here when the carts were first created, she’s thrilled!
It’s a national holiday—Women’s Rights Day—so we can’t go to the PICU. Instead, we ask Soupna to take us to visit the Killing Fields, a museum that honors the 3 million Cambodians who were tortured during the Khmer Rouge era. Kim tells me that Soupna lost one of his brothers during this time, but he prefers not to talk about. At the end of the day, Kim and I are touched when Soupna presents us with two beautiful silk scarves in honor of the holiday and the “two women in his life.”
The PICU is quiet when we arrive. We’re told that the two patients we cared for on Monday “went home.” No other information was offered. Kim and I exchange a quiet glance—both of those children were too sick to survive at home. Kim says this is the first time in her three missions to Cambodia that we’ve had no patients in the NPH PICU. She assures me that this can change overnight.
We spend the day teaching the young nurses, and they’re eager to learn. I’m astonished to learn that they’re not allowed to use stethoscopes to listen to the lungs of their pediatric patients. Stethoscopes are reserved for the doctors only. We do our best to impress upon them how utilizing a stethoscope can be used to help a baby by listening to their lung sounds, but I decide that we need to back track a bit more.
With the help of our interpreter, Mr. Bon, I ask the nurses if their Cambodian nursing education involves the nursing process. In unison, they recite the steps of the nursing process. I’m astonished that the words are not in Khmer—they’re in English. The very first word is Assessment. What better respiratory assessment tool than a stethoscope to assess a baby’s lung sounds? The body language of the nurses reveals that a revelation has taken place. Kim and I know that the use of stethoscopes its beyond the current nursing practice. Although we’re careful not to make any promises, we let them know that we will discuss this vital nursing concern with the attending physician when he returns in the morning.