Global health: Cambodia days 7-8

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. Last week we shared the the middle of their journey, here is their final installment.

Day 7: With only two clinical days remaining at NPH, we’ve got to redirect our efforts if we’re going to accomplish all our goals for this mission. We finally complete unpacking a very large suitcase filled with donated supplies from Children’s Hospital Boston and Kim’s friends from the community. We start an email list for all of our new NPH friends who have email addresses, but it’s not too long because only a few of the staff actually know how to use email.

Today we continue to make rounds in the PICU—we still have only three patients.  Unfortunately, bedside checklists weren’t done on any of the patients until after noon, and only two of the three patients had alarms that were set properly. Kim does an informal chart audit and finds that immunization records on all patients are incomplete.  It also takes a fair amount of convincing for a medical student to accept that EKG leads can be concealed and work just as well on an active one-year-old’s back as they do on his chest.

Protheory, one of the brightest young nurses at NPH, tells me she’ll be working a 24-hour shift in a private clinic, prior to coming to work Friday morning. On a salary of $30 U.S. dollars per month, the nurses are unable to support themselves without a second job.

Our tuck-tuck driver, Soupna, brings us back to the stationary store where we spend another $100 dollars on basic office supplies such as a pens, one decent pair of scissors, white boards to go above every patient’s bedside, clipboards for vital signs, jump drives to store basic lectures, and print cartridges and paper for the printer. All of these items will be needed to ease workflow and provide educational materials until our Boston team returns (hopefully) in six to eight months.

We end our day by taking Soupna out to dinner. We let him pick the restaurant because, at age 32, he has never been to many of them. Over dinner, he tells us that he is embarrassed because he is the only “older” student who attends the university who drives a tuck-tuck. As we say good night, he tells us that he’s genuinely thankful that we have returned to Cambodia for two weeks because his business has been very slow.

Day 8: This morning, I’m managing solo at the hospital. Kim and I were invited to a Khmer wedding for Soupna’s sister. Kim’s attending, since this is her third trip, but since it’s my first, I politely declined.

I start my day by following up on the great work in the stock room that our first Boston team initiated on their previous trip.  Unfortunately Foley catheters and suction catheters have become mixed together and reorganization is needed.  We find a brown box filled with medical supplies donated from a hospital in France, but the packaging edges are brown with age. To my disappointment, the staff will not let me throw these items out. We move on to another box of mixed, outdated ventilator tubing and electronic wires that are dusty and are too outdated to work with any of their equipment. I learn that these are “keepers” as well. I can hear Kim’s voice in my head stating the Cambodians are very creative when trying to make anything work. I remember that on our first day, when we didn’t have the right connections to get an electronic blood pressure on a baby, it only took Mr. Barach minutes to find the necessary adapters to make it work.

After finding the vital sign flow sheet in a patient’s chart for three visits in a row, Dr. Yina agrees that Kim’s idea of keeping it at the bedside can be adopted. He’d like to hang it on a bulletin board at each patient’s bedside, but no one in the hospital has a screwdriver. The reality of life in a Cambodian hospital sets in once again.

With the help of Mr. Bon and the nurse manager, Socteata, we create and translate a few more documents for the newly created PICU Policy Notebook, which will also be transferred onto a flash drive. Mr. Bon kindly reminds me not to use the word “stick,” as in data-stick, because the nurses are likely to go outside to find a real stick to use. It may sound odd to us, but it’s common here. They routinely use sticks and branches as IV poles in the ER.

Children's David Kantor, MD,PhD slaps five with a patient

We don’t have enough time to teach the nurses how to become comfortable with the one computer. If we had access to some of our nursing students to provide hourly one-on-one computer instruction on a daily basis, the ability to communicate with our Cambodian nurses would dramatically improve. Our only short-term solution is to exchange email addresses with the few that do have access and hope they share information with the others.

While the focus of today has been more about taking steps to help the nurses improve their workflow, we check in with patients at the bedside a bit later.  Sadly, their practice has slipped a bit. Without some of the nurse leaders present on the floor, the nurses need reminders to perform some of the tasks that we have tried so hard to impress upon them. Heads of the beds were not elevated and vital signs were not done regularly overnight. Again, I find myself wishing a second Boston team were following us to provide the much needed ongoing reinforcement.

Kim and I brainstorm about how we can sustain our sister PICU project. The state of world economics remains difficult, even in Boston, and it continues to be a challenge for each of us to raise $3,000 to travel to Cambodia and support ourselves during this two to three week stretch. On a personal level it’s been challenging for Kim and I to leave our responsibilities at home, including young children, aging parents, classes to teach and classes to take. Over the past two years, we’ve made two visits per year and each lasted for a month, but this time, there’s no second team from Boston coming to take over for us. The Cambodian nurses could benefit from the presence of role models for a full four weeks. Due to financial constraints, this time they’ll get only two.

One thought on “Global health: Cambodia days 7-8

  1. I’m a PICU nurse at Miller Children’s Hospital in Long Beach, Ca. I am also a licensed respiratory therapist for more than ten years. In 1981 my family emigrated to the US from a refugee camp in Thailand after surviving the killing fields. I am touched by the nurses of Children’s Hospital Boston and their dedication to help Khmer nurses and the NPH PICU. Please email me at vkhay@memorialcare.org if there is anything that I can do to help with your efforts.

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