Stories about: National Pediatric Hospital

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.

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Children's global health: Cambodia Days 4-6

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 their first 3 days in Cambodia, here we learn more about their efforts.

This small structure is the family waiting room, laundry room, and cafeteria at the National Pediatric Hospital (NPH) in Phnom Penh

Day 4: Today, when we enter the unit, we find a newly admitted one-month-old baby with moderate respiratory distress. This is great timing, as one of the main objectives of our visit is to enhance the NPH PICU nurses’ knowledge of the respiratory and neurological system.

I continue to be stunned by some of the things we’re encountering in Phnom Penh. I’m boiling when I find out nurses aren’t allowed to use stethoscopes—only the doctors! Our hands are tied, so Kim and I start by reviewing the most straightforward respiratory assessment items like respiratory rate, saturations, retractions and nasal flaring. Operating under the premise that some rules were made to be broken, we help ourselves to the four stethoscopes sitting idly on the E-Trolley (an emergency cart, created by the Children’s team two visits ago. How did a PICU exist without an emergency cart?) Since there aren’t too many doctors around, we encourage the nurses to put on stethoscopes and take a listen! After an hour or so, they have a sound understanding of stridor and more specifically on this baby who has wheezing, crackles and decreased aeration on one entire side. Lots of reinforcement will be needed here. The nurses need to be able to use stethoscopes and this will be an agenda item to discuss with the medical director, but Kim warns that this is a big issue that will likely not be resolved on this trip.

After lunch outside in 100+ degree weather (it’s worse inside since we have no air conditioner), we return to the unit and get into teaching mode. Mr. Barach, the unit educator, wants to learn more about the newly donated CPAP (continuous positive airway pressure) machine. Since CPAP has only been used infrequently here, and we have no patients currently in need of noninvasive ventilation, Kim will be our subject. What would be straightforward process to our colleagues at home takes twice as long in Cambodia because all information must be translated. In addition, more information is needed than home, because this ICU doesn’t have the luxury of a respiratory therapist as a resource.

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Children’s global health: Cambodia

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.

photo by Brienne Johnson, RN

Day 1:

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!

Cambodian child weighed at NPH’s emergency department

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.

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