Making Progress at AHC

I must admit that after yesterday, the first day of my third week at Angkor, I was beginning to doubt whether I was actually going to do anything worthwhile during my volunteer time here. Last Friday, and yesterday (Monday) the staff at AHC were just too busy to spend any one-on-one time with me to work on my projects. But I was pretty much finished with everything they asked me to work on so far. This included a new curriculum for their nursing preceptor program (which I had expanded into a whole day training event), and then a lecture on pain management in children. I was hoping for some constructive feedback about either presentation, but so far had only received just some minimum editing suggestions. Otherwise, the staff almost seemed uninterested in what I had prepared.

But today was a different story. I gave my lecture on pain management at lunch today. I was expecting possibly 4-6 nurses to attend. Instead, 72 nurses were there, most coming in on their day off!! Of course, it probably helped that they all received a free lunch out of the deal. And I deeply suspect that for the majority of the audience my English was either too over their ability or too hard to understand. But, based on some of the questions I received (and with a little help from AHC’s head of nursing) I really think many of the nurses got something worthwhile from what I had to say.

Pain management at AHC (and in most of SE Asia, from what I’ve read) is drastically different than what we do in the United States. Granted, there are some cultural differences such that the Western focus on attempting complete pain control would not work so well here. I am not saying that Cambodian children do not have much pain. I suspect, though, their culture and history gives them internal resources which may help them cope with pain better than American children. That said, I personally think their pain is undertreated here. But instead of using this lecture to tell the staff at AHC what they are doing it wrong, I took the approach, “This is how we do it in the United States.” Then they can take what parts they feel applies to their hospital. And based on some of the questions and feedback I received from senior nurses and unit managers today, I suspect there will be some changes down the road.

I did learn a wonderful new phrase today. As I was talking about chronic pain in certain patients, one of the lead nurses brought out the term, “douleurs sans frontières,” which is a French term that means Pain Without Frontiers. I think that is a wonderfully useful way to describe the type of pain some of our patients sometimes feel.

The rest of today I spent talking with the nurse overseeing infection control at AHC. She is one of only two women in the upper ranks of nursing at AHC (the other is the critical care unit manager). First off, is it very difficult to compare how we practice infection control issues in the United States with our somewhat unlimited resources to what is available and practical here in Cambodia. I have read through a ton of information that I received from some associates I work with in Indianapolis, plus what I’ve researched on my own; and I feel like I’ve just touch the surface. What I can see is that AHC has truly made some incredible strides and used innovative ideas really dig themselves up out of the Dark Ages of what used to be the status quo in Cambodia!! AHC started a hand hygiene program just 18 months ago, and in that short time their compliance numbers went from 20% to over 70%! I know we have much higher numbers than that in the United States, but I’m pretty sure it took much longer than 18 months to get there.

But the infection control nurse still has her work cut out for her. She has no real authority to enforce the standards she has learned and knows need to be implemented to bring infection control up to the next level. If she approaches a staff about wearing gowns in isolation rooms, she has no recourse to enforce it if they refuse because they are “too hot” (which it really can be!) Her dedication keeps her going so far, though. Next month she will be going down to the capital of Cambodia (Phnom Pehn) to be part of a consortium of health care personal working toward a national program on infection control. The World Health Organization has put together a set of guidelines to help third world countries to create national programs. Cambodia’s neighbors, Thailand north and Vietnam south, both have national programs.