Nursing at AHC, Part 2

I have spent one whole week now at the Angkor Hospital for Children. I’ve been trying to put my thoughts around some why to summarize the experience, and the best I can come up with so far is: Nursing care is surprisingly similar to the way we practice in the United States; yet I was constantly noticing subtle differences between how they do things and how American nurses practice. Many of the differences in techniques I think my nurses buddies would just find jaw-dropping. For example, most blood draws are done with just a syringe and the needle it comes packaged with!!


AHC Inpatient Unit

One example of how things are the same…. Hand hygiene is a huge push at AHC, and they are measuring compliance just like we do in the U.S. They have staff go around the hospital and observe whether staff, nurses versus doctors, do hand hygiene each time they are suppose to. And they report the results to the staff just like we do.



There are squirt bottles containing alcohol gel hanging on the walls almost everywhere, and signs with hospital honchos demonstrating the correct way to use them. Family members are even encouraged to watch the hospital staff to make sure they use the gel.

Then there are the differences. The gel is made within the hospital based on a formula developed by the World Health Organization. Purchasing Purell would just be too expensive. And they use the gel for almost everything. Instead of alcohol swabs/pads, they just take cut-up pieces of gauze and squirt the gel on them before using them to “sterilize” surfaces (such as skin). I saw the same thing used in the operating room when the anesthesiologist simply cleaned off the bag mask between surgery patients!! The bottom line, though, is that these may all be reasonable differences when you factor in the limited resources they have at AHC.

As I mentioned in a previous blog entry, teaching is a huge task at AHC. Many of the “rural” patients that come to AHC have a poor or misguided understanding of health practices. For example, many Cambodians worry that meat is a high infection risk (which most Americans would not doubt after they observe how most meat is sold in the open markets!). So when their children are not healthy, they often avoid giving them meat products; and that leads to a dietary deficiency called Kwashiokor. The day I was in the inpatient nursing unit, I saw two patients suffering from that.

AHC has a special kitchen just outside the hospital where they teach families how to cook healthy, well-balanced meals. There are posters everywhere demonstrating the main food groups (using Cambodian staple foods as examples), and how to include all of them in meals. And the big screen TVs frequently show videos demonstrating proper diets and food preparation.

Speaking of videos…. I was really impressed with the quality of the teaching videos I watched on the various TV sets. One great example was a video about disease transmission by coughing. A beautiful woman walks past a group of young Cambodian men, and one of the men’s eyes pop out of his head like a Roger Rabbit cartoon. But when she has cough, suddenly all the guys turn away in disgust. Other videos had great animation, or contained catchy little tunes. One of the nurses, though, told me he didn’t think the patients or their families really paid attention to education videos; and only watched the TVs when there were Hollywood animation movies on. If you look at the TV on the photo above over the inpatient unit, the TV is showing Ice Age 3.

I am impressed with the dedication of the nurses at AHC. Most of them could make more money at other hospitals in the area, or for private clinics. They chose to stay at AHC because they believe that is where patients get the best care. They are eager to learn new, improved ways to do things. And they work together well. Whenever a nurse needed to start a new IV, draw blood or had a new patient arrive, there were always at least 2-3 other nurses right there to help them.

The nursing managers are the same way, but in a more encompassing way. One manager asked me about measuring pain; so I downloaded and printed out a variety of pain scales (the only place they use pain scales at AHC is in critical care!!!). The director of nursing has stopped me a couple of times to ask me some questions about nursing research. Yesterday he showed me an upper-management book on nursing, and asked me to explain to him about Nursing Theory (for those of you that are not a nurse, this is something of an inside joke!). They are all hungry for the type of education they could get with a bachelor degree in nursing; but right now the only nursing degree offered in Cambodia is a three-year diploma nurse degree (which I am told is equivalent to an associate/RN degree in the West).