Nursing at AHC

So this is where I tell you just how impressed I am with the staff of Angkor Hospital for Children! I have just spent the last two days following around the nursing staff of AHC, and observing just how nursing can be in third world countries with the best resources that can be found in third world countries. Yesterday I spent the day observing the outpatient clinic, and today I spent the day on the IPD, or inpatient department.

First the outpatient clinic…. I remember how impressed we used to be when the ER I worked at several years ago managed to see over 100 patients in one day! Now imagine that times five, and that’s your typical day in the AHC clinic! Some days the count goes over 800! In fact, many of the patients, some who travel long distances for the chance to be seen at AHC, do not get make the cut, and have to spend the night waiting/sleeping in the AHC courtyard. Of course, the AHC outpatient staff are on the look-out for any patients in the crowd who are too sick to wait; and they are brought back right away. Most patients seen first by three very busy triage nurses. After that, there are as many as seven pediatricians waiting to see those patients who make the cut past the triage processes.

I spent today on the inpatient unit. There are just over 40 beds. 24 beds are in the main room on cots two feet apart, 6 more in a small room with isolettes for neonatal patients, and the last 12 patients in beds in the hallway. Each nurse has around six patients. The worse case I saw was a patient with tuberculosis meningitis. Below is one of the patients in the hallway. She is suffering from some type of dietary deficiency related to poor carbohydrate intake that turns her skin so pale.



About half of the nursing staff at AHC is male. I was told today that is mostly because many young men go to nursing school because they have no other job prospects. In the past most nurses were male, so that is changing, and AHC expects to hire more women to be nurses as they feel women are more devoted to the job. The staff I followed were all very efficient and engaging with their patients and families, and most of them have been male. In fact, most of the upper managers in nursing at AHC are men; and all of them have impressed me with their dedication to providing the best nursing care at AHC, and toward the nursing profession in Cambodia overal.

I found more similarities than differences between the AHC and pediatric nursing in the U.S. Their charts look amazingly similar to how we charted before the hospital implemented computerized documentation. They use similar techniques for starting IVs, placing feeding tubes and administrating medications. The doctors and nurses work closely together, and frequently joke around with each other and their patients.

Educating patients and their families at AHC is HUGE!! They have a special cooking school where parents are taught how to prepare nutritious meals for their children. They even have an herb garden, and offer free plants to anyone to start their own gardens. The courtyard, the cooking school area and the inpatient main room all have big screen TVs where they continuously show professionally prepared public service videos on diet, cooking, and good hand-washing. That is, until mid afternoon when they show a children’s movie. Today it was Ice Age 3, and most of the kids were “glued” to watching, even though the sound was inaudible!!

We have No Smoking signs all around our hospital, but AHC has a different concern outside their hospital: