Week 2 at Angkor Hospital for Children

It’s starting to become a routine around here. I wake up at 6:30am, eat breakfast down by one of the four swimming pools here at the Golden Banana, then catch a tuk-tuk to the hospital to arrive by 8 am. By then there is already a large mob of Cambodian families waiting to be seen outside the outpatient area. I go to work with the nursing education staff (mostly Vibol) on our current projects until around 11:30am. Then the staff goes to lunch, and doesn’t return until 2pm. The work day ends at 5pm. Of course, the nursing staff is a little different. They only take an hour for lunch. Half of them leave the unit at 12pm; the second group takes their lunch break right afterwards. Everyone makes sure they get a good nap in over lunch, including me…. (In the United States, nurses are lucky to get 30 minutes for lunch; and usually they’re still answering call lights in between bites of food.)

I still walk almost everywhere. There are lots of foreigners here – Koreans, Japanese, Indian, Australians, Europeans, who knows. I bet there’s at least a thousand new tourists go through this town every day, and this is the slow part of the season. I walk by them on the streets, but very few of them even make eye contact with me. The locals, on the other hand, are very friendly. Everyone says hello; even the toddlers say “hello” in English to me, with or without their pants on (diapers seem to be limited only to infants). Of course, many of them want me to buy something or take me somewhere on their motorcycle or tuk-tuk. And they’ve figured out what I’m about, probably after I walked back and forth to the hospital all last week in scrubs, because now many of them greet me with, “Hello, doctor.”

This week I’m finally starting to do some of the things I actually came here to do. I’ve spent most of this week putting together the details of a preceptor program for the AHC nursing staff. Before I leave, I will be presenting two all-day classes to experienced AHC nurses on how to be a nursing preceptor.

I also started today working on a class about pain management in children. This actually may be where I can make the biggest immediate impact on nursing care here at AHC. While the nursing staff at AHC are compassionate and caring nurses, they have no clearly defined methods for evaluating and treating pain for their patients. This has become a standard of care in the United States; certainly at my hospital in Indianapolis.



Of course, I can see there may be significant cultural differences here about pain. I have not seen any patient at AHC who were unduly suffering from untreated pain. In fact, on the day I spend in the post surgical unit, one of the nurses took me around to every patient on the unit that morning and we evaluated together the level of their post-operative pain. They all appeared to be without significant pain, including two patients with burns, and one patient recovering from an infection in his leg bone (which can be VERY painful).

So we have plans for me to give two short talks on evaluating and treating pain in children, one to the staff at AHC, and a second lecture to be presented to one of the satellite hospitals I plan to visit the week after next. This particular satellite hospital is a small rural hospital mostly run by the Cambodian government; but it has started to coordinate with AHC to improve their care of pediatric patients there.

I just had to finish out this post with a photo of some beach graffiti I took at West Baray, which is a gigantic lake created several centuries ago ago during the Angkor Empire. Today it is a beach resort frequented by the locals. The mystery is who posted this little love note on this uniquely Cambodian landscape, but in English.