Cambodian Reflections: An ER Nurse's Adventure

Within a month of being selected to go to Cambodia, my bags were packed, I gave big hugs to my family and was quickly off to Cambodia. First stop, Siem Reap (the “must visit” destination of Cambodia). The ruins and temples of this region were the inspirational settings for Indiana Jones Temple of Doom and Laura Croft’s Tomb Raider… Majestic. Beautiful. Tropical. Breathtaking. After a quick day of exploration and bringing in the Khmer New Year (a water-soaked, fun, chaotic, music-filled night), I headed to Phnom Penh – the capital of Cambodia.

First impression: concrete jungle replaces ancient jungle. Phnom Penh is a world of cement, with their roads teaming with motos (small motorcycles), tuk-tuks (two-bench transportation), cars, trucks and pedestrians. Despite the traffic chaos & crowding, the people love to smile, laugh and are laid back.

 My partner Sumi working with our Calmette Local Nurse Champion partners for some bedside education. Bringing Sepsis and the patient assessment into clinical practice!

My partner Sumi working with our Calmette Local Nurse Champion partners for some bedside education. Bringing Sepsis and the patient assessment into clinical practice!

Our (myself, ICU nurse Sumi and doctor at large Cora) mission included visits to two hospitals (Calmette and Khmer Soviet Friendship Hospital (KSFH)). The very first day, Cora and I taught a dozen ‘Local Nurse Champions’ and 120+ ICU and ER nurses how to do head-to-toe assessments. Throughout the two weeks we performed Quality Improvement checks by checking off nurses as they did assessments on patients. Besides the head-to-toe assessments, I am also proud of the much-need assessment sheet Sumi created for the nurses to document their findings. Additionally, it was exhilarating to see the ER nurses realize the difference and necessity of focused assessments for new patients versus when to do head-to-toe assessments. (One of the sad realities I learned about Cambodia healthcare is that ICU patients who cannot afford to pay are placed in the corner of the ER for staff to care for them “when they can.”)

 Working with over 120+ ICU and ER nurses to teach the head to tow patient assessment. Phase One in Calmette Hospitals's very first Quality Improvement Project organized and lead by the INP Local Nurse Champions.

Working with over 120+ ICU and ER nurses to teach the head to tow patient assessment. Phase One in Calmette Hospitals's very first Quality Improvement Project organized and lead by the INP Local Nurse Champions.

 The nurses who attended the Phase One Education Day: Learning the Patient Assessment.

The nurses who attended the Phase One Education Day: Learning the Patient Assessment.

Additionally, while Cora taught the doctors how to treat and recognize sepsis, Sumi and I taught the nurses what to anticipate for early sepsis treatment, sepsis management, and how to advocate for patients and communicate with the doctors (i.e. SBAR). At the end of our mission, we combined the physicians & nurses for a fun day of simulation at both KSFH and Calmette to demonstrate a sepsis scenario.

Highlights of the trip that went beyond the medical mission included being invited to the country to visit the family home of one of the hospital coordinators and to meet his kids. We also visited the S21 Tuol Sleng Genocide Museum, where the depressing and recent history of Cambodia was well depicted and remembered.

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A few observations: 1) Nurses in both hospitals have unexpectedly fantastic skills – starting IVs, making due with supplies and equipment (who knew and NG tube would work to gravity!), intubating patients and being positive throughout their extremely high acuity and chaotic days. However, it is their critical-thinking skills that need continued growth. 2) Helmets and traffic rules are suggestions only. I literally feared for my life as I took a public van to the coast along their two lane highway. Sadly, there are dozens of mostly young patients who are intubated due to head trauma. 3) I loved that at this time of year, Phnom Penh was actually hotter and more humid than my home town of New Orleans. 4) Medical missions, like volunteering, are similar to hikes for me: it sounds like an awesome idea before I go; I wonder “what the heck I was thinking” in the middle of it; also, in the middle of the journey, I find ‘miraculous moments’ that make it all worthwhile; and afterwards, I am oh so glad I did it.

 Our team with KSFH nurse leaders, Pak Sopheak and Vuth, our INP Cambodian Coordinator. 

Our team with KSFH nurse leaders, Pak Sopheak and Vuth, our INP Cambodian Coordinator. 

 Our Local Nurse Champions from KSFH with me, Sumi, and Cora after our Sepsis simulation training. 

Our Local Nurse Champions from KSFH with me, Sumi, and Cora after our Sepsis simulation training.