Teaching at Pediatric hospital
Trip Start
Jul 09, 2008
1
5
7
Trip End
Jul 26, 2008
Pho Nang Ho Chi Minh,
Vietnam
Wednesday, July 16, 2008
Dads of children sat along the floor of halls outside the burn unit, where the kids were 6 beds to a room and almost all tied down stretched out on the bed. There is nothing to look at except the white walls and ceiling, other patients, and anyone in the hall outside. Most were completely naked except for bandages over their burns. Alot of kids get burned by knocking over the big cooking pots that are on fires or stoves near the floor I guess. We had to gown, put on hairnets, masks, and change into hospital sandals to enter, but there were no gloves in sight and noone asked us to wash our hands. Nurses did not seem to wash hands either.
One child was on nine IV drips/medications and was intubated. A nurse was assigned to provide ventilations by hand with a bag-valve mask as there are not enough ventilators...usually the family is trained and assigned to do this around the clock. We bring bag-valve masks with us every year as there is a severe shortage and they get reused after a patient is finished. Apparently some families fight over access to a bag-valve mask.
I got a chance to check out the emergency room and was pleasantly surprised. It has 5 beds, 2 baby beds, and an ICU holding room. One room off to the side is the training room complete with mannequins and seems pretty well set up. There is a Broselow-type peds crash cart with color-coded drawers for different sized children and common equipment sizes for that child size. They saw the design on the internet and had it locally produced as they cannnot afford the incredibly expensive genuine article. The one old defibrillator in the department only has the old paddles and is an adult model.
We covered some of the more basic material in Advanced Life Support (by American standards). The ICU doctor who was translating said most of the material was new to the nurses. We covered a review of CPR, management of endotracheal tube placement and troubleshooting, Intra-osseus needle insertion (ok...even alot of US MDs and RNs are scared to do this one even though safe and easy), a structured approach to assessment of life threatening emergencies, and the resuscitation team concept. We also went through 2 case scenarios where the nurses had to apply the assessment skills in an organized manner.
Some of the more experienced members of our team said that the material was a little above these nurses' level of training. Nurses here are very limited. There is no certification or licensure available, and they are often not expected to know basic assessment and management of intubated patients. The head nurse in the NICU asked me at lunch who can put in IO needles, which they do use sometimes here. In the states, the expectation is that MD, RN, EMT-P can all put it in, but in my experience only paramedics put them in. In peds hospitals the MDs probably do too. I would be very surprised if nurses in VN are allowed to insert IOs any time in the next decade, but at least some will hopefully be more comfortable with managing them once placed.
When we did the assessment piece the nurses ate it up...some were taking note furiously despite having some of my lectures translated into VN ahead of time and side-by-side with the english on the handouts. They especially liked the video scenarios with real patients we put them through to practice preliminary problem categorization and emergency treatment.
One of our Ph.D nurses on the team (Susan) taught Kangaroo care in the NICU while I was teaching in the classroom. Apparently the nurses here are not taught that babies will lose heat if not kept warm...thermoregulation is only taught to MDs. Basic, basic things are missing in their education...we will bring this up when we visit the BSN program the the medical school.
There are no nurses aids, respiratory therapists, etc here it seems, have only seen MDs and nurses in the wards. People go straight into their medical training after high school, bachelors degrees are rare...most graduate with a diploma and that is enough.
About 15 showed up for English class tonight and we covered the same topics as last night. One of the MD's brought a few nurses and most of our usuals were there, some who have known our mission leaders for 10+ years. More took teaching materials from my dad's work home this time, and we went a little late due to doing some singing and dancing (chicken dance...painful). One of our VN regulars also organized a massive, hilarious game of Simon Says.
Tomorrow we are back at Peds to teach Biomedical ethics and English. I hope to see the NICU and some of the other wards. I also need to start on my Community Assessment project for nursing school. Hopefully will see more of Saigon soon as one of the English teachers who brings her students to our classes wants to take me out on the town with all of them.
