The Sihanouk Hospital Center of HOPE, has been open since 1996, and provides a center for education and clinical training of medical professionals, while providing 24-hour health care to thousands of medically underserved people at no charge.The hospital is staffed with nearly 400 people, the majority of which are Cambodian and have received medical training at the hospital. The hospital, managed by HOPE worldwide, is one of the busiest in the country and sees 350 patients daily and more than a million patient consultations have been completed since 1996. One important service the hospital offers is the availability of life-prolonging antiretroviral drugs (ART) for patients living with HIV/AIDS. More than 2,800 HIV positive patients are currently being treated by the hospital.
Patients enter the hospital system through the Outpatient Clinic or Emergency Room. The medical and nursing staffs manage the majority of patients since only the most serious are admitted to the medical ward. The hospital is a member of MEDICAM, the membership organization for Non Government Organizations (NGOs) active in the health sector of Cambodia.
Across the street from the Sihanouk Hospital Center of HOPE is a for-profit Medical/Surgical Clinic.Patients who come to this clinic must pay privately for their medical or surgical service under three levels of payment which were termed as Level A, Level B and Level C which is based on income.
The driver from Sihanouk picked us up at 0800 and took us to the main campus. We went up to the International Volunteers office and a manager escorted us to the department of Nursing Education. We met a Nurse Educator by the name of Hay who welcomed us to the hospital. She was involved in wound care and she offered to take us over to the Medical/Surgical Center to see some patients who had been admitted with wounds.
|Dr Monica Joyner and Cathy outside the hospital|
|Sign in Hospital Foyer|
We walked across the street to the clinic and it was very hot. A guard was outside the clinic door monitoring the people who entered and left the clinic. We went up to the Surgical Center and it was full of activity. We learned about a young girl who had sustained a large acute traumatic wound to the outside of her knee ad leg as a result of a tractor collapsing on it. Dr Joyner and Cathy went into the operating room where a Cambodian Orthopedic surgeon performed surgery to drain infection as well as do a skin graft. He took skin from her thigh and grafted the wound very carefully. Once the skin graft was sutured into place he immobilized the leg using casting material , bandaged with gauze and wrapped the leg and instructed the bandages to be left in place for five days before changing.Resources are very precious and so every bandage was placed with care - and there was certainly no waste.The operating room team worked very efficiently together. We will follow up with this patient after the weekend.
|Treatment Room in Surgical Clinic|
|Cathy, Ready for the OR|
While we were in the operating room, Mary was shown around the surgical floor by nurse Hay. They have 6 rooms and seven beds. One room is for VIP (very important people aka people with money). One isolation room with a young girl of 16 years who broke her leg in a moto accident (very common here in Phnom Penh). She had an external fixation device and a leg wound that had just closed. She was MRSA positive which is also very common as they have trouble controlling the spread of it in the surgical area because of the close proximity of patients and the less than adequate infection control techniques.
|Mary and Surgical Clinic Nurse outside the clinic|
Once Cathy and Dr. Joyner returned from the OR we met with Dr. Cornelia Haerner, a general surgeon who has dedicated her service to the Surgical Centre and the Centre of Hope for 12 years. We were able to observe minor surgery on a gentleman who originally had an abdominal abcess, resulting in septicemia, ICU stay and ultimately an open abdominal wound. Dr. Haerner had previously attempted to close the defect with a mesh and had success for a short time before it reopened again. Today she removed a small amount of scar tissue proximal to the wound and the sutures beneath it which was the cause. She sutured the area closed. To dress the wound a 4x4 gauze was laid over it and a sugar solution poured over top. More gauze was used as a secondary dressing and tape. The sugar solution is made at the hospital by the nurses. It consists of boiling 1 litre of water and then letting it cool to a warm temperature. 1 kilo of sugar is then added to the water and dissolved. More sugar is added until the appropriate viscosity is achieved. It is stored in what looks like a clear 500 ml saline container and used with no expiration date. We were told the sugar solution for wound care is effective in controlling bacteria due to its high osmolarity. We found this very fascinating and somewhat perplexing, considering it is a sugar solution that is left at room temperature and used on wounds to the last drop. We wondered about bacteria growth in the bottle but we were assured that the osmolarity of the solution killed the bacteria. It was then we realized that all our knowledge regarding advanced wound care products would have to be suspended because they have very little technology and supplies to work with and our knowledge of wound assessment and infection control would be shared with our colleagues here in Cambodia. Dr Haerner recommended that we keep things very basic.