So the other day we (the other two young expat nurses and I) started talking about whether we are
going the right way about what we are doing here and whether it’s likely to have any
lasting effect after we leave.
None of us really have experience in this kind of work which
is sort of looking at the hospital and then making projects to try and improve
it – trying to increase patient safety and reduce rates of infection, and to
introduce idea’s of leadership, self regulation of the ward and trouble
shooting and critical thinking and self/hospital improvement to the Nurse unit
managers. Also trying to create a culture where everyone feels that they have a
say and promotions etc. are given out on merit not bribery.
Culturally we are very different, and I don’t think any of
us understand much about Khmer culture, it is easy to put something down to
someone’s culture, but I don’t know how much of that is assumption and how much
is accurate. There are also big differences between khmer culture in city’s and
out in rural provinces and among people who have had more jobs and more contact
with westerners and those who haven’t and I’d say probably it differs with
class as well. So a blanket statement about something being ‘their culture’ is
maybe just going to be inaccurate anyway. Our lives have definitely been very different up to this point.
There are so many
assumptions that you just can’t make, and so many inherent misunderstandings
that occur and we are learning as we go. Things like talking about medication
errors, because it has been so ingrained into us what they are and that they
are bad, when we introduced the new medication charts I think we forgot to
explicitly say that if you haven’t signed for having given the medication, that
is an error, even if you gave it correctly, you still need to document it,
there’s no rule like at home that ‘if you didn’t document it you didn’t do it’
because there aren’t the regulating bodies and authorities here to do anything
about it.
And we gave the NUM’s calenders to fill out the other day to
help us all stay on the same page with what’s going on and when they were sort
of looking a bit confused I asked has anyone used a calender before? And only
one person out of eight had. Sometimes you just have to go ok, and go back a
few steps. It’s a bit of an eye opener about just how ingrained our culture is
and how much we assume. The NUM’s are
great and try really hard, I have such respect and appreciation for them
working with us and our crazy ways. We have started meeting briefly everyday to
keep up with introducing all of the things we want to introduce and trying to
keep up with following everything up etc. It’s also hard to know how much is
just doing what we say because we are white as well, and whether they feel
comfortable really telling us their opinions, but a few times recently they
have told us problems they see in our plans which is really heartening.
So back to the question of whether it is effective, there
are a few reasons that perhaps these changes won’t stay in place when we go;
one is that we don’t know much about the culture and if we aren’t doing these
things in a way that fits in with the culture here, it will probably just go
back to the old way when we leave, (although we are making some changes to the
culture of the hospital as well, and I will be interested to know if they will
stay). Also we are introducing many changes,
we have so so many things we want to introduce and I think we need to
calm down a little and pick some focus area’s to work on that are the most
important perhaps and do really good follow through with our projects, I might
only be here for another four or five months, (or maybe a little longer) and
The others might only be there for a further eight months (unless they get
further funding) so we need to be a bit realistic about what we can achieve in
that timeframe…
We are trying to do a lot of things right now, we have
changed the medication charts and vital sign charts in the hospital, opened a
medical ward, introduced a crash cart, started Nurse Unit Manager meetings,
started portfolio’s for staff and writing policies and procedures, started
writing a pharmacy book as a reference for all the drugs, started teaching
anatomy and physiology and pathophysiology, we are about to try and introduce a
new way of documenting, make a system so that patients have unique medical
record numbers and introduce medication error reporting forms, trying to get
the policies that we have written part of hospital culture and self regulating
checking of those things, (trying to convince the hospital board that the cost
of paper towels to dry hands is worth the reduce in infection rates that proper
handwashing is shown to have). And I’m sure I’m forgetting things, so within
all of that I’m sure that some of those will not get followed through, or fall
by the wayside..
It can be disheartening trying to make changes, but I think
some of that is just wanting things to happen to fast or misunderstanding why
it’s not working. The time I usually end up frustrated is in the middle of a
nightshift when there is someone very sick and I can’t communicate well and the
standard of care that I’m used to for a patient, and things that I take for
granted as basic don’t get done, but I just try to remember that this hospital
has been running for a long time without us and yes some people probably
have died from aspiration pneumonia etc, but also the hospital has saved a whole lot
of people who would have died otherwise.
It's a very funny situation to be in helping a hospital that was set up as a war hospital to start accepting medical patients, and to be trying to bring the standards of care and the idea of responsibility for your patients to be more like a western hospital, and still being constrained by resources and budget and trying to make the best of the material we are donated. I think its sort of a unique situation in that, and I am hopeful that we can help the hospital to become a little safer and the nurses hopefully to develop more knowledge and pride and responsibility in their work.
We'll see, but its 02:30am, so goodnight for now!
