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Teaching in real time

Louise Buckley, a nurse from Co Cork, realised a childhood ambition to be an overseas volunteer when she went to Cambodia in 2011 to work as a nursing adviser in a community hospital. She has found the people she works with learn most when she leads by example.

Teaching in real time

The baby is not breathing. How long? No time to ask. Two doctors and three nurses surround the little body in the emergency ward. The infant’s mother sits silently on the floor by the entrance. Her mother and aunt peer in from the porch.

It is early afternoon and Louise Buckley has just waded back from lunch across flooded hospital grounds. Ngam Kim, her volunteer assistant, greets her with an urgent message. She is needed in emergency. Her first reaction to the scene, as she will say later, is a feeling of frustration.

Quickly, she reminds them of steps from the practice. One team member uses a bag-valve mask to cover the infant’s face and pump oxygen into his lungs under pressure. Another begins chest compressions. Louise steps back, finds a lamp to shine on the bed, and reminds each nurse taking turns with the mask to keep an airtight seal around the infant’s nose and mouth.

Maybe they are getting better at this.

“Now they know to get a good seal with the chin in and the head back so the air is getting in. If they look like they know what they’re doing and look quite comfortable, then I have them swap with somebody else. It is all about getting practice...

“And yes we are trying to save the baby, but we’re also educating so the next time a baby comes in they don’t need a baraing (a westerner) to come in and say, ‘No, you do this!’”

Testing professional knowledge

This is teaching in real time. In this classroom, outcomes are a matter of life or death. Louise has trained for years to be here. She set her heart on becoming an overseas volunteer while growing up in Ireland. She has a post-graduate degree in nursing and worked in the intensive care unit at the hospital in Cork before coming to Cambodia. Now the test is to make good some of her professional knowledge in a place where health care is sometimes little more than an amulet and a prayer.

Louise is the only baraing in Angkor Chum, a rural centre just over an hour’s drive from Siem Reap and the great temples of Angkor Wat. The referral hospital where VSO Cambodia has placed her provides emergency and obstetrical services for a population of more than 20,000 people. Since her arrival early in 2011, she has tried to stick to the role of nursing adviser, to hold the routines of the day at arm’s length.

Sometimes that works, as in the case of the woman with snakebite, a widow with young children. Let’s treat her here, Louise argued, rather than send her to the regional centre where a doctor likely would take off her leg. The woman needed three months to heal, enough time for Louise to train the entire staff in sterile dressing of the wound.

Emergencies represent a different opportunity. The hospital staff is largely untrained or unpracticed in life-saving procedures. In cases of critical injury or a child’s life in danger, all turn for leadership to the determined Irish nurse. Even the two staff physicians defer to her experience.

“In an emergency, Louise is the most important person,” the more senior doctor, Sieng Kheng, acknowledges.

Louise is uneasy with that endorsement.  She is here to teach others her skills, not take their place. In the emergency ward, she pointedly looks to the doctor to make decisions.

“What is the plan?” she asks when an unconscious admitted infant begins to show some signs of vitality. The soles of baby’s tiny feet are pink, not deadly white. Louise gives a small yelp of delight when a stethoscope detects a steady heartbeat. The next step she leaves up to the doctors. Their decision is to move the child to the regional hospital in Siem Reap. The infant, the mother, the grandmother, Louise and two nurses – Sokha and Sokhean – head off in the ambulance.

Working together as a team

The mission will not be successful. The nurses continue with the mask and compressions but baby dies on the way. Going back to Angkor Chum, the mother’s distress is compounded by nausea from the unfamiliar ride. Sokha prepares the little body for the mother to take when she has composed herself and the three nurses come together in a hug.

“I was proud of the girls,” Louise says later.  “They kept going and there was no stage of staring out the window, which is what they used to do. And there was a lot of respect to the baby, after you know, wrapping it up and keeping its face covered.”

The afternoon has been a defeat, but not a failure. At the morning meeting next day, Louise congratulates the staff. Even two months ago, she tells them, she doesn’t think they would have worked together so well.

She means this sincerely. Her fear has been that the good practices she has stressed will be forgotten when she leaves in two years' time. But ever so cautiously she is beginning to hope they may instead become good habits, and that her example of professional pride and purpose may be taking hold.

“Instead of floating in here with a couple of tablets,” she says when trying to explain the feeling, “I’m floating in with knowledge and experience and some of the staff are sponging it up. Not all of them, but some of the staff are sponging it up.”

Extract from an article taken by a Journalist on behalf of VSO/Cuso International.

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