Welcome to Angkor Hospital for Children, Siem Reap, Cambodia. SOM SOPHAL Director of Nursing Angkor Hospital for Children

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1 Welcome to Angkor Hospital for Children, Siem Reap, Cambodia SOM SOPHAL Director of Nursing Angkor Hospital for Children

2 Contents: 1. Cambodian mapping 2. Background/recent history 3. Health care system in Cambodia 4. Background of nursing Education in Cambodia 5. Friends Without a Border (FWAB) 6. Angkor Hospital for Children (AHC) 7. Nursing Care and education in AHC 8. Challenges 9. Questions & Answers

3 1- Cambodian Mapping

4 Kingdom of Cambodia

5 2-Background: recent history Independence from France in 1953 Secret bombings by USA early 1970s Khmer Rouge Vietnamese occupation 1980s with continuing civil war UN sponsored elections 1993 Fall of last Khmer Rouge rebels 1999 Relative stability 2000s

6 USA Bombings 2.4 million bombs: ,000 killed

7 Khmer Rouge 1-3 million died out of population of 7-8 million 40 doctors left in entire country

8 3 - Cambodian Health Care System: 1 Level Central Ministry of Health (MoH) National Hospitals National Programs Training Institutions Research Institute 2 Level Provincial Health Department Human resource Development Management Public health Provincial Hospital (24) 3 Level Operational District (77) Referral Hospitals (57) Health Centers ( ) Health Posts ( )

9 3 - Cambodia statistics * Land Area = Km 2 Population = 14 million 80% live in rural areas 40% aged < 15 years 30% have access to clean water 17% have access to adequate sanitation 16 doctors per 100,000 population *from WHO and UNDP websites

10 3 - Cambodian health statistics * Life expectancy = 58 years Infant mortality rate = 66/1000 live births Under-5 mortality rate = 83/1000 live birth Maternal Mortality Ratio : 437 per 100,000 live birth % of children under 5 years are malnourished (-2 SD below mean) 1% of population has HIV Only 40% of births are attended by skilled health workers. *from WHO, CIA, and UNDP websites

11 4 - NURSING EDUCATION SYSTEM TODAY I. Basic Program 1.1 Nursing Education Program 1 year (Primary Nurse) 3 years (Associated Degree) 4 years ( Bachelor Degree) 1.2 Lab. Technology Education Program..3 years 1.3 Physiotherapy Education Program...3 years 1.4 X-ray Technology Education Program 3 years 1.5 Midwifery Education Program...3 years

12 4 - NURSING EDUCATION SYSTEM TODAY II. Post basic Training Program 2.1. Continuing Education Program (1-6 weeks) Midwifery Training 4 months Program Training of Trainer (ToT) 2.1.Specialty Programs Anesthetist Nurse Program... 2 years Mental Health Nurse Program 18 months Chief Nurse Program months Midwife Program.. 12 months Operating Theater Nurse Program 4 months

13 4 - NURSING EDUCATION SYSTEM TODAY DIPLOMA OF -Continuing Education -Specialty programs 1month - 18 months NURSE-MIDWIFE 1-year MW.program ASSOCIATE DEGREE IN NURSING SCIENCE RN.program Year 3 Year 2 Year 1 HIGH SCHOOL DIPLOMA

14 4 - NURSING EDUCATION SYSTEM NOW AND IN FUTURE PhD.program Year 3 Year 2 Year 1 MSN.prog. Year 2 Year 1 ADN.program 1.½-year BSN.program Year 3 Year 2 Year 1 BSN.program Year 4 Year 3 Year 2 Year 1 HIGH SCHOOL DIPLOMA

15 5 -Friends Without A Border (FWAB)

16 5 - Friends Without A Border Friends Without A Border (FWAB) was founded in 1995 by internationally acclaimed photographer Mr. Kenro Izu. After a series of visits to photograph the Angkor monuments Izu dedicated himself and his photography to Cambodia's children.

17 5 - Friends Without A Border has 4 main projects: 1). Angkor Hospital For Children (AHC) 2). Medical Education Centre 3). Capacity Building and Health Education Program (CBHEP) 4). Satellite Clinic at Sotr- Nikum

18 6-Angkor Hospital for Children (AHC) - Supported by Friends Without A Border, based in New York - All care is free including medicines, surgeries, etc

19 6- Angkor Hospital for Children (AHC) Opened in January,1999 has Two goals: 1. Provide high quality care for children in a warm, supportive environment. 2. Act as Medical Education Center (MEC) providing both theory and practicum training to healthcare professionals & non-healthcare professionals.

20 6- AHC became a formal Teaching Hospital recognized by MoH on Nov 8, 2005.

21 6- AHC s Staff The hospital employs more than 300 Cambodian staff: 48 doctors 142 nurses. 11 Lab. Technicians 8 Pharmacists & technicians 3 Anesthetists 4 Physiotherapist 132 Administrative staff

22 6- Comprehensive Care at AHC Outpatient Department Inpatient Department Emergency Room Intensive Care Unit Operating Theater Surgical Unit Low Acuity Unit Dental Clinic Eye Clinic Pharmacy 24-hour Laboratory Radiology (XR & US) HIV/AIDS clinic Play Therapy Physiotherapy

23 6- Out Patient Department children arrive every day at Angkor Hospital for Children Many patients travel a long distance and borrow money for the trip to AHC

24 6- ORT Corner Based on IMCI guideline Simple, inexpensive, effective to re-hydrate. Started July 25 th 2005

25 6- Common Diseases Acute Respiratory infection Severe malnutrition Gastroenteritis (diarrhea) Sepsis and septic shock Tuberculosis HIV/AIDS Meningitis Neonatal infection CHD/Congestive Heart Failure Dengue Hemorrhage Fever Malaria

26 6 - Emergency Room 24 -hour emergency care is available in the Emergency Room All doctors and ER nurses get APLS training

27 6 - Intensive Care Unit Intensive Care Unit Our sickest patients require the most care 1 nurse takes care of only 1 or 2 patients.

28 6 - Operating Theater Approximately 40 operations are performed per week

29 6 - Surgical Unit 10 beds for surgical patient More than patients each month.

30 6- In-Patient Department (IPD) More than 300 children are admitted each month

31 6 - Low Acuity Unit (LAU) 10 beds are available for patients who require: - a long convalescence, or - complex health teaching for the family

32 6- Support Services Laboratory Pharmacy Medical Imaging: X-ray & Ultrasound

33 6- Dental Program More than 600 children are treated every month Another 400 are treated and given dental hygiene at their schools and in their communities

34 6- Prevention of Childhood Blindness More than 800 children are treated per month including surgery Screening of primary school children children per month receive glasses Preventive eye health education in OPD waiting area and communities

35 6- Home Care / HIV program More than 200 families follow-up visits every month More than 60% of Home care patients are HIV+ Active hospital program for HIV testing and pediatric ARV treatment

36 6- Mobile Clinic at rural area

37 6- Child Friendly Environment Play is an important part of care for the children at the hospital Follows UNICEF guidelines for providing a child friendly hospital

38 6- Nutrition project & child/family health education

39 6 - Project activities Nutrition nurse education Child/family health nurse education Cooking demonstration Gardening demonstration Food support Transportation support

40 6- Ingredients of special food Rice : 100 g Meat : 100 g Tofu : 100 g Green leaf vegetable : 50 g Yellow vegetable : 50 g Oil : 30 g Sugar : 50 g Salt : As needed Add water to make one liter

41 7- Nursing Care and Education at AHC Director of Nursing (DON) = 1 Assistant Director of Nursing (ADON) = 1 Nursing Education Coordinator (NEC) = 1 Unit Managers (UM) = 6 Nurse Educator & Team Leaders (TL) = 22 X-ray Technician = 2 Dental Nurses = 3 HIV/Home Care nurses = 7 Nursing staff = 99 Total = 142, Female = 70 Male= 72

42 7- Nursing education for AHC nurses

43 7- Continuing Nursing Education(CNE) is a key for success in improving the nursing profession

44 1. Annual nursing intake and nurses training 2. Nursing team presentations 3. Doctors lectures to nurses 4. Nursing standard committee 5. Nursing Journal club 6. IPD nursing care conferences

45 7. Nursing Teachers Group/ Nurse educator 8. Nursing Rotation Certificate Course 9. Yearly Advance Pediatric Life Support 10. Yearly First-Aid Training (Provider and Instructor courses) 11. English classes 12. Volunteer/special guests teaching 13. Nutrition project & child/family health education

46 7- AHC Nursing education for nursing professionals and non-health care professionals outside of AHC

47 1. First-Aid training for communities 2. Basic hygiene and HIV/AIDS training for communities 3. Health Center Training for local health centers (HCT 1, 2, 3) 4. Basic Pediatric Nursing Care Course for referral hospital nurses

48 5. Refresher course for nursing instructors and preceptors (Basic & Advanced) 6.National nursing student clinical placement 7. Integrated Management of Childhood Illness (IMCI) 8. Emergency Triage Assessment & Treatment (ETAT)

49 8 - Challenges 1- The education system/ curriculum is recognized only in Cambodia. 2 - Human Resources in nursing is limited 3 - Code of Ethics, Nursing Regulation, Registration & Licensing are still on the process under sub-decree. 4 - Quality Assurance(QA) and Nursing Excellence?

50 Thank you for your attention Any questions?

51 Nursing Education In USA? 1- Nursing Aids 2- LPN/LVN (training.years & Roles) 3- AND ( training.years & Roles) 4- BSN ( training years & roles) 5- MSN (training..years & Roles 6- PhD in Nursing ( training...years & Roles

52 Nursing Education In USA? 7-Nursing Practitioner 8- Nurse educator 9- Clinical Nurse Specialist 10- Nurse Administrator 11- Family Health Nurse 12-Registered Nurse (RN)= AND & BSN?? 13- Association & Nursing Board/ Council?

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