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Weekly UpdatesA few years ago, when I received a small inheritance, I decided to fulfill a lifelong dream. While my many years working in hospital lab environments had taught me much about diagnostic testing, my experience with volunteer work taught me just as much about the hardships some people face through the bad luck of being born poor.
Now, I had the chance to put the two together and make a difference. When I read that Angkor Hospital for Children (AHC) in Siem Reap, Cambodia, needed lab volunteers for stints of a week or more, offered free room and board, and was close to "civilization" (meaning an airport), I knew this was the opportunity I had been looking for.
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Angkor Hospital for Children was established in the early 1990s as the first academic pediatric hospital in Cambodia. AHC's dedicated medical staff has the enormous challenge of providing medical care to impoverished children with chronic malnutrition and diseases such as AIDS, tuberculosis, and malaria. In a country with no health insurance, few government-supported social services, high levels of illiteracy, and isolation in rural communities with no transportation, children frequently do not arrive at the hospital until they are sick enough to require intensive-care treatment.
Digging in
I was eager to get started as soon as I arrived, but the incredible heat and humidity almost knocked me flat as soon as I stepped off the plane. I immediately realized that my first day would be difficult--and brief. My trip to Cambodia took more than 24 hours, giving me a serious case of jet lag, so after I was introduced to the lab crew and given a tour of the lab, I headed back to the guest quarters for a few hours of sleep.
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During my nearly three-week stay, my job was to consult with the laboratory staff about some problematic practices. Khmer, the official language of Cambodia, is the most challenging language I have ever attempted to learn, so I could only communicate effectively in English. The lab manager, who spoke and wrote some English, told me he needed help with some microbiology and biochemistry procedures.
The techs at Angkor Hospital for Children receive a good technical school education in Cambodia and work diligently six days a week. The lab offered very basic hematology, chemistry, microbiology, serology, urinalysis, and blood banking services--with an emphasis on basic. Some of the instrumentation was very old; the lab started in the 1990s with donated used equipment, and the techs still used most of this older instrumentation since there was no money for replacements. Due to the problems inherent in performing tests on aged, poorly behaving instruments, AHC's lab was in desperate need of new instrumentation. I wrote to the hospital board of trustees outlining the problems with the current biochemistry instrumentation, arguing the need for new equipment. After I got back home, I learned that the letter I wrote to the AHC hospital board ended up in the hands of a generous donor, who contributed the funds to purchase a new biochemistry analyzer for the hospital lab.
AHC's lab had only a couple of basic computers, which were used just to record simple patient data. There was no air conditioning, and space was at a premium. Blood donors, for example, were frequently drawn in a room that served as storage, the lab manager's office, a break room, and the distilled water preparation area.
The lab also needed help with the overall quality assurance (QA) and daily quality control (QC) programs, which turned out to be a difficult task. The language barrier prevented me from explaining the benefits of performing daily QC and having a solid overall QA program in place. I saw evidence of previous attempts by past volunteers to put a good program in place; but for the most part, their instructions were not followed consistently by the lab staff. While the medical director was aware of the need to provide more oversight and enforce such programs, like all physicians at AHC, he was an overworked clinician with an overwhelming patient workload, so he simply did not have the time.
A recent MLO interview on the globalization of the medical lab (March 2009, p. 30) hit on the very essence of a reluctance to accept and embrace standardized practices worldwide. Without the need to pass inspections required to obtain reimbursement for services, with language barriers that prevent the understanding of standards, and without other local programs to emulate, there is no true interest in following any written internal QC "requirements" or adopt a QA program.
A world apart
While I was mentally prepared for much of what I saw in the laboratory, nothing could have prepared me for what I observed around the hospital. Day after day, tremendous numbers of sick children arrived, dressed in rags. Families sat patiently outside the triage clinic on hard benches in the open courtyard for hours waiting to be seen. While this was often disheartening for me, most of them still offered me a smile when I walked by. Inside the non-air conditioned hospital, the beds were made of thin foam pads on metal frames without guardrails. Monitoring equipment was scarce. Almost every patient-supporting device we are accustomed to in American hospitals was absent. But, I was surprised and happy to see a true interest in accurate patient identification at the bedside. The patient ID practices I saw when visiting the wards at AHC were perfect.
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The mix of 21st-century technology with overwhelming poverty in Cambodia was surreal. Multitudes of Cambodians five in homes that float on the water, with the larger structures serving as community centers and health clinics. I visited one of the floating health clinics on Tonle Sap Lake, where portable medical equipment was carried by small power boats to what looked like nothing more than a large floating raft. A growing number of Internet cafes crowded with cell-phone-carrying locals lined the dusty dirt streets of Siem Reap. New motorcycles streaked by, followed by old trucks carrying a number of people, pigs, and petrol bottles. Tourists from around the world come to Siem Reap to visit nearby Angkor Wat, said to be the largest religious monument in the world.
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Helping hands
Because the hospital was is in need of so many supplies, I wanted to bring some needed supplies with me. Once word got out to the laboratorians of Rhode Island Hospital where I worked, as well as to friends and relatives, that I was collecting things to bring, supplies came pouring in. Many generous people donated money for medicines, lab supplies, surgical supplies, and toys for the children. While I was in Cambodia, I realized that generosity comes from many places. During a home healthcare visit in a village near Siem Reap, I asked where the medications came from for the children infected with HIV. I was told that they came from "Bill Clinton." It took me a moment to realize they meant the William J. Clinton Foundation, which receives contributions from governments, companies and individuals from around the world.
While I enjoyed my experience at Angkor Hospital for Children, I have no immediate plans to return to Siem Reap--mostly because I have to accumulate vacation time to go on such a long trip. In the meantime, I am helping another lab in need from right here at home. I am working with Dr. Walter (Sunny) Dzik at Massachusetts General Hospital in Boston to obtain lab supplies for Mulago Hospital in Kampala, Uganda. The pediatric lab at Mulago is basically empty, and while physicians and nurses are accustomed to working with no diagnostic instrumentation, I hope to help Mulago Hospital the way so many have helped Angkor Hospital for Children.
By Karen Mann McHugh, MEd, BB(ASCP)
Karen Mann McHugh, MEd, BB(ASCP), is a clinical trials specialist for a laboratory instrumentation company and fives in Massachusetts.
Information on how to help Angkor Hospital for Children in Siem Reap is available at www.angkorhospital.org. To learn more about helping Mulago Hospital's pediatric laboratory, go to www.cd36malaria.org.
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