By Shawn Tan and Vincent Neoh

In February 2016, the pair of us medical students from Lee Kong Chian School of Medicine, National Technological University (NTU), were thrilled to accompany a medical team from KK Women’s and Children’s Hospital (KKH) travelling to Kampong Chhnang, Cambodia, to train local healthcare providers in acute paediatric emergency resuscitation.

The team’s purpose was to equip Cambodian healthcare professionals with the knowledge and skills to respond in situations where a child’s life might be threatened without immediate medical intervention, and enhance the care they could provide to their community.

Over four days, the team conducted an Acute Paediatric Emergency Resuscitation Course (APEC) for 50 doctors, nurses and midwives from three district hospitals and 39 village health centres spread across Kampong Chhnang.

Overcoming language barriers
The APEC was conducted through theory sessions and circuit-style interactive practical and skills stations. As few local course participants were fluent in English, the team had to rely heavily on translators to convey the course material. To mitigate the loss of information in translation, and help course participants fully grasp the concepts being taught, they were quizzed from time to time.

Course participants were given different scenarios of cardiac arrhythmia and asked to respond appropriately, using their newly-acquired knowledge and skills. Their responses revealed any gaps in their knowledge, allowing the team to address these with a demonstration of the proper technique coupled with step-by-step explanations.

The participants were then asked to repeat the scenario, to demonstrate that they had successfully acquired the knowledge and skills to carry out the appropriate intervention.

Debunking healthcare myths
Healthcare professionals in Kampong Chhnang often refrain from administering defibrillation, believing that the procedure is tantamount to electrocution, and holds little or no medical benefit. A common fear is that the patient will die in the process.

Dr Teng Sung Shin, Registrar, AST, Children's Emergency Department, KKH (left) demonstrating paediatric intraosseous needle insertion into the bone. 

To correct these misconceptions, the team explained the science behind defibrillation, and the medical reasons behind its necessity in treating certain forms of cardiac arrhythmias. In addition, it was stressed to the course participants that defibrillation is a common procedure used around the world that has been shown to improve patient outcomes, giving anecdotal evidence to further illustrate its benefits.

Enhancing respiratory support
In Cambodia, it is not uncommon for healthcare facilities to have limited access to equipment, technology and staff while seeing substantial numbers of patients. A village health centre in Kampong Chhnang (equivalent to a small clinic in Singapore), equipped with only a few consultation rooms and beds, can see up to a few hundred patients in a day from surrounding villages.

To help ease the technology shortage and address the lack of replenishable oxygen in these remote health centres, the team introduced an improvised design of a bubble continuous positive airway pressure (CPAP) machine from existing pressure pumps. The machine was co-developed by team leader Associate Professor Ng Kee Chong, Chairman, Division of Medicine; Dr Nirmal Kavalloor Visruthan, Associate Consultant, Neonatology, KKH; and our local partner non-governmental organisation, Water and Health (WAH).

Constructed at a fraction of the cost of a commercially-available machine, the air-driven bubble CPAP design obviates the need for oxygen tanks for initial respiratory resuscitation and support. It is hoped that this cost-saving design and much lower price will increase the machine’s prevalence in local healthcare facilities, and enhance respiratory support for paediatric emergencies in the village health centres.

A/Prof Ng Kee Chong (left) and Dr Nirmal Kavalloor Visruthan (right) with their improvised bubble CPAP machine design.

WAH saw to the team’s various needs of transport, course venues, logistics and food, enabling the trip to proceed seamlessly. The NGO works with companies to improve hygiene practices and access to clean water for Cambodian communities, and had provided invaluable aid during previous KKH medical outreach efforts to Kampong Chhnang in 2013 and 2014 – efforts which eventually saw the high maternal mortality rates drop by 75 percent.

Training the trainer
Following the old adage: ‘give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime’, a KKH team will be returning to Kampong Chhnang to conduct a second round of APEC training in the latter half of 2016, together with several potential trainers selected from the local healthcare community.

Investing in medical training and education has a transforming effect on healthcare and a powerful flow-on effect beyond just treating illnesses. Patient education, outcomes, prevention, health and wellness are also improved. In addition, crosspollination of medical best practices are useful to strengthen national health guidelines and regulations.

We are glad to have been part of KKH’s partnership efforts with fellow medical colleagues in Cambodia to help build the capacity of the healthcare system and improve the health of Cambodia’s people.

This article was first published in KKH Special Delivery Issue 2, 2016.