A nursing lecturer from the University of South Wales experienced Cambodia’s healthcare system first hand in July, describing it as “like nothing she had ever experienced before”.
Paula Hope, senior lecturer in learning disability nursery, highlighted differences such as the role of families in direct care, the layout of hospitals and lack of learning disability nursing as a specialty.
“We realised that learning disability nursing was an unknown concept”
Along with a colleague from Teesside University and 17 student nurses, she spent two weeks at Battambang Referral Hospital.
Ms Hope she said she immediately noticed huge differences in care when she had a tour of the hospital.
“Family members are far more present in every aspect of the patient’s care,” she said. “While doctors and nurses carry out medical procedures, it’s the family who see to the aftercare, meeting hygiene needs, toileting and feeding.”
The layout of the building was also unlike hospitals in the UK.
“The hospital was built in a colonial style, mostly on one level, made up of lots of small buildings and outdoor areas or landings were utilised on some wards,” she added.
The group was sent to the hospital in Cambodia’s third largest city through the charity Transform Healthcare Cambodia and worked alongside clinicians and delivered teaching sessions.
Nursing lecturer fosters links between South Wales and Cambodia
“We realised that learning disability nursing was an unknown concept; the four fields of nursing do not exist in Cambodia,” noted Ms Hope.
“Students are not trained in caring for patients with learning disabilities, and there isn’t any special education provision for children with additional needs,” she said.
Another group of staff, this time specialising in child and adolescent mental health and children and young people’s services, will travel to Cambodia with the charity in November.
Meanwhile, Ms Hope is hoping to take a group of nursing students from the University of South Wales to Cambodia next summer.
She said: “One of the nurses said something that’ll stick in my mind for a long time to come – ‘We may not have the best resources or equipment, but we have our eyes, we have our hands and we have our ears, and that’s what we need for a thorough assessment of a patient’.
“That’s the essence of nursing – using our ability to understand what the patient is going through,” she said.
Nursing Times spoke to Paula Hope about her experience in South East Asia
What did you learn from you experience in Cambodia?
“I learned so many things while I was there, about our healthcare services and Cambodian, student nurses and myself! The thing that I have thought a lot about since my return is the role of the family. When somebody was in hospital they had at least one member of their family with them at all times. The family member would clean, feed, dress and support the person in all aspects during their stay.
“The doctors and nurses would carry out the procedures but the family member was central. One day I saw grandparents bathing a baby for the first time and almost everybody in the room was watching this. The value that is placed on older people in society and the experience they bring was so evident. It has really made me think about how this could be utilised and replicated in services, I will be discussing the importance of this with our students at USW.
What was the most significant training that you taught while on your trip?
“While we were there the whole team went to the nursing school and we delivered between us a session on what the UK nursing curriculum looks like. I felt that this opened up discussion on people with learning disabilities and what learning disability nurses do.
”The student’s asked questions about communication and community nursing and this also led to a home visit for a child with Autism. From my perspective as a learning disability nurse, this was most significant because in Cambodia, they do not have learning disability services (other than short term projects from non-governmental organisations).
Why don’t the four fields of nursing exist in Cambodia?
“There needs to be understanding of the historical and political factors related to Cambodia, with Pol Pot and the Khmer Rouge regime, intellectuals and trained, skilled people were targeted and wiped out, the population has been very young since the 1970’s and services are very different in Cambodia. The focus on rebuilding the country has been on education and the health care systems across the countries vary. There is poor sanitation and accessibility. People pay for their healthcare unless they are very poor and they have a ‘poor card’ which entitles them to free treatment. In some communities people are more likely to go to a ‘local healer’ than hospital.
“The culture is very much based on family input and support and contribution to the family, therefore there are no care homes or community services. Mental Health needs are only treated with medication, within Cambodian society there are many misconceptions and stigmatisation in relation to the needs of people with learning disabilities and mental health issues. Healthcare is generally hospital based, all nurses are trained in the same way and then learn more specific skills in the areas that they go on to work in.
What are you hoping international students bring to your classroom in the future?
“I currently run a couple of modules on a professional practice M.Sc focusing on Safeguarding Vulnerable People and Advocacy. Having been to Cambodia and seen that there are cultural beliefs about healthcare and interventions, the are financial implications which impact on treatments available. Understanding that the hierarchy is very much respected and evident has helped me to think about what some of our international students bring with them.
“The lack of resources such as having only one type of antibiotic available in the pharmacy will then impact on the assessment, decision making, intervention and prognosis. The international students will be very aware of these dilemmas and I strongly feel that appreciating that culture, hearing these stories will transfer to the way that care is delivered.”