On August 12th, 13th, and 14th, thirteen members of the 3rd Medical Battalion, of the United States Marine Corps from Okinawa, Japan, spent time with me, and the staff of my health center. They came on a Medical Exchange (MEDEX) for a military to civilian Subject Matter Expert Exchange or SMEE as they like to call it. Since the Marine Corps do not actually have medical personnel, most of our guests are actually Sailors assigned to the Marines from the US Navy. It was a pleasant surprise for me to learn the US military does this kind of humanitarian work.
For the Marines, the purpose of their Cambodian MEDEX 13.2 is to improve interoperability, increase local medical capability and capacity, and foster goodwill while developing a medical needs assessment to plan for future exercises within this region. For my Health Center staff, it is an opportunity to share with them how the medical system works here in Cambodia, and to learn some new skills from the Marines. This opportunity came through the US Embassy who contacted all the Peace Corps Volunteers in my province. I responded with a proposal and after a site visit they selected my health center for the exercise.
Throughout the event, I acted as the liaison between the health center and the Marines. Although the Marines brought very good Khmer translators, I was often able to better clarify information flowing in both directions interpreting the cross cultural and medical perspectives needed for both the Marines, the Khmer translators, and Cambodian staff.
On the morning of day one, I made introductions and gave a tour of or facility to the Marines. During the tour, I told the marines about the services we offer, and they observed the staff work, while learning about the resources my health center has, and does not have. I think the most telling comment came from one of the corpsmen who said to me, “wow, and I thought we had to work with a minimum of equipment under hard conditions”.
Critical Care Nurse Angela visits with a new born baby born just a few hours earlier.
After the tour, with the help of the two excellent translators the Marines brought, I facilitated a meeting with the Marine officers and my HC Director, Dr. Sera. We identified areas of medical knowledge both wanted to share and learn about. Prior to their arrival, I had spent a fair amount of time working with Lt. LaBarbera, the Company Commander coordinating and formulating a schedule, but after an on the ground look at the health center and a chance to meet with the staff, we chose to make some adjustments. Throughout this whole event, I was very impressed with the Marines willingness and flexibility to adjust the schedule.
After Lunch, Dr. Grant the dentist gave a presentation on dental assessment. In my community, there is absolutely no dental care. This means there is very limited and incorrect basic knowledge, and no preventative check-ups. If you have a problem here, unless you can afford to go the provincial capital or Phnom Penh, you just suffer until your teeth fall out.
The staff showed real interest in this presentation and asked a lot of questions. It also became clear that simple things, like how to properly brush your teeth, are things they did not know. When Dr. Grant was finished, I suggested if time permitted, he should speak again tomorrow and give a proper brushing demonstration.
The second presentation of the day was from Critical Care Nurse Dougherty on teamwork. For the Cambodian staff this is a brand new concept. It was a shortened presentation as the staff honestly seemed a bit bewildered and confused by the concepts. Structured teamwork with predefined roles in a crisis is just not common here, and I think the presented concepts were too abstract and un-relatable.
Dr. Decker, an Emergency Room Physician presented next on trauma assessment. This subject is particularly valuable for the staff to learn. As a former medic, I am acutely aware through observation of the lack of knowledge the staff here has about even the basics of treating traumatic injuries. I asked Dr. Lawrence to keep to the basics, which he did presenting the introductory course they give to the Marines for field trauma assessment, stabilization, and transport. The HC staff really seemed interested, and it gave me the idea to follow this up later as a practical session.
Day two started with the Marines doing a more formal inventory of the hospitals resources. They took a closer look at equipment, procedures, and spoke with the staff in each department about what resources they have, is broken, or is lacking.
Dr. Grant presented on proper tooth brushing in the afternoon. I had a stash of toothbrushes I collected from the freebees given in hotel rooms, and we passed them out as Dr. Joe spoke and showed proper brushing technique. I encouraged Dr. Grant to emphasize the need to get the young children brushing. A common belief in Cambodia is that children do not need to brush because they have baby teeth, which just fall out any way. When I told this to Dr. Grant, he was shocked.
Nary Ly is a Cambodian who achieved her PHD in the US, and now works for the US Naval Medical Research Unit (NAMRU) here in Cambodia. She spoke on recognizing and proper treatment for two respiratory infectious diseases that have been a problems here, severe acute respiratory syndrome (SARS) and “bird flu” or A(H5N1) a subtype of the influenza A virus.
Dr. Decker finished the day with part one of a talk on non-surgical approaches to birth complications. Childbirth is one of my health centers primary services. Although we provide a higher level of care than many Cambodian health centers, they are not equipped or staffed to handle all problems, so this presentation was of great interest for them. Typically when a problematic delivery is recognized the patient is transferred in our ambulance to the referral hospital in Kirivong. This presentation focused on what to do when there is not time to send a patient on this 45-minute trip.
In the morning of day three, I joined the Marines on a tour of the Referral Hospital in Kirivong. They were interested in learning what the next higher level of care here in Cambodia is like, and what services and equipment they provide. In the afternoon, we heard part two of the non-surgical approaches to birth complications, and then it was my staff’s turn to present.
I did not want this event to be a one-way exchange of knowledge, so I arranged for our midwives to show the Marines how they handle a delivery. This was really fun. The Staff was reluctant at first. They told me they feel that the Americans know more than they do. However, in fact, this is not at all the case. As a field medical unit, delivering babies is not what these military doctors, nurses, and corpsmen do on a daily basis. The midwives at my health center however actually do. They deliver an average of 30 babies a month. So, we all piled into the delivery room, and the Midwives put on an excellent presentation. That’s my host family sister Theray a senior Midwife on the left above and playing patient below.
They did a role-play, and acted out how they handle a delivery complication known as eclampsia. Eclampsia is an acute and life-threatening complication of pregnancy in which the delivering mother has seizures. It was great to get everyone out of their seats, have a reverse flow of information, and see them all laughing together having fun.
This led into a second role-play in which Nurse Dougherty led the Cambodian staff through a role-play on neonatal resuscitation. The staff loved it when one of the male corpsmen was volunteered as the expecting mother. I was proud when it was obvious that most of the information presented, the midwives already new. The big take away for the staff was really how she had them working together as a team, understanding the need to prepare for the worst in advance, and the need to practice.
The teamwork. preparation, and practice concepts were carried forward in our last activity. I gathered everyone at the primary treatment area and asked Dr. Decker to run through a real time demonstration of the trauma assessment presentation he had made.
I then partnered our HC staff with the Marines, and had them do the drill shadowed by the Doctor and corpsmen. I wanted the staff to do this exercise and experience how important it is to have leadership, predefined roles, and see how drilling together bonds them into an efficient team in which everyone knows what to do in a crisis situation. This is exactly the approach to training I used for years as an EMT instructor.
Finally, the HC staff did the drill on their own several times. It was super fun for everyone. Like me, Cambodians generally seem to be better hands on learners, and I think that doing this really sold the concepts of teamwork that were so intangible in Nurse Dougherty’s presentation the day before. As a follow up, I asked the staff what their thoughts on doing this drill are. They said they liked it and it was not hard. Dr. Sera, the health center director told me that he wants me to do drills like this with the staff every week.
No event in Cambodia would be complete without a closing ceremony. Dr. Sera made a formal thank you, and the Marines presented him and the health center with a framed copy of the group photo you see at the top of this post. Staff members also each received a certificate for their participation.
The hope is for the Marines to return at some point in the future, further build capacity at this health center, and serve the community with a MEDEX treatment clinic. It would be great if it happens, but already I think the primary goals of increasing local medical capability and capacity, and fostering goodwill have been achieved. Additionally, I think this has been a great cooperative effort between two US agencies, the US armed forces, and the Peace Corpse.
The young women on staff getting their picture with the hansom Lt. Joe.
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