STORIES
July 25, 2019

This Is What Medical Mission Nursing In Cambodia Is Like

This Is What  Medical Mission Nursing In Cambodia Is Like

By Mariam Yazdi

How many times have you gotten off work after a busy day and felt like you were just another cog in the big wheel of healthcare? Have you felt like your role was less about helping people and more about pushing administrative agendas, avoiding litigation, and drowning in a never-ending list of tasks? 

Unfortunately, this is the mindset that some nurses -- including myself -- sometimes struggle with. So many of us are susceptible to feeling jaded from the current state of the American healthcare system and its nature as a great big money-making machine. 

Many days, this struggle left me feeling deflated and unsatisfied. 

When the opportunity came up to go to Cambodia for two weeks with other nurses to administer care to rural communities, I initially said no. My excuses started pouring in. “I don’t have time...I should spend money on other goals, like a house... I’m going to miss my dogs too much.” 

But after the seed was planted, it only took a few days to sprout. One day it hit me...OF COURSE I SHOULD GO!  When an invitation to do something big and impactful is presented, there is only one answer: YES. Like one of my favorite writers and podcasters Gretchen Rubin says, “I wanted to choose the bigger life.” 

And so I said yes; the process began, my excitement and nerves grew. This is how I went on a medical mission to Cambodia and what it was like. 

The Medical Mission Preparation 

I went on my mission trip with the nonprofit organization, Project Helping Hands (PHH), founded by former emergency room nurse, Jeff Solheim. (Side note: If you haven’t heard about Jeff Solheim, I recommend doing some reading on him. His accomplishments as a nurse and businessman are awe-inspiring.)

PHH had begun preparation for the trip more than a year prior. Kimonui, a critical care nurse manager and experienced mission trip goer, stepped in as coordinator for this particular trip to Siem Reap, Cambodia. In conjunction with a Cambodian non-government organization Build Your Future Today (BFT), PHH organized the mission.

(Second side note: Build Your Future Today does incredible things for the Cambodian people. If you’re looking to directly volunteer with the locals, this is it.) 

How Much Does Medical Mission Nursing Cost? 

Volunteers were required to raise about $3,000 each, which would go towards our flights, transportation in Cambodia, room and board, meals and even a day pass to go sightseeing in Siem Reap (like Angkor Wat, made Hollywood famous by Angelina Jolie in Tomb Raider). The only things we paid for out-of-pocket were any souvenirs or trip extensions outside of the dates of the mission. 

In addition to monetary donations, the entire group collaborated on a shared spreadsheet of medical supplies we were gathering: medications, gloves, fluids, needles and ointments. (Shout-out to the materials management department at Mount Sinai St. Luke’s in New York City for sending me to Cambodia with suitcases bursting at the brim with supplies for our cause. Thank you!) 

Medical supplies en route via tuk tuk! 

Arrival in Cambodia 

The first order of business when we arrived in Siem Reap was to sort through and organize all of our medical supplies so we could run an efficient clinic. We used almost 20 pieces of luggage, labeling each with its contents. The general division went like this: 

  • Pain medicine bag — Tylenol, ibuprofen, aspirin, etc.
  • Albendazol bag (A deworming medication used to treat tapeworm infection caused by contaminated food and water)
  • Antibiotic bag
  • More antibiotics
  • Possibly even a third case of antibiotics
  • Vitamins — prenatal, geriatric, children, you name it...
  • Antihistamine bag — from Benadryl to Cetirizine to Claritin
  • The gut bag — laxatives, fiber, imodium, fiber, pepcid, etc.
  • Topicals — anti-itch, steroids, hemorrhoid cream, petroleum jelly, etc.
  • Wound care, wound care, and more wound care (gauze, suture kits, etc.)
  • IV Supply Bag - IVs, tubing, saline, syringes, etc.
  • Personal protective equipment, including gloves and face masks
  • Reproductive health — speculums, pregnancy tests, condoms, etc.
  • Toothbrushes galore — everyone, regardless of what they are seen for, was to leave with a toothbrush and some floss
  • Readers — we had about 500 pairs of reading glasses to give out
  • Sunglasses — we had about 300 pairs of sunglasses

After spending the afternoon sorting, organizing, and fighting jet lag, we spent time getting to know each other and began gearing up for our first day as a team. We weren’t hosting clinic just yet. Instead, we had been invited to speak to the nursing students at the local college, Angkor University. 

Angkor University Nursing Students

Angkor University is a private university in Siem Reap, which is located about five hours northwest of the capital of Cambodia, Phnom Penh. We had been asked to speak to the nursing students on two major topics: leadership and diabetes.  

After arriving at the University, we found ourselves standing face-to-face with a group of intelligent and eager students who blew us away. Their engagement was inspiring and got us fired up for the hard days to come. 

What Nursing Is Like In Cambodia

The nursing students in the audience ranged from 18 to 20 years of age, and their nursing studies began with science classes and flowed directly into basic patient care courses. After about two years of study, students applied to work in a local hospital to gain experience. They were then able to apply for a nursing certificate, which is required to work as a nurse.

The scope of nursing in Cambodia is more comparable to the scope of a nursing assistant in the United States. The role of nurses is heavily involved in ADL functions and assisting with procedures. Nurses do not readily handle medications as doctors will administer them to patients. The nursing program therefore did not include many of the subjects found in other curriculums, like pharmacology and more detailed pathophysiology. 

Although many students spoke English (and some very fluently), we were fortunate to have a local pediatrician from the community step in as a translator. He assisted us immensely — especially when it came to presenting on diabetes, which is on the rise in Cambodia. We explained the differences between HHNK and DKA and how to manage these syndromes.

Nursing student uniform poster at Angkor University

Onto The Medical Mission

Early the next day, we packed our bags and headed into the Domdek District, what would be our home-away-from-home for the next three days. The commute into the village was an over hour-long drive on dirt roads, through neighborhoods of small homes and cashew farms. On the first day, we held a clinic at the elementary school of Cham Resh. 

Various elementary schools were chosen to host the clinics due to their religious neutrality and familiarity within the community. Every school had the same basic physical structure. Cement walls with glass-less windows, shutters, and no central cooling system. The schools were located in largely untamed geography: tropical savanna climate in the dry season, which meant large dirt fields of rich, orange-brown sediment, punctuated by natural brush. It made for dusty classrooms and muddy little toes. 

Time For Clinic

Every day we set up and broke down clinic, never going to the same school twice. We took up three classrooms: one for clinic, one for pharmacy and one for dental and glasses. We arranged the desks, set up all the medications and supplies in the pharmacy,and began taking patients. Among our group of 13 was an amazing team of about 10 translators who were hired for the entire length of the project. Not only were they crucial in providing effective care to the people, but they became our dear friends.

Our clinic was set up around seven stations, with a nurse and translator per station. We each had our bag of tools at the ready: stethoscope, bp cuff and spo2, thermometer, gloves, antimicrobial, extra baggies of Tylenol and ibuprofen from the pharmacy, and maybe a page of cute stickers. 

As people caught word of our presence, they arrived in droves. The classroom would fill with the sounds of English and Khmer (the Cambodian language) as translators, patients, and nurses took leaps across the language barrier.

Treatments

As patients came in and sat at our station, we greeted them and asked if they had any ailments or complaints. Patients, coming from near and far to be seen,  had an array of complaints, some serious and some simple. 

Back pain and body aches were common as the majority of the Cambodian population are farmers with laborious daily work.

  • Infected dog bites from the overpopulated stray canines on the streets needed courses in antibiotics. 
  • Many gynecological issues needed treatment and education.
  • Children with abscesses on their feet from walking without proper shoes had to get their little toes I/D’d, then were given a course of antibiotics and pain medicine. 
  • Many people were dehydrated. 
  • Many people showed symptoms of tapeworm infection from bad drinking water. 
  • One or two patients needed more advanced care and were provided transportation to the hospital. 
  • Pregnancy tests, condoms, and vitamins were passed out liberally.

After a few patients, you begin to get a mental flow. My initial series of questions went something like this: Sous dei! How are you? What are you feeling? What do you do for work? Do you get your water from the well or do you drink bottled water? Is anyone at home sick? 

Many times, patients were shy and did not offer up their complaints willingly. It took strategic questioning, gentle digging and a long series of “why’s” to get to the final issue. 

Threds of Red

On the trip with us was pediatric nurse and founder of Threds of Red, Laurie Freeman. Laurie created Threds of Red after doing a few medical missions and realizing women’s health in many villages of the world was shrouded in shame and silence. Many girls are not educated about their period. As a result, they stop going to school after starting menstruation, leading to an education gap in knowledge that is passed from generation to generation.

Laurie is determined to change this, and to make menstrual management accessible to all girls and women regardless of socioeconomic level. At every village, Lorrie pulled aside girls of premenstrual and menstrual age, and showed them how to create their own reusable menstrual pads out of cotton and thread. The girls laughed in delight, sewing their pads and learning about their cycles. They were even more elated when they realized reusable pads meant they didn’t have to buy the overpriced menstrual products sold at pharmacies.

Our Provider

This volunteer group was composed entirely of nurses. Our provider was Christy, a nurse practitioner who works in an emergency department in Dallas. Apart from being an amazing practitioner, Christy had experience with rural and tropical medicine. She assisted the team in treating the patient populations with the proper courses of antibiotics, the best combination of pain medications, antihistamines, and ointments. 

Even when cases got complicated, Christy’s judgment and experience were a grace to us and to our patients. We never felt lost with her assistance.

Tropical medicine in villages can be tricky. Villagers are not as exposed to the same amounts of antibiotics as populations regularly treated with Western medicine. Christy had studied the specific diseases and ailments each village suffered from and knew what we were walking into. She liked to say, “You must always act in a way that does more good than harm.”  

The Pharmacy 

On typical medical missions with PHH, there is a mix of healthcare professionals, pharmacists, dentists, and medical doctors. But not this time. 

On this trip, we played pharmacy and set up a shop that would make any Pharm D proud. A main table was cleaned for mixing and preparing antibiotics as well as counting pills into baggies for a 30-day supply. Nurses could run into the pharmacy classroom and grab whatever bag of pills would best help their patients, and some days we even had a pharmacy runner. 

Like Jennifer from Boston said, after working pharmacy the first few days, “I have a new appreciation for pharmacy!”

The Best Of Times And The Worst Of Times

Going on a mission trip is an incredible experience, but it’s not always fun and games. There were a handful of low moments that really tested my strength. One of them was when I got a gut-bug. Nurses in our group had been getting sick, and some got it worse than others. 

When I finally got sick, my course was less severe than I had been anticipating, but it still made for a miserable day in a hot, humid, dusty classroom and an equally miserable night in a guesthouse where the electricity would go out every few hours. I laid in bed in the dark with no electricity and no air conditioning and thinking, “This is literally and figuratively the darkest moment of the trip.”

Despite these times, we could see the beauty of the work. Let me rephrase that — because of these moments, we could see more clearly the grandness of this work. 

There were many other low points that had nothing to do with our GI health:

  • Seeing children with no shoes walking in the dirt
  • Malnourished children and adults alike
  • The lack of resources, infrastructure, and education

In the midst of so many factors we can't control, what we could do, we did. And it brought so much joy to the people. You could see their gratitude and love in their faces, so much so that it would make me tear up in the middle of my assessment. This was the raw form of patient care: helping, healing, and advising. These were the best of times.

How The Medical Mission Trip Changed Me

If this mission trip did anything to my current nursing practice, it showed me what it is like to give raw and authentic patient care. It gave me an idea of what it must have been like to be a nurse centuries ago — sans insurance companies, mountains of documentation, and the constant threat of litigation.

Now I’m back at work in that hospital grind but it feels different this time. Of course I have my daily frustrations with the politics, but now I have a new perspective. This mission trip introduced me to a particular headspace I had never been in before — one of inner tenderness and raw compassion. More frequently, I find I am accessing that headspace with my patients at home. This makes a tremendous difference for me and for everyone around me. 

We never truly know the long term effects of our care or if our interventions really made a difference in our patients lives. But, like our coordinator Kimo said, “That one course of antibiotics or that one patient interaction can cause a tiny shift in the matrix. And a tiny angle change now can yield a great big difference in the future.” 

If you’ve always wanted to go on a mission trip, but have kept it in the back of your mind, consider this your official invitation to your first mission. GO. You won’t regret it. 

 

What my Cambodia mission trip colleagues had to say about the experience: 

Sarah, ENA Governance Coordinator 

"Our missions trip was an awe-inspiring opportunity that I will cherish for a lifetime. I will never forget how thankful people were when they received glasses and could read clearly for the first time. These are memories that I will always treasure." 

 

Becca, Med-Surg in Colorado

“While there are many moments from this trip that I will always treasure, I will remember the gratitude and kindness of the Cambodian people with me on my more challenging days as a nurse. Doing simple medical tasks such as cleaning out eyes and ears of dirt, and listening to ongoing medical issues were met with overwhelming appreciation.” 

 

Jen, Emergency Room in Massachusetts 

“To say this mission trip has changed who I am is an understatement.  I had wanted to do a mission for many years leading up to this day.  I fought a battle between volunteering in foreign lands when there is so much disparity and remaining grounded in the needs of my own community.  I chose to celebrate my 20-year jubilee in nursing with the seemingly selfish act of dipping my toe in the pond of global health.  Little did I know how quickly I would be ready to jump in the deep end.”

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