It has been brought to my attention that I think that Cambodian health workers are stupid & therefore look down on them. I'm inclined to think that this is slightly unfair & perhaps it would be more accurate to say that I think Cambodian health workers have a very poor basic education & hence knowledge about health care which combined with endemic corruption, the hierarchical system & an obsession with money (over & above human life) means that I have witnessed some pretty horrific medical 'care' during my time here.
I discovered if anything after 2 years I still tend to overestimated the basic medical education of health workers & my underestimation of their general ignorance means I expect them to know an awful lot more than they actually do.
This was brought to my attention this week when training on the stabilisation of a severe acute malnourished (SAM) child in a small hospital. One of the key messages of the training was to check & treat hypoglycaemia (low blood sugar) in every child who presents with malnutrition. Sick children as a rule are susceptible to hypoglycaemia & hence a malnourished child is even more likely to be in need of sugar.
After the training one of the staff asked a question about hypoglycaemia & breast feeding. I thought it was a good question so gave a detailed answer including that breast feeding is a treatment & a prevention of hypoglycaemia in children which is why it is so important to re-establich breast feeding in children under 2 years old. My translator, R, shook his head & told me I hadn't answered the question. I explained I was trying to explain about hypoglycaemia generally as a learning point but what had I missed?
What is the difference between a child that is breast fed & one that is not breast fed when taking a blood sugar?
Hmmm - well as I had previously explained breast feeding reduces the risk of hypoglycaemia but SAM children are at risk, especially if they have an infection, which most do. So we should do a blood sugar on ALL SAM children regardless of whether they are breast fed to screen for hypoglycaemia.
Blank stares..... You still haven't answered their question I was told by R.
Oh! So can you repeat the question?
What is the normal range of blood glucose in a child? I was asked.
Similar to an adult, I replied.
Well in an adult we make sure they haven't eaten before doing a blood glucose, so what can we do to make sure the child hasn't eaten?
The penny then dropped for me.
I think I see the problem, I told them. There is some confusion here - I am talking about hypoglycaemia in malnourished children & you are talking about screening for a high blood sugar - diabetes - in adults, using a fasting blood glucose test.
Collective blank stares.... what is the difference? they shrugged.
Well...one is increased blood glucose due to a problem with insulin production or the bodies sensitivity to insulin & the other is the body not having enough stores or intake of energy resulting in a LOW blood glucose.
Further blank stares.
But if the child has had Bor Bor or been breast fed they will have a high blood sugar, they asserted.
Not necessarily, I explained. The human body does have a mechanism for regulating blood sugar so that it remains in a steady state. In diabetes this is broken because of the hormone insulin not working properly & diabetics patients will have a high blood glucose. In children as they have limited stores of sugar sometimes when they are sick they can become hypoglycaemic, which is why we should test every child with SAM.
Silence.
So what should we do if a child has fed already?
DO A BLOOD SUGAR ANYWAY- I said it much nicer than this but in my head is was in upper case & bold.
They all shook their heads & clearly thought that my advice was seriously flawed.
So it appears that all that I have successfully managed to do is to train staff to do a 'fasting' blood glucose in all SAM children, mainly because I had seriously underestimated the baseline knowledge of my audience.
It now becomes apparent that any of their bluster, shouting, accusations, arrogance & rudeness is clearly just a smoke screen for their general ignorance....
I discovered if anything after 2 years I still tend to overestimated the basic medical education of health workers & my underestimation of their general ignorance means I expect them to know an awful lot more than they actually do.
This was brought to my attention this week when training on the stabilisation of a severe acute malnourished (SAM) child in a small hospital. One of the key messages of the training was to check & treat hypoglycaemia (low blood sugar) in every child who presents with malnutrition. Sick children as a rule are susceptible to hypoglycaemia & hence a malnourished child is even more likely to be in need of sugar.
After the training one of the staff asked a question about hypoglycaemia & breast feeding. I thought it was a good question so gave a detailed answer including that breast feeding is a treatment & a prevention of hypoglycaemia in children which is why it is so important to re-establich breast feeding in children under 2 years old. My translator, R, shook his head & told me I hadn't answered the question. I explained I was trying to explain about hypoglycaemia generally as a learning point but what had I missed?
What is the difference between a child that is breast fed & one that is not breast fed when taking a blood sugar?
Hmmm - well as I had previously explained breast feeding reduces the risk of hypoglycaemia but SAM children are at risk, especially if they have an infection, which most do. So we should do a blood sugar on ALL SAM children regardless of whether they are breast fed to screen for hypoglycaemia.
Blank stares..... You still haven't answered their question I was told by R.
Oh! So can you repeat the question?
What is the normal range of blood glucose in a child? I was asked.
Similar to an adult, I replied.
Well in an adult we make sure they haven't eaten before doing a blood glucose, so what can we do to make sure the child hasn't eaten?
The penny then dropped for me.
I think I see the problem, I told them. There is some confusion here - I am talking about hypoglycaemia in malnourished children & you are talking about screening for a high blood sugar - diabetes - in adults, using a fasting blood glucose test.
Collective blank stares.... what is the difference? they shrugged.
Well...one is increased blood glucose due to a problem with insulin production or the bodies sensitivity to insulin & the other is the body not having enough stores or intake of energy resulting in a LOW blood glucose.
Further blank stares.
But if the child has had Bor Bor or been breast fed they will have a high blood sugar, they asserted.
Not necessarily, I explained. The human body does have a mechanism for regulating blood sugar so that it remains in a steady state. In diabetes this is broken because of the hormone insulin not working properly & diabetics patients will have a high blood glucose. In children as they have limited stores of sugar sometimes when they are sick they can become hypoglycaemic, which is why we should test every child with SAM.
Silence.
So what should we do if a child has fed already?
DO A BLOOD SUGAR ANYWAY- I said it much nicer than this but in my head is was in upper case & bold.
They all shook their heads & clearly thought that my advice was seriously flawed.
So it appears that all that I have successfully managed to do is to train staff to do a 'fasting' blood glucose in all SAM children, mainly because I had seriously underestimated the baseline knowledge of my audience.
It now becomes apparent that any of their bluster, shouting, accusations, arrogance & rudeness is clearly just a smoke screen for their general ignorance....
No comments:
Post a Comment