I went to another border town & another hospital this week to train another ER how to use their newly donated ECG machine & monitor. It seemed a futile mission as one solitary visit was hardly going to make them confident & able to read a monitor or 12 lead ECG but the Bong had promised the hospital director a training session & so I went with only a couple of weeks left in country.
I conducted 2 training sessions that covered basic rhythm recognition & then common brady & tachycardias they may see. I also went to the ER & demonstrated how to use the ECG monitor & did a 12 lead ECG on a patient who has Hyperthyroidism so takes B-blockers which had induced a first degree heart block.
The ER doctors seemed interested & eager to learn but told me they really needed a lot more supervision & support before they felt confident to use & diagnose. I could understand this. It took me 10 years before I could tell the difference between a VT & a SVT with aberrant conduction. Maybe this was because I am very dense but despite my cognitive struggles I still think that reading ECGs takes a lot of practice, training, time & you need to see hundreds to establish good, reliable pattern recognition. Like a lot of things in medicine it is both an art & a science.
I tried to comfort myself with the knowledge that maybe the 5 part training package I had developed which is soon to be filmed to make a training DVD, which hopefully the TV obsessed Cambodians health care workers will watch, will actually be useful & help hospitals to benefit from all the donated equipment they receive.
The 2 packets of ECG dots I bought them in Phnom Penh hardly solves the problem of consumables nor will the basic job aids I've developed be a substitute for the English language user manuals & maintenance guides. But I am trying to be positive about my 33 months here.
The morning before we left, the Bong & I went to the ER where the young ER doctor showed me an ECG of a SVT. A woman had come in with palpitations so the doctor had connected her to the monitor. She had seen the fast rate so went on to do her first ever 12 lead ECG. From my training & handouts she was able to recognize that the patient had an SVT. She was currently in the process of arranging transfer to a larger hospital after some failed vagal maneuvers. She had diagnosed the woman as thyrotoxic due to her goitre & history. Words can't describe how happy this incident made me.
It doesn't happen often, in fact it is extremely rare, but once in a while in capacity building the stars align.
I conducted 2 training sessions that covered basic rhythm recognition & then common brady & tachycardias they may see. I also went to the ER & demonstrated how to use the ECG monitor & did a 12 lead ECG on a patient who has Hyperthyroidism so takes B-blockers which had induced a first degree heart block.
The ER doctors seemed interested & eager to learn but told me they really needed a lot more supervision & support before they felt confident to use & diagnose. I could understand this. It took me 10 years before I could tell the difference between a VT & a SVT with aberrant conduction. Maybe this was because I am very dense but despite my cognitive struggles I still think that reading ECGs takes a lot of practice, training, time & you need to see hundreds to establish good, reliable pattern recognition. Like a lot of things in medicine it is both an art & a science.
I tried to comfort myself with the knowledge that maybe the 5 part training package I had developed which is soon to be filmed to make a training DVD, which hopefully the TV obsessed Cambodians health care workers will watch, will actually be useful & help hospitals to benefit from all the donated equipment they receive.
The 2 packets of ECG dots I bought them in Phnom Penh hardly solves the problem of consumables nor will the basic job aids I've developed be a substitute for the English language user manuals & maintenance guides. But I am trying to be positive about my 33 months here.
The morning before we left, the Bong & I went to the ER where the young ER doctor showed me an ECG of a SVT. A woman had come in with palpitations so the doctor had connected her to the monitor. She had seen the fast rate so went on to do her first ever 12 lead ECG. From my training & handouts she was able to recognize that the patient had an SVT. She was currently in the process of arranging transfer to a larger hospital after some failed vagal maneuvers. She had diagnosed the woman as thyrotoxic due to her goitre & history. Words can't describe how happy this incident made me.
It doesn't happen often, in fact it is extremely rare, but once in a while in capacity building the stars align.
Esther, I am a family physician in Indianapolis. I have a Cambodian patient with hyperthyroidism and am struggling to help her understand as her english is poor. The interpreter isn't very helpful. Would you have any handouts I might be able to use? I'd appreciate any help or guidance you have. Thank you.
ReplyDelete