Nurse anesthetist Si Lee recently returned to LFHC after visiting the U.S. to observe anesthesia procedures at medical facilities in Pittsburgh.
Si received a Warfield Scholarship from Health Volunteers Overseas, a Washington D.C. nonprofit, to observe clinical activities at University of Pittsburgh Medical Center-Presbyterian, West Penn Hospital and UPMC Children’s Hospital.
Si also presented a lecture to anesthesia students and faculty at the University of Pittsburgh School of Nursing and attended the annual American Association of Nurse Anesthetists Congress in Chicago.
Joining Si on the trip was Hor Eng from Angkor Hospital for Children, who also received the scholarship. Richard Henker, a professor at the University of Pittsburgh and a committee chairman with Health Volunteers Overseas, guided both nurses during the U.S. visit.
Two LFHC doctors will soon begin training in the Pediatric Residency Program in Vientiane, having finished among the top candidates in a highly competitive, national selection process.
Dr. Bounloth Sordaluck and Dr. Phoumy Manivong were awarded placements in the three-year program.
Dr. Sordaluck is from Sainyabuli Province and has been working at LFHC for nearly three years. Dr. Manivong is from Vientiane and has been working at LFHC for more than four years. Both said they were eager to gain knowledge and experience in pediatrics because LFHC is treating a growing number of children and handling more complicated medical cases.
The two doctors had to pass a written exam and performance review at LFHC, as well as a written examination in Vientiane, to qualify for the program. During their three years of training, they will rotate among three hospitals.
LFHC will continue to pay the doctors’ salaries. They are expected to return to LFHC at the end of their training and will serve as faculty members in a new pediatric training program being developed by LFHC Medical Education Director Dr. Rathi Guhadasan.
Immediately after AirnoyKhamyai was born in early June, doctors noticed he was having difficulty breathing. The delivery room summoned help from LFHC and its team quickly treated the infant with positive pressure ventilation and took him to our hospital’s Emergency Room.
A chest X-ray revealed a large amount of fluid in the right side of the newborn’s chest. Ultrasound imaging confirmed the presence of fluid.
The staff drained more than 100 milliliters (a little more than 3 fluid ounces) from Khamyai’s chest and his breathing quickly improved.Doctors continued to drain fluid during the next day and noticed that the amount was increasing and thickening as the infant’s mother began breastfeeding. This prompted the doctors to make a rare diagnosis of congenital chylothorax, a life-threatening anomaly that causes a substance called chyle to accumulate in the chest.
Dr. Shaun O’Dell, a volunteer neonatologist from Utah, helped the LFHC staff provide the specialized care that Khamyai needed. The nutrition team offered recommendations about feeding the infant and the lab techs centrifuged his breast milk to separate and remove the fat from the milk to reduce chest fluid.
Infants with this condition need a special type of fat-free baby formula, called MCT formula, which is very expensive and not readily available. A very generous donation through the LFHC Outreach Program provided the special formula that Khamyai required.
After a little more than a month of intensive care in the Neonatal Unit, Khamyai and his parents returned to their home. His family will need to continue feeding him with MCT formula, give him his medications and bring him to LFHC for frequent check-ups and ultrasounds.
Thiamine deficiency is rampant among the patients we care for at Lao Friends Hospital for Children, especially among our poorest and most rural children. We see children with severe thiamine deficiency — known as beriberi — on an almost daily basis in children only a few months old.
Without quick treatment, most of these children would die. We often hear sad stories about how a mother has lost several babies in the past with similar symptoms — almost surely beriberi. Beyond these children with very severe disease, nearly every infant has some degree of thiamine deficiency that hasn’t yet become so severe as to risk their life.
Indeed, if there were one single disease that were to define our hospital, it would be beriberi. By caring for hundreds of children per year with a disease that is found throughout rural populations in Asia and Africa, LFHC has the opportunity to become a center of excellence for patient care, education, and research into beriberi and more milder forms of thiamine deficiency. We are thus proud to have partnered with colleagues at the Institute for Global Nutrition at the University of California, Davis and the Lao Tropical and Public Health Institute, to undertake what may be the world’s most comprehensive study into the physiology and pathology of thiamine deficiency in infants. Funded by the Bill & Melinda Gates Foundation, a large team of researchers has joined LFHC to enroll nearly 700 hospitalized children over the course of the next year who have illnesses consistent with severe thiamine deficiency.
We are very excited to take part in this work — the hospital’s first large research study. As a tertiary-care teaching hospital, we feel obligated to help advance the state of knowledge by conducting research studies into diseases that affect children near and far.
The training that our staff will receive as part of the study will also help develop them into independent investigators in the future, helping empower them in yet another way to be the best pediatric care providers in the country.
The hospital’s process of training nurses in anesthesiology recently gained formal recognition by the International Federation of Nurse Anesthetists.
Three staff members have met all the educational requirements to become graduates of the LFHC Nurse Anesthesia Program. Noy Keopaseuth and Si Ly are the latest graduates. They join nurse anesthetist Kuelee Lao Faiyia, who graduated from the program last year.
The scope of LFHC’s program has already been approved by the Luang Prabang Department of Health.
The three LFHC nurses spent 5-7 months at Angkor Hospital for Children as part of their education. The nurse anesthetists at AHC have received the Golden Apple award from the Health Volunteers Overseas (HVO) organization for their teaching program in 2019.
Friends Without A Border Founder Kenro Izu and Richard Henker, a member of the HVO Board of Directors and a professor of nurse anesthesia at the University of Pittsburgh, initiated the creation of the nurse anesthesia education program at LFHC.
Recognition of the nurse anesthesia program at LFHC by IFNA requires a didactic curriculum and clinical component with anesthetic management of 550 cases. In addition, nurses in the program are required to take a comprehensive exam.
Educational experiences for the program have included teaching by HVO volunteers in addition to using APEX and Khan Academy, online programs incorporated into many nurse anesthesia programs in the United States.
Clinical instruction was provided mostly at AHC but also at Mahosot Hospital in Vientianne, and Siriraj Hospital in Bangkok.
In the next six months, Kulee will be traveling to the United Kingdom to observe anesthesia care and Si Ly will travel to Pittsburgh to observe anesthesia care. The goal for the LFHC nurse anesthetists in the future is to teach others in the region how to provide high-level anesthesia care.
The Luang Prabang community came together last month to donate blood and support Lao Friends Hospital for Children and the Lao Red Cross in raising awareness about the need for blood donations.
A total of 171 blood donors contributed to the five-day campaign, which ended on World Blood Donor Day (June 14) – 60 more donors than the 2018 campaign.
The donated blood is used at LFHC during surgeries and for transfusions needed by children afflicted with thalassemia, an inherited blood disorder.
The campaign featured a Team Challenge, a competition among the many local restaurants, hotels and businesses. The team that brought the most staff to donate blood won incredible prizes generously donated by Accor Hotels Luang Prabang. The winning team this year was the staff of Kiridara Luang Prabang.
Many people who came to donate blood did so for the first time!
The hospital encourages people who donated during this campaign, to continue giving blood throughout the year. In Laos, men can donate every three months and women can donate every four months.
Thank you to everyone who participated and who #giveLuangPrabangblood.
A motorbike accident left 14-year-old Thong unconscious and injured, so his family rushed him to nearby Nambak District Hospital, where he was treated for his wounds and then referred to Lao Friends Hospital for Children.
After a five-hour journey, Thong and his parents arrived at LFHC. Emergency Room doctors immediately noted that the boy exhibited symptoms indicative of a head injury. They ordered a CT scan which showed an epidural hemorrhage — bleeding between the outer membrane of the brain and the skull.
Thong was taken to the Operating Theatre where surgeons inserted a drain tube to relieve the pressure on his brain.
Thong initially experienced a great deal of pain and was unable to feed himself. He remained hospitalized for two weeks, during which time he received nutrition through a nasogastric tube. The staff also treated his wounds and ensured that he received appropriate medications. His family never left his side.
Thong’s condition gradually improved. His pain subsided. He began to walk again and eat and drink. Doctors removed the drain tube from his head.
Thong was clearly happy that he was able to return to his home. His family was very grateful that the LFHC doctors and staff had saved their son’s life.
LFHC is welcoming three new staff members to its management team.
Mark Gorman, who most recently served as the Interim Country Director of World Education Laos (WEL), will become the hospital’s Executive Director in September.
Mark brings 40 years of experience in the administration of nonprofits and public entities to LFHC. He speaks English, French, Lao and Thai.
Prior to being the interim director at WEL for four months last year, he served as that NGO’s Country Director in Laos from May of 2010 to October 2013. During that time, he spearheaded education and awareness projects related to unexploded land mines, as well as various programs aimed at economic development and increasing medical capacity. As director, Mark represented WEL at meetings with senior officials of the Lao government officials, the UN and the U.S. State Department.
Prior to working at WEL, Mark worked several years in Thailand for the International Rescue Committee. Mark served in the Peace Corps in the Central African Republic after earning a graduate degree in public health at the University of Hawaii in 1982.
Dr. Lisa Rynn, who has taught pediatrics in Uganda, is the hospital’s new Medical Director.
Lisa is a graduate of New York Medical College, where she was a Primary Care Research Fellow. She performed her residency in pediatrics at St. Christopher’s Hospital for Children in Philadelphia.
Prior to joining the LFHC staff, Lisa worked as the Attending Physician in Emergency Medicine at Temple University Hospital in Philadelphia. She worked nearly seven years in emergency medicine in hospitals in Pennsylvania.
In Uganda, Lisa served as a visiting faculty member in pediatrics at universities in Mbale and Gulu.
She is certified by the American Board of Pediatrics.
Amalia Berger, a registered nurse who most recently worked with Medical Teams International in Bangladesh, is the hospital’s new Nursing Educator.
A graduate of the University of Pennsylvania School of Nursing, Amalia also earned a Masters in the Science of Nursing there. She worked more than three years in the Emergency Department of the university’s hospital.
Amalia first worked in Bangladesh in October 2018 as a nurse with the Hope Foundation for the Women and Children of Bangladesh. She served as a health coordinator and mentor for the nursing staff at a new hospital in the Kutupalong Refugee Camp.
She joined Medical Teams International in January to support the Joint Rohingya Response Program, which helps local health care workers provide primary care to people at the Kutupalong Refugee Camp.
Six-year-old Jack Nouseng was recently struck by a car and dragged along the ground — an accident that left him unconscious with cuts on his shoulder and legs and a very large gash on his scalp.
His family rushed him to the local district hospital, where he woke up in terrible pain. The hospital staff treated his wounds and covered his severe head laceration so that he could be taken to Lao Friends Hospital for Children.
When Jack arrived at LFHC, the Emergency Department staff immediately recognized that he had a large portion of skin, muscle and tissue torn away from his scalp, exposing his skull. As this poses a high risk for infection, the staff quickly cleaned his wounds, gave him antibiotics, and helped alleviate his pain. After ruling out other injuries, he was quickly taken to the Operating Theatre to begin the long process of removing dead scalp tissue to help start the healing process and prevent infection from invading his skull.
LFHC’s surgeons and Operating Theater team have been taking meticulous care of Jack’s wounds every 2-3 days to ward off infection. They remove dead and devitalized tissue, and promote the growth of muscle and scalp tissue. His wound is now closing up over the open areas of his skull.
Doctors say Jack was very lucky to not have internal damage; it remains very important that Jack remain hospitalized and receive appropriate antibiotics and proper care for all his wounds. He will have to stay a little bit longer until more tissue is regenerated to completely cover the open skull injury.
After more than a month at LFHC, he has become a close friend to all of our nurses, doctors, therapists and staff. He is now often found running around and playing with the other kids.
LFHC has taken a step “deep into the 21st century” with a new capability to store X-rays and other diagnostic images via cloud computing – thanks to the nonprofit RAD-AID organization.
RAD-AID recently linked the hospital to its Friendship Cloud, which it formed in a partnership with Google Cloud, Ambra Health and Tribalco. LFHC is the first hospital to use the RAD-AID Friendship Cloud and has already stored more than 14,000 patient files on it – making the hospital’s patient care more efficient and effective.
RAD-AID introduced LFHC to digital imaging with the installation of its Picture Archiving and Communication System (PACS) more than a year ago. PACS enables doctors and nurses to view X-rays, CT scans and ultrasound images on computer screens and store them on a computer’s hard drive at the hospital. The system allows comparisons between old and new images for a patient, helping doctors track a patient’s progress.
Friendship Cloud enables the staff to store an unlimited number of digital diagnostic images on a secure internet platform. At the moment, LFHC is using Friendship as back-up storage for its diagnostic images. The hospital is sharing the system with the adjacent Luang Prabang Provincial Hospital.
The system uses an innovative compact server that doesn’t require the cool temperatures of an air-conditioned room. RAD-AID engineers and partners adapted the server to create Friendship Cloud for running advanced health-care software and PACS, making digital health accessible for hospitals in remote low-resource conditions.
“What we’ve done here is a compact server with access to the cloud,” said RAD-AID President and CEO Dr. Dan Mollura in a video about the project. “Retrieving from the cloud gives you that power of comparison so you can see how things are improving (for the patient) or make course corrections if something needs to be changed.”
The million-dollar PACS and Friendship system was donated to LFHC by RAD-AID, which also helped to train staff in how to get the most out of the system.
The system gives LFHC an incredibly important diagnostic tool used by hospitals in technologically advanced countries.
“In the long-term game, this brings LFHC deep into 21st century,” said Dr. Mollura.
In addition to Laos, RAD-AID has installed PACS to hospitals in Nicaragua, Ghana, Guyana, Nepal, Ethiopia and Guatemala.
RAD-AID has been instrumental in building the diagnostic imaging department at LFHC. Friends Without A Border presented its Healing Asia Award to RAD-AID in 2017.