By Ariana Barkley, MD (left); Jonathan Medina-Beckwith DNP, ARNP, NP-C (center); Abhijit Lele, MBBS, MD, MS, FNCS (right)
Neurocritical care educational initiatives for staff at two hospitals in Phnom Penh, Cambodia emerged as a capacity development initiative that native healthcare providers enthusiastically voiced when a survey was conducted in October 2018. The Emergency Neurological Life Support Course (ENLS) serves as a paradigm of organized neurocritical care education and exists on a platform that allows dissemination of educational resources and evidence-based knowledge. Therefore, in response to this request and in keeping with the theme of working together to share neurocritical care educational initiatives worldwide, representatives from the University of Washington Neurosurgery and Neurocritical Care Departments partnered with Calmette Hospital and Khmer-Soviet Friendship Hospital (KSFH) to conduct two ENLS courses for their emergency, neurology, ICU and neurosurgery providers in May 2019.
The two courses were conducted for providers at each hospital and focused on eight of the 14 modules whose topics centered on the most commonly encountered neurological emergencies in Phnom Penh: traumatic brain injury, intracranial hypertension, subarachnoid hemorrhage, intracranial hemorrhage, acute stroke, meningitis/encephalitis, seizures and spinal cord compression. Dr. Ariana Barkley, a senior neurosurgery resident at the University of Washington, Dr. Jonathan Medina-Beckwith, a nurse practitioner with the department of neurosurgery at the University of Washington and Dr. Abhijit Lele, the director of neurocritical care at Harborview Medical Center and Neurocritical Care Society ambassador, presented translated presentations and moderated discussions throughout the lecture sessions to ensure understanding. Although participants had knowledge of English, there remained a language barrier which was accommodated by having simultaneous projection of both English and Khmer slides and providing Khmer handouts so participants could take notes in the language most comfortable for them. Additionally, an in-person medical translator assisted with clarifications and periodically solicited audience feedback to assess understanding. This was incorporated into allotted time for each lecture which lasted approximately one hour each.
Over 50 healthcare providers participated in the course and with the assistance of our local collaborators including Mr. Seang Sothea, Professor Koy Vanny, Mr. Pak Sopheak, Professor Prom Phannit and Professor Hul Vannthon. The course was received with enthusiastic participation and praise, especially when reviewing pre-course and post-course quizzes as measures of knowledge, retention and understanding. The majority of providers reported increased comfort with managing patients presenting with pathologies discussed during lectures and many saw the ENLS algorithms as opportunities to standardize practice within their departments.
Common challenges and insights gained from conducting these two courses included the importance of translation assistance to facilitate knowledge transfer and modification of the course to include settings that are resource limited and therefore may not have access to materials to conduct suggested interventions in ENLS algorithms. Lack of TPA, MRI, c-EEG, 3% saline or 23.4% saline, may provide challenges to neurocritical care providers as they make efforts to disseminate information in resource limited settings. This opportunity for mutual learning was invaluable and from this first capacity development initiative emerged a long-term collaboration to improve neurocritical care in low-middle income country settings such as Cambodia.
This work was funded by the Global Innovation Grant from the University of Washington School of Public Health.