ICOE Triumph: Revolutionising Obstetric Emergency Training in Cambodia

By Dr Chua Wang Ching
Specialist, Obstetrician & Gynaecologist
Hospital Sultan Idris Shah, Serdang, Selangor

(Published in AOFOG Newsletter October 2023, Volume 4/2023 & OGSM CONNECT Newsletter December 2023, Issue 1, Council 2023/2024)

On 30th September to 1st October 2023,, we embarked on a transformative journey to Cambodia, where dedicated healthcare professionals joined hands to revolutionise maternal healthcare through the Intensive Course in Obstetric Emergencies (ICOE).

Cambodia, a nation rich in history and culture, stands at the heart of our narrative. Yet, beneath its vibrant surface, lies a healthcare challenge that cannot be ignored. The maternal mortality rates, a critical indicator of a nation’s healthcare system, have been a cause for concern. As of September 2023, Cambodia’s maternal mortality rate stood at 154 per 100,000 deliveries, reflecting the urgent need for improved maternal healthcare. Our mission was clear: to equip doctors with the essential emergency skills required to confront obstetric crises head-on and contribute to reducing these alarming figures.

Our story begins at the bustling National Maternal and Child Health Centre in the heart of Phnom Penh, Cambodia. This remarkable institution serves as a beacon of hope for countless mothers and children. However, we recognised that more can be done to enhance the quality of care and, in turn, reduce maternal mortality rates.

Our participants, a diverse group of 27 dedicated individuals, including OBGYN residents, specialists and doctors, came from various corners of Cambodia. Their commitment was nothing short of inspiring, with one participant even traveling a staggering 410 kilometres from Poipet Referral Hospital to join our mission. Our trainers, both local and international, brought their collective wisdom to the table.

On the inaugural day, we directly delved into Training of Trainer (TOT) sessions, paving the way for a cadre of six newly minted trainers. Subsequently, we plunged wholeheartedly into a series of intensive hands-on workshops that would span the following days. Throughout this transformative experience, our steadfast companions were none other than meticulously designed mannequins—silent allies in our unyielding pursuit to elevate our obstetric emergency skills. Yes, we explored everything from basic obstetrics to effectively tackle labour ward emergencies, aligning with the global goal of achieving a maternal mortality rate of less than 70 per 100,000 deliveries in year 2030. Our program focused on critical topics, including complicated caesarean sections, nonsurgical techniques for postpartum haemorrhage, managing shoulder dystocia, precise estimation of blood loss, maternal resuscitation, B-Lynch sutures, vaginal breech deliveries and the vital art of communication and transfer during emergencies.

At the end of our intensive sessions, the room was buzzing with energy and enthusiasm. Participants
shared their thoughts and experiences. Many expressed their thrill at learning new skills and pledged to share their newfound knowledge with colleagues and communities. Some even had ambitious plans to organise emergency drills within their healthcare settings, ensuring that knowledge and response to obstetric emergencies remained sharp.

However, it wasn’t all praise; there were constructive criticisms. Some participants felt that the course had been a bit rushed, and there hadn’t been enough time for hands-on practice. Others noted that the venue was crowded and noisy, affecting the overall experience. There was a specific request for including a Cardiotocography (CTG) course in future training sessions. Language emerged as a formidable challenge during our training in Cambodia. However, our dedicated local trainers often conveyed their expertise in their native language, with our international team providing support and assistance when needed. The presence of local translators among the training staff proved invaluable in bridging language barriers.