Laos | Overview
Attending to Burnout and Secondary Traumatic Stress in a Pediatric Hospital
Many years of widespread conflict and poverty have stalled healthcare development in Laos, and poor infrastructure combined with a mountainous terrain present a constant barrier for children and families to access high-quality health care. As a result, children often die from preventable conditions and treatable diseases. These realities can weigh heavily on hospital staff who are frequently working around the clock with limited resources in fast-paced, high-stress situations to save children’s lives.
Where We Started
The Lao Friends Hospital for Children (LFHC) opened in February 2015 with the intent to establish a locally sustainable hospital by and for the Lao people. Since its opening as an outpatient clinic, LFHC has grown rapidly into a multi-department, international-standard pediatric hospital. Boston Children’s Hospital has partnered with LFHC to support this growth; recently, Emma Cardeli, PhD, a clinical psychologist from Boston Children’s, was invited to conduct a needs assessment to enhance LFHC’s understanding of programmatic and clinical stressors in addition to resilience levers.
In October, Dr. Cardeli completed 38 qualitative interviews with Lao and expat staff working in various capacities at the hospital. She reviewed findings with the LFHC leadership team and outlined a multi-tiered, self-care program for hospital staff that takes into account culturally specific staff needs.
Boston Children’s will continue to work with LFHC to build capacity for a multi-tiered, self-care program. This will include training LFHC staff in reflective supervision techniques and in evidence-based coping skills to manage symptoms of burnout and secondary traumatic stress.
Emma Cardeli, PhD
Addressing Longitudinal Care in the Treatment of Extreme Anemia
Thalassemia is an inherited blood disorder and a major cause of severe anemia in the southeast Asian population. In northern Laos, where years of poverty, poor infrastructure, and geographic barriers to care exist, mortality rates for thalassemia are among the highest in the region. It remains a largely under-diagnosed, under-recognized public health problem in national statistics.
Where We Started
Local leadership at Lao Friends Hospital for Children (LFHC) identified the need to reliably diagnose and systematically see patients affected by this disease, who were being managed in a fragmented outpatient care system. In late 2016, they advocated to create a thalassemia clinic to begin providing regular blood transfusions and health maintenance. As the clinic reach expanded and children are anticipated to live longer, the clinic has experienced issues with retention, compliance, and longer-term treatment plans for these patients.
Boston Children’s former Pediatric Global Health Fellow Neeru Narla, MD, MPH, partnered with LFHC to support clinic logistics, patient counseling and education, blood supply, and surgical care planning. She worked with local Lao providers to develop a model of assessment and education for pediatric patients through their transition into adolescence and adulthood.
We hope to maintain improved systematic management for early adolescents with other childhood-onset diseases, including nephrotic syndrome and epilepsy, currently cared for in the hospital's overwhelmed pediatric outpatient system. The goal is to foster continued support for the successful transition of these patients who are now living to adulthood with better access to healthcare.
Nirmala Narla, former Pediatric Global Health Fellow