Different, and yet the same...

The following was written by DeAnna Friedman, 3rd year pediatric resident

So, I arrived in Cambodia about a week ago. The overland travel was hot and somewhat uncomfortable at times - glad to have it behind me. The first thing I noticed is that it is more like Africa than Thailand here - there's a lot more impromptu marketing on the street ("lady want a tuk-tuk?", "lady want massage?", "okay, you buy one thing", "please look inside"), etc. 

It's also been interesting to me that because it's a different language, it's a different accent, the misunderstandings that were improving are back to square one. 

The hospital here is much smaller, mostly since it is solely a children's hospital. They also do much more of the care as outpatient care, which is nice for families to be able to seek. The 6-7 doctors in outpatient on any given day see 400-500 patients. There is an area with room for maybe 5-10 children where they can receive ORS if they are mildly dehydrated and be sent home from outpatient if they improve with this.

The ICU also doubles as the ER and has approximately 10 beds. The inpatient ward has 30 beds.  There's also a surgical wing that has 10 beds. There's one operating theatre and one minor procedure room. There's also a separate building for eye surgery and ophthalmology consultations. 

There are many residents here, and this is one of very few official training programs with a longitudinal curriculum in the whole of Cambodia. We have 2 seniors and 2-3 interns on in the inpatient department, and there are 2 seniors and 2 interns on at any time in the ICU as well (I believe - they rotate taking days off, so sometimes it's hard to keep track of who is where and how many people there are). 

One large contrast from Chiang Mai is the availability of resources. The laboratory tests that we can order are ordered off of 1 of 3 pages, where there is space for the results and normal value ranges as well. They do have a good number of drugs, including imipenem, which is good. We can also get x-rays, ultrasounds, and echos for imaging. Many times, though, children become ill and we cannot figure out why. They get treated empirically, and while most survive, some don't (although the death rate here is much lower than it was where I worked in Uganda - so that is where Cambodia is more like Thailand). 

Many more children have a component of malnutrition, and a child was lost the other day, likely to complications of kwashiorkor. While the hospital has echos, heart surgery is only available to fix the congenital heart lesions when a team comes from the U.S. or Singapore. Also, because the surgeons are here only briefly, they all do simple surgeries so that they can fix as many children as possible.

There is a patient in the ward right now with an AV canal that is "unrepairable." There's also no chemotherapy yet, but the doctors here are working with some doctors from St. Jude to write protocols, and they should have simple regimens for chemotherapy by the end of the year. 

The residents have been very nice and very helpful, and we're already rounding on and writing notes on several children per day, which is great. It has been very interesting to me to see some of the more classic diseases that occur here.

We are starting to see dengue hemorrhagic fever and dengue shock syndrome; they tell us that it is early for this, and they worry that this year may be a bad year for it. They can diagnose it with very few clues in the outpatient department, and then as the next day or two passes, it becomes very clearly DHF/DSS. These children need boatloads of fluids to survive because of the plasma leakage that occurs, and I saw one who had a fairly uneventful course but received probably 2-3 L of fluid over the first 12 hours of admission. He really looked well the whole time, but could have really done poorly without the fluids we poured in to him.


The patient had a very classically positive tourniquet sign

So far so good - although I'm really starting to miss having a kitchen! 

DeAnna