Vislisel's Third Week At AHC

The following was submitted by Amy Vislisel, third-year Pediatrics resident.

I have finished my third week at AHC and continue to see a variety of interesting things. My time this past week was mostly spent within the inpatient department.

I admitted a young infant whose chief complaint was rash and fever. The child had been sent to AHC due to concern for a 'drug eruption'. Immediately when I saw the child being brought into the ward by his mother, I knew there was more to the story. The infant was 6 months old and slightly puffy. He had severe dermatitis with numerous raw and macerated areas. On further history, we found out that the mother only fed him 'ALASKA' milk. It was difficult for the staff to explain exactly what this was to me (they didn't know the English words), but it turns out to be a type of condensed milk, which offers poor nutrition for infants. We diagnosed the child with dermatitis from vitamin deficiency (likely zinc) as well as kwashiorkor. His rash has been slow to improve, but he is otherwise doing well clinically.

Six month old child with dermatitis from vitamin deficiency. He also had slight edema
and was diagnosed with mild kwashiorkor.

Another picture of dermatitis from zinc deficiency. We gave him oral zinc supplementation,
as well as zinc oxide ointment (the white cream on his skin).

As volunteering residents, we have the opportunity to attend ICU rounds every afternoon. This has been an interesting and worthwhile experience. It is in this ward that we usually see the most interesting and difficult cases, and it is here that the differences in the diagnostic and treatment capabilities between Cambodia and the U.S. are most evident.

There is currently a 10-year-old male with acute fulminant hepatitis who is doing poorly. The ICU staff have done all the testing that is available (hepatitis B and C), and both have been negative. The history of the illness is also not helpful in elucidating a possible diagnosis, and so by exclusion, the child has been diagnosed with hepatitis A.

It is frustrating to be involved in this case, because there are so many more options at home for diagnosis (liver biopsy, toxin testing, different viral testing, and liver specialist consultation), as well as the possibility for liver transplant.

The ICU also admitted a 28-week premature infant this week. Fortunately, this child has done remarkably well and has not required intubation. This is a good thing, because the hospital does not have endotracheal tubes small enough for this child.

The hospital staff on a regular basis discusses what to do if this child were to need intubation, and due to the overwhelming odds this patient faces (no TPN, surfactant, or premature formula), they will likely need to withdraw care. The hospital is working on the development of an NICU, and so it will be interesting to see in the upcoming years how the capability for caring for these infants will change.

DeAnna and I have had more time to explore Siem Reap and the temples, and will be taking a cooking class this weekend to learn how to make fish amok (a popular Cambodian dish). We have one week left at the hospital...the time has gone so fast!

Front entrance to AHC. This is the waiting area for the outpatient department (OPD), and
also serves as a place for families to sleep if they live a far distance away and are unable to travel

home at the end of the day.

One of the many side entrances to Bayon, definitely one of

the most impressive temples we have visited.


Carvings at Bayon, within Angkor Thom. There are 216 of these carved faces within the temple!