This week was really busy. On Monday and Tuesday, I worked in the outpatient department.
Our first visit was a four-month-old baby with constipation and URI symptoms. The resident asked about any traditional medications the mother was taking, and she was indeed taking some herbs to help her milk supply. The resident told me that many of the mothers do that, and that it often causes constipation in the infants, for which they prescribe the mothers metaclopramide, because they don't think that the mothers will stop taking the herbal remedy unless they are given something else to take instead.
Many of the children over the age of 1 get a one time dose of mebendazole when they come to clinic because of the high rate of parasites here. Many of the schools have anti-parasite programs, though, so before giving it, the residents ask whether the child goes to school.
A stool study is currently being conducted that is going to send the stools to a more sophisticated lab to do more sensitive testing and some resistance testing. There's some thought that single-dose mebendazole is selecting for parasites that don't respond to this treatment, or are now resistant.
I saw another child in clinic who was nine months old and had hypochromic, microcytic anemia. They suspected thalassemia, given the pattern on the CBC, so sent testing. I understand that it can take up to two months to get the results back, which seems like a long time when there is so much anemia.
On Tuesday, we had an interesting dilemma. One of the girls who was back for follow up after a stool sample had a stool that was positive for hookworm and Strongyloides. However, she also had an ALT of 1,025. They're still working out why she has hepatitis, but they decided to treat the hookworm alone because of the side effect profile of the drugs that are available to treat Strongyloides. It also seemed interesting to me that a disease that is more prevalent in areas that have a higher incidence of hepatitis is usually treated with a drug that can cause hepatotoxicity.
We also saw a set of brothers who were in for cough and fever. It sounded mostly like a URI, although one had a history of asthma. The other boy had marks all over his chest and back from coining, one of the traditional healing practices. For those of you who aren't familiar, oil is applied, and a coin is scraped in a pattern along the back and chest. I asked one of my older patients back in the US about it once, and he said that it felt "warm and nice," even though it looks like it would hurt. I thought it was interesting that the boy who had a history of asthma had the same symptoms but hadn't had the coining done.
Here's a picture of coining, a traditional healing practice
A wheelchair that was in the hallway outside the Low Acuity Unit
On Thursday, we went on a home visit with the Home Care Program. The Home Care Program makes home visits for at-risk patients who need close follow up. The staff we traveled with told us that 70% of these patients are HIV-positive. The visits are helpful because staff can get an idea of what other supplies they need to keep the children healthy.
There also used to be a lot of stigma associated with HIV, so many of the families found it very hard to work or find transportation to clinic visits. The Home Care Program visits them once a month, and then the children need to come to clinic for a medical check-up once every two months. They count the pills, talk with the parents about any challenges they have, and bring them a bag of food for some supplies.
One of the families we saw had a house with a thatched roof and some wooden sides. They want to build a better house, but can't afford to pay the $200 that it will cost to do so. The Home Care Program will go back and ask donors for help.
On Friday, we went around helping out where we could. We rounded in the Low Acuity Unit (kids getting rehab or parents getting education in preparation to take the kids home), then helped in the ED.
This past weekend, we went all around Siem Reap. We saw Angkor Wat on Saturday, then went on a bike ride in the countryside on Sunday, then went over to Angkor Thom today. It was all very awe-inspiring. Here are a few pics for your enjoyment!
Looking up at the central temple at Angkor Wat
A monk studying Apsara
Biking through the Cambodian countryside
Bayon in Angkor Thom. There are 216 of these faces carved throughout this temple structure.