Vislisel Arrives in Cambodia

The following was submitted by Amy Vislisel, 3rd year pediatric resident.

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The front gate at Angkor Hospital For Children

I arrived in Cambodia on April 2 to start my elective month at Angkor Hospital for Children (AHC), and the first week seems like it has already flown by. After an interesting day of travel (delayed flights, lost luggage, etc.), I was able to explore the town and get acclimated to the heat before starting my first day at AHC. We had orientation to the hospital on Monday morning and shadowed in the inpatient unit during the afternoon. The following day, however, we were able to jump in and start seeing patients.

I based myself in the inpatient unit (IPD) and picked up several patients. My first patient turned out to be quite rewarding. He was 13 months old, and had initially been admitted with multiple skin abscesses that grew out pseudomonas. He then developed septic arthritis of his right knee. He was taken to the OR and had his joint cleaned out.

Despite appropriate antibiotics, he continued to be febrile and had a painful right knee. Through discussion with the staff, I recommended obtaining an x-ray of his right knee/femur to evaluate for osteoarthritis. They agreed, and this was read as osteomyelitis of his right femur. He was taken back to the OR the following day, where he wasn't found to have osteo, but septic arthritis (again). After his joint was washed out, he has been a febrile and hopefully will be switched to oral antibiotics soon and discharged home. What has been frustrating about the patient, however, is our inability to really evaluate why he has pseudomonas abscesses, as the studies needed for work up of immunodeficiency aren't available.

My second patient illustrated how difficult treating severe malnutrition can be. She was a 1 year old female with kwashiorkor and had been admitted more than 1 month ago. Despite proper treatment, she passed away during the middle of the week.

In the upcoming weeks, I will be able to spend time in the low acuity unit, the outpatient department (which functions much like an urgent care clinic and sees on average of 500 patients a day!), and the ICU. I will hopefully also be able to accompany staff on a home visit as well.

Outside of work, DeAnna Friedman (also here for a month) and myself have had an incredible time exploring Siem Reap. There are wonderful (and inexpensive) restaurants, great nightlife, and interesting markets. I am looking forward to exploring Angkor Wat in the upcoming weeks!

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I had the chance to visit Tonle Sap Lake, the largest lake in Cambodia and known for its floating villages. There are over 100 villages on the lake with tens of thousands of inhabitants. Above is a typical house and shop on the lake.

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Floating house with its inhabitants.

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The group of sticks seen in the background are used to anchor the oases during bad weather.

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You could find children everywhere carrying water along the shore of the lake.

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We also had the chance to visit a pagoda, which had lots of interesting architecture and art. The Khmer New Year is coming up soon, and many Cambodians are going to the pagoda to receive blessings from monks.

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Typical market in Siem Reap