Vislisel's Final Week At AHC

The following was written by Amy Vislisel, third-year pediatric resident:

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Buddha statue at Preah Khan. Like most statues of Buddha at the temples, the head has been removed. The missing faces are actually from a couple of different reasons. First, the temples have changed from Buddhism to Hinduism (and some back again), and the faces of Buddha were removed at those times. Second, people over the years have stolen what faces remained to sell or to place in museums..

I am completing my 4th and final week at AHC, and I was able to spend some time in different areas than in past weeks. Specifically, I spent a day with Dr. Lyda, a pediatric radiologist who has been working at AHC since it was founded. He reads all imaging studies, including x-rays, ultrasounds, and echocardiogams.

I was able to observe several echos, and a new ASD was diagnosed.. Fortunately, a cardiothoracic surgeon will be at AHC in the upcoming weeks and will hopefully be able to close this child's ASD.

Another child with severe mitral regurgitation, however, will not be as lucky. The surgeons will not be able to repair his valve due to the severity of his disease and the poor outcomes they have had so far with bypass surgery. It is difficult to see a child with a fixable heart condition be transitioned to palliative (and soon hospice) care.

I was also able to spend more time in the outpatient unit (OPD). Every day that I have worked in the OPD, I have seen a child with an animal bite. These are usually dog bites, which didn't surprise me at first because there are so many stray animals on the streets.

It turns out, however, that most of the animals were pets and were able to monitored for rabies. This has been true for all but one patient I have seen. For that child, the family did not know the dog, and they thought it actually looked 'crazy' and was foaming at the mouth. There was clearly concern for rabies exposure, and the child was treated accordingly. Her bite was on the thigh, and given the location (a reasonable distance from the brain), AHC protocol is to give only the rabies vaccination. Rabies serum is not readily available and is reserved for people who have been bitten on the head and neck.

During my month here, I have had the opportunity to get to know some of the residents. I have found it especially rewarding working with the interns. Their medical education is quite a bit different than ours. They go to medical school for 4 years, as we do, but have no clinical experiences during this time. We performed a fundoscopy on one patient, and I was able to demonstrate for the interns the proper technique, as well as describe what a normal retina looks like (with the help of the internet).

I think it would be great it future resident volunteers were able to take some of their time to help teach basic physical exam skills, as this is an area where I feel we can be especially useful!

On a different note, I wanted to add some follow-up on a patient I mentioned in my blog last week. The 6 month old with kwashiorkor and zinc deficiency dermatitis is doing well, with remarkable improvement in his dermatitis. It is remarkable what zinc replacement and better nutrition can do!

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This was the 6-month-old male with kwashiorkor and zinc deficiency dermatitis, one week after admission. His rash has remarkably improved after only one week of zinc replacement - compare with last week

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Tree growing out of a temple at Ta Prohm, well known for being where Tomb Raider was filmed!

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The site of our cooking class. We learned how to make fish amok (traditional dish in Cambodia). Hopefully I'll be able to reproduce it at home!

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Garden at local house near our cooking class. Some families are able to use PVC piping as planters, which makes the plants easier to water (especially in the dry season).