Vislisel Finishes Second Week At Angkor Hospital for Children

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

I have finished my second week of work at Angkor Hospital for Children (AHC) and had a great week. I was able to spend more time in the inpatient unit, seeing a variety of patients.

This is an area in the hospital used for teaching families
the importance of clean water, well-balanced diets, etc.

Entrance to the ICU and ER

This is the home of one of the families we visited during a home visit. The AHC staff is
carrying food for the patient in the plastic bag.

The hospital has its own garden to provide food for families. Fresh food and clean water is
free to all the families, but the parents are responsible for actually preparing the food and
feeding their children.

I followed a child admitted for cryptococcal meningitis (in the setting of HIV), and have been impressed at how well she is doing since being started on amphotericin B. It has been challenging trying to get a feel for how the staff here manages certain illnesses and treatments, as it differs from what we do in the U.S. At home, this child would have frequent blood draws performed to check for toxicity of the amphotericin. At AHC, however, electrolytes and LFTs were checked at four days after initial administration of medication. Abnormalities in her electrolytes and LFTs were found, but there were minimal things we could do other than supplement electrolytes as needed (as there is not an alternative medication for amphotericin). There is a fine balance between ordering tests that I think should be ordered and ordering those that will actually be useful to the patient.
A number of patients have been admitted with a diagnosis of leukemia, usually after blasts have been found in a blood smear. I've felt frustrated in treating these patients because chemotherapy is not available. Instead, they are treated symptomatically with transfusions and pain control. Fortunately in the near future, the hospital is planning on starting chemotherapy regimens for patients with ALL. The courses will involve less intense therapy to decrease the side effects, which will likely result in decreased cure rate, but this is still a huge step for these patients.

I was able to go on a home visit this past week as well. We drove for almost 1.5 hours into the countryside, and met with two separate families. Most of the patients being seen on the visits have HIV and most are under the age of ten. Proper administration of the medication was reviewed to ensure the children were being treated appropriately. The hospital also brings some food with them for the patients, as many of the medications should be taken with food. I noticed during our visits that all of the children were home, even though it should have been a school day. When we asked if these children go to school, we learned that there were many schools in the countryside, but not all of them have teachers. These children, therefore, had no one to teach them in their school.

This past weekend was the Khmer New Year, which is an important holiday in Cambodia. The hospital had a four-day weekend in celebration, and DeAnna Friedman and I were able to be somewhat more useful at the hospital by filling in, since many residents were off. We will hopefully have the chance to help out more next week as well, as many of the residents will be gone for a training course.

Over the weekend, I made my first trip to Angkor Wat. The place is impressively large, and the architecture and carvings are amazing to see! The place was packed, as many local Cambodians were visiting for the New Year. There are many more temples to visit as well, so that should keep us busy during our days off. We have also had the chance to explore some local swimming pools, which are desperately needed after a hot week. Some locals say that the month of May is actually a bit hotter than April, but I couldn't imagine it getting any hotter than it already is!

This was snapped from our vehicle. I am amazed by how many
chickens he fit on that bike!

Buddha statue towards the entrance of Angkor Wat. These
statues are still worshipped, and offerings and incense are placed at
the feet.

This picture was taken within the central structure of Angkor Wat.
There used to be a pool in the foreground of the picture.

Two monks sitting outside the moat surrounding Angkor Wat. My pictures do a poor job
of showing how massive Angkor Wat is. The place is huge! The central structure can be
seen in the background and there is some scaffolding where restoration is being performed.