It has been a great rotation! I had a chance to see illnesses and disorders that I have never seen before in the US. I especially liked working in the ID unit and the HIV unit. Both were full of enthusiastic professors and students. And my last week working in the surgery department with the cleft lips and palate specialist was amazing!
It was eye opening to work in an environment with such limited resources. We are so used to ordering tests and images that sometimes we forget to focus on the history and physical, on the clinical signs and symptoms. But it also made me grateful for the abundant of resources that are available in the states.
These four weeks have been wonderful, both working in the hospital and visiting the country. And now I'm off for more adventures! I'm heading to Siem Reap to see the great Angkor Wat! And then I'm off to Thailand before heading back to the states. Hopefully some of this wonderfully hot weather will follow me home!
Saturday, February 28, 2015
Thursday, February 26, 2015
an almost encounter with the prime ministers wife
Day started with morning meeting, where the intern gave a summary of all admissions yesterday. There were a few hernia and fractures due to motorcycle accidents. I decided to go straight to the operating theatre rather than round toys morning. There was another cleft lip on the schedule. Then there was a second degree burn that needed to be cleaned and debrided.
By this time, it was almost lunch time. So I went home, but I returned at 1 because the wife of the prime minister was scheduled to visit the hospital. By 1:30, everyone was dressed in their whitest white coat and cap and waiting at the entrance to the surgery building. By 2:30, the entourage arrived. We could see the cars and we could catch glimpses of her and her delegates add they went into the main building for a meeting. The visit to the surgery department was scheduled for after the meeting. So there we waited. By 3:30, we could see activities across the courtyard. All of a sudden, lights started flashing and the cars were pulling away.
So there went my chance of meeting someone famous.
By this time, it was almost lunch time. So I went home, but I returned at 1 because the wife of the prime minister was scheduled to visit the hospital. By 1:30, everyone was dressed in their whitest white coat and cap and waiting at the entrance to the surgery building. By 2:30, the entourage arrived. We could see the cars and we could catch glimpses of her and her delegates add they went into the main building for a meeting. The visit to the surgery department was scheduled for after the meeting. So there we waited. By 3:30, we could see activities across the courtyard. All of a sudden, lights started flashing and the cars were pulling away.
So there went my chance of meeting someone famous.
Wednesday, February 25, 2015
Orthopedic consults and arthrogryposis surgery
Tuesday: After morning meeting and ward rounds, I spent an hour with a general surgeon consulting on new cases. We admitted a 6 year old with inguinal hernia. At first, the parents aren't sure they would be able to afford the operation. It costs about 200$ for the surgery. Fortunately, there is a governmental program that will with the cost. Unfortunately, if the parents decide to go with the governmental program, they might have to stay in the hospital for several days until there is a free spot in the surgical schedule. And each day at the hospital costs about 10$. If they were private pay, they were guarenteed to be on schedule that same day.
After the general surgery consults, I went with an orthopedic surgeon. We saw about 30 patients in about 4 hours. We saw new patients and follow up patients with Developmental Dysplasia of the Hip. I was not expected to see so many cases and with such varied range of age, from 6 months to 5 years old. But in Cambodia, newborns and infants are not routinely screened for hip dysplasia. I also saw a few cases of arthrogryposis, something that I don't remember seeing in the states. We also had several cars of scoliosis and one case of osteogenic imperfecta.
Wednesday: after the morning meeting, I skipped ward rounds and went to the operating theatre. My first case was a 6 month old girl with cleft lip and palate. Today, we were only correcting the lip and is one of my top ten procedure that I've taken part in. To me, it's like a
puzzle where pasta don't seem to fit our make sense, but once the procedure is finished, the result is amazing. This is the second time I've worked with Dr. Vanna and I've been following my first cleft patient from Monday. If I had not seen this patient before surgery, I would not have imagined that he had cleft lip.
After the cleft surgery, I observed an osteotomy procedure of bilateral femurs in a year old boy with arthrogryposis. The procedure was performed to release the contractures at the knees so the legs can straighten and the patient can have some mobility. The surgery was performed by a visiting surgeon from the states.
After the general surgery consults, I went with an orthopedic surgeon. We saw about 30 patients in about 4 hours. We saw new patients and follow up patients with Developmental Dysplasia of the Hip. I was not expected to see so many cases and with such varied range of age, from 6 months to 5 years old. But in Cambodia, newborns and infants are not routinely screened for hip dysplasia. I also saw a few cases of arthrogryposis, something that I don't remember seeing in the states. We also had several cars of scoliosis and one case of osteogenic imperfecta.
Wednesday: after the morning meeting, I skipped ward rounds and went to the operating theatre. My first case was a 6 month old girl with cleft lip and palate. Today, we were only correcting the lip and is one of my top ten procedure that I've taken part in. To me, it's like a
puzzle where pasta don't seem to fit our make sense, but once the procedure is finished, the result is amazing. This is the second time I've worked with Dr. Vanna and I've been following my first cleft patient from Monday. If I had not seen this patient before surgery, I would not have imagined that he had cleft lip.
After the cleft surgery, I observed an osteotomy procedure of bilateral femurs in a year old boy with arthrogryposis. The procedure was performed to release the contractures at the knees so the legs can straighten and the patient can have some mobility. The surgery was performed by a visiting surgeon from the states.
Monday, February 23, 2015
Surgical unit
I started in the surgical department today and it was a great day, I started the morning in the ward, rounding with a physician on about 7 patients, 4 had come in with open complex fractures from motorcycle accidents, another fell off a couple of stacked boxes. There was a newborn who had a colostomy surgery after an open abdominal exploration for suspicion of malrotation or vulvulus. The last patient is a one year old who at 7 months old was somehow burned. Now his face is nothing but scar tissues.
After rounds, I went and observed 2 surgeries, a cleft lip repair of a 6 month old and a palate repair of an 18 year old. The surgeon was very friendly and eager to answer any questions.He does these repair every morning from Monday to Thursday and consult and follow ups on Friday. He does about 200 of these repairs a year and completely free for the patients. The funding is from Smile Train, an NGO that helps many countries provide cleft surgery for free.
After rounds, I went and observed 2 surgeries, a cleft lip repair of a 6 month old and a palate repair of an 18 year old. The surgeon was very friendly and eager to answer any questions.He does these repair every morning from Monday to Thursday and consult and follow ups on Friday. He does about 200 of these repairs a year and completely free for the patients. The funding is from Smile Train, an NGO that helps many countries provide cleft surgery for free.
Thursday, February 19, 2015
New week, new illness.
First it was allergies. Then it was diarrhea. This week? The flu!
The week started out so well, but I must have picked up a bug from one of the patients on Monday. Went to work on Tuesday and lasted through half the morning before I started sniffling, then coughing. I left work early and stopped by the pharmacy for some cold medications. Asked for guanfenesin, which they didn't have. The pharmacist suggested Decolgen forte, which contains paracetamol and chlorpheniramine, which I recognized, and phenylpropanolamine HCL, which I didn't recognize. But as I was feeling kind of miserable, I took some anyway. Went home, went to sleep. Woke up a few hours later with a fever. And I've been fighting it until it finally broke late last night (on Wedsnesday). Between sleep, coughing, and listening to the people ringing in the Year of the Goat, I researched phenylpropanolamine HCL. Turned out that it is a decongestion, but it had also been used in diet pills, and it has been banned from the US since the early 2000s for its potential effects of hemorrhagic stroke in women between age 19 and 49.
So I went to another pharmacy and found a drug where I knew all the ingredients, Sinex Forte. Manufactured in India, it contains phenylephrine, paracetamol, dextromethorphan, and cetirizine.
The good news is that the fever is gone and I'm feeling well enough to get up and go outside. The bad news is that I feel like I'm coughing every 5 minutes. Hopefully I'll be well enough to go to work tomorrow and hopefully I won't catch anything else. But with my luck, it might just be malaria!
Happy New Year!
The week started out so well, but I must have picked up a bug from one of the patients on Monday. Went to work on Tuesday and lasted through half the morning before I started sniffling, then coughing. I left work early and stopped by the pharmacy for some cold medications. Asked for guanfenesin, which they didn't have. The pharmacist suggested Decolgen forte, which contains paracetamol and chlorpheniramine, which I recognized, and phenylpropanolamine HCL, which I didn't recognize. But as I was feeling kind of miserable, I took some anyway. Went home, went to sleep. Woke up a few hours later with a fever. And I've been fighting it until it finally broke late last night (on Wedsnesday). Between sleep, coughing, and listening to the people ringing in the Year of the Goat, I researched phenylpropanolamine HCL. Turned out that it is a decongestion, but it had also been used in diet pills, and it has been banned from the US since the early 2000s for its potential effects of hemorrhagic stroke in women between age 19 and 49.
So I went to another pharmacy and found a drug where I knew all the ingredients, Sinex Forte. Manufactured in India, it contains phenylephrine, paracetamol, dextromethorphan, and cetirizine.
The good news is that the fever is gone and I'm feeling well enough to get up and go outside. The bad news is that I feel like I'm coughing every 5 minutes. Hopefully I'll be well enough to go to work tomorrow and hopefully I won't catch anything else. But with my luck, it might just be malaria!
Happy New Year!
Monday, February 16, 2015
Week 3: respiratory unit
I started in a new unit today, Ward B, the respiratory unit. There are about 10 patients, ranging from 5 months to 11 years old. Most have been diagnosed with bronchitis and pharyngitis. One patient, an 8 month old boy, was brought in last night with febrile seizure., but has been stable since admission with no more seizure activities.
The unit is run similar to the Infectious Disease unit. There are 7 rooms in this unit, 1 room dedicated to those who can't make any payments, 2 rooms for those who could pay some, and 4 private rooms. There is a doctor and about 10 students assigned to each room, except for the private rooms, which are seen only by attending physicians.
The unit is run similar to the Infectious Disease unit. There are 7 rooms in this unit, 1 room dedicated to those who can't make any payments, 2 rooms for those who could pay some, and 4 private rooms. There is a doctor and about 10 students assigned to each room, except for the private rooms, which are seen only by attending physicians.
Friday, February 13, 2015
HIV ward cont.
Weds: First day actually working in the ward and we had three admissions. All around 10 to 12 years old and all taking ART. One came in with diffuser joint pain. Another with a groin abscess. And the third with outer ear infection. Her ear had swollen to its normal size. Fortunately, their last CD 4 count were high and vital load was low. However, the little 12 year old boy with the joint pain barely weight 18 kg, putting him little above the fifth percentile.
Thursday: I checked in with our three patients in the morning. The abscess was drained and the little girl now feels much better. The boy with the joint pain feels about the same, even with scheduled Tylenol and Ibuprofen. The girl with the ear infection has improved. The swelling has decreased, but it was still still painful to touch.
After rounding on the patients, I went to clinic. And there I met two brothers, about 5 years apart. The oldest has been taking ART since he was 9, about 5 years ago, and his brother, 8 years old, had been taking it since he was 3.
Friday: It's my last day in this unit and I'm back with PMTCT. New babies were brought for HIV testing and preventative medications. Some have already been confirmed as being positive for HIV, while others are still waiting for their results.
Thursday: I checked in with our three patients in the morning. The abscess was drained and the little girl now feels much better. The boy with the joint pain feels about the same, even with scheduled Tylenol and Ibuprofen. The girl with the ear infection has improved. The swelling has decreased, but it was still still painful to touch.
After rounding on the patients, I went to clinic. And there I met two brothers, about 5 years apart. The oldest has been taking ART since he was 9, about 5 years ago, and his brother, 8 years old, had been taking it since he was 3.
Friday: It's my last day in this unit and I'm back with PMTCT. New babies were brought for HIV testing and preventative medications. Some have already been confirmed as being positive for HIV, while others are still waiting for their results.
Subscribe to:
Posts (Atom)