New week, new ward.
On Monday, I followed a physician who worked in the PMTCT unit (Prevention of Mother to Child Transmission). We saw nearly 15 children, ranging from 3 months to 9 months. Some have known history of parents who have the disease, others are found or adopted with unknown history. Some have already been tested positive, others are still waiting for the results. Most live in the city, but some had to travel many hours just to get here. For those who live in the city, they have to be brought to the clinic every month for monitoring their symptoms and for distribution of their medications. For those who live far away, the medications are given in 2 or 3 months supplies. These medications are supplied by The Global Fund and given freely to most of the patients. Those who can afford to pay are asked to pay what the could.
On Tuesday, I spent the morning in their clinic where children who have been confirmed by trains to have HIV are also seen monthly for monitoring and for distribution of their ART medications. I met a little girl about 14 years old who have tested positive since birth from transmission from her mom. She had been on the first line treatment since birth until last year when she became resistant to most of them and her CD 4 count drop to 9 while her viral load increased to more than 300,000. She was started on the 2nd line treatment. If she also fails this line, her options become very limited as the 3rd line regimen is not easily available here. Unfortunately, she is but one of the 5000 children in Cambodia currently infected with this disease.
Tuesday, February 10, 2015
Sunday, February 8, 2015
How medicine is sometimes practiced in Cambodia
It was Friday afternoon and off we went to the coast for some abcs, air (the non-exhausted filled fresh air), beach, and crabs. The air was indeed better, cooler, and fresher. The beach was beautiful with cool crystal clear water and hammock-filled stalls to while away the day. The seafoods, however, did not agree so well with me.
I was determined to suffer as quietly as possible through this terribly uncomfortable ordeal and to push as much fluid as I could stomach until it had worked its course. My fellow travelers had other ideas. One offered this Chinese typical balm compost of menthol and eucalyptus oil. Indications include cold, headache, rheumatism, neuralgia, insect bites, cramps, and, all chest complaints. Aside from its very strong odor, it does have is uses, especially against cramps and insect bites. I had no reservation using it for this particular ailment. As I have never used it for the other indications, I can't attest to its effectiveness, but the Asians I've known would say it is a cure-all for all kinds of ailments.
Another friend offered 2 pills, which she swore would bring my pain to its immediate end. Other passengers agreed and no matter how hard I protested against taking medications not specifically prescribed to me, I finally gave in. Not surprisingly, symptoms did not disappear!
When I finally had access to the Internet and could look up those pills, I found that one was diiodohydroxyquinolone, used for treatment of amoebiasis. The other, a black square pill, I'm almost sure was activated charcoal!
How did she come to think that these two medications would treat diarrhea? Well, in Cambodia, one could go to any pharmacy, describe the symptoms, and be given the medications. And depending on the pharmacist, these medications could be prescribed correctly or erroneously. No doctor's order necessary.
I was determined to suffer as quietly as possible through this terribly uncomfortable ordeal and to push as much fluid as I could stomach until it had worked its course. My fellow travelers had other ideas. One offered this Chinese typical balm compost of menthol and eucalyptus oil. Indications include cold, headache, rheumatism, neuralgia, insect bites, cramps, and, all chest complaints. Aside from its very strong odor, it does have is uses, especially against cramps and insect bites. I had no reservation using it for this particular ailment. As I have never used it for the other indications, I can't attest to its effectiveness, but the Asians I've known would say it is a cure-all for all kinds of ailments.
Another friend offered 2 pills, which she swore would bring my pain to its immediate end. Other passengers agreed and no matter how hard I protested against taking medications not specifically prescribed to me, I finally gave in. Not surprisingly, symptoms did not disappear!
When I finally had access to the Internet and could look up those pills, I found that one was diiodohydroxyquinolone, used for treatment of amoebiasis. The other, a black square pill, I'm almost sure was activated charcoal!
How did she come to think that these two medications would treat diarrhea? Well, in Cambodia, one could go to any pharmacy, describe the symptoms, and be given the medications. And depending on the pharmacist, these medications could be prescribed correctly or erroneously. No doctor's order necessary.
Thursday, February 5, 2015
Medical Education
The morning was filled with more patients with diarrhea, fever, and phatyngitis. Nearly 10 more patients were admitted yesterday with these same symptoms. Most were from the city, but a few were from far away provinces. I spent some time with some of the new admits before rounds started. And in a fashion and rhythm that is only known by the natives, all 20 something patients were seen by 3 attendings and nearly 40 medical students, including yours truly.
After rounds, there is usually a student presentation of a case, but not this morning. So I had more time with the students to compare notes on medical education, in the states vs. Phnom Penh.
From what I understood, the medical education in Cambodia is modeled after the French system. After graduating from high school, those who have the capacity, financially and intellectually, can enter straight into medical school where they will spend the next 6 years. The first 3 years are spent in the classroom, where they learn the basic sciences. Year 4, the students start their clinical duties. They spend the mornings rotating in hospitals and the afternoons in lecture halls. After 6 years, those who want to specialize, say in pediatrics or surgery, will spend another 4 years rotating between NPH and another general hospital that also provides pediatric care. After all these years, a selected few will have the opportunity to further their education in France. Those who do not want to specialize can finish their education with just 2 more years of rotating through different hospitals.
When I told them about the medical education in the states, how students spend 4 years in college, then 4 years in medical school, before finishing in residency and possibly in fellowship, they questioned the necessity of college. They were even more puzzled when I told them that students can major in a variety of subjects, not necessarily in the field of science. I can see why they are puzzled. It might seem like wasted time. Could I have succeeded if I had gone straight to medical school from high school? I believe I could have, but I would miss out on the experiences I gained in college, in the 6 weeks I spent studying abroad in France or the 3 weeks I spent volunteering in an orphanage home in India. The "extra" years have given me the opportuntities to go to new places, try new things, experience new cultures, like coming to work at NPH for a month.
After rounds, there is usually a student presentation of a case, but not this morning. So I had more time with the students to compare notes on medical education, in the states vs. Phnom Penh.
From what I understood, the medical education in Cambodia is modeled after the French system. After graduating from high school, those who have the capacity, financially and intellectually, can enter straight into medical school where they will spend the next 6 years. The first 3 years are spent in the classroom, where they learn the basic sciences. Year 4, the students start their clinical duties. They spend the mornings rotating in hospitals and the afternoons in lecture halls. After 6 years, those who want to specialize, say in pediatrics or surgery, will spend another 4 years rotating between NPH and another general hospital that also provides pediatric care. After all these years, a selected few will have the opportunity to further their education in France. Those who do not want to specialize can finish their education with just 2 more years of rotating through different hospitals.
When I told them about the medical education in the states, how students spend 4 years in college, then 4 years in medical school, before finishing in residency and possibly in fellowship, they questioned the necessity of college. They were even more puzzled when I told them that students can major in a variety of subjects, not necessarily in the field of science. I can see why they are puzzled. It might seem like wasted time. Could I have succeeded if I had gone straight to medical school from high school? I believe I could have, but I would miss out on the experiences I gained in college, in the 6 weeks I spent studying abroad in France or the 3 weeks I spent volunteering in an orphanage home in India. The "extra" years have given me the opportuntities to go to new places, try new things, experience new cultures, like coming to work at NPH for a month.
Wednesday, February 4, 2015
Week 1, day1-3
After nearly 48 hrs of flying and wandering around international airports, I finally made it to Phnom Penh, Cambodia! The plane landed around on Saturday at 11:30pm and nearly an hour later, I obtained my visa, collected my bags and made my exit. I have long shedded my sweater, winter coat and scarf that I had brought along for the transit tour of Seoul, Korea. I needed them in Seoul, but not here in Phnom Penh. Even with only one layer of t-shirt, I could feel the stifling heat and the sweat rolling down my back as I made my way to the guesthouse.
A few days later, I found my way to the technical office, where I was given my schedule for the month. This first week, I will be spending my days with Infectious Disease specialists. Day 1, I saw patients with diarrhea and fever. Some were suspicious of dengue fever. Although the season for dengue has been over for several months, there have been some isolated cases. And living in the tropics, dengue is always in the differential for diarrhea and fever. After rounding with the physician, there was a presentation by an intern about hypoxic ischemic encephalopathy. The PowerPoint was in English, but the presentation was in a mixture of English and Khmer.
The next day followed similar pattern.
8am: preround on patients
9am: rounds and teaching with physicians
10:30am: PowerPoint presentation by students
12pm: break for lunch
The afternoons have been very flexible. Most afternoons, students have lectures at schools and the physicians have their own meetings or they are the ones giving these lectures.
Only a few days into the first week and I feel like I'm learning so much, about how medicine is practice here, about how medicine is taught here, and the pathologies that are seen here.
A few days later, I found my way to the technical office, where I was given my schedule for the month. This first week, I will be spending my days with Infectious Disease specialists. Day 1, I saw patients with diarrhea and fever. Some were suspicious of dengue fever. Although the season for dengue has been over for several months, there have been some isolated cases. And living in the tropics, dengue is always in the differential for diarrhea and fever. After rounding with the physician, there was a presentation by an intern about hypoxic ischemic encephalopathy. The PowerPoint was in English, but the presentation was in a mixture of English and Khmer.
The next day followed similar pattern.
8am: preround on patients
9am: rounds and teaching with physicians
10:30am: PowerPoint presentation by students
12pm: break for lunch
The afternoons have been very flexible. Most afternoons, students have lectures at schools and the physicians have their own meetings or they are the ones giving these lectures.
Only a few days into the first week and I feel like I'm learning so much, about how medicine is practice here, about how medicine is taught here, and the pathologies that are seen here.
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