Angkor Children's Hospital

Hello friends,  
   I have just completed day two at Angkor Hospital for Children (AHC), and have already seen more cases of malaria and tuberculosis than during my previous 2 years of residency.  I have also seen many cases of malnutrition-- some with kwashiorker (protein malnutrition- these are the kids with the distended bellies)  and some with marasmus (total body wasting from complete caloric deprivation).  Yes, it has been quite an education so far.  I am struck by how much the hospital and the doctors who run it are able to do with such limited resources.  For example, earlier today, a patient who is suspected of having leukemia, had a bone marrow biopsy performed by one of the residents.  The child will then be sent to Phnom Pen where he will receive treatment, if the family can afford it, which many cannot.  Procedures that are done by subspecialists in the US are all done by the generalists here.  In fact, I feel somewhat inadequate in regards to my procedural skills when compared to these Khmer doctors.  Sure, I can do a lumbar punction at the drop of a hat, but ask me to do a bone marrow biopsy and I'm on the phone to oncology.  But AHC is an impressive, efficiently run, children's hospital.  It has an outpatient department that sees about 200 patients a day.  The majority of these patients have upper respiratory infections, asthma exacerbations, gastroenteritis-- not so different than what I see in my clinic in Minnetonka, MN.  But a large portion also have HIV, TB and/or malaria (mostly falciparum), definitely not diseases I see in my clinic.  The inpatient unit has around 30 beds, and again, the leading diagnoses are: asthma, malaria, TB, HIV, malnutrition, and meningitis.  The ICU has 4 beds, and, from what I gather, 2 ventilators, one of which recently lost the capacity to do one of its major functions, SIMV, and is stuck doing IMV solely-- I'd explain what this means, but that explanation would probably be longer than all my History of Cambodia entries altogether, and I wouldn't want to bore the medical and nonmedical reader alike.  There is also a one room OR, a small laboratory, a 10 bed step-down unit, and a small radiology suite.  Yes, this hospital has economized its space well, and functions on a shoe string- a most impressive feat, especially given the overly spendy philosophy of Western medicine I am used to.
   I look forward to an enlightening several weeks at AHC.

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I can't enter a child hospital without feel a deep grief into me, the saddest place on a town..

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