In the clinic

Today we spent the morning in the outpatient department. We arrived at 7:30 and there were a lot of families already waiting. I sat with one of the triage nurses and observed him with a family of 4. The first and youngest of these 4 boys had a mild cold, the next one had a cold with wheezing on one side. The next son had a severe abscess on his ankle so was set up to see the surgeon and the last brother was having a significant asthma attack. Mom related that there was a 5th child in school. 2 of those children really needed medical help but I wonder if we would have seen this family if only one was ill. It is an effort for most families to get to the hospital although care is free, transportation is not and the average family in Cambodia lives on 1 dollar a day. The hospital has funds to help the families get back home, as well as clothing, and everything is donated.
For the short time I was observing, I saw a few colds, a terrible infection under the eye in an adolescent girl (periorbital cellulitis) a tiny child with “crossed eyes” whose health card read congenital heart disease and a toddler who was seen urgently for a dog bite. There are a lot of dogs in Cambodia and lots of mother dogs with pups. Spaying and Neutering is expensive and uncommon so the result is a lot of dog bites. One of the children who came in for a cold was missing a small piece of his nose from a bite.
Cambodians have large families and 50% of the population is under 15. Remember that much of the population of the country was wiped out during Pol Pot’s reign and he died only 10 years ago. An appalling statistic is that of the 4,000 physicians in Cambodia, there were on 40 left after the fall of the Khmer Rouge. Some escaped and emigrated but many were killed. This also wiped out the nurses and other health care providers which is why this mission of ACH to train pediatric nurse is so important.
The children are fascinated by these white people with round blue eyes and love to have their picture taken. This little girl was pretty funny- she hammed it up and laughed for the camera. She was pretty healthy but skinny as they tend to be.