Dr. Adrie Voorhoeve

Seven o'clock on Monday morning in Siem Reap, Jon has just opened the doors and Vuthi and Pheaktra, two of our Cambodian doctors have already put on their blue uniforms with the emblem of Friends. Sophal, the teamleader of the nurses, in his green uniform, goes to greet the first patient, a boy of about 5 years who is patiently sitting with his father in the waiting hall. The Pharmacist Veasna opens the pharmacy and the nurse, who is working today as the receptionist, is getting her book and forms out. In the administrative office, there is a coming and going of guards and cleaners reporting for duty and getting their assignments for the day.

Marlene and Joost come into the directorÕs office, discussing what to do about the severely malnourished children we are seeing more and more of. They are all from desperately poor families, often broken homes. There is no functioning social service yet in Cambodia, and although there are orphanages, there is no place where widows or women abandoned by their husbands can turn to for help. Ashwin comes in with the latest E-mail from New York and we discuss missing equipment which we hope will come with the next shipment.

The first patient is weighed and measured and his temperature is taken. In the meantime, the nurse discusses with his father the reason for coming to the hospital. In his case, it was a cough and fever for a few days. The reason why the father brings him is that the mother has just given birth to her second child. The nurse takes them to the examination room where he is declared basically healthy with only an upper respiratory infection. No antibiotics are needed and, after reassuring the father, they go home with some paracetamol and vitamins. Before they leave the nurse explains to the father that he should keep the boy away from his newborn sister for the next few days, and that they should bring the baby to the vaccination center for her first vaccination.

In the meantime things are getting really busy, most children are coming with respiratory illnesses, from common cold to severe pneumonia. Many also have intestinal parasites. We have seen only a few cases of malaria, but that will undoubtedly increase when we open the hospital for inpatients. The patients we are seeing at the moment are mainly children from nearby, and in Siem Reap town, the mosquito which transmits malaria does not survive (because this mosquito needs clean water to breed and the river that passes through the town is heavily polluted). While Marlene checks the ears of a little girl, Joost confers with the laboratory technician about what worm eggs they are seeing under the microscope. From the treatment room comes the sound of a child crying and it appears that Channy, one of the medical assistants, is giving him a shot of penicilline as prevention for acute rheumatic fever. Mieko is busy in the reception hall organizing the referral of a child. We suspect an acute appendicitis, and Va, the driver, takes the boy and his parents and a nurse to the Provincial Hospital for an operation. Jon is trying to diminish the noise level by taking children outside while they wait. There they can play with the toys we are gradually acquiring and run around while the parents are talking with the nurse.

In the meantime it is already 11 o'clock and half of the staff leave for their lunch break, while the others finish with the now diminishing stream of patients.

In the afternoon Bernadette comes with three children with severe Potts disease, tuberculosis of the spine. The eldest, a girl of 6 years is severely bent and cannot walk because the diseased spine is compressing the nerves in her spinal cord. One of the hip joints of her younger sister has been destroyed by tuberculosis and the third child, although able to walk, is also already badly bent. The children are receiving treatment for their tuberculosis, so the main thing we can do is to teach them simple exercises to try and prevent further bending and to put them on the list of children we need to see when the rehabilitation center opens.

We see together a little girl with severe epilepsy and retardation, probably due to an illness she got as a baby, meningitis or encephalitis, even cerebral malaria has sometimes devastating effects on a child's development and the uncontrolled fits make things even worse. We start her on epilepsy medicines and explain to the grandmother, who is caring for her, that it is extremely important to continue with these drugs for a really long time. We also try to explain to her the importance of physical and mental stimulation.

This was the last patient of the day, we discuss our new work schedule for next month, clear our desks, lock up the pharmacy and the safe and each of us finds his way home on motorbike, bicycle or on foot.