August
2003 Telemedicine Clinic in Robib
Report and photos
submitted by David Robertson
On Tuesday,
August 12, 2003, Sihanouk Hospital Center of Hope nurse Koy Somontha
gave the monthly Telemedicine examinations at the Robib Health
Clinic. David Robertson transcribed examination data and took
digital photos, then transmitted and received replies from several
Telepartners physicians in Boston and from the Sihanouk Hospital
Center of Hope (SHCH) in Phnom Penh.
The following day, all patients returned to
the Robib Health Clinic. Nurse "Montha" discussed advice received
from the physicians in Boston and Phnom Penh with the patients.
Following are the e-mail, digital photos and
medical advice replies exchanged between the Telemedicine team in
Robib, Telepartners in Boston, and the Sihanouk Hospital Center of
Hope in Phnom Penh:
Please reply to David Robertson <dmr@media.mit.edu>
Dear All:
Another quick reminder that the August
Telemedicine clinic in Robib, Cambodia is still scheduled for
Tuesday, 12 August 2003.
We'll have the follow up clinic at 8:00am,
Wednesday, 13 August (9:00pm, Tuesday, 12 August in Boston.) Best
if we could receive your e-mail advice before this time.
Thanks again for your kind assistance.
Sincerely,
David
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #1: THORNG KHUN, female, 38
years old
|
|
Chief complaint: Patient still
complains of chest pain sometimes, neck tenderness, and
palpitations.
Note: We sent this patient to
Kampong Thom Hospital last month for consultation and management
of her health problem. Kampong Thom was only able to do
something for the stomach problem, for the goiter they could not
do anything as they cannot do the thyroid function test. They
did an unknown blood test and an EKG. The patient was admitted
there for five days and covered with medication and discharged
with chronic gastritis diagnosis.
Subject: Patient still has
palpitations, shortness of breath, sometimes chest tightness,
has a headache, neck tenderness, has no abdominal pain, no
fever, has neck tightness, no hair loss, has sweating, and no
coughing.
Object: Looks stable.
BP: 110/60
Pulse: 104
Resp.: 20
Temp. : 36.5
Hair, eyes, ears, nose, and throat:
Okay.
Neck: Small mass at anterior neck,
moveable, size 3 x 6 cm (not developing.)
Lungs: Clear both sides and symmetry
on bilateral size.
Heart: Regular rhythm, no murmur
Abdomen: Soft, flat, not tender, and
has positive bowel sound on all four quadrants. She has been
pregnant for six months. She said there is good fetal movement.
Limbs: No stiffness and no edema.
Assessment: Toxic goiter? Pregnancy for
six months.
Plan: I think we should draw this
patient’s blood and do a Thyroid function test at Sihanouk
Hospital Center of Hope in Phnom Penh, then follow up with her
next month. Please give me any other ideas. |
> -----Original Message-----
> From: Kvedar, Joseph Charles,M.D.
> Sent: Tuesday, August 12, 2003 9:17 PM
> To: Kelleher-Fiamma, Kathleen M., Telemedicine
> Subject: RE: Patient #1: THORNG KHUN, female, 38 years old
>
> Thank you for this interesting case.
>
> Patient #1 38 yo female with chest pain, palpitations
> and neck mass/tenderness.
>
> General recommendations regarding the report:
>
> Review of symptoms and physical exam ; any other
> symptoms consistent with thyroid disease? (ie
> diarrhea, nervousness, trembling, moist skin)
> (hyperrelexia?)
> Was EKG normal?
>
> The constellation of symptoms presented does suggest
> hyperthyroidism of some kind.
>
> 1. Acute thyroiditis (also called DeQuervain's
> throiditis) often presents with pain and often follows
> a viral illness. is therefore quite possible in her.
> 2. Toxic goiter or toxic adenoma are also possible in
> that a nodule was apparently identified on exam.
> 3. Graves disease is usually a diffuse painless goiter
> and is therefore less likely.
>
> If at all possible have thyroid studies completed
> somewhere (TSH, free T4, T3 re-uptake) would be a
> good start. A thyroid scan (radioactive iodine
> uptake)- if available- would be next if she is indeed
> hyperthyroid to differentiate the possible causes -
> BUT SHOULD NOT BE USED IN PREGNANT PATIENTS.
>
> Recommendations:;
> 1. Patients with thyroiditis usually improve on
> their own. Management of non-pregnant patients
> includes treating the symptoms if they are severe
> (tachycardia, nervousness) with beta blockers such as
> propanolol. Also, prednisone 20mg to 40mg for a short
> course often gives rapid relief of pain associated
> with painful thyroiditis but often not recommended
> during pregnancy.
> Propylthiouracil is the drug of choice in pregnant
> patients with hyperthyroidism. Typical initial dose
> is 100mg per day and may increase to three times per
> day. Symptoms usually improve in 2-3 weeks.
> 2. If not done already, rule out anemia as a
> contributing cause with a CBC
>
Joseph C. Kvedar, M.D.
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
|
|
Patient #2: NGET SOEUN, male, 56
years old
Chief complaint: Still has abdominal
distension and both legs edema.
Weight: 42 kg
Note: We saw this patient last
month. He was covered with:
- Furosemide, 20 mg per day
- Tums, 1 gram every 12 hours
- Cotrimoxazole, 960mg every 12 hours for
four days
Subject:
Still has headache, has shortness of breath, no chest pain, has
mild fever, cough on and off with sputum, has palpitations, has
abdominal distension and abdominal pain, mild edema both legs,
and only passing urine a small amount – one litre per day, and
has poor appetite.
Object: Looks mildly sick. Alert
and oriented x 3.
BP: 110/60
Pulse: 88
Resp.: 24
Temp. : 37
Hair, ears, nose, and throat: Okay.
Eyes: Mild jaundice and mild sunken
eye.
Lungs: Lower bilateral crackle.
Heart: Regular rhythm, no murmur
Abdomen: Soft, mild distension,
pain, has positive bowel sound all four quadrants,
Hepathomegalie about 6cm, has pain tapping kidney at lower back,
and has pain bilateral and radiating to chest.
Limbs: ++ pitting edema both legs.
Assessment: Ascitis? With cirrhosis?
Pulmonary TB? Nephrotic syndrome? Hepatitis?
Plan: Should we refer him to Kampong
Thom for some tests like blood work (CBC, lyte, creatinine, Bun,
Hepatitis B & C, blood sugar,) and abdominal ultrasound and
chest x-ray?
Please give me any other ideas. |
This patient should go to hospital for
evaluation for test of his heart
liver and kidneys. He will need xchest xray,
bun, creatinine, ast, alt,
urinalysis, and abdominal ultraosund,
RCGoldszer
Brigham and Women's Hospital
Boston, Mass, USA
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #3: THO CHANTHY, female, 36
years old, farmer
|
|
Chief complaint: Palpitations, neck
tightness, and shortness of breath for the last five months.
Weight: 40 kg
Subject: Patient complains she got
a mass on her anterior neck, mass develops day to day. She got
this mass followed by severe palpitations, shortness of breath,
and difficulty in swallowing, neck tightness, weight loss, and
sweating a lot. These symptoms have become worse and worse,
especially seven months after delivering a baby. She has never
seen a doctor at all.
Past medical history: Unremarkable
Review of system: Has dry cough, no
fever, no chest pain, has neck tightness, has blurred vision,
has palpitations, has shortness of breath, does not have
abdominal pain, no diarrhea, no edema on limbs, lost 10 kg
weight in the last year, has normal period.
Social history: Does not smoke,
drinks alcohol, and during delivery drank 20 litres of alcohol.
Family history: Her mother has
hypertension.
Current medication:
None
Allergy:
No known allergies.
Object: Looks mildly sick. Alert
and oriented x 3.
BP: 120/60
Pulse: 150
Resp.: 26
Temp. : 37.4
Hair, ears, nose, and throat: Okay.
Eyes: No jaundice, bilateral
exothalsis.
Neck: A moving goiter on anterior
neck, size about 10 x 8 cm, and no JVD.
Lungs: Clear both sides, bilateral
symmetry.
Heart: Irregular rhythm, no murmur
Abdomen: Soft, flat, not tender, has
positive bowel sound all four quadrants, no HSM.
Limbs: Both hands tingling, no edema
or stiffness
Neuro Exam:
§
CN – I
to XII good intact.
- Good orientation to person, place and
date
- Cerebella function, good intact with
point-to-point, gait.
- Motor, normal 5/5
- Sensory, normal
- Reflex hyper reflexive on both elbows,
another good intact
Assessment: Hyperthyroidism. Cardiac
arrhythmia with Afib? Or PVC? Tachycardia.
Plan: Should we refer her to Sihanouk
Hospital Center of Hope in Phnom Penh for some tests like
Thyroid function, CBC, lytes, Bun, blood sugar, creatinine, EKG,
and a chest x-ray. Or do we try to give her Propranolol 20 mg
twice daily and draw her blood to do Thyroid function test at
SHCH and then follow up with her next visit? Please
give me any other ideas or comments. |
I think plan depends upon how ill she looks.
This sounds like hyperthyroidism but could be
other problems causing tachycardia.
IF her pulse is truly 150, that is TOO fast and
I would give propanolol 20 mg, BID, draw blood for TSH and CAB and
CBC rate, and also have her seen at the hospital for evaluation of
severe tachycardia and possible thyroid dysfunction RCGoldszer
Brigham and Women's Hospital
Boston, Mass, USA
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #4: PROM MUTH, female, 63 years
old
|
|
Chief complaint: Left leg pain for
five days.
Subject: Patient complains she gets
severe pain on the left leg after waking up in the morning. One
day before getting the pain, she worked in the rice fields
digging a big hole as well as her usual work. She gets these
symptoms followed by a burning feeling on the left leg from hip
to foot with difficulty walking.
Past medical history: Unremarkable
Social history: None
Family history: None
Allergy:
No known allergies.
Current medication:
Paracetemol, 2 grams per day
for five days.
Review of system: Has no cough, no
weight loss, no sore throat, no shortness of breath, no fever,
and no upper abdominal pain.
Object: Looks stable, alert and
oriented x 3.
BP: 100/50
Pulse: 80
Resp.: 20
Temp. : 36.5
Hair, eyes, ears, nose, and throat:
Okay.
Skin: Warm to touch, not pale and no
jaundice.
Lungs: Clear both sides, bilateral
symmetry.
Heart: Regular rhythm, no murmur
Abdomen: Soft, flat, not tender, has
positive bowel sound all four quadrants.
Limbs: Left leg pain from hip to
foot, but no redness, not swollen and no stiffness, no numbness,
and both leg measurements are equal.
Assessment: Nerve root pain on the left
leg.
Plan: Should we give her Aspirin 500mg
four times daily and Multivitamin 1 gram daily for 14 days?
Please give me any other ideas or comments. |
> -----Original Message-----
> From: Kvedar, Joseph Charles,M.D.
> Sent: Tuesday, August 12, 2003 9:43 PM
> To: Kelleher-Fiamma, Kathleen M.,
Telemedicine
> Subject: RE: Patient #4: PROM MUTH,
female, 63 years old
My thought on this one is that she should be
examined carefully for any evidence of arterial disease, e.g. are
the pulses strong in taht leg and equal on both sides.
If there is any hint of vascular disease, it
woudl probably be helpful to have either a doppler study or possibly
an angiogram, if this is feasible.
Sometimes quinine is helpful for leg cramps.
A simple way to dose this is to give the patient 10-12 oz of tonic
water daily.
Joseph C. Kvedar, M.D.
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #5: PROM HORN, female, 48 years
old, Farmer
|
Chief complaint: Patient complains
of neck tenderness, headache, and blurred vision on and off for
three months.
Subject: Patient complains she got
some symptoms like neck tenderness, headache, and blurred vision
on and off. Symptoms develop during nighttime sometimes
followed by chest pain, dizziness, and palpitations. She went to
a private pharmacy and bought some unknown medications to take
for releasing headache on and off and it helped a little bit.
Past medical history: Malaria last
year.
Review of system: No fever, no
weight loss, has chest tightness, has headache, has
palpitations, has neck tenderness, no cough, does not have
abdominal pain, no diarrhea, and no limb numbness.
Current medication:
Took some unknown medication on
and off for three months for releasing headache.
Family history: Unremarkable
Social history: Does not smoke and
does not drink alcohol.
Object: Looks stable, alert and
oriented x 3.
BP: 100/60
Pulse: 80
Resp.: 20
Temp. : 36.5
Hair, eyes, ears, nose, and throat:
Okay.
Neck: No lymph node and no JVD.
Skin:
No jaundice, not pale, no edema, and warm to touch.
Lungs: Clear both sides, bilateral
symmetry.
Heart: Regular rhythm, no murmur
Abdomen: Soft, flat, not tender, has
positive bowel sound, and no HSM.
Limbs: Not stiff and no edema.
Neuro Exam:
- Good orientation (place, person and
date.)
- Cerebella function, good intact
(point-to-point, gait.)
- CN – I to XII good intact.
- Sensory, normal
- Reflex, normal
- Motor, normal
Assessment: Tension headache. Anxiety?
Plan: Give her Paracetemol 500 mg four
times daily for ten days. Educate her to do exercise.
Please give me any other ideas. |
Case #5 female 48 yo with headache, blurred
vision on-off for 3 months, chest pain dizziness, palpitations.
>From the information here, I would agree with
your assessment of anxiety could cause nearly all these symptoms.
I don't know if you addressed recent psychosocial stressors, but
that may lend support to a diagnosis of anxiety.
However, because of chest pain, associated with
her dizziness and palpitaions an EKG (during her symptoms if
possible) would help identify any coronary syndromes (for example
angina. I would also recommend a CBC to rule out anemia as a
possible contributing factor.
If non-cardiac causes are ruled out, consider
further evaluation of anxiety causes and consider anxiolytics such
as lorazepam for a short-term treatment only.
Tan, Heng Soon,M.D.
Please reply to David Robertson <dmr@media.mit.edu>
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #6: CHHIN SAM ONN, female, 20
years old, Farmer
 |
Chief complaint: Patient complains
of frequency of urination on and off for the last two months,
and upper abdominal pain on and off for the last five months.
Subject: Patient is married. Two
months ago she got frequency of urination, about five times per
day in small amounts and also she feels burning during
urination. She has another problem, five months of on and off
upper abdominal pain, pain like burning, especially after a
meal. She got these symptoms accompanied by excessive saliva in
the morning and nausea. She has never seen a doctor at all and
just came to see us.
Past medical history: Five months
ago she had malaria.
Review of system: Has a headache, no
sore throat, no cough, no fever, no weight loss, no chest pain,
has upper abdominal pain, and no shortness of breath.
Social history: Does not smoke and
does not drink alcohol.
Family history: Unremarkable.
Allergy:
None.
Current medication:
Metronidazole, 250 mg four
times per day for seven days.
Urinanalysis:
Protein +2
Object: Looks stable, alert and
oriented x 3.
BP: 100/50
Pulse: 80
Resp.: 20
Temp. : 36.5
Hair, eyes, ears, nose, and throat:
Okay.
Neck: No goiter and no lymph node.
Skin: Not pale, no jaundice, and
warm to touch.
Lungs: Clear both sides.
Heart: Regular rhythm, no murmur
Abdomen: Has upper abdominal pain,
soft, flat, not tender, and has positive bowel sound all four
quadrants.
Limbs: Okay.
Assessment: Urinary tract infection.
Dyspepsia.
Plan: May we give her:
- Ofloxacine, 200mg, twice daily for
five days.
- Tums, 1 gram, ˝ tablet twice daily
for 30 days.
Please give me any other ideas. |
Dear David:
I agree with the assessment and plan as
outlined in the patient's note.
Edward T. Ryan, M.D.
Please reply to David Robertson <dmr@media.mit.edu>
Following is the final case we will be sending
this month. Thanks again for
your kind assistance.
Telemedicine
Clinic in Robib, Cambodia – 12 August 2003
Patient #7: ROS YANY, female, 46 years
old
|
Chief complaint: Patient complains
of chest tightness and left side headache for the last three
months.
Subject: Patient is married.
Patient says she knows that for the last eight months she has
hypertension. She gets headache and chest tightness that
increases during nighttime. This is accompanied by blurred
vision, dizziness, and neck tenderness. She went to consult
with a private doctor and they gave her some unknown drug to
take for hypertension (just takes during episodes of high blood
pressure) and the drug helped her a little bit.
Past medical history: Hypertension
for the last eight months.
Review of system: Has no sore
throat, no weight loss, no cough, no chest tightness, no
shortness of breath, and no abdominal pain.
Social history: Does not smoke and
does not drink alcohol.
Family history: Unremarkable
Current medication:
Vastarel, one tablet per day
for 10 days.
Allergy:
None.
Object: Looks stable, alert and
oriented x 3.
BP: 160/80
Pulse: 70
Resp.: 30
Temp. : 36.5
Hair, eyes, ears, nose, and throat:
Okay.
Neck: No goiter and no lymph node.
Skin: Not pale, no jaundice, and
warm to touch.
Lungs: Clear both sides.
Heart: Regular rhythm, no murmur
Abdomen: Soft, flat, not tender, no
HSM and has positive bowel sound.
Limbs: No edema but has stiffness.
Neuro Exam:
- Good orientation (place, person and
date.)
- Cerebella function, good intact.
- CN – I to XII good intact except XI,
facial droop.
- Reflex, normal
- Motor, normal, except left elbow 4/5 and
left knee decreases 3/5.
- Sensory, normal
Assessment: Mild hypertension. Left
side weakness due to mild stroke? Ischaemic heart disease?
Plan: May we give her Propranolol 20 mg
twice daily for one month and Aspirin 75 mg daily for one month?
Please give me any other ideas. |
> -----Original Message-----
> From: Kvedar, Joseph Charles,M.D.
> Sent: Tuesday, August 12, 2003 9:19 PM
> To: Kelleher-Fiamma, Kathleen M.,
Telemedicine
> Subject: RE: Patient #7: ROS YANY,
female, 46 years old
>
> First off I would like to take a brief moment
to offer
> constructive criticism to the report.
> 1. history: The following would be
beneficial to know
> a. Length of the L-sided weakness
> b. You say she is taking some unknown BP
medication
> when she has episodes of high blood
pressure. Does
> she actually take her BP with a BP monitor or
does she
> just take it when she has symptoms....if the
latter,
> what symptoms prompt her to take that
medication?
>
> 2. vitals: if high, should take in both arms
for
> comparison and it should be repeated.
> 3. Telemedicine should not be used for
potentially
> emergent cases such as stroke, MI.
>
> Well, I agree the group of symptoms suggest
> hypertension. The symptoms of headache,
blurred
> vision, rapid respirations, L-sided weakness
suggest
> end-organ damage however, as is seen with
hypertensive
> crisis (hypertensive emergency) The recorded
BP of
> 160/80 however is NOT consistent with
hypertensive
> crisis. You said she takes a BP med as
needed. If
> this medication is nifedipine, it is quite
possible
> that she took this medication and has
suffered a
> stroke due to the risk of rapidly lowered BP
when
> using this dangerous drug. [sublingual
immediate
> release nifedipine is no longer recommended
for
> hypertensive urgencies or the routine control
of BP
> because of the risk of stroke]
>
> Assessment;
> 1. hypertension (isolated systolic
hypertension)
> 2. Chest pain: ischemia (ie angina) is a
strong
> possibility, and may be secondary to
hypertensive
> emergency (however diastolic pressures are
greater
> than 140mm Hg)
> 3. Left-sided weakness: Stroke vs TIA (TIA
resolves
> within 24 hours of symptom onset). May be
secondary
> to high blood pressure ( OR possibly improper
use of
> nifedipine if that is the drug she was
taking.)
>
> Recommendations:
> 1. Ruling out stroke and MI are priorities.
An EKG
> while chest symptoms are occurring would help
> differentiate angina versus MI vs.
non-cardiac causes.
> As would cardiac enzymes if there are EKG
> abnormalities. If head imaging is available
(for
> example CT scan) it should have been be used
> immediately to rule out stroke or to
differentiate
> ischemic from hemorrhagic stroke.
> a. If ischemic stroke
> i. evaluate for carotid artery stenosis or
mural
> thromi in the atria if carotid ultrasound or
cardiac
> ultrasound is available.
> ii. Consider anticoagulants
> (NOTE: telemedicine is not the way to
evaluate for
> stroke, MI or other emergent medical cases.)
>
> 2. Once stroke and MI are ruled out,
> a. begin medicine for high blood pressure
very
> gradually. A beta blocker like propanolol is
OK, but
> should not be stopped abruptly as a rebound
> hypertension can easily occur after using for
just a
> month. Avoid using nifedipine. [Review JNC
7
> guidelines for BP at
>
www.nhlbi.nih.gov/guidelines/hypertension/ ]
> b. Aspirin should be 325mg or 81mg if patient
cant
> tolerate
> c. Consider look for possible secondary
causes of
> hypertension
> i. Labs: CBC,
> ii. electrolytes, BUN, creatinine,
urinanalysis
> (renal disease, )
> iii. CXR (rib notching suggests coartation)
> iv. EKG (LVH suggests long-standing
hypertension)
>
> 3. Consider other causes of blurred vision
and head
> ache: temporal arteritis, glaucoma, drugs
>
Joseph C. Kvedar, M.D.
Dear David and Montha,
I am writing a quick e-mail to you to inform
that our e-mail system broke down this morning and we were unable to
respond in time for you guys. I am outside at Internet Cafe now
doing this. I will send a short note on each patient after this
message. I hope you get this.
Thanks,
Rithy
Dear Montha and David,
Here are our replies to the cases you presented
this
month:
Patient #1 Thorng Khun, 38F
We think the patient is clinically euthyroid
but we need to rule out this problem. You can draw her blood to do
a TSH and free T4 at SHCH. If her symptoms are tolerable without
medications, this is better since she is pregnant. Wait for her TSH
and free T4 before considering any medication. Her sx could have
come from pregnancy itself. What you can give her is multivitamins
with iron and folate (prenatal vitamins) taken qd with meal. Find
out also what exactly happended at K Thom Hosp. and her lab results,
etc.
Patient #2 Nget Soeun, 56M
Sounds like cirrhosis. Is/was he a heavy
drinker? Go ahead and send him to K. Thom Hosp for work-up abd. US,
CXR, and CBC and renal function with electrolytes, etc., and try to
get info on him on your next return what they diagnose and treat him
with--get copies of all lab and radiology results also.
Patient #3 Tho Chanthy, 36F
possible hyperthyroidism. can give propranolol
10 mg (lower dose due to HR=70) bid and ASA 300 or 500mg 1/4 po qd.
Draw blood for TSH and free T4 at SHCH and send patient to K. Thom
Hospital for EKG, CXR. Again get results on your return next month
if you following her up.
Patient #4 Prom Muth, 63F
Possible sciatica problem. We agreed with
treatment of ASA 500mg qid if no dyspepsia.
Patient #5 Prom Horn, 48F
Para 500mg 1-2 tab po qid prn for HA is fine.
Patient #6 Chhin Sam Onn, 20F
Is she pregnant? If not, can give Ofloxacine
200mg 2 tab po bid x 5d, TUM 1-2 tab chew tid or Cimetidine 400mg 1
po tid x 2months.
Patient #7 Ros Yany, 46F
If she was recorded before with high readings
of BP, then she does have HTN. Can tx her with Propranolol 10mg
bid (will help with her HA also), ASA 300 or 500mg 1/4 qd, and
discontinue her Vantarel--she does not seem to have any heart
problem.
Last comment, remember that all your
reproductive age female patient need to be asked about possible
preganancy because management of this patient group is quite
diffeerent from non-preganat women.
Thanks,
Rithy Chau (as discussed with Dr. Jennifer and
Dr.
Bunse of SHCH)
Follow up Report, Friday, 15 August 2003
Per e-mail
advice of the physicians in Boston and Phnom Penh, the following
patients from this month’s clinic and several follow up case were
given medication from the pharmacy in the village or medication that
was donated by Sihanouk Hospital Center of Hope:
January 2003 Patient: SAO PHAL, female,
55 years old
January 2003 Patient: SOM THOL, male, 50
years old
October 2002 Patient: MUY VUN, male, 36
years old
October 2002 Patient: PEN VANNA, female,
38 years old
June 2003 Patient: SOM DEUM, female, 63
years old
August 2003 Patient #1: THORNG KHUN,
female, 38 years old
August 2003 Patient #5: PROM HORN,
female, 48 years old
August 2003 Patient #6: CHHIN SAM ONN,
female, 20 years old
August 2003 Patient #7: ROS YANY,
female, 46 years old
The following patient did not return to the
follow up clinic in Robib so we could not provide her any advice:
August 2003 Patient #4: PROM MUTH,
female, 63 years old
Transported to Kampong Thom Provincial
Hospital on 13 August 2003 by the Telemedicine team:
August 2003 Patient #2: NGET SOEUN,
male, 56 years old
August 2003 Patient #3: THO CHANTHY,
female, 36 years old
Transported to Phnom Penh on 13 August
2003 by the Telemedicine team for a follow up appointment at
Sihanhouk Hospital Center of Hope on 14 August:
April 2003 Patient: LENG HAK, male, 68
years old
Transport & lodging arranged for August
18th follow up appointment at Kantha Bhopa Children’s
Hospital in Phnom Penh:
June 2001 Patient: SENG SAN, female,
13-year-old child
Transport & lodging arranged for August
25th follow up appointment at Sihanouk Hospital Center of
Hope in Phnom Penh:
September 2001 Patient: CHOURB CHORK,
male, 28 years old
Transport & lodging arranged for August
27th follow up appointment at Calmette Cardiology
Hospital in Phnom Penh:
February 2001 Patient: CHHEM LYNA,
female, 3-year-old child
Transport & lodging arranged for
September 1st follow up appointment at Sihanouk Hospital Center of
Hope in Phnom Penh:
April 2003 Patient: PROM NORN, female,
52 years old
Transport & lodging arranged for
September 5th appointment at Sihanouk Hospital Center of
Hope in Phnom Penh:
February 2001 Patient: NOUNG KIM CHHANG,
male, 48 years old
The next Telemedicine
Clinic in Robib is scheduled for September 2 & 3, 2003.
