|
   
August
2001 Telemedicine Clinic in Robib
Report
submitted by David Robertson
On
August 15, Sihanouk Hospital Center of Hope nurse Koy Somontha gave
Telemedicine examinations at the Robib Health Clinic. David
Robertson transcribed the examination data and took digital photos,
then transmitted and received replies from Dr. Graham Gumley at
Sihanouk Hospital Center of Hope (SHCH) in Phnom Penh via the
Hironaka School Internet link.
On
August 16, follow up consultations were given to the previous day's
patients to discuss the e-mail recommendations from Dr. Gumley.
Based on these e-mail recommendations, the majority of the
patients wanted to receive follow up care.
Transportation was organized to assist seven patients with
travel to Kampong Thom Provincial Hospital and four patients to
Phnom Penh’s Sihanouk Hospital Center of Hope.
The people were taken by four-wheel drive pickup truck,
accompanied by nurse Koy Somontha and David Robertson, with seven
villagers admitted to Kampong Thom Provincial Hospital late that
afternoon.
We
continued south with the Phnom Penh patients, arriving that evening,
and got them settled in a guesthouse.
On the morning of August 17, Sihanouk Hospital Center of Hope
examined the four villagers on an outpatient basis, and all patients
were able to return home on August 18 with free medicine and follow
up appointments to SHCH scheduled.
Admitted
to Kampong Thom Hospital:
Patient
# 2: LAM SEILA, male, 3 months old
(mother is Hem Thona, 22 years old)
Patient # 3: HEM THONA, female, 22 years old
Patient # 5: CHEA KIM SOK, female, 39 years old
Patient # 7: CHAN HIM, female, 53 years old
Patient # 13: H0EM DARO, male, 8 months old
Patient CHEA KIM SOK, male, 40 years old (examined at the July
Telemedicine clinic)
Patient PRING MEY, female, 45 years old (examined at the July
Telemedicine clinic)
Outpatient
at Sihanouk Hospital Center of Hope:
Patient
# 1: PHENG ROEUNG, female, 56 years old
Patient # 4: CHHIM NEANG, female, 44 years old
Patient LACH PHAT, male, 52 years old (examined at the July
Telemedicine clinic)
Patient NOUNG KIM CHHANG, male, 48 years old (previous Telemedicine
patient, still receiving monthly out-patient follow up care as a
result of a February Telemedicine clinic exam)
Following
are the e-mail and photos exchanged with the Telemedicine team in
Robib and Dr. Graham Gumley at Sihanouk Hospital Center of Hope in
Phnom Penh:
Date:
Wed, 15 Aug 2001 06:55:32 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
Subject: Robib Telemedicine Clinic - 15 August - message 1
To: ggumley@bigpond.com.kh,
sihosp@bigpond.com.kh
Please
reply to <dmr@media.mit.edu>
Dear
Dr. Graham Gumley,
Attached
this message:
15
August 2001 Telemedicine Clinic in Robib - text
#1.doc
PHENG_Roeung_1510.jpg
PHENG_Roeung_1511.jpg
Telemedicine
Clinic in Robib, Cambodia
Wednesday, 15 August 2001
Please
reply to David Robertson <dmr@media.mit.edu>
We are looking for
advice on the following patients.
Most helpful if e-mail advice could be received by 7:00AM, 16
August (8:00pm, August 15, in Boston.)
I will download and print e-mail at that time and Nurse
Montha will discuss your recommendations with the patients in a
follow-up clinic during the morning of 16 August.
We plan to depart
Robib at 12:00pm on 16 August and could transport patients to
Kampong Thom Hospital or hospitals in Phnom Penh if a physician
recommends by e-mail that we do so.
Advice that
arrives after we depart Robib village is still welcome.
The less urgent cases will return to the next Robib
Telemedicine Clinic for follow up (dates are September 12 & 13.)
|
Patient
# 1: PHENG ROEUNG, female, 56 years old
Chief
complaint: Still palpitations.
Shortness of breath on exertion, abdominal pain.
Diarrhea
three times per day for one month.
BP:
150/60
Pulse: 100
Resp.: 24
Temp. : 36.5
Past
history: One year ago
diagnosed with hypertension, BP 185/?, otherwise not
significant.
Lungs:
clear both sides
Heart: regular rhythm, no murmur, and positive trill.
Abdomen: soft,
flat, positive mild epigastric area.
Bowel sound: positive
Skin:
mild pale, warm to touch, negative dehydration, no
rash, and no edema
Neck: has small mass, size 2 x 2 cm on anterior neck, and
mobile.
Other systems: okay
Assessment:
Toxic goiter? Mild
hypertension. Mild
Anemia. Dyspepsia. Valvular
heart disease?
Recommend:
Blood tests (like CBC, BUN lyte, creatinine, TSH, T4,)
EKG, urine and stool microscopic, chest x-ray |
NOTE to Dr.
Graham Gumley: Last month, Dr. Jennifer Hines suggested putting this patient
on Proprainolol 20 mg q 12 for one month, which we did. Her HR before was 140, now 100, which means her HR went down.
But we can’t do the blood tests here – how do we do?
Should we refer her to our hospital?
Please let me know clearly as we have seen her at the
Telemedicine clinic three times already.
At 10:38 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient # 1: PHENG
ROEUNG, female, 56 years old
SHCH
Advice: At this point referral to SHCH the best choice.
Date:
Wed, 15 Aug 2001 07:03:37 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To: ggumley@bigpond.com.kh,
sihosp@bigpond.com.kh
Please
find attached this message:
LAM_SEILA_2507.jpg
LAM_SEILA_2508.jpg
HEM_THONA_2515.jpg
|
Patient
# 2: LAM SEILA, male, 3 months old
(mother is Hem Thona, 22 years old)
Chief
complaint: Shortness
of breath, dry cough, on and off for two months.
BP:
-
Pulse: 140
Resp.: 32
Temp. : 36.5
Past
history: Unremarkable.
Lungs: Rhonchi on left
lower quadrant.
Heart: regular rhythm, no murmur
Abdomen: soft,
flat, no pain, not tender
Bowel sound: positive
Skin: warm to
touch, no rash, no edema, not pale
Ear, Nose, Throat: okay.
Assessment:
Chronic bronchitis?
Recommend: Should we
treat in the village with antibiotics?
Or refer to hospital for chest x–ray?
|
At 10:38 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 2: LAM SEILA, male, 3 months old
(mother is Hem Thona, 22 years old)
SHCH
Advice: Recommend referral for Chest x-ray and treatment. Kampong
Thom.
Or
if severe to KB
 |
Patient
# 3: HEM THONA, female, 22 years old
Chief
complaint: Dizziness,
weakness, ear ringing, numbness all over the body for one
month.
BP:
120/80
Pulse: 88
Resp.: 20
Temp. : 36.5
Past
history: Unremarkable.
(She gave birth three months ago at home, has not had any
medical attention until now.)
Lungs:
clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft,
flat, no pain
Bowel sound: positive
Skin: warm to
touch, no rash, no edema, not pale, no cyanose
Limb: Numbness at extremities.
Ear, Nose, Throat: Normal
Assessment:
Anxiety? Vitamin
deficiency?
Recommend:
Should we giver her vitamins here?
Or refer her to the hospital?
|
At 10:38 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 3: HEM THONA, female, 22 years old
SHCH
Advice: perhaps has anemia. Recommend CBC and see doctor at Kampong
Thom.
The
rest of your assessment may well be accurate.
Date:
Wed, 15 Aug 2001 07:08:36 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh, sihosp@bigpond.com.kh
In-Reply-To:
<NEBBLOHAEIHDALAOKLDEGECLCEAA.ggumley@bigpond.com.kh>
MIME-Version:
1.0
Content-Type:
multipart/mixed; boundary="0-1382102627-997884516=:44614"
Status:
RO
Please
find attached this message:
CHHIM_NEANG_2526.jpg
 |
Patient # 4: CHHIM
NEANG, female, 44 years old
Chief
complaint: Still mild
edema all over the body.
BP:
120/60
Pulse: 64
Resp.: 20
Temp. : 36.5
Past
history: She was a Telemedicine patient referred to Sihanouk
Hospital Center of Hope in April of
2001. She was diagnosed with severe anemia, iron deficiency, antero
septal IHD, and ovarian cyst.
Lungs:
clear both sides
Heart: regular rhythm, murmur (mild)
Abdomen: soft,
flat, not tender
Bowel sound: positive
Skin: mild
pale, warm to touch, no rash
Limb: mild edema on both arms and both legs
Assessment:
Severe Anemia, Septal IHD.
Recommend:
Should we refer her to our hospital for reassessment
and do some tests? (like blood tests and EKG)
|
Note: This was a
Telemedicine patient referred to Sihanouk Hospital Center of Hope in
April 2001 and she visited SHCH twice.
She also had tests done at Calmette.
She was given medication for three months and given an
appointment to return to SHCH on July 25.
Patient missed her return appointment because she lacks funds
for transport to Phnom Penh. She took all her medication during the three months,
but started to feel not well again after going off the medication
and missing her July 25 appointment.
NOTE from David:
Another previous Telemedicine patient, a 48 year old school
director, Noung Kim Chhang, is visiting SHCH this Friday for a
follow up visit. He
could show this patient the travel routine as her last trip to Phnom
Penh was via helicopter and she doesn’t seem capable of making the
trip by herself. Could
CHHIM NEANG travel together with the school director tomorrow, she
would stay at the same guesthouse in Phnom Penh, and then be seen in
the AM of Friday, 17 August? Then she could return home to Robib with Noung Kim Chhang as
well.
If Patient #1 of
today, PHENG ROEUNG, is being referred to SHCH, could she travel to
PP on Thursday with us and go to SHCH on Friday as well?
At 10:38 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 4: CHHIM NEANG, female, 44 years old
SHCH
Advice: Agree with above. To
SHCH as you suggest on Friday, (although
this is usually a difficult day to fit people in)
There
are more photos to edit and cases to send, hope to have another
batch to you in an hour or so.
SHCH
Advice: Having some computer probs here in PP. May reply to further
e-mails in am.
Good
work.
Dr.
Graham Gumley
Director,
SHCH
Date:
Wed, 15 Aug 2001 08:26:33 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh, sihosp@bigpond.com.kh
Please
find attached this message:
15
August 2001 Telemedicine Clinic in Robib – text #2.doc
CHEA_KIM_SOK_2539.jpg
KONG_ROEUT_2058.jpg
 |
Patient #
5: CHEA KIM SOK, female, 39 years old
Chief
complaint: Chest tightness and chest pain on and off for
13 years. Sometimes cough up with sputum on and off for three months.
Upper abdominal pain for one year.
BP:
9/50
Pulse: 80
Resp.: 20
Temp. : 36.5
Past
history: In 1984 she
had malaria and was treated well with modern medication, got
resolved.
Lungs:
clear
Heart: regular rhythm, no murmur
Abdomen: positive
epigastric pain, soft, flat, not tender
Bowel sound: positive
Skin: not
pale, warm to touch, no rash
Ear, Nose, Throat: Normal
Assessment:
Anxiety? Dyspepsia.
Recommend:
EKG to rule out Ischaemic heart disease.
Should we treat her with some medications for
dyspepsia? If
yes, please let me know the name of the drug.
|
At 10:43 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 5: CHEA KIM SOK, female, 39 years old
SHCH Advice:
Agree with ECG. Will advise re meds in am.
 |
Patient # 6: KONG
ROEUT, female, 45 years old
Chief
complaint: Upper
abdominal pain radiating to chest and to left upper quadrant
on and off for two years.
BP:
100/60
Pulse: 88
Resp.: 20
Temp. : 36.5
Past
history: Last month
she came to the Telemedicine clinic and we thought it was an
anxiety disorder.
Lungs:
clear both sides
Heart: regular rhythm, no murmur
Abdomen: positive
epigastric pain radiating to left upper quadrant, soft, flat
Bowel sound: positive
Skin: mild
cold to touch at extremity, no rash, no edema
Assessment:
Anxiety? Dyspepsia.
Recommend:
Should we test her in location for dyspepsia?
If you agree, please, let me know about the name of the
drug. For anxiety, I want to educate her on how to release it.
|
At 10:43 PM
8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 6: KONG ROEUT, female, 45 years old
SHCH
Advice: Will advise re meds in am.
Date:
Wed, 15 Aug 2001 08:35:20 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh, sihosp@bigpond.com.kh
Please
find attached this message:
CHEM_HIM_2542.jpg
 |
Patient
# 7: CHAN HIM, female, 53 years old
Chief
complaint: Headache,
neck tender, chest tightness, dizziness, on and off for three
years.
BP:
190/100
Pulse: 80
Resp.: 20
Temp. : 36.5
Past
history: Three years ago she had mild hypertension, NP
160/90. During that time she was treated with HTN drug but did not
get better.
Lungs:
clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft,
flat, not tender
Bowel sound: positive
Skin: warm to
touch, no rash, no edema
Urinalysis: negative
Assessment:
Severe hypertension, Ischaemic heart disease?
Recommend:
EKG, some blood tests, chest x-ray.
Should we refer her to the hospital?
|
At
10:43 PM 8/15/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 7: CHAN HIM, female, 53 years old
SHCH
Advice: Should be referred to K. Thom for ECG, Chest x-ray and eval.
Date:
Wed, 15 Aug 2001 19:16:44 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,Jennifer
Guest Hines <sihosp@bigpond.com.kh>
Please
find attached this message:
15
August 2001 Telemedicine Clinic in Robib - text
#3.doc
PHIM_Sichhin_1515.jpg
PHIM_Sichhin_1516.jpg
Any
advice on meds for the earlier patients before we leave the village
this morning is appreciated. One
of the
pharmacies up here has been helpful and can get medicine in a day if
not in stock (not the assistant clinic director's pharmacy, another
place in the middle
of the village.)At 10:10 AM 8/16/2001 +0700, "Graham
Gumley" <ggumley@bigpond.com.kh> wrote:
Dear David and
Montha,
For the two
patients who needed antacids, Dr. Hines recommends the use of
TUMS or Rolaids
to treat/assess.
Thanks.
Graham
|
Patient
# 8: PHIM Sichhin, female, 35 years old
Previous Telemedicine patient
Chief
complaint: Weakness,
palpitation, muscle pain, left upper quadrant pain.
BP:
120/60
Pulse: 100
Resp.: 28
Temp. : 36.5
Past
history: We have seen this previous Telemedicine patient
at two other clinics. The
assessment then was valvular heart disease, anemia, hepatitis.
Two months ago she was admitted to Kampong Thom
Hospital for 10 days. They gave her a blood transfusion of two units for her anemia
and gave her some medication like ASA and vitamin.
Last month I saw her again and reported to Dr. Hines.
She suggested to add Furosemie 10mg q D and Albendazole
200mg q 12 for 3 days. We
gave the meds but she is still not better.
Weight:
45kg
Urinalysis: negative
Lungs: clear both sides
Heart: regular rhythm, positive mild systolic murmur
Abdomen: splenomegalie about 4 cm and pain when palpable,
soft, not tender
Bowel sound: positive
Skin: pale,
warm to touch, no rash
Limb: both pitting edema ++, mid numbness
Assessment:
Severe Anemia, Valvular Heart Disease? Vitamin deficiency.
Recommend:
Recheck some blood tests like lyte, creat., BUN, CBC,
peripheral blood smear. Chest x-ray, EKG, heart and abdominal ultrasound.
Should we refer her to the hospital?
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 8: PHIM Sichhin, female, 35 years old
Previous
Telemedicine patient
SHCH:
This is a good case for us to review the discharge notes from
Kampong Thom Hospital. Based on their examination and test results (eg.
ECG) we can make a more informed decision. Can we get these
documents
Date:
Wed, 15 Aug 2001 19:20:55 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,
Jennifer Guest Hines <sihosp@bigpond.com.kh>
Please
find attached this message:
THORNG_KHIT_2566.jpg
 |
Patient
# 9: THORNG KHIT, female, 38 years old
Chief
complaint: Diarrhea with mucous two times per day on and
off for three months, chest tightness radiating to upper back
on and off for one year. Small mass, size 4 x 6
cm, on the left breast and painful.
BP:
120/80
Pulse: 120
Resp.: 20
Temp. : 37.59
Past
history: Unremarkable.
She says she’s lost about 5 kg of weight during the
last three months. Her
husband is currently sick, coughing up sputum.
But he’s “still strong, working in the rice field
today.” Montha
asked her about husband’s and her sex history and she says
they are both monogamous.
Weight:
36 kg
Urinalysis: negative
Lungs: clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft, flat, but mild pain around umbilical.
Bowel sound: positive
Skin: skinny,
++ mild dehydration, warm to touch
Mouth: Thirsty
Breast: on the left breast, mass, size 4 x 6 cm, positive
pain, mass is mobile.
Assessment:
Retrovirus? Dehydration,
malnutrition. Left
breast tumor? R/O
PTB.
Recommend:
Do some blood tests, especially HIV test.
Chest x-ray, abdominal ultrasound, stool microscopic.
Should we refer her to Kampong Thom Hospital?
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 9: THORNG KHIT, female, 38 years old
SHCH:
Should refer to Kampon Thom for investigations you suggest. Will
need review of her discharge notes from them when investigations
complete.
Date:
Wed, 15 Aug 2001 20:15:18 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,
Jennifer Guest Hines <sihosp@bigpond.com.kh>
Please
find attached this message:
15
August 2001 Telemedicine Clinic in Robib – text #4.doc
Moury_Kea_2569.jpg
YOU_KHIM_2574.jpg
 |
Patient # 10: Moury
Kea, female, 53 years old
Chief
complaint: Headache,
weakness, vaginal discharge, on and off for ten years. One
mass, size 2 x 2 cm, in vagina for 20 years.
BP:
120/80
Pulse: 80
Resp.: 20
Temp. : 36.5
Past history: Unremarkable.
Urinalysis: Glucose +
Lungs: clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft, flat, no mass
Bowel sound: positive
Skin: not
pale, warm to touch, no rash, negative dehydration
Other systems: okay
Note:
We can’t do gyneco exam here.
So I don’t know how to do.
I know the mass in her vagina through her description.
Assessment:
Diabetes? Vaginal
mass?
Recommend:
Should we refer her to Kampong Thom Hospital to do the
gyneco exam and do an abdominal ultrasound or not?
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 10: Moury Kea, female, 53 years old
SHCH:
Refer to Kampong Thom Hospital for above tests and investigations.
 |
Patient
# 11: YOU KHIM, female, 30 years old
Chief
complaint: Upper abdominal pain radiating to upper back.
Weakness on and off for four months.
For four months she has had burping, nausea, dizziness,
headache, but no fever or cough.
BP:
100/60
Pulse: 84
Resp.: 20
Temp. : 36.5
Past history: Unremarkable.
Lungs: clear both
sides
Heart: regular rhythm, no murmur
Abdomen: soft, flat, not tender but mild pain on
epigastric pain.
Bowel sound: positive
Skin: warm to
touch, no rash, no dehydration signs, not pale
Assessment: Dyspepsia.
Recommend:
Should we treat her here in location?
Please, let me know the name of the drug if you agree.
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 11: YOU KHIM, female, 30 years old
SHCH:
May have gastric ulcer. Trial of antacid (TUMS or equivalent).
May
need endoscopy if this is not effective.
Date:
Wed, 15 Aug 2001 21:43:53 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,
Jennifer Guest Hines <sihosp@bigpond.com.kh>
Please
find attached this message:
15
August 2001 Telemedicine Clinic in Robib - text
#5.doc
HO_SAO_SOVANTHA_2575.jpg
HO_SAO_SOVANTHA_2578.jpg
|
Patient #
12: H0 SAO SOVANTHA, male, 14 years old
Chief
complaint: Sore
throat, has sticky mucous in it, on and off for one year.
BP:
100/60
Pulse: 100
Resp.: 20
Temp. : 37.5
Past
history: One year ago
had malaria, was admitted to Kampong Thom Hospital and treated
well.
Lungs:
clear both sides
Heart: regular rhythm, no murmur
Abdomen: soft, flat, not tender, no pain
Bowel sound: positive
Skin: not
pale, warm to touch, no rash
Throat: mild redness.
Tonsils mild enlarge on the right side and has some
mucous.
Assessment:
Chronic Tonsillitis.
Recommend: Throat
culture. Or
should we treat him here with antibiotic?
Please let me know.
|
At 04:52 PM
8/16/2001 +0700, Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 12: H0 SAO SOVANTHA, male, 14 years old
SHCH:
Could be treated with antibiotics locally and review next clinic.
Date:
Wed, 15 Aug 2001 21:07:59 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,
Jennifer Guest Hines <sihosp@bigpond.com.kh>
Please
find attached this message:
16
August 2001 Telemedicine Clinic in Robib – text #6.doc
HOEM_DARO_2590.jpg
 |
Patient
# 13: H0EM DARO, male, 8 months old
Chief
complaint: Shortness
of breath, fever, and cough with sputum for four days.
BP:
-
Pulse: 180 (not a typo)
Resp.: 48
Temp. : 37
Past
history: Unremarkable.
Lungs: crackle on both
lungs
Heart: regular rhythm, no murmur
Abdomen: Soft, flat, not tender.
Positive hepathomegalie, about 3 cm.
Bowel sound: positive
Skin: not
pale, warm to touch, no cynaose, no edema
Ear, Nose, and Throat: Throat redness, has a few white
points on the tonsils.
Assessment: Pneumonia, tonsillitis.
Recommend:
Chest x-ray, throat culture, some blood tests.
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 13: H0EM DARO, male, 8 months old
SHCH:
Recommend referral to Kantha Bopha for evaluation
Date:
Wed, 15 Aug 2001 22:32:58 -0700 (PDT)
From:
David Robertson <davidrobertson1@yahoo.com>
To:
ggumley@bigpond.com.kh,
Jennifer Guest Hines <sihosp@bigpond.com.kh>
Dear
Dr. Graham Gumley and Dr. Jennifer Hines,
Please
find attached this message:
16
August 2001 Telemedicine Clinic in Robib - text
#7.doc
MEAS_REM_2591.jpg
PROM_ROURN_2592.jpg
These
are the final cases being sent today.
We are departing
the village shortly. Any quick advice on whether
to transport these patients or to see them again next month is
appreciated. In lieu of a hospital visit, would providing any medication
help them this month?
Best
regards,
David
Note to Dr. Gumley:
We plan to depart Robib at 12:45pm
today and could transport patients to Kampong Thom Hospital
or hospitals in Phnom Penh if a physician recommends by e-mail that
we do so.
Advice that
arrives after we depart Robib village is still welcome. The
schoolteachers at the village school will help us to relay e-mail
advice that arrives after Montha and I depart to the patients and
the Robib village medical clinic director (i.e. buying medication in
the village or helping arrange public taxi transport to Kampong Thom
Hospital.)
The less urgent
cases will return to the next Robib Telemedicine Clinic for follow
up (dates are September 12 & 13.)
 |
Patient # 14: MEAS
REM, female, 79 years old
Chief
complaint: Chest pain
radiating to upper back on and off for three months, left
upper quadrant pain for five days.
BP:
140/50
Pulse: 70
Resp.: 20
Temp. : 37
Past
history: Unremarkable.
Lungs: clear both
sides
Heart: regular rhythm, positive diastolic murmur, negative
trill.
Abdomen: Soft, flat, not tender, mild pain on left upper
quadrant.
Bowel sound: positive
Skin: not
pale, warm to touch, no rash, no dehydration signs
Assessment:
Valvular heart disease? Parasitis.
Rule out Ischaemic heart disease.
Recommend:
EKG, blood test, stool microscopic, heart ultrasound.
Should we refer her to Kampong Thom Hospital?
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 14: MEAS REM, female, 79 years old
SHCH:
Should have evaluation ?by surgeon. Refer to Kampong Thom
 |
Patient # 15: PROM
ROURN, female, 57 years old
Chief
complaint: Upper abdominal pain.
Weakness for 15 days.
Cough up with sputum for 10 days.
BP:
110/60
Pulse: 88
Resp.: 20
Temp. : 37.5
Past
history: Unremarkable.
Lungs: both lower base
crackle
Heart: regular rhythm, no murmur
Abdomen: Soft, flat, not tender.
Negative hepathomegalie, positive mild pain on the
epigastric area.
Skin: not
pale, warm to touch, no rash, no edema
Ear, Nose, and Throat: Throat redness, has a few white
points on the tonsils.
Assessment:
Dyspepsia, LB Pneumonia on the base.
Parasitis. Rule
out PTB.
Recommend:
Chest x-ray, stool microscopic, some blood tests.
|
At 04:52 PM
8/16/2001 +0700, "Graham Gumley" <ggumley@bigpond.com.kh>
wrote:
Patient
# 15: PROM ROURN, female, 57 years old
SHCH:
Agree with recommended tests. ? Kampong Thom
August
22, 2001
UPDATE:
Results
of 17 August outpatient exams at Sihanouk Hospital Center of Hope:
Patient # 1:
PHENG ROEUNG, female, 56 years old
Given
an exam and medication at SHCH.
Will be reassessed by the nurse at the September Telemedicine
clinic in Robib.
Patient # 4:
CHHIM NEANG, female, 44 years old
Given
an exam and medication at SHCH.
Will be reassessed by the nurse at the September Telemedicine
clinic in Robib. She
received four months of free medicine by SHCH and has been scheduled
for a follow up exam on December 14 at SHCH in Phnom Penh.
Patient LACH
PHAT, male, 52 years old (examined at the July Telemedicine clinic)
Given
an exam and blood tests at SHCH.
Results will be discussed at a follow up exam on August 27 at
SHCH. Could be
reassessed by the nurse at the September Telemedicine clinic in
Robib.
Patient NOUNG
KIM CHHANG, male, 48 years old (previous Telemedicine patient)
Given
an exam and medication at SHCH.
Could be reassessed by the nurse at the September
Telemedicine clinic in Robib. He will continue monthly visits to
SHCH to monitor his heart condition and to receive medication.
Next
Robib Telemedicine Clinics:
September
12 & 13
October 11 & 12
November 14 & 15
[English Version][Khmer
Version]
|
