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Robib and Telemedicine

Robib Villagers Questions about their Health to Mass General Hospital Specialists

On a recent visit to Robib, Nuon So Thero, the local representative for American Assistance for Cambodia/Japan Relief for Cambodia, polled Robib inhabitants on their health and medical concerns in order to elicit responses from specialist at Massachusetts General Hospital/Harvard Medical School who are developing a telemedicine project with Robib Village through this page. Villagers and the district chief provided Thero with these questions which appear here in English and Khmer. As the responses from the medical specialists come in, they will appear on this page. The questions follow:

Can the rheumatism disease be cured? Why it cause this disease? In 1998 there is one man got this disease. When it is serious he could not walk, but he drags and the local health official said this
disease can not be cured.

There is a little boy whose age is 13 years old. He had coma two
times a day. The symptom is when the disease cause he is
unconscious without moving his body, and there is no foam from his mouth. It looks like he is sleeping, but his heart is too weak
until we had someone help his heart movement. He is unconscious
about 5 to 10 minutes per time. What kind is that disease ? Can it
be cured ?

There is someone has a head-ache dizziness. He is hurt from his
neck leading to his head and he has this disease two to three times
a day. Since he has this disease he tried to cure, but he failed.
How can he cure this disease? and what kinds of medicines should he takes ?

There is a man who had a strange disease. He has head ache but
not serious. It seems that his head is heavy and is exhausted and
when walking he is almost unable to support his body, he walks as
if he is drunk. He has this disease 15 years ago. he can eat meal
as usual. This disease can be cure ? What is the name of this
disease? What is medicine should he take?

There is a man who has a cold fever . His back and shoulder blade are hurt and his urine is pale and hot. He get cold fever two times a day ( his temperature is hot but not hottest). What kind is this disease ?

Does Goiter disease can be cured ?

One child has dropped from his hut in the rice field and a stick
hit him on his eye ball, but not in the center. After that his eye
became ill and had something white happened and he could not see anything by this eye. can the doctor cure his eye ?

Can the doctor treat abscesses on the head. What kind of
medicines should a child take to cure abscesses on his head ?

What is the disease that had symptom as follows: - The
temperature of his body is permanently high, but not highest. - He
is exhausted and tired and difficult to breath What medicine should
he take ? 10- Is there any effective medicine to heal the
hemorrhoids disease ?

Is there any trouble for people who have the typhoid and heard
diseases and drink water with ice?

What medicine should patient take to treat his / her typhoid
disease ?

What 's symptom that show a man or woman have HIV ?

In Robeib village, there is a man who have had an abscess on his
heel since 1979. He tried to cure this abscess, but it can't be
cured, the effort is only preventing it from spreading. Right now
the abscess has the same size as before. Could the doctor please
give advise to him to cure this disease.

There is a woman who has head-ache dizziness and vomiting
occasionally, perhaps two to three times a month. What 's disease
she has had 9 What 's medicine should she take ?

What cause people get grippe disease ? Does grippe kill person
who got it ? Does grippe transmit from one to another ? How to
prevent this disease ? What medicine should the patient take it ?

Why are people effect with malaria ? What is the name of malaria
virus ? How to prevent this disease ? What is the name of medicine that can cure this disease ? Who had found out this medicine ? His or Her nationality ? and when ?

What is the name of the virus of Yellow fever or dengue ? What's
caused this disease ? Is it an epidemic disease ? If it is an
epidemic disease, how does it transmit from one to another ? What 's measure should we take to prevent the widespread of this disease ? Do we have any medicine to cure this disease ? If any, who find this medicine ? Nationality ? What age of the people does this disease affect mostly ?

What is the narne of the virus (bacteria) of the typhoid disease ? Why does it cause this disease ? is it an epidemic disease ? What
medicine should the patient take ? Who discover this medicine ?

What is the name of the virus (bacteria) of tuberculosis ? Is it
an epidemic disease ? How it transmit from one to another ? Is there any medicine to cure this disease ? Who discover the medicine ? Nationality ?

What is the name of virus (bacteria) of leprosy ? What is the
symptom of this disease 9 is it an epidemic disease ? If an epidemic disease how should we prevent ? Is there any medicine to treat this disease ? Name of the medicine if any ? Who discover
this disease ? Nationality ?

Why people get asthma? What is the name of virus (bacteria) of
asthma? Is there any medicine to cure this disease? What's name?

A woman who has pregnant, should she has medical check one a
month ? Do they charge if she get checked ? Is there any medicine
for her when she got pregnant ? How often should she take the
medicine a month ? When should she start to have medical check when she is pregnancy ?

Generally in Robeib village, people are subjected mostly to
malaria and the health officials of the government also agree with
this matter. The people even children in this area have malaria,
showing liver lower and flatulent and malaria haKs became a
permanent disease in the area. What method should people do to
avoid this disease ?

In the past few years, there are some strange diseases occurred
in the village. People hurt in their body, especially stomach. All
clinics and pharmacies in the village said people with strange
disease come up to them and they do not understand why and so far they had never seen such disease. They can not diagnose the disease because they had no sophisticated equipment and laboratories to examine. Why do people have strange disease or because of international phenomena such as volcano and radio actives from the nuclear power plant that impact to Cambodia?

Answer to Robib Villagers' Medical Concerns

The Robib villagers encounter many medical problems as is evident by the questions they posed to in our recent survey. These questions were sent by e-mail from Robib to Partners Telemedicine in Boston, which is developing a system to bring telemedicine to the village. Instead of answering each question, the group of doctors from Mass General and Harvard Medical School, have chosen to provide general information regarding diagnosis, prevention and treatment of some of the illnesses which hit this community. This is the first response, which will be translated into Khmer and appear here soon:

HIV/AIDS

Definition: AIDS (acquired immunodeficiency syndrome) is a very dangerous illness that attacks and greatly weakens the immune system. It is caused by infection with HIV (human immunodeficiency virus). HIV is spread through sexual intercourse, blood, and from an infected pregnant woman to the child. After about 10 years without treatment, a person infected with HIV will probably develop AIDS. The virus is a big problem all over the world.

Symptoms: Symptoms of HIV infection include:

- Fatigue
- Fever
- Sore throat
- Headache
- Rash
- Weight loss
- Nausea
- Vomiting

Symptoms of AIDS include:

- Fever
- Night sweats
- Weight loss
- Decreased appetite
- Nausea
- Vomiting

Prevention: Avoiding contact with infected people through sexual intercourse, blood (including sharing needles for drug use) and breast milk. Abstinence or the use of condoms during sexual intercourse can protect against HIV infection. HIV is not spread through casual contact (touch, food, drink, etc.). HIV testing allows people to find out if they are infected before even any symptoms show up.

Treatment: Right now there is no vaccine to cure or protect against HIV and AIDS. Drug treatments such as zidovudine (AZT), didioxyinosine (ddI), and dideoxycytidine (ddC)
are used to slow the progression of AIDS, but nothing can completely get rid of it once it the virus enters the body.

Malaria

Definition: Malaria is an infection spread by a mosquito that feeds at night. The mosquito carries a tiny “bug” that enters a person’s blood through a mosquito bite. The bug creates many more bugs just like it and they feed on the person’s blood cells, causing the person to get very sick. Malaria is a serious health problem in more than 90 countries around the world, including the Amazon region and the southern parts of Africa.

Symptoms: High fevers and shaking chills.

Prevention: Try not to get mosquito bites. Try not to go outside after the sun sets.

Treatment: Once infected, people should go to a doctor as soon as possible. Otherwise, certain drugs (including mefloquine, halofantrine, artemisinin derivatives, malarone, atovaquone + proguanil, co-artemether, chloroproguanil, dapsone, pyronaridine, and chloroquine) can be used to treat the disease.

Pregnancy

Definition: Prenatal care has to do with how a pregnant woman cares for herself and the baby she carries. It is a good idea to be seen by a doctor or nurse who can check the health of you and your baby. They will tell you when you should be seen again and what costs may be involved. It is a good idea to take vitamins but usually there is no need to take a special medicine.

Important Ideas:

-    Remember you are eating for two.
-    Drink more fluids than usual
-    Take vitamins if they are available.
-    Don’t eat undercooked meat.
-   Get enough rest.
-   Do not drink alcohol, smoke cigarettes, or take drugs (unless they are prescribed
     by a doctor). They can hurt the baby you are carrying as well as you.
-   Stay away from chemicals.
-   Find out if your family has had any problems with birth in the past to be aware of
    what could happen.

Asthma

Definition: Asthma is a chronic inflammation and irritation of the bronchial tubes, which carry air in and out of the lungs. The bronchial tubes become smaller or the lining of mucous inside the tubes swells, causing the person to have trouble breathing. Asthma is more likely the result of infection in the lungs/bronchial tubes or emotional stress. 15 million people suffer from asthma, 4 million of whom are under the age of 18. Medications will reduce the symptoms but may not cure the asthma

Symptoms:

-   Shortness of breath (often triggered by exercise) which leave a person unable to breathe
     properly and fully.
-   Wheezing (which usually begins suddenly, is aggravated by cold air, can be worse in
     early mornings or at night, and ends unexpectedly).
-   Cough (sometimes with blood).
-   Bluish color on the lips and face due to lack of oxygen (in severe cases).
-   Rapid pulse (in severe cases).
-   Sweating (in severe cases).
-   Flaring of the nose.
-   Tightness or pain in the chest.

Prevention: Asthma often occurs suddenly and has no cure. It can also be treated very effectively.

Treatment: Once the disease is identified, it can be treated by staying away from things in the environment that start the asthma attacks and by taking medicine ordered by a doctor. Nutrition, enough sleep, and limited activity may help asthma patients to avoid attacks. Other ideas that can help to treat asthma include:

- Staying away from furry animals, dust, feathers, and other things that can irritate the
lungs.
- Avoiding smoke.
- Avoiding cold air.
- Staying away from people with the cold or flu.

Tuberculosis

Definition: Tuberculosis (TB) is an infection caused by bacteria. It usually affects the lungs, but in some cases it infects areas such as the lymph nodes, bones and joints TB is spread through coughs and sneezes.

Symptoms:

Primary pulmonary tuberculosis-

- Many do not show any symptoms. The ones that do may have a small cough, weakness, fever, sweating during the night, no appetite, or weight loss.

Postprimary pulmonary tuberculosis-

- Fever, heavy sweating during the night, weight loss, small appetite, coughing, discolored mucous, and a feeling of sickness. The patient may cough up blood, feel short of breath, or develop severe breathing problems.

Extrapulmonary tuberculosis-

- Swollen lymph nodes on the sides and base of the neck which may eventually leak a thick fluid, a hunchback, pain or swelling in the knee or hip, or problems with urination (frequent, painful, or bloody).

General-
         - Sweating
         - Fatigue
         - Overall discomfort

Prevention: Avoid crowds and exposure to infected persons.

Treatment: Treatments include:

- Drugs (including isoniazid, rifampin, pyrazina ethambutol, streptomycin, ethionamide,
PAS, and ofloxacin)

- Rest
- Food
- Fluids

Typhoid Fever

Definition: Typhoid Fever is a life-threatening illness caused by bacteria passed to others in the stool and urine of infected patients. The bacteria must be ingested to bring about the disease. Typhoid fever is common in most developing parts of the world.

Symptoms: Symptoms include:

- High fever
- Headache
- Malaise
- Anorexia
- Slow heart rate
- Constipation
- Diarrhea
- Cough
- Extreme fatigue
- Joint pain
- A rash across the abdomen

Prevention: Wash hands thoroughly and often, especially after using the toilet and before eating. Dirty water and exposure to human waste can be the source of a typhoid problem. Immunization to protect against the disease is a good idea.

Treatment: Antibiotics (including chloramphenicol, ampicilllin, and ciproflaxacin) are the best treatment for typhoid fever. Patients must be treated even after their symptoms stop because they could still be carrying the bacteria.

Leprosy (Hansen’s Disease)

Definition: Leprosy is a chronic disease caused by bacteria that attacks the skin, eyes, respiratory tract, and other areas of the body. It takes about 4-8 years after infection with the bacteria for symptoms to show up. Exactly how leprosy is spread is still a mystery, but it is caused by close contact with people who have leprosy. The bacteria probably enter the body through the nose or broken skin. They get into the air through sneezing and coughing.

Symptoms: Symptoms include:

-   Skin lesions (darkened blotches that often have no feeling and sometimes have
     spreading edges and clearing centers)
-   Nerve swelling
-   Reddened bumps
-   Thickening of the skin
-   Stuffy nose
-   Loss of feeling in the toes and fingertips
-   Gangrene

Prevention: The disease is very contagious, so it is good to avoid close contact with infected people. Early detection of the disease and early treatment of infected people are also important prevention methods.

Treatment: Leprosy is very rarely completely removed from the body, but medications (dapsone, rifampin, clofazamine) can help to slow its progress. After about three months of medical treatment, patients are usually no longer contagious. Patients should also keep a careful watch over their bodies for cuts, bruises, and signs of infection.

Influenza (the flu)

Definition: Influenza is a virus that causes serious infection to the respiratory tract. There are many different types of influenza viruses. Often, patients recover from the illness, but some cases develop into serious, life-threatening problems. Pneumonia can result from infection with Influenza. The people most at risk are the very old, the very young, people with poor immunity, and people with conditions like diabetes, lung disease, kidney disease, heart disease, and liver disease.

Symptoms: The worst symptoms last for about 3-5 days. Sometimes influenza patients feel so terrible they do not leave their beds. Symptoms include:

- High fever
- Strong aches and pains (often in the back and muscles)
- Headache
- Cough
- Sweating
- Shivering
- Sore throat
- Raised body temperature
- Vomiting
- Diarrhea

Prevention: People at risk of influenza infection should:

- Get an annual influenza vaccination
- Avoid infected people

Treatment: Infected people should:

- Stay at home
- Drink plenty of fluids
- Take pain relievers and throat/nasal medications if available
- Wash with a cloth or sponge and warm water
- Let your body do naturally do its work

Yellow Fever

Definition: Yellow fever is a disease that is spread from person to person by mosquitoes infected with the yellow fever virus. It is usually found in South America and Africa in both humans and monkeys. Many cases of yellow fever are mild, but some cause very serious illness.

Symptoms: Symptoms of yellow fever appear about 3-6 days after the mosquito bite. They include:

- High fever.
- Chills.
- Headache.
- Muscle aches.
- Vomiting.
- Backache.
- Shock (after short recovery).
- Bleeding (after short recovery).
- Kidney and liver failure (after short recovery).

Prevention: People at risk of yellow fever infection should:

- Get a vaccination
- Avoid mosquito bites (wear long-sleeved shirts and pants, use insect repellent,
etc.)
- Find out if you are infected or not by getting a yellow fever blood test

Treatment: There is no specific treatment. It is important to try to treat the illness as quickly as possible. Still, the recovery period can sometimes be long. Infected people should:

- Rest
- Drink plenty of fluids
- Stay away from mosquitoes (to help stop the spreading of the disease)

Internet Resources

http://www.whosea.org/
http://www.who.int
http://www.medinfo.co.uk
http://www.drkoop.com
http://www.4woman.gov
http://www.medicinenet.com
http://www.cdc.gov
http://www.outbreak.org
http://www.intelihealth.com

[English Version][Khmer Version][Robib Villagers Q&A]
[Latest Telemedicine News - February, 2001]
[Second monthly Telemedicine examinations in Robib on March 16 and 17]