Day Four: Of Big Heads and Small Bodies

Today, I decided to hang out with the residents in the Inpatient Department and help out with new admissions. Of course, this usually translates to me observing them interact with patients in fluent Khmer, maybe helping here and there with parts of the physical exam. But still, it’s a wonderful way to get exposure to a wide range of patient diagnoses.

So it was after I had seen a few patient admissions in a row that I found myself noticing a fundamental difference between the patients here and the ones I was used to seeing back in the U.S. For one thing, they are much, much smaller here. This is one of those very obvious traits that I failed to really appreciate until I had a couple of cases of babies with possible developmental delay. When asked by the resident whether or not I noticed any physical abnormality, I would say, “well, their heads look big…but I can’t tell if it’s because it really IS big, or if it’s because their bodies are so skinny!”

I know…what else do I expect in a country where many people subsist on less than a dollar a day?

The point was driven home to me when I was showing the residents my new Pocket Pediatrics book. Flipping through, they came to the chapter dedicated to “Overweight and Obesity” and immediately burst into laughter. “We don’t have this problem here,” one resident told me, “it’s more like the opposite…”

I vaguely remember a tip that I learned during my pediatrics clerkship. It was some clinical pearl that went something like “when a baby is starved, the body will fight to conserve head circumference at the sacrifice of both weight and length.” I don’t think I ever realized the validity of that saying until now…

Big heads aside, what amazes me is that in talking to the parents, a lot of them think that it is normal for their children to have some degree of emaciation. When asked, parents usually voice some degree of surprise that their child can eat so much yet be so skinny. I’m told that the problem is often that a lot of people are unaware that children must eat a variety of food to grow. As a result, it’s not uncommon for children to subsist on a diet of rice and little else—both because it’s cheap and because parents may not know any better.

Luckily, the hospital has a lot of educational programs going on. The staff offers cooking lessons to parents, focusing on how to make a palatable cheap nutritious stew for kids. There is also a fairly impressive vegetable garden on the hospital grounds, part of a project to encourage sustainable living in the countryside. Here’s a picture:



Overall, today was a better day than the previous three. I can’t wait to fast-forward to the point in this trip that I finally get over my jetlag. On the plus side, I think I’m finally able to understand about 65-70% of the Khmer that is spoken. Now if only I could speak back with as much precision.

Speaking of food, I've got another outing with the residents and attending tonight. Not sure if it will be as exotic, but given my state of exhaustion, I'm certain that whatever I eat will put me to sleep!