Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 80

Figure 2. Patients awaiting our arrival at an area clinic.

Figure 4. Scars from the application of heated cups, to self-treat pain in the
head, chest, and abdomen.

The fall of the Khmer Empire in the early 1400s was due
likely to invasions, floods, droughts, and a lack of access to
emerging shipping trades (2). Cambodia was remote to the
outside world until the arrival of explorers, including French
naturalist Henri Mouhot, who discovered Angkor and published accounts of his findings in 1868 (3).
POLITICAL CONCERNS TODAY
To compete with factories in China, foreign companies have
been heading to Cambodia. Between 2011 and 2012, foreign
direct investments increased by 70%. National elections on July
28, 2013, produced claims of widespread ch eating and threats
of mass protests, owing to thousands of temporary “identification cards” that voters required. Forests are being chopped
down and burned to make charcoal. Large sugar plantations
are confiscating individual homes at subpar prices and selling
their products largely to Europeans, who enjoy duty-free access.
Cambodian and Thai troops have clashed in recent years over
ownership of land and temples along the border, an area near
where one of our clinics was held.

MEDICAL PREPARATION
Each of us was given a large shopping bag full of medications and supplies we took with us and assembled at the hotel
in Siem Reap. We were advised to get typhoid shots, to take
atovaquone-proguanil (Malarone) for malaria protection, to
spray our clothing with Permethrin, and to apply DEET to
exposed skin areas to help protect against dengue fever. It was
not very reassuring that a current guidebook advised us to “get
a blood test if you suspect you have dengue fever, as there is a
fatal variety that does not need to be treated” (1). We also took
ciprofloxacin and metronidazole in case we got traveler’s diarrhea and used standard precautions since HIV/AIDS and tuberculosis were common. Upon our return, we added mebendazole
to protect against worm infestations.

THE MEDICAL MISSION
Our medical team was busy, seeing a total of over 1000
patients in 4 days of clinics, with about 20% of the cases being
dental. We visited four different sites (Sre Nouye, Chanleasdai,
Svay Chek, and Srogne). Patients were waiting for
us upon our arrival (Figure 2). Our facilities were
adequate (Figure 3), except for the lack of sinks and
running water.
Medical histories were hard to obtain, even
with fairly good translators. Important aspects of
chest pain, such as precipitating cause, duration,
etc., were vague at best. Only 1% of patients I saw
had histories consistent with angina pectoris. Eleven
percent were hypertensive. Heart murmurs were
heard in 3%. One of the latter, a diffuse grade 3/6
murmur, was likely due to mitral regurgitation, as
the carotid upstroke was normal and the murmur
did not change on the beat after an ectopic beat.
Another was most likely a bicuspid aortic valve with
aortic stenosis and aortic regurgitation. A 14-yearold girl had clubbing of the fingers and toes and
a diffuse grade 3 systolic ejection murmur spillFigure 3. (a) My medical office and (b) my wife, Marilyn, who helped in medication packaging ing over in diastole; she likely had a bidirectional
shunt with Eisenmenger physiology and possibly
and distribution.

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Baylor University Medical Center Proceedings

Volume 27, Number 2