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Compassionate healthcare and purposeful innovation for Cambodia’s children

Importance of nutrition for cancer patients

Chinda is a 14-year-old girl from Sangke District, Battambang Province, over 190km from AHC. She lives with her stay-at-home mother, Phary, and her four siblings. Her stepfather, Sovann, has been working in a food factory in Thailand since 2018, sending around 75USD once in a while back to the family. Sovann used to visit his family every three to four months, but due to COVID-19, has not seen his family for over two years.

As long as Phary and Sovann could remember, Chinda has always been unwell. Mid-2021, Chinda developed severe bruises all over her body and had difficulties with mobility. A friend from school, who received treatment at AHC before, recommended her to go to AHC. Phary borrowed money from their neighbour for bus tickets and left her four other children behind with their aunt in their village. China and Phary arrived at AHC in November 2021.

Chinda was first admitted to AHC’s Intensive Care Unit for severe swelling and dyspnoea (shortness of breath). AHC’s doctors suspected her swelling was caused by leukaemia cells built up in her liver and spleen. After a bone marrow aspiration and series of blood tests, Chinda was diagnosed with Acute Lymphocytic Leukaemia (ALL). ALL is a type of cancer of the blood and bone marrow that progresses rapidly and creates immature blood cells, as opposed to mature ones. Immature blood cells stop children from fighting bacteria, fungi, and viruses. Currently, AHC is one of three facilities in Cambodia treating ALL.

Phary was terrified to learn the news, and felt overwhelmed after learning that she would need to stay with Chinda at AHC for months of chemotherapy treatment. She did not have money or support, and would not be able to go back home to take care of her other children. Phary felt scared to ask for help or ask questions, so she did not tell AHC doctors and nurses about her financial hardship.

Phary was unable to provide Chinda enough food to eat. Once Chinda relocated to AHC’s Oncology Unit and chemotherapy began, her body could no longer cope. Chinda could not move her body; she could not get out of bed. Chinda endured, and once the induction phase of chemotherapy was complete, her swelling subsided. Dr Samly Vannak, AHC’s oncology specialist, observed that Chinda might actually be malnourished.

Like all patient families at AHC, Phary had been attending cooking demonstrations and basic nutrition education every morning from AHC’s Nutrition Team. Phannsy, AHC’s nutrition team leader, examined Chinda as per Dr Vannak’s request, and diagnosed her with Severe Acute Malnutrition (SAM). With a height of 142cm and weight of 30kg, Chinda’s Body Mass Index (BMI) was 15.

“Chemotherapy is an intense process. We need our patients to be healthy to be able to endure the treatment. This is why when we suspect a malnourished child, we work closely with the nutrition team to find the balance between successful treatment and patient health and safety,” explained Dr Vannak

Phannsy began specialised care and treatment for Chinda. Chinda began to receive four extra food packs a day with produce such as eggs and greens, rich in proteins and vitamins. Phary received one-on-one education about when Chinda should eat and how to encourage healthy eating habits. They also began to receive financial support from AHC’s Social Work Unit while staying at AHC to minimise financial stress.

Phannsy also performed an oral check-up on Chinda, inspecting her teeth, jaw, gums and oral tissues. For communities in rural areas, knowledge in dental care and the importance of dental hygiene is limited. Along with the side effects of leukaemia and chemotherapy, any sign of bruising or fungi would be reducing her appetite and sense of taste. Chinda received a hygiene pack and instructions on how to take care of her teeth and gums.

After a few weeks of specialised counselling and support from AHC’s Nutrition Team, Chinda began to eat properly, now with efficient and balanced nutrients. Her BMI increased to 16, which is still underweight, but in progress to become stronger.

The oncology and nutrition teams met every few days to update each other on Chinda’s case and progress. Chemotherapy could not have continued without the support from Phannsy.

“Chinda looks so different from when I first saw her lying on the bed. She was a very unhealthy teenager with bruises and a big bloated belly. Now, every time I come check up on her she is so lively. I am so happy to see the change in her in such a short time,” shared Phannsy

Children with ALL receive five rounds of chemotherapy over the course of three years. After an intense four-month stay at AHC, Chinda will soon be discharged to rest before her next round of chemotherapy. Chinda and Phary are looking forward to going back to their village and sharing their knowledge about nutrition; the importance of meal plans, nutritional foods, and most importantly, how to help others tackle nutrition.

“I was so scared to come to the hospital. We do not have money and I do not want to be a burden on my mother. The doctors and nurses here are so kind and helpful. I feel better and strong. I look forward to going back home soon,” shared Chinda.