Wednesday, March 12, 2014 – Another visit to Upper Kitete

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We had some wonderful rains last night to fall asleep to accompanied by frequent lightening in the distant. The morning was clear and beautiful as we readied for another day of mobile clinic in Upper Kitete hoping for more patients today than yesterday. We swung by the ward to check on our two patients, the elderly Masai women with a stroke and the young boy with seizures.

Our stroke patient was 88 years-old and came in our first day here last week with a very large stroke affecting the left side of her brain such that she couldn’t move either her arm or her leg, had a facial droop and had a global aphasia. She was also nearly obtunded which was a problem with the size of her stroke and we worried about her swelling. I’m happy to say that she amazed us all and regained most of the use of her leg so she could actually stand and walk some and was understanding speech quite well. She was also swatting at anyone who walked behind her as she was quite vain and didn’t want to chance anyone seeing her open hospital gown. Megan worked on a word board for her as her family took her home this morning and we also instructed them on what physical therapy to do. That’s a huge difference here. Families want to know when they can take their family member home and care for them. Here’s a photo of her with two family members just before discharge:

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Our young boy with seizures isn’t do quite as well. We’re forging ahead trying to get him up on carbamazepine, but will decide tomorrow morning whether to load him on phenytoin as he’s continued to have a few seizures most days though his carbamazepine isn’t fully up to speed yet. He’s a very tough case where an EEG would make all the difference in the world – hear that Danielle? More later on this one.

Off to Upper Kitete where there weren’t as many patients as last year, but we had some very good pathology. Our first case was a gentleman who supposedly had arthritic complaints and when he got up to go to the exam room it was clear to both Megan and me that he was walking with a spastic gait! He was a heavy drinker and we’re suspecting B12 deficiency, but need to get some other tests including a CT scan of the c-spine, but will wait for the other test results to come back first.

We had a woman with headaches since 2002 and who on exam was obese and had a right APD with loss of vision that was gradual on further questioning. We’re suspecting pseudotumor cerebri or benign intracranial hypertension. We put her on topiramate and asked her to lose some weight. Here’s a photo of her, Megan and Dr. Ken:

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We saw several more patients including a wonderful old Bebe (elderly woman in Swahili) with a postural tremor who we put on propranolol as her BP was somewhat high and we could kill two birds with one stone.

I played frisbee (or as Will has tried to train me to say, “threw the disc”) with the kids again today as my leg was somewhat better and I just made sure I didn’t make any sudden moves with my left leg. It is much better today.

As we were finishing patients a huge storm began to role in with lots of lightening and heavy rains so we closed up shop and packed up as quickly as possible. We escaped just in front of the heavy rains and managed to skirt around the storm, but it rained quite heavily for a very short period of time here in Karatu as evidenced by this photo of the street just next to the marketplace that was completely flooded.

Flooding in downtown Karatu

Flooding in downtown Karatu

It’s times like this that make you appreciate the difficulty of living here. The clouds cleared and we had a lovely, albeit cold, evening for dinner with Joyce on her veranda and a quite evening to finally catch up on emails and reading. We had planned to go back to Upper Kitete tomorrow, but the volume of patients right now is low for some reason so we’ll work here at FAME unless we’re asked to go somewhere else. It’s disappointing not to have the same volume for this one clinic that we’ve had in the past, but there are many reasons why that might happen and one of them isn’t lack of need. We’ll be back and I’m sure there will be patients.

Mike

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