Today was our final day of patient care. Not only was a day of mixed emotions given the fact that we’ll be heading home soon, but we had highs and lows concerning our patients at FAME.

Thobias, or Toby, as his mother and now we call him also, had a single brief seizure last night, but looked like a million bucks this morning! It was such a pleasure to see him awake and chatty and engaging. He’s a lovely child and his mother has been incredibly patients with us. Our plan was to discharge him today if he looked well and indeed he did so we’ve arranged for him to be seen next weekend at our clinic near his home and then back to FAME in a month to check labs, etc. His mother thanked us this morning on rounds and perhaps the most telling thing she said was that when she brought him to us a week ago she never expected him to look as good as he did this morning in such a short time. She was thrilled. Here is a picture of Toby and his mom in the ward and then Toby and Megan right before they left for home.

Thobias and his mother

Thobias and Megan

We were asked to see the niece of one of our clinic officers here, Dr. Isaac. It is his sister-in-law’s daughter who is eight months old and has been having seizures. They had been seen at Kilimanjaro Christian Medical Center prior to seeing us and it didn’t take long to see that the baby had significant problems as she was having repetitive seizures in her mom’s arms that were likely infantile spasms. The baby’s neurological exam was significantly abnormal with hypotonia and probable cortical blindness and she was very small (<3rd %) suggesting that this was West syndrome. This is a disorder with a terrible prognosis and often develops into Lennox-Gastaut syndrome which is a terrible seizure disorder of multiple seizure types and injury. The baby had been started on valproic acid and at least we had something to offer as we probably have the only topiramate in the country here and could start her on that. Having to tell mom, who already had some inkling of the diagnosis the bad news was one of our low points for the day.

While we were seeing the young baby and sent her off for labs, Dr. Mshana was seeing a young boy across the hall in another exam room whose family had brought him in and he was malnourished and apparently hypoglycemic. We weren’t involved in his care, but he was very ill and they moved him to the ward. After we were finished with our baby and I was walking across the courtyard to copy some records for them there were several women sitting and wailing. We weren’t sure what had happened, but found out that the little boy had died. It affected Megan greatly and as it was our time to say goodbye here it reminded both of us of how fragile the balance of life is here. We do what we can to benefit the people here, but there are still many that we cannot help and though we are saddened by that it cannot dissuade us from continuing our work.

We had grilled cheese sandwiches and sliced tomatoes (not Megan who doesn’t like tomatoes) for dinner tonight. We had planned it that was, but it was perfect comfort food for a tough day. Tomorrow we tackle Ngorongoro Crater and will stay at FAME tomorrow night. It has been a remarkable visit to FAME overall and we say over 90 neurology patients in our time here which isn’t the largest number of patients I’ve seen, but they were all pure neurology which hasn’t been so in the past. Megan has been a star as I knew she would and she will leave her mark here as Danielle did in the past. I am already looking forward to my next visit in September when Danielle returns for an encore and hopefully we will have another here with us at the same time so there will be three neurologists practicing at FAME!

Mike