Thursday, September 18, 2014 – Old Friends and Muscular Dystrophy

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Our first three days of clinic have been amazing in regard to the number of patients we’ve seen and the diversity of diagnoses. Lots of epilepsy to keep Danielle happy and lots of pediatrics to keep Doug happy as a clam. We had another very busy day and in the first four days were we’ve now seen 94 neurology patients with lots of mobile clinics to go.

Most of the patients we see here at FAME are either Maasai, Chagga or Iraqw with a smattering of other tribes. There are actually 120+ tribes in Tanzania which is an amazing diversity and has been a real challenge since their independence to unit the country. This diversity, though, is what makes Tanzania the country that it is both culturally and aesthetically. Practicing at FAME in the Karatu district we often need multiple interpreters to help with our evaluation. Most of the Maasai women from the boma do not speak Swahili and only speak Maa (Maasai literally means those who speak Maa) and we often run into Maasai men who only speak Maa. There are few Maa interpreters, but we have several here at FAME which is a real bonus so we don’t require double translation. Same with the Iraqw language as none of these languages have very much in common. We deal with this everywhere we travel often using local townspeople to help us with the translating duties.

Monday we got to see Roza in followup. She is the 15 year-old that Danielle and I diagnosed with Syndenham’s chorea in December 2012 and who we have followed since then. It is an amazing story of making a diagnosis by internet, initiating treatment prior to arriving and then following up to finally see the patient in person. Danielle and I first evaluated Roza in March of 2013, I saw her by myself the following September and then Megan and I saw her together last March. When I last saw her the movements were persistent and bothersome for her, but this visit they are now almost imperceptible and she has blossomed into a beautiful young woman who has so much ahead of her. She is doing well in school and just took her national examinations to see whether she can continue in school or not. She is very optimistic and has reason to be. Roza’s story encapsulates the importance of FAME, it’s mission and our work. Had they not sent the video of her when they did and had Danielle and I not seen it right away Roza very likely wouldn’t be here to grace us with her lovely smile. She was that sick and in need of the right treatment and it is a very tough diagnosis for a non-neurologist to make.

Roza on the left with Danielle and Roza's mom

Roza on the left with Danielle and Roza’s mom

Doug got some amazing experience with neuromuscular cases over the last two days seeing a number of boys brought by a Norwegian gentleman who runs an orphanage in Mto wa Mbu (Mosquito River) and also helps out with the local Maasai. He brought a young boy back who I had seen last September and diagnosed with muscular dystrophy (probably Duchenne). He is obviously no better, but also not much worse and I had initiated steroid therapy last year when I had originally seen him so that may have helped a bit. Doug also saw two of three brothers with muscular dystrophy yesterday. Now keep in mind that Doug is pretty certain that he’s never cared for an outpatient muscular dystrophy patient in his training career to date. He’s seen and diagnosed three so far here and has more on their way from Mto wa Mbu coming. An amazing teaching experience!

A young Maasai boy with muscular dystrophy and his mom

A young Maasai boy with muscular dystrophy and his mom

Doug examining our patient

Doug examining our patient

Finally, Danielle and I had the privilege to see elderly Maasai women today who was so amazingly elegant and just glowed with a sense of grace. Her facial expressions had both of us totally in enthralled and it was impossible to watch her and not have such a sense of security and warmth. This is Tanzania. Danielle also spent the day teaching Dr. Isaac the neurologic examination and by the end of the day he was a pro.

Danielle evaluating a very elegant patient with Dr. Isaac assisting

Danielle evaluating a very elegant patient with Dr. Isaac assisting

Another successful day in clinic with Danielle and Doug. Many more to come.

Lala salama,

Mike

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