No walk this morning as we have clinical lecture on Friday mornings and today Danielle was giving a talk on status epilepticus. The group of clinical officers, assistant medical officers, doctors, and nurses we have at FAME are all like sponges for information. They are an amazing group and the discussion we most often have after lectures is a clear indication of their desire to learn as much as possible from us. Epilepsy is one of the more common neurologic illnesses (if not the most common) we treat here and most likely the result of all the childhood infections such as cerebral malaria and meningitis in addition to trauma. They have had numerous patients present in status over the last months so Danielle’s lecture is quite apropos to the patient population here.

Danielle giving a lecture on status epilepticus

Today is the day that Danielle and Doug are scheduled to go to Rift Valley Children’s Village on a mobile clinic while I’ve decided to stay back at FAME to see the neurology patients still flocking here. This will be the very first mobile clinic that I’ve not gone on to supervise and it feels a bit like sending your children off for their first day of school. I can’t think of anyone more capable than Danielle so I have no worries that end. Last year I had to leave her behind at FAME to care for an acute stroke patient (Frank wanted both of us to stay but we negotiated) and she had an incredible experience of not only caring for the stroke patient, but also an infant in status and a psychotic Brit from Zanzibar all while I was completely out of telephone communication as there is none at Upper Kitete on the Rift.

The day back at FAME was crazy and I ended up seeing 18 patients with Dr. Isaac by my side. He is becoming a very good neurologist having worked with us now for several days as well as past visits. We also had to send 9 patients away telling them we would call them when we’d be available as next week we will all be on mobile and tomorrow we may all be heading to Rift Valley Children’s village.

Patients waiting to be seen at FAME

Watching health videos while waiting to be seen

The young boy with the post encephalic encephalopathy and probable Lennox-Gastaut left today because his father didn’t want to stay any longer. He looked better on valproic acid and we had him up to the dose we wanted so it was probably fine and we’ll get him back soon to check him out. We also have an acute hypertensive hemorrhage patient in the wards who presented two days ago and is looking much better. Don’t forget, we have no CT scan so this is all based on clinical presentation and his response to treatment. Such is life in the bush. We have an amazing facility here with resources that match anything in Northern Tanzania, but we practice by clinical acumen obtaining tests only if absolutely necessary as they are very costly for the patients to get in Arusha. Some day we hope to have a CT scanner here as it would certainly assist us in these diagnoses. In the meantime we will continue as we are providing the very best of medical care in an area that otherwise has very little.

Thanks everyone for your support,

Mike