Wednesday, September 24, 2014 – Upper Kitete Neuorlogy Mobile Clinic

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Danielle and I did a long loop walking early this morning which was great. The weather was perfect and the views were amazing as usual. We will typically do 2.5 to 3.5 miles in 45-60 minutes and maintain a fairly quick pace. The sun comes up as we walk and all of life here begins to awaken with the new day.

Rounds in the morning are always quite unpredictable. Last night a woman two weeks postpartum came in quite hypertensive, but it seems the staff didn’t want to disturb Kelly who is here to set up their women’s health program. Despite our best efforts it is often difficult to change things here and the term “urgency” in Tanzania, let alone “emergency” is often lost in translation. This is undoubtedly one of the very best medical facilities in all of Tanzania, though the pace of progress in the face of years of cultural and societal habits is often very, very slow. This is a work in progress.

We also had a little 4 year-old in the ward with respiratory stridor for five (!) months with plans to bronch her today for what we thought would be a foreign body. In the end it turns out she has large papillomas nearly completely obstructing her vocal cords likely secondary to HPV from birth. She had to remain intubated and was sent to Arusha Lutheran Medical Center where there is a visiting pediatric surgeon and ENT. Hopefully something can be done for her, but it’s very possible she’ll need to be trached either way.

After sorting out Kelly’s issues with her patient in the ward we were finally able to get on our way to Upper Kitete. This village is a bit further on the Rift than Kambi ya Simba and is about 1-1/2 hours away. We’ve had very big clinics there in the past, but by the time we arrived today (close to noon) a few patients have returned home, but for the most part it’s very light. In the future we will spend only one day in each village (rather than the two as we’re doing now) and the DMO (District Medical Officer) here in Karatu has taken notice of our clinics and has asked if it would be possible for us to select a few other villages in which to provide neurology care. William (our amazing outreach coordinator) and I will discuss this further and likely have new sites for our March visit.

Most of the "Neuro Team" (is Doug playing with kids again?)

Most of the “Neuro Team” (is Doug playing with kids again?)

Doug and Diana evaluating a patient in Upper Kitete's nurse's office

Doug and Diana evaluating a patient in Upper Kitete’s nurse’s office

Danielle and Dr. Isaac evaluating a patient in Upper Kitete

Danielle and Dr. Isaac evaluating a patient in Upper Kitete

Evaluating a patient in the "Labour Room" at Upper Kitete

Evaluating a patient in the “Labour Room” at Upper Kitete

Monica, our nurse, manning the pharmacy in Upper Kitete with another satisfied customer

Monica, our nurse, manning the pharmacy in Upper Kitete with another satisfied customer

The cases today are basic musculoskeletal with a few neuropathies and headaches thrown in which is often the case. Our last case of the day is a gentleman whoI have seen at least twice before with fairly advanced Parkinson disease and probably some superimposed dementia. I started him on carbidopa/levadopa in March 2013, that worked quite well so that he was actually ambulatory, but he has now been off his medicines for the last month and is very, very rigid. So rigid, if fact, that he can’t ambulate and is essentially housebound, if not bed bound. We’ve decided to see him as our last patient of the day and we’ve brought a large bottle of carbidopa/levadopa with us thankfully that we have enough to give them for three months which is when a FAME team will stop by again to refill medications. He would be very difficult to transport to FAME so if it were not for our mobile clinic who wouldn’t be seeing anyone. I’ve explained to his family that we will do our best, but that there will likely be a time when his medications won’t work as well as they have in the past. His wife is very good and thanks us for our visit and trying to help him.

Obtaining a history during our house call

Obtaining a history during our house call

Examining our Parkinson patient

Examining our Parkinson patient

Contemplating a treatment plan

Contemplating a treatment plan

After our clinic we’ve decided to visit the overlook which is a spot on the Great Rift that looks down 2000+ feet into the Great Rift Valley for miles and miles. You can see Mto wa Mbu and Lake Manyara in one direction and the valley floor leading to Lake Natron and Oldoinyo Lengai in the other. It is truly one of the most amazing sights I’ve ever seen and is even more spectacular considering we are standing atop the birthplace of humanity. All Homo sapiens can trace their lineage back to a spot very close. For now though, we are here and marvel at the landscape unfolding before us.

The "Overlook"

The “Overlook”

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Delivering eye patches to our facial palsy patient from the day before

Driving home we met the little boy with Bell’s palsy waiting for us on the road as we had requested. We dropped off eye patches and eye drops to them in the morning and realized we didn’t have any photos of the boy trying to close his eyes. Of course, this was another opportunity for Doug to get his fix of kids and hand out more toys.

Doug in his element!

Doug in his element!

We arrive home just before sunset and will prepare for another day at Upper Kitete tomorrow. We hope to have more patients.

Asante sana (Thank you very much) for everyone’s support.

Mike

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