Thursday, September 25, 2014 – Mobile Clinic in Upper Kitete

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Awakened to a somewhat cool morning for our walk. No matter, it is still breathtaking here even with the breeze and the views of the Ngorongoro Highlands are as lovely as ever. We usually try to do a 2.5 to 3.5 mile brisk walk in the morning which takes us about 45 minutes to an hour. We start at 6:30 am which is sunrise here. I should also mention that in Swahili time that would be 12:30 as they use 6 am as 12 and 7 am as 1. Most of the signs here are in both Western and Swahili time. That’s because on the equator the sun usually rises and sets around the same time all year and life is much simpler.

We learned yesterday that a young Maasai boy with cutaneous anthrax was admitted and on rounds Doug spent some time examining him. Cutaneous anthrax, though uncommon, is not rare here and it’s the third case I’ve seen since working at FAME. It is contracted by eating an animal that has been dead for some time and laying on the ground where the anthrax spores become an issue. This boy has it inside his mouth and his lower jaw and neck are quite swollen. It is very treatable with antibiotics but has to be done early and his airway will be closely monitored.

Doug evaluating suspected cutaneous anthrax patient

Doug evaluating suspected cutaneous anthrax patient

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Lesion on the lower alveolar surface

Lesion on the lower alveolar surface

We needed to leave earlier today to reach Upper Kitete which is a good 1-1/2 hours away and we didn’t want to arrive after lunch. The drive is very bumpy and there are always great sights such as Land Cruisers packed to overflow and then some or today where a bus couldn’t make it up the hill fully loaded so that most of the passengers had to get out and walk it first before the bus could follow. On arrival to Upper Kitete they are having their well-baby checkups for the government dispensary so we are surrounded by dozens of the cutest kids you can imagine all there to be weighed on the hanging scale. We had to wait until most of the clinic was finished before we could start, but it was a great picture of the local community to see all the children and moms.

Waiting room at Upper Kitete

Waiting room at Upper Kitete

Dr. Isaac helping out with baby weights for well-baby clinic

Dr. Isaac helping out with baby weights for well-baby clinic

Our very first patient was a woman who was accompanied by her husband and the complaint was that she was having episodes of unresponsiveness. It’s always quite difficult to sort out patients with non-epileptic events (what we used to call pseudo-seizures) as it often relies tremendously on having the patient come into the hospital for a prolonged video EEG during which we hopefully record an event that doesn’t have epileptic activity on the EEG. We don’t have EEG here yet, though that is one of our next projects and something Danielle is working on. The next best thing, though, is for them to have one of their typical events right in front of us and that’s just what this patient did. Several minutes into her visit while obtaining the history from she and her husband, she looked slightly agitated, stood up and promptly dropped to the ground (with the assistance of Doug and Isaac, of course). We put her on the bed and her eyes were fluttering and she had no convulsive movements and minutes later awakened. The tough part then is to begin a thorough history looking for clues as to why she’s subconsciously doing this – usually stress with a spouse, sexual abuse, etc., etc. Not the easiest history to obtain. Despite Doug and Danielle’s best efforts, though, we weren’t able to come up with anything. They were educated that these aren’t seizures and may be related to stress and hopefully some insight for them may help.

Patient with non-epileptic events moments prior to having an episode

Patient with non-epileptic events moments prior to having an episode

Danielle had her compliment of seizure patients today with a mother with very typical JME (juvenile myoclonic epilepsy) who had been having seizures her whole life and a her little girl with seizures very likely also JME but too early to diagnose. It is a autosomal dominant gene so typically runs in families like this. Danielle placed her on levetiracitam (available only because we bring large quantities of it with us) as she’s still planning on having more children. This will hopefully change her life and also give her daughter a good chance of seizure control (her daughter was on phenobarb and doing well).

Our incredible outreach coordinator, William, screening a new neurology patient

Our incredible outreach coordinator, William, screening a new neurology patient

I saw three women with very typical migraine and two of them with medication overuse headaches causing them to have daily headaches. The selection of medications to control their headaches was different in each based on factors such as still wishing to have children, frequency of migraine, etc. which is exactly how we do it at home. We have some medications that we brought with us (such as sumitriptan or Imitrex), but mostly it is medications available here that we can use which is always the best.

Patient waiting to be seen at Upper Kitete

Patients waiting to be seen at Upper Kitete

We didn’t get home until after 6 pm (sunset) and Frank and Susan had a wonderful get together for everyone last night at their place as Danielle is leaving tomorrow (Friday). It’s so rewarding to see all the volunteers together along with the others who really make this place run. Ultimately, though, it will be the Tanzanians themselves who will provide the link to the future and that is the goal.

Lala salama,

Mike

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