Danielle and I were heading to Arusha today as I had planned to take her to the airport tonight for her trip home and we had wanted to see Leonard’s kids and Pendo again before we left. Danielle was scheduled to give another lecture this morning on medications for epilepsy which was from 8-9 am and Dr. Frank had asked her (or perhaps guilted her) to see a women with severe headaches and a significant pyschosocial history requiring some finesse that Danielle could certainly provide. She was taking care of that issue when Jacob asked if I could possibly see a patient that had come the day prior when I was on mobile and had come back to see me.
This is an excellent example of the local health care and why it is so necessary to do what we’re doing here. The patient was a 40ish year-old gentleman who three weeks prior had been found down with no apparent witnesses and was unconscious with blood coming from his nose and ears. Anyone worth their weight would immediately tell you that you need to rule out a basilar skull fracture with that history all. Here, though, he was admitted to the outside local hospital where he woke up after 16 hours with a severe headache for which they gave him paracetamol (tylenol) for pain and discharged him after 3 days. He still wasn’t right after two days and his family brought him back to the local hospital where he was admitted for three days again and discharged. They finally brought him to us and I sent him for a CT scan in Arusha (not everyone can afford that) and contacted Sean Grady at Penn who is chairman of neurosugery and a good friend. Sean got back to me within hours with a recommendation and hopefully I’ll see the patient back before I leave or Doug will take care of it after I’m gone. Chances are he won’t need anything done, but it was very risky not to have imaged him earlier on. The fact that he hasn’t deteriorated in the three weeks is a good sign and he may be lucky.
Danielle finished with her case about the same time and then it was lots of good byes for her, a final cup of chai masala (the absolutely wonderful tea they make here with all different spices and sugar and the bees love as much as we do so we often have to fight them for it!) and we hit the road for Arusha. It is a wonderful countryside with Masai bomas scattered throughout and a small (very small) town here and there. Coming into Arusha is the going to the big city with traffic, pollution and commotion, but it has it’s own character. It is real and authentic and everyone is out living their daily lives. The streets are full of people walking from place to place, doing business and it is very lively. I’ve included some photos courtesy of Danielle since I was driving 😉
We did a few quick errands and then went to visit Pendo and the boys. Lennox and Lee are now five and eight and I have known them for four years. They have transformed into fine young gentlemen and it is so great to see them every visit. Visiting a Tanzanian home isn’t an easy task here as it almost always entails a meal otherwise it would be interpreted as rude by the host. Pendo hadn’t expected us as she thought we coming the following day (a miscommunication thanks to Leonard who was away guiding a safari). Pendo said she’d put something “quick” together for us before we left for the airport and what was to be a simple meal turned into a delicious lunch of salad, grilled chicken and grilled vegetables that took them nearly two hours to prepare. That left us more time to visit with the kids but unfortunately less time to eat and even less time to get to the airport. We made it there in time, but Danielle was last in line to check in for her flight to Amsterdam.
Since I was staying in Arusha that night (it is not very safe to drive at night here because of animals and crazy drivers) and leaving the next more back to FAME I anticipated the same issue with breakfast so I texted the clinic and told not to expect me until noon for patients. I had a very nice breakfast of eggs, toast and jam, and fresh cut fruit and then had to say my goodbyes. I would not be seeing Pendo and the boys again until March and these partings get more difficult every year. Pendo is also pregnant, due in early February so there will be a new one the next time I am here.
I arrived back in Karatu and to FAME a little after noon and had patients waiting for me so it was right to work. The first gentleman spoke very good English so I didn’t need an interpreter and he gave an amazing history. He had been through University and subsequent certification, but told me he had a difficult time concentrating since he was in high school and that he had always had tremendous energy, but would go through periods of depression as well. 20 years ago a doctor had put him on amitriptyline at low doses as he couldn’t sleep and he has been taking it ever since. He had never been diagnosed by anyone here and clearly had bipolar disorder and unfortunately his marriage had failed due to not being treated for this. He was very hypomanic in the office and told him I could treat him with either of two medications, one of which I had brought, lamotrigine (though it is also available here in Tanzania). He was worried about the cost of the medication which would be about 25 to 50 cents a day (quite a bit for a Tanzanian budget for a month and on a long term basis), but I was able to give him two months of it now to see if it would work and we would go from there. I am very hopeful that this will change his life for the better. Also of note, when I asked about siblings and parents it is likely that his father and several siblings also have similar problems.
I saw an elderly women with myelopathy (spinal cord disease) probably from vitamin B12 deficiency who we will medicate and hopefully make better. I saw several other patients with more typical problems and my final patient of the day was a women coming to see me with headache, sore and swollen throat and neuropathy symptoms of a little over one year duration. Thankfully, Dr. Gabriel was with me as the women had a swollen tongue with a friable lesion on it and huge, firm lymph nodes on both sides of her neck. She most likely has a malignancy and will be getting a fine needle aspirate of one of her nodes on Tuesday (the lab is not set up here yet to do tissue biopsies though hopefully soon).
I worked only the afternoon, but it was another wonderfully successful day of patients and teaching (Gabriel was fascinated with the exam of the women with the myelopathy) and I only have a few more left. It’s always a bit easier for me to leave as I know I’ll be back in six months and again after that.
We’re going on safari to Lake Manyara tomorrow, Sunday, and everyone always looks forward to that.