So we left off with Payal on her way back from Arusha after escorting an infant with Meningitis there for care. Meanwhile, we had to get back up to Rift Valley Children’s Village for day two of our neurology clinic so I drove everyone up in my vehicle and we left a driver and vehicle back at FAME to bring Payal after she arrived. It turns out that she came home with the patient and parents as they didn’t want to stay in Arusha for treatment and rather chose to come to FAME. Not surprising as you shall see.

The rest of the story was that Payal, her patient and their parents (who are friends of Rift Valley FAME) were met with a experience at the top hospital in Arusha of total frustration. After receiving antibiotics at FAME, the baby improved on their way to Arusha, but her story was still quite scary for meningitis and because of her focal examination we were unable to do a spinal tap safely without first obtaining an imaging study. Hence, the need for the CT scan. After running a gauntlet in registration after arriving at the hospital and being told that the CT scanner would not be available again until Monday morning (it was Friday night) except for emergencies and the only way for that to happen would be them to be seen by the on call pediatrician, but no one was available until Monday. They were finally directed to the emergency room where they were met by a rude and insulting doctor on call who later turned out to be an intern. He wasn’t interested in listening to Payal one bit and told them he wasn’t going to order a CT scan for the baby. Payal was obviously incredibly angry with the doctor who ended up throwing the chart in the air and walking away. They were then essentially kicked out of the emergency room which is when they called me and I, in turn, called Frank who subsequently called the head of the hospital who I’m sure was totally mortified over the situation.

Shortly thereafter, they were escorted back into the hospital and told that the CT tech was on their in to the hospital. The baby ended up getting a contrasted CT (with way more contrast then she needed so thank goodness her kidneys are functioning fine) that was abnormal in that it showed evidence of meningeal inflammation or meningitis. They offered to admit her to the hospital, but neither Payal nor her parents had any faith whatsoever in the hospital at that point and they took her to their home in Arusha with IV intact and brought her to FAME this morning.

Had the child’s family not had connections with FAME and RVCV it is very clear what would have happened. It’s doubtful she would have ever been assessed by anyone who would have recognized the problem and far less likely that she would have been referred to a hospital for a CT scan. Whether should would have received the proper antibiotics is quite unlikely. Even if her family had taken her to the hospital on their own they would have run into the same reception at the hospital and the child would have died due to the lack of access of competent medical care. Solely because of Payal’s persistence in the matter and recognizing what needed to be done and sticking to her guns, the child ended up with the appropriate treatment and is alive today. I have known her father for several years and he is the most unassuming, gentle and giving man you could ever meet. He is greatly troubled by this experience, knowing that had he been a regular Tanzanian his child would very likely be dead. These are the issues we wrestle with every day here.

Payal returned to RVCV before noon which was a good thing considering our list of patients somehow kept growing throughout the day. Payal saw the children for the most part and Christyn saw the adults while I bounced between both rooms. Try not to believe Christyn if she tells you that I occasionally dozed while she was taking a history – she will confirm, though, that I was awake for any necessary decision making 😉 We amazingly made it through everyone there to be seen though had to let the regular FAME clinic staff leave before us as it was late.

Back at FAME we thought we’d relax for the evening, but Payal had to check on her patient and we had a gentleman admitted to the ward earlier in the day for tremor and ataxia. I had seen him a few years earlier and converted him to Dilantin and without boring everyone with the details, his Dilantin dose had been significantly increased in January after an admission. Hopefully all the neurologists reading this got the answer as quickly as Christyn and I did – Dilantin toxicity. His Dilantin is now discontinued and he is on levetiracetam! We made it home in time for grilled cheese sandwiches, tomatoes, avocados and left over fruit from Payal’s missed dinner the night before. It was glorious!

Such are the stories and experiences here that we encounter everyday. Tomorrow (Sunday) is our day of rest – don’t forget we are only neurologists – and we’ll be off on safari to Lake Manyara for the day. Look forward to sharing that with you.