FAME Neurology Clinic – Day 3 (hump day)

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Having recovered from our incredible dinner the night before at Gibb’s Farm, I arose early to finish my blog regarding the prior days. Posting my blogs has become part obsession and part therapy, but either way it’s an important way for me to share these experiences that would otherwise be so hard to convey after returning to “civilization.” I’ve mastered the transition between cultures without a problem, but the real issue for is trying to relate experiences from one culture to the other. Trying to describe a patient encounter here to someone at home is just very difficult when the other person hasn’t experienced what it’s like here and vice versa. Because of that, it’s much easier for me to describe those events while I’m still here rather than when I return. Hence, my blog.

We began our clinic day with Payal’s nursing lecture on seizure management that was reasonably well attended, but either way we were there to support her. In fact, Christyn served as her epilepsy patient during her patient simulation. There were lots of great questions from the nurses and it’s always tough to tailor recommendations to what’s available here, but she did a great job of it.

Payal giving her seizure management lecture to the nurses

Payal giving her seizure management lecture to the nurses

Christyn doing a seizure patient simulation helping out Payal

Christyn doing a seizure patient simulation helping out Payal

We had another totally swamped day with the same number of patients being seen as Monday. We’ve seen 91 patients in the three days that we’ve been at FAME which is amazing both from the standpoint of what Christyn and Payal have done as well as the fact that all of the patients have been genuine neurology patients so the message was clearly conveyed to the community by William, our outreach coordinator. Payal was working with Dr. Isaac again and Christyn with Sokoine as an interpreter. They were both subjected today to the experience of multiple translators as we had several patients who only spoke Iraqw and needed a family member to translate from Swahili and Payal had a young Maasai woman whose husband didn’t speak Swahili either and they brought a translator with them.

Payal’s Maasai woman presented other obstacles that are often encountered here with the Maasai specifically. The Maasai have traditionally practiced polygamy and the women often do not leave the boma while the men regularly attend the local markets so speak Swahili out of necessity. The patient was having episodes of unresponsiveness that were just about to be interpreted as possible seizures though the history to that point was supplied exclusively by the husband and not until the men were asked to leave the room and a female Maasai interpreter was enlisted was the true story apparent. She was sixteen and had been married at nine. She had been pregnant three times with three children. Her episodes were limited to when she was pregnant and were clearly syncopal and not epileptic. Thankfully the more accurate history was obtained and she avoided a trial of unnecessary medication.

Payal after evaluating two syndromic siblings

Payal after evaluating two syndromic siblings

I sat down for lunch and was immediately summoned to meet with a surgeon that we had met the night before at Gibb’s Farm and I had invited to have a look around FAME. In fact, he brought the entire safari group he was with so I spent about 30 minutes showing off the facilities here at FAME and totally impressing the group. It is hard not to marvel at the medical facility here and what can be accomplished with an idea and lots and lots of energy.

In the afternoon I worked with Christyn and the interesting patients continued. We saw an elderly gentleman with a one year history of generalized weakness and muscle wasting and symptoms of neuropathy. He denied coughing or fever and we decided to check for all the likely suspects including HIV, syphilis, and finally TB. Of course everything was negative other than his sputum for AFB – he had active pulmonary tuberculosis as an explanation for his gradual decline over the last year. Even neurologists can diagnose pulmonary disease.

We also saw a depressed woman who was also complaining of memory loss and decided to check her for syphilis along with thyroid function only to find that she had the former so we had to counseled her on STDs and had to have her come back to be tested for others by the women’s health nurse practitioner.

We again ended up seeing 34 patients today and finished a bit late. We were heading to Daniel Tewa’s home for dinner and wanted to get over there in the daylight, but on arriving home to get the vehicle found that I had a flat tire. It took probably 20 minutes to figure out the jack for the Land Rover as it is one of those hijack models given the height of the vehicle. I finally got the tire changed and we were off to Daniel’s. He is just the amazing individual and always a pleasure to visit. I have visited with him every time I’ve been here and have brought all the residents accompanying me to visit with him as well. We went up to his daughter, Isabella’s home for dinner that was all local Iraqw dishes and were amazing. They are so gracious and remind us over and over again how we honor them by visiting and sharing a meal with them. We fell quite the same, that it is such an honor to spend time with them for despite the struggles often encountered here just to provide for their own family that they bring us into their home and share their evening meal with us. It is a relationship of mutual respect and love and Daniel constantly reminds us that they are our Tanzanian family.

We returned home at 10pm and after such an amazing meal I don’t think we lasted that long before bed.

One more thing. I’ve linked Payal’s blog to mine, but just in case, you should all visit it as well. It’s wonderful and another perspective of this amazing trip:

http://www.lionsdontbite.blogspot.com

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