The day started rather uneventfully, but quickly escalated into more a typical day here. Payal had gone to the ward to evaluate Grace, the young patient with leukemia, and found that her headache was worse. Given her leukopenic state on chemotherapy she was a set up for an opportunistic infection or worsening of her leukemia as an explanation for her headache. Payal spoke with the patient’s oncologist at Muhimbili University in Dar and they agreed that she needed an LP as soon as possible and that we couldn’t do it here. She needed to transported to Dar so we contacted Flying Doctors to hopefully arrange a flight if they had a plane available. The cost was still an issue hence my plea for donations in an earlier blog.
There was also another young child in the ward who had been very sick with sepsis and an altered mental status as well as a history for epilepsy and concern about non-convulsive status epilepticus. Between young Grace and the other patient, Payal didn’t feel comfortable leaving FAME for our second day of mobile clinic and we all decided that she could stay here to tend to the two patients and Christyn and I would go an tackle Kambi ya Simba for the second day. Prior to our leaving for clinic, arrangements were made to fly Grace to Dar and Payal would help take her down to the Manyara Airpot about 20 minutes away. I told Payal not to let them take her to Dar with Grace as it was likely she’d get stuck in Dar overnight and we needed her for clinic the following day. Sure enough, I heard later that Payal almost ended up accompanying Grace, but instead Hannah went on the flight. It was a very small plane and quite windy so it wasn’t a nice flight and, as predicted, Hannah ended up spending the night in Dar and didn’t eventually get back to FAME until the 2:30 p.m. the following day.
Meanwhile, it was quite slow at Kambi ya Simba, Christyn and I evaluated a six month old child with increasing head circumference and abnormal eye movements. Not a very good sign and quite concerning. He had been born at full term following a normal pregnancy and the family had noticed that the child’s head was beginning to increase in circumference at about one month of age, but hadn’t taken him anywhere to be evaluated yet. He was still feeding normally, but as the head grew his eye movements were becoming abnormal. The child’s head was far too large for him to hold it up now and he had a bulging fontanelle as well as abnormal eye movements suggesting that he had increased intracranial pressure and was in rather desperate need of a VP shunt.
Luckily, there is a funded program in Arusha (Pediatric Surgery Neuro Project) that we could refer him to. That would cover the cost of the surgery, but they would need to have money not only to travel to Arusha, but also for them to stay there for at least a week. William is the one who arranges for these matters and we were able to come up with around 100,000 TSh (about $67 USD) that would cover the cost for them and we urged mom to take the child the following day. It’s very difficult to get follow up often, but I’m sure that William will check back on them shortly.
We returned from Kambi ya Simba early this day and got back to clinic in time for us to some other work and catch up with Payal on Grace’s story as well as another patient on the ward that she was seeing. We had planned to all go out to a local bar that night for barbecued chicken and chips (fries). The bar is called “Carnivore” so it obviously something that didn’t appeal to Payal so she spent the night in. There was a large group of volunteers, nurses and doctors from FAME there that night and it was great to spend time out together. I can’t comment enough on the closeness of the FAME staff including the volunteers, but it’s not surprising given the amazing warmth of the Tanzanians and their always welcoming nature. It’s why I keep coming back over and over again.