Today was a national holiday in Tanzania – it is the day that Julius Nyerere, the first president and father of the country, died. Tanzania became an independent country only in 1964 and was formed from the union of then Tanganyika and the independent island state of Zanzibar. When Tanzania gained it’s independence, there were eleven college graduates in the country. The current incumbent party has been in power since independence and in just ten days, they will have a national election pitting the current party in power against a coalition of opposition parties. There have been travel warnings to avoid large crowds in cities due to the demonstrations and the chances of being swept up in one, and though we have seen plenty of campaigning around the countryside, it has yet to cause us any issues during our travels. Things will likely become more tense as we get closer to the elections on October 25, so we will have to keep a close watch. We’ve already had to alter our normal schedule and will not be doing the mobile clinics to the villages.
Morning report was at 8:00 am this morning as usual. Dr. Ann and Dr. Gabriel had a very busy night as several victims of a highway robbery had come in during the wee hours and required sutures for wounds they had suffered. This didn’t appear to have anything to do with the upcoming elections, but certainly reinforced why we don’t travel at night on the roads here as something like that would never happen during daylight hours.
A young man had also been admitted overnight that needed our attention in the ward before we started outpatients. He appeared to be more medically ill, but did have an altered mental status so it was decided that he should have a lumbar puncture to rule out and central nervous system infectious process. The is very routine for us so Thu took the opportunity to give Fima some additional instruction in the fine art of performing this procedure and I’m happy to say that it was quite successful. I should give a shout out to Clyde Markowitz back at Penn, and though it pains me to admit it, Thu used Dr. Markowitz’ drawings and instructions to prep Fima and apparently did a wonderful job of it.
Fima performing a lumbar Puncture
The first patient we saw this morning is someone who I have followed for several years after suffering a subcortical infarction and who we have managed with medications since and has done quite well. He is 85-years-old and his two sons continue to take impeccable care of him and it shows in both they attention to him along with how well he continues to do for his age in this country of such difficult health care.
Our elderly stroke patient
Young Glory is a delightful nine year old girl who was sent to us for an evaluation regarding a prior history of stroke. One year ago she had presented to her local pediatrician with severe hypertension and headache. She was sent to Dar es Salaam where she worsened and was found to have a pheochromocytoma in the region of the right adrenal gland, but had also suffered a right temperoparietal hemorrhage and right frontal hemorrhage with associated neurologic deficits. She was transferred to a hospital in India where she spent several months earlier this year, with significant improvement in the majority of her deficits, but unfortunately has been left cortically blind from what appears to have been PRES (posterior reversible encephalopathy syndrome) after reading through the MRI reports from Muhimbili University Hospital in Dar as well as the hospital in India. We explained to her father that it was unlikely, though not impossible, that she would regain any of her sight, but on the other hand, she looked fantastic neurologically given everything she had gone through.
Glory
Naomi is a sweet little soon-to-be seven year old who we’ve seen several times in the past for seizures and was doing very well on the medication we had started 6 months ago while weaning her off of the phenobarbital she had been taking for several years and which was ineffective at the dose she was taking. She had had only a single seizure in the intervening six months and the dose she was taking of the new medication was still relatively low so we were able to increase it without any concern as she was tolerating the medication quite well.
Young Naomi
While we were seeing patients, the epilepsy group (Danielle, Lindsay and Cara) were on a mission to get the EEG machine up and running and to train the dedicated neuro nurse (Patricia) to perform the EEGs after we’ve all left and gone back to the states. Sahewa (FAME’s anesthetist) was nice enough to volunteer his clean shaven head for them to practice on which took several hours and the training is still ongoing. Once up and running, the EEG will enable to better diagnose and treat epilepsy patients.
The Neuro “Peeps” + Fima
EEG instruction
Sahewa volunteering as an EEG patient. Easy electrode placement 😉
We have another full day at FAME tomorrow and then it’s off to Rift Valley Children’s Village which is just it sounds like as opposed to an orphanage. More on that later. For now it’s off to bed with thoughts of another successful day under our belts and several more weeks of the same to look forward to. Everything we do here has a major impact on the health of this rural community that is my second home.