The lightening and thunder began well in advanceb and the rain started around bedtime, but it was a light rain that fell slowly throughout the night. It was enough of a rain, though, that I decided to have Ema drive for me as the roads can become very treacherous here this time of year and there is no automobile club to come to the rescue. Four years ago my Land Rover slid off the road on the way to clinic and that memory remains fresh in my brain. Much of life here revolves around the weather – travel is clearly dependent on whether the roads are passable and volume at our clinics will depend on whether patients can get there by walking or vehicle. Planting and harvesting are also times that will cause our clinic volume to be low.
On Tuesdays we have a doctors lecture and it was decided that Jess would do a lecture on dizziness, which is always a frustrating subject for neurologists. It is not that the dizzy patient is complicated, but rather that there is really no specific definition for “dizzy” so the group of patients is very heterogeneous. There are patients that are lightheaded, weak, vertiginous (spinning), or fuzzy headed. The first job is to determine what they are complaining about. Jess covered primarily the neurologic causes of vertigo and how to break them down into central (brain) or peripheral (inner ear and nerve) causes. She did an excellent job for the doctors and gave them a good algorithm to cover the dizzy patient.
After her lecture was morning report and then we left for mobile clinic. The drive to Kambi ya Simba for our second day of clinic there was uneventful, but the rains likely have kept some patients away. We ended up seeing only about seven or eight patients that day which is far lower than our average that we have seen there in the past. It’s always a bit of a dilemma as to whether it is worth our while to travel that distance for so few patients, but we never know how many will show and the patients that are seen are often returns. By traveling to the villages, though, people become aware of what FAME has to offer and it is certainly possible for them to get there if needed.
Our first patient of the day was a woman who first described two episodes of prolonged loss of consciousness, but it was readily apparent that she was depressed and the episodes weren’t seizures. She had actually had the episodes for some time and had been depressed. Her care was a bit tricky for a number reasons and in the end we placed her on fluoxetine, which is available here, but with the proviso that she come to FAME in two weeks to check in and make sure she was doing well.
Our other patients were afflicted with the more common disorders including one gentleman who had had a stroke in the distant pass and had been placed on aspirin in the past, but was no longer taking it as he had run of the supply given to him. His blood pressure was also very high and he wasn’t on any antihypertensive medications. We placed him on the aspirin, but asked him to come to FAME for further testing of his cholesterol and kidney function before starting him on any medications. We don’t have access to these tests in the field here. Both Jess and Jackie stayed busy seeing the patients with Dr. Anne and Sokoine, but we finished early and left for home.
Arriving back to Karatu during the afternoon is always a treat as it gives us time to explore the town a bit. Both Jess and Jackie had been interested in having a dress made from their lovely conga cloth here so after dropping everyone else off in town, I took them to the tailors shop that I have gone for the last several years. Nick and I walked to the vegetable market while Anne helped the girls describe what dress and skirt styles they wanted. They found some wonderful cloth to use for the clothing and their dresses will be very inexpensive and custom made.
It was home early for dinner and we all spent time chatting before an early bedtime after a long day and tiring day.