March 17, 2017 – A more routine day of neurology…


Having arrived in the middle of the night after their incredible adventure of the day before, it was somewhat amazing that Glen was up bright and early with us this morning to head for our educational conference that Chris had been asked to give. He had prepared a lecture on stroke, a topic we have done a number of times before, but between new staff and the fact that this is a topic that can not be reinforced too often, we were happy to include it in our schedule. Unfortunately, there had been a miscommunication and when we walked into the conference room and saw all of the nurses there along with the doctors, we quickly discovered that had been an important nurse/doctor conference to smooth over an issue that had come up. It was 7:30am, when we’re typically having breakfast and preparing for the day and we were now all dressed up with no where to go. We walked to Lilac Cafe to get coffee and found, much to our dismay, that they were closed. So we waited around for morning report while the other meeting when on and on until much past when morning report and rounds should have started.

Cliff and Renata interpreting for Chris, Glen looking on

We were eventually able to organize our team so we could get started seeing patients and we found Renata there with one of her teachers. I received a text from her grandfather at the same time informing me that one of Renata’s teachers wanted to be seen by us and had requested Renata to accompany her to FAME. Before that, though, we had a gentleman to see who I’ve followed now for several years and continues to do well on his medications, but did have a few complaints that he wanted to discuss with us. After that we got to work on Renata’s teacher, though I explained to her that it was not appropriate for her to help us or be in the room when her teacher was being seen. This was tough, I think, for Renata to really understand since she so wanted to have her teacher see her working with us, but it was just not something that was possible, or appropriate for that matter.

Chris evaluating the gentleman who had a stroke one week ago

Chris saw a gentleman in the morning who was having significant difficulty with slurred speech and who had actually been seen at FAME the week prior when we had been there, though we hadn’t been asked to see him for some strange reason. His symptoms had begun the week prior rather acutely and after a brief discussion it was readily apparent that he had likely had a brainstem or posterior fossa stroke explaining his symptoms. There was very little we had to offer him at the present time, nor could we really have done anything a week prior had he come to see us immediately, after the incident. We could, on the other had, check his secondary stroke risk factors and treat those accordingly with agents designed to reduce blood pressure, reduce his LDL and, lastly to begin low dose aspirin (75 mg here rather than the 81 mg we’re all familiar with in the US). None of these had really been done before and he had been diagnosed with a TIA, or transient ischemic attack so it is obvious that we really need to reinforce these strategies and Chris will do so next Tuesday when he gives his talk.

Jamie evaluating a patient with numerous somatic complaints

Nan had asked the mother of the child we had seen on Wednesday and who we believe to have some genetic syndrome to come back with the father of the child so she could evaluate both parents. They came in Friday after lunch and she went over both of them thoroughly, with no findings to suggest that they were also affected and sometime later she heard from her resource at CHOP that the child’s morphology was non-specific, and that though he could be worked up with genetic studies were he in the US, it would be very unlikely that any of these would ever lead to any specific treatment for his condition. So once again, we run into a dead end making a specific diagnosis, yet our hope is that we can at least give patients and family some information that will prevent them from continually searching for a cure for conditions such as this where none exists, not here and not at home.

A young Maasai epilepsy patient and his mother

We needed some groceries for the house so Glen and I decided to run downtown during a lull to visit the “supermarket,” which are stores here that for the most part are perhaps ten feet wide and fifteen feet deep with shelves packed with everything you could possibly ever need (not really, but they have lots of “stuff”). We weren’t gone long, but on our return, Chris informed me that he had seen a patient who he felt could benefit from occipital nerve blocks and that she had received them previously from us with some benefit, but that the pain had returned. Luckily, I still have supplies here to provide these blocks which are so often effective for patients who complain of headaches that radiate from their occipital region forward over their head to their eyes. Chris hadn’t wanted to proceed without me being there, though to be honest, he is more than knowledgeable about when to do these and had he gone ahead it would have been perfectly fine. We went ahead and provided her with bilateral blocks and hopefully she will get some much needed relief from this.

Mom with her young patient in who we have concerns about a genetic disorder

Chris performing an occipital nerve block

Also, lunch for us was very late today as we had plenty of patients in the morning, so we all ran down to the Lilac Cafe, which the residents had been wanting to do since we’ve been here. The Lilac is a small cafe on the grounds of FAME that serves meals throughout the day, but also provides all of the food for the hospital patients as it was realized that something like this would be necessary once the wards had opened. Their food is good and necessary diversion at times from the food at the cantina that we eat for lunch every day which is rice and beans, rice and beans, more rice and beans with some ugali and pilau interspersed. Frankly, the rice and beans with greens that we eat each day is perhaps my favorite all time lunch regardless of where I am. The main issue with the Lilac, though, is that it may take close to an hour for your food to be served which can be an issue if you’re on a tight schedule. Luckily, this is Africa, which is what we tell each other multiple times a day and on many levels. Time is superfluous here and you accomplish what you accomplish in whatever time is necessary to do so. Having eaten lunch so late, we postponed our dinner back at the house and, instead, relaxed outside on our veranda to watch the sunset and share stories among friends which is what we do here. Life here moves at a different pace and one that is much more conducive to wellbeing and happiness. We are all grateful for that.

Sunset on the ridge overlooking our house

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