Saturdays are typically very slow as I have mentioned in the past, but today was very, very quiet it seemed as we showed up in our neuro clinic following morning report. It was unclear why, until we were told that it was actually a national holiday, Julius Nyerere Day, and workers all over stayed at home rather than go into work. Nyerere was the first president of Tanzania, their George Washington. He was an amazing man who had been educated in Uganda then England and in 1961, became the countries prime minister, and later after the formation of the United Republic of Tanzania when Tanganyika and Zanzibar united, became the first president. They had very few resources at the time including other qualified college graduates that could help, but they persevered and eventually brought a country consisting of 120 unique tribes, each with their own language and living in their own villages, together for the benefit of all and a means of creating an infrastructure to best serve the country. He is simply known here as “teacher.”
The combination of a Saturday and Julius Nyerere Day, though, decimated our clinic volume and after a very slow start, the clinic remained slow as we moved on towards lunchtime. Sara saw a young woman, actually adolescent, who we had treated in the past for seizures, but had run out of medication and was no longer having seizures, but was now complaining of headaches that were very likely migrainous in nature. It was great that she was no longer having any seizures and we were perfectly comfortable now treating her headaches that would be a much easier proposition. We did make sure that her mother realized, though, that she was not totally out of the woods and to make sure to come back should she have seizures again. Unfortunately, we do not have topiramate (Topamax) here which would be the perfect drug to use in this situation to give us extra insurance as far as covering both the headaches and the seizures.
Whitley evaluating a patient with Emmanuel
Whitley’s highlight of the day was doing a consult on a patient in the ward who had been admitted yesterday with recent onset of psychosis. The patient had remained quite psychotic overnight and the story was much more concerning for a rapidly progressive dementia than anything else. Two daughters were present, but neither of them had been living with her so were not totally aware of the recent history. Whitley had a bit of a handful examining her (the patient was spitting on her caregivers including Whitley), but eventually had gotten enough information to begin a workup. All of her routine dementia labs (RPR, HIV, TSH) were negative or normal so it was decided that she would probably benefit from a lumbar puncture to help direct our future recommendations. An autoimmune encephalitis was certainly in the differential, but trying to evaluate that here would only be less difficult than trying to treat it if that were indeed the diagnosis. None of the therapies other than steroids would really be available here so our inability to confirm such a diagnosis would only be disappointing from an academic purpose.
Neena examining a patient with Baraka’s assisting
Neena saw a patient with primary insomnia as well as another patient with carpal tunnel syndrome and Whitley had a patient with back pain and “numbness,” a common complaint that we see here that isn’t often the more typical neuropathy symptoms that we see back at home. This is usually numbness involving an entire limb or one side of the body in the absence of findings on examination and most often in a patient without much else medically or too young to consider a vascular etiology (i.e. stroke).
We all went to lunch (my favorite, rice and beans) and discussed what we’d do with the afternoon since we had no more patients for the day. Neena decided to stay at the Lilac Café (excellent internet) to work on her presentation for Tuesday morning while the rest of us went downtown to get phone cards to recharge our internet and also to walk around town a little bit. Glen ended up buying ingredients to make a nice cucumber and salsa for dinner tomorrow night and I purchased a shovel for the Land Cruiser that I wish we had had last March when we were stuck down in the Southern Serengeti deep in the mud with numerous other vehicles and it took us half the day to get ourselves out.
Sara evaluating a seizure patient with Emmanuel
For dinner, we had made plans to go to the Plantation Lodge, another of the great traditional lodges here in Tanzania. We made it there around sunset and it was again an absolutely gorgeous evening so we all sat on the outside patio to have drinks. They had provided a table full of appetizers for us so when Neena, Whitley and Sara disappeared, it didn’t take a detective to figure out where they had gone for the moment. They eventually made it back to our table so we all ordered drinks, including my Moscow Mule, and relaxed in the amazing glow of sunset and the sounds of the Ngorongoro Highlands quite close reminding us that we were all definitely in paradise. There was no rush to get to our table for dinner as we were only one of two parties there that night, the other being the owner of the lodge with some of her guests from Germany. Dinner was a delicious meal with tasty beef filets as the main course along with vegetables while dessert was an ice cream creation that we all quickly devoured.
We arrived home much later than we normally do for a dinner which was significant as we were all getting up quite early to head to Tarangire National Park for a safari. The park opens at 6:30am and is about an hour and a half away so we all decided on leaving at 5:30am in the dark so we’d have an early start on the animals. So it was off to bed for everyone with a very early awakening and the hope that we’d have hot water that early in the morning. Our water heaters are wood burning “kuni” boilers that the askari (Maasai watchman/guards) fire up morning early, but we weren’t sure just how early that meant.