October 16, 2017 – A day in Qaru….

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Sara and me prior to clinic starting in Qaru

Today we would begin our week of mobile clinics, traveling to villages in the more remote areas of Karatu district to provide neurological care, though most patients could make it to FAME if necessary. Glen was also leaving today, heading back to Botswana for some important meetings there regarding the Botswana-Penn Partnership and future goals for the program. His visit here had been productive and having the support of the Penn Center for Global Health has been essential for the continuation of our program and to determine future directions that will benefit FAME and possibly Penn.

Angel (second from left) triaging patients for us at the beginning of clinic

Whitley evaluating a patient with Emmanuel

It’s always a bit stressful for me when we start the week of mobile clinics as there are a number of logistics that need to be taken care of. Angel will be the point person for this visit, making certain that we have everything we need before we depart since we will always be an hour or more from home and there’s no running back to grab something forgotten. I have been traveling to Kambi ya Simba and Upper Kitete for 6-7 years to do a mobile clinic in those locations and we’ve recently added Qaru to our list of sites. The idea of our mobile clinics is to provide only neurological care to these communities as they have district health offices and clinical officers there who can provide general medical care. The villages are not remote enough that patients cannot get to FAME as we often have them come to get labs checked there after they’ve been on the medication for a month and to assess any possible adverse effects. Most of these patients, though, don’t realize that they have conditions that are treatable which is our main purpose here. There really is very little in neurology more gratifying than treating an epilepsy patient who has been seizing their entire life without ever ave been treated.

Neena and Dr. Anne evaluating a patient

Whitley evaluating an elderly patient with Sara working on her notes

The group we had today for mobile clinic included the three residents, me, Alex, one translator (Emmanuel), one clinician (Dr. Anne), Angel and Selena, our nurse who would be dispensing medications at clinic. We stopped at the tarmac at the end of the FAME road to buy things for lunch and get some bottled water and sodas for the day as we’d need something to drink. Our lunch consisted of lots of pastries – beef samosas, chapatti, vitumbua (fried rice cakes), and mandazi. Our course, most of us opted for the wazungu favorite drink of Fanta Passion. Once outfitted with our food and hydration, we embarked down the main road heading south of town in the direction of Qaru.

Sara and Emmanuel examining a happy little boy with epilepsy and delay

examining an elderly women with back pain and numbness

Qaru is about 45 minutes south of Karatu on the road to Endabash and we had first visited this site last March when it had been very productive with many good patients for us. The road is very good save for long stretches of washboard bumps that are mostly annoying, but can still produce back and next pain. We pass through several other villages that all look quite similar, but we eventually come to Qaru after passing right through it realizing our mistake only a moment later and turning around after we told our Tanzanian friends in the vehicle that we were just checking in on them to make sure they were paying attention.

examining an elderly women with back pain and numbness

examining an elderly women with back pain and numbness

Sara and Emmanuel examining an elderly women with back pain and numbness

The district health center at Qaru is a very nice facility and had room enough for us to run three exam rooms, but the patient load started out slow so we used only two exam rooms for patients. It was very clean and the building we were in was quite separate from the main clinic where the routine medical patients were being seen by their district clinical officer. Most of the patients had been there in the morning, but had gone home since we hadn’t yet arrived and so they slowly filtered back in throughout the day. The volume of patients at our mobile clinics can be quite variable and may depend on the season (e.g. harvest time) or perhaps just what has been going on recently in the village.

Sara examining the little girl with abnormal movements

Sara examining the little girl with abnormal movements

The most interesting patient we saw today was a young child that Sara evaluated. She was seven years old and had definite developmental delays, but she was extremely social and interacted well with us. She was completely unable to walk, though, and had abnormal movements that looked mostly like a combination of both chorea and ataxia. On her examination, she was very hypotonic and was actually unable to stand on her own because she was so floppy in combination with the ataxia and her movements. She would sit on the ground with her legs flexed at the knees and splayed outward, scooting herself along until she found something she could grab onto and try to pull herself up, most often unsuccessfully. She didn’t have convulsive seizures, but she did have interesting sudden tonic extensions of entire body that looked somewhat myoclonic in nature. She was a lovely young girl who with a problem that appeared to be either congenital or genetic, perhaps mitochondrial, and would be something quite unlikely to have any treatment per se, but it would be nice to identify her problem. She had three younger siblings, all of whom were normal neurologically and very loving parents.

Sara and Neena discussing our little girl with the abnormal movements and myoclonic seizures

Patients continued to straggle in throughout the day and we worked until 5pm since we didn’t want to turn away patients as we wouldn’t be coming back and we weren’t confident they would get to FAME if we had asked them to. I believe we saw perhaps 14 patients for the day – not a bad day, but we certainly would have preferred more. We continue to get the word out about our clinics and the Qaru clinic added last visit was somewhat in response to the District Medical Officer having asked if we could go elsewhere in addition to the Mbulumbulu region where we had been going for several years. Our neurology mobile program is one that has been based on bringing the awareness of neurological disease to these remote villages rather than trying to see as many patients as possible.

Selena (sitting furthest) running our pharmacy

A happy crew in the Land Cruiser

The drive home from Qaru had beautiful views of the region south of Karatu and off into the distance. The soft lighting of the evening was in sharp contrast to the strong equatorial sun from earlier in the day. We arrived home before 6pm and had planned to work most of the evening as Neena was doing her presentation on headache the following morning and this required our participation as headache patients. Tomorrow, following the presentation, we would be traveling to Rift Valley Children’s Village for another mobile clinic.

The driver’s view on the road home from Qaru

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