Wednesday, October 3, 2018 – Another neurology visit to FAME…

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The “first day of school” obligatory photo. On our way to clinic

I think we all slept well given our recent transcontinental flights and long overnight layover in Nairobi only several days prior. We were all still recovering from the stress of the trip and the missing baggage and the fact that none of us had gotten any sleep while in Nairobi. We were all quite sleep-deprived and certainly in dire need a good night’s sleep. The weather was quite cool the night before and remained that way in the morning as we were all getting ready for the first day of our fall neurology clinic for this year. It was overcast, but still amazingly beautiful outside as we walked the path towards the hospital and morning report that would begin at 8 am sharp. During my first years here, there was no inpatient hospital and therefore, no morning report. In fact, the compound was empty other than the volunteers as there was no overnight shift necessary without the inpatient hospital. I would arrive early to clinic in the old days and it was some time before other employees would arrive.

Morning report on our first morning

The Neuro team

We met for report to hear about any overnight events of interest concerning the inpatients along with any necessary updates for us such as patients they may want us to see in consultation. Since this was our first day here, I did take a moment to introduce everyone in our group that not only included the residents, but also our infectious disease expert, Steve Gluckman, and our medical student, Peter Schwab. Steve is an incredibly experienced and capable global health physician who has traveled widely and is responsible for the Botswana-UPenn Partnership that has been in existence for nearly fifteen years with countless students and physicians from Penn having worked there and eventually created a medical school in Botswana where none existed before. We are incredibly fortunate to have him here with us and at FAME as he will be a wonderful resource for the Tanzanian doctors and us alike. I am so excited that he was able to make the trip and am hopeful that this will open the door to other specialties from Penn to assist FAME with their mission.

A patient enjoying Amisha’s evaluation

Amisha and Dr. Anne evaluating a patient

Today’s clinic was planned to be a bit less hectic than our announced clinics are and was primarily filled with patients who Angel, our coordinator, had called to come in today. Amazingly, she had contacted fifteen patients and twelve of them had showed as it is not always a simple thing getting here for most patients. Some come from a long distance and other things in their lives that can’t be postponed may not allow them to come. In the past, during the national elections, people were worried about leaving their homes to travel here and so the clinic was very slow on those occasions. Our clinic in March is also somewhat slower (only fractionally) as it is harvest time meaning that everyone is working in the fields and can’t come. It is wetter then as well and the roads are often difficult to pass on making it tough for patients and their families to come. The weather today was overcast in the morning, but became clear and beautiful during the day so there were no impediments from that standpoint that keep people from making it here.

Lindsay evaluating a patient

Hannah and Shaban examining a patient

The neurology clinic works out of the emergency room area that is across from the outpatient clinic which gives us our own waiting area for patients which has been very helpful in managing patient flow for often busy clinics. We see patients in the doctor’s night office, the emergency room and the hallway in between which gives us our three stations to see patients. We work with one clinician, and two translators and this visit we have been lucky enough to have a fourth-year medical student from Muhimbili University who is on holiday decide to spend his time with us and help us with the translation duties. Shaban is the son of the head of housekeeping here at FAME and I hadn’t met him before, but it was quickly clear to all of us that he is a very capable student interested in learning from us and we’re all very excited to have him with us. Our goal here is to work with as many clinicians as possible and though it would be amazing for us to have three from FAME, it would be impossible for that to happen as they are needed for all of the other duties here (outpatient clinic, ward, surgeries). Though it certainly benefits FAME by having us train them in neurology, the resources just do not allow for that many clinicians to be taken out of their daily routine when we are here. I am hopeful that in the future we will be able to fund a portion of a clinicians cost so that we would have a dedicated person to train that would theoretically not leave FAME with one less clinician. This has been a work in progress and that will come.

Lindsay and Richard evaluating a patient

Dr. Anne, Peter and Amisha evaluating a patient

Perhaps the most exciting event of the day for me was to see Amisha when it became clear that she would have children to see. Of course, it is obvious that she loves taking care of children as she is not only a very qualified pediatrician having practiced before she went back to residency to become a pediatric neurologist, but there is something about the children here that is so endearing and can be overwhelming at times. Though there can be so many issues that one has to be careful of here when it comes to our relationships, I am certain that this feeling is not inappropriate in any manner. It comes from the totally genuine sense of no expectation by anyone and the fact that we are grateful to be here and they are equally grateful to have us here. Children everywhere are so unassuming and unaffected, but those here are perhaps even more so. They are truly disarming and their smiles could easily melt an entire iceberg in the blink of an eye. I think we all wish we were pediatricians here.

Dr. Anne, Peter and Amisha evaluating a patient

Amisha saw several children with episodes of unresponsiveness that were quite interesting. There was a two-year old who was having recurrent episodes of lethargy that we felt were clearly epileptic in nature and was started on carbamazepine. There was also a nine-year old with episodes of loss of consciousness that had been felt by others to possibly have been seizures but we felt were consistent and were most likely syncopal episodes. We obtained an EKG and recommended that she be followed over time. We had several patients with prior episodes of stroke that were most likely small vessel in nature, one of them with a thalamic pain syndrome. And, of course, we had our several cases of psychiatric disease, one with schizophrenia who we had seen before and was well controlled.

Peter entering information into our data base in the afternoon

Overall, it ended up being a slow patient day for us which was totally fine as the residents were getting their bearings. We came back to our house early and it was a beautiful day for everyone to relax and, for those so inclined, to go out for a run on the local roads. It was also our night to go out to Happy Day, the local pub where all of the ex-pats and volunteers meet weekly to socialize and compare stories.

Dr. Anne, John, LIndsay and Amisha enjoying a free moment

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