NOTE: I do apologize for the seemingly long delay in getting these blogs posted. After our long days of work in addition to a few added issues (sorry, you’ll have to read the blogs), it is often difficult to sit at the computer and type at night.
After another successful game viewing drive at Tarangire, it was time to get back to neurology, but only for a half day clinic as I had scheduled this afternoon for a wellness day for the residents. Wellness days and wellness in general is a very hot topic as far as training programs are considered, not only for the residents, but also for faculty and other physicians alike. My only argument was really that this entire month is really like one big wellness day, but that wasn’t good enough and so today we would be working only a half day so that the afternoon would be free for the residents to do what they wished. I made several suggestions, but the one that always seems to win out is to go to Gibb’s Farm for their buffet lunch that is not to be missed. So, I decided once again to take one for the team and accompany the group for one of the best meals of our trip. First though, we would be working for the morning and trying to finish by around 1 pm for lunch.
Morning report had some interesting discussions with one of the main ones being about antibiotic use and specifically giving children ampicillin and gentamicin for community-acquired pneumonia where it was argued that gentamicin did not add anything in that situation and was a potentially toxic medication. Now mind you, I had very little input in this discussion considering this is the furthest thing from my practice, but both Amisha and Steve weighed in heavily with their knowledge on the subject. Apparently, this is something that the Tanzanian Health Ministry has also placed a special interest in and is following what it believes to be the WHO recommendations on the matter. Dr. Msuya agreed with their argument and said that he had actually questioned the health ministry on the issue, but had never heard anything back from them and since this was essentially a directive, they would follow it until it was changed or rewritten in some way.
We did here about an interesting patient who had come in on Sunday – a man was attacked by a leopard in Ngorongoro Conservation Area and had suffered a compound fracture of the tibia in addition to a very severe injury of his hand most likely suffered in trying to defend himself. Leopards do not usually attack humans so there was some concern as to whether the leopard could have been rabid, but regardless, they were planning to track it and to kill it. Animals such as this, whether rabid or not, are often very likely to repeat the attacks once it becomes a pattern of theirs. His tibia fracture was significant enough that he was transferred to an orthopedic hospital in Moshi the following day. A few years ago, we had stumbled upon a leopard on the Ngorongoro Crater rim road while driving early one morning to go for a hike at another crater. The leopard had jumped into the road, looked at us and then just sauntered off to the side of the road where he sat for several minutes allowing us to take photos of him. As we drove on, we encountered a park ranger around the next bend, walking with a rifle, thankfully, and informed him of the leopard. Most often, though, these animals are far more afraid of us than we are of them.
Planning for half a day in clinic is always a bit of a crapshoot. I learned long ago that once you start, the work seems to accumulate and fill in whatever the amount of daylight hours there are. When we work a normal full day in clinic, I usually choose a patient number that is less than what we can actually do as I know patients will continue to come and somehow, I will be talked into seeing them. The other problem was that we wouldn’t be at FAME for the next three days as these were our mobile clinics off in the villages so we couldn’t tell people to just come back the following day. There are many patients who have we have been seeing for several years and when they come after we’ve already capped the clinic, it’s hard for me to turn them away. There are no appointments for patients, though we will sometimes see patients with a hardship of some sort over in the OPD so as not to create a huge stir over on our side which is what will happen if were to see patients out of order. It will happen occasionally when we have a pediatric patient as we try to have Amisha see all of those (to keep her happy) if possible.
At one point, Hannah needed to repair her glasses so I sent her to Frank as I knew for certain that he would have at least a dozen tubes in his office. Sure enough, he had more, and Hannah returned to successfully repair her glasses. At the end of clinic, she had to run to the OPD for something so set her glasses on a chair with her charts. Shortly thereafter, we heard John asking whose glasses they were and, sure enough, he had picked them up and promptly glued two of his fingers together. He pulled them apart somewhat painfully and much to our amusement, after which we learned from Hannah that the enzymes in saliva will dissolve the superglue and in a far less painful manner.
We were actually able to get through all of our patient, though with little time to spare, and after collecting everyone in Turtle, we were on our way again to Gibb’s Farm, this time for their scrumptious buffet lunch. Now, if by wellness, we’re talking about mental health, this was certainly the solution. If by wellness, though, we’re talking about physical health, that’s another matter. That’s not to say that the food that is being served isn’t healthy because it absolutely is, but rather it is related to the amount that most of us eat. I won’t name names, and it didn’t occur this trip (Lindsay, Hannah, Amisha, Steve and Peter – I wouldn’t rat you out even if it did involve you, but it didn’t), but in the past, lunch goers have been noted to have three plates of food not including desert! It would be impossible to name all of the dishes, but leave it to say there were probably a dozen variations on vegetable salads, cold cuts, main dishes, a lovely cauliflower soup, cheeses, breads, samosas, quiche and various toppings. The desert selections included fruit, pancetta, a flan-like dish and a date cake. And oh, yes, it also included the famous Gibb’s Farm fresh-brewed coffee. It was truly a lovely and relaxing affair that included the seven of us and Kat, the social media coordinator here at FAME, who was acting as the volunteer coordinator in Alex’s absence as he had seen fit to abandon us and spend the week in Zanzibar.
After our relaxing lunch, we decided to spend some time visiting one of the local artist’s workshop here. Athuman Katongo is a wonderful artist who has been at Gibb’s for several years and I had bought something from him in the past. He makes paper from recycling cardboard and uses the local fabrics to create amazing montages of animals and people. He also makes some wonderful notecards that everyone found attractive and so we purchased probably over a dozen of them from here. His studio was filled not only with his finished artwork, but also with unfinished products that were equally stunning. Being in a paradise like this with such lovely artwork surrounding us in the presence of the artist himself was certainly an incredible treat for all of us.
We had originally thought of going shopping after our lunch, but Frank had texted me that he had a complicated epilepsy patient that had traveled from Arusha and wondered if we’d have time to see him. Frank is a very hard person to say “no” to so most of us drove home from Gibb’s (Hannah and Steve had a nice walk back to FAME through Tloma village) and Amisha and I went to work at the OPD to see the boy while the rest of the group headed back to the house to work on other things such as their presentations and charts. The boy was 14-years-old and had had epilepsy since the age of three, and all of the time poorly controlled. The history was quite convoluted, though thankfully mom spoke perfect English. He had been on multiple combinations of anticonvulsants, but none had ever really been pushed to their maximum nor had they been thought out very well. We came up with a good plan that involved an MRI (he had only had CT scans previously), levetiracetam and the possibility of using lacosamide if the levetiracetam didn’t work well, but they would have to check to see whether they could get it Arusha first. We had seen a patient on it here earlier in the month, but you never know if it was obtained in this country or not as there are some patients who travel to Rwanda for medications. We drew up very specific instructions for them to follow and going forward, they will communicate with us through Frank.
That night we watched Lion King as Steve had never seen it before. Halfway through the movie, we took a break to apply some Korean face masks that Amisha had brought and were intended to make us all feel more luxurious. I can honestly say, at least for myself, that I was unaware of any effect. Tomorrow, we would begin our mobile clinic push, first at Kambi ya Simba, which is about 45 minutes away.