As it was Thursday, it was another day of education and Dr. Ken had asked us for a presentation on psychosis, something we see quite often here and end up being the primary doctors treating it as there are no psychiatrists to be found anywhere in the area, a sad fact for most of Africa. I have had patients brought to us who were acutely psychotic and potentially dangerous and have had to give them intramuscular injections of a combination of haloperidol, a very strong antipsychotic tranquilizer that can stop an elephant with enough of it, and lorazepam, a milder, but very effective anxiolytic (antianxiety) medication.
To be honest, I’m not sure if the incidence of schizophrenia is actually higher here than at home, but I’ve seen so many patients over the years as well as those who follow on a regular basis, that it would not surprise me in the least if it were higher here. Possible causes would probably be similar to that of epilepsy – childhood infections and injuries. Throughout the country, the patients are treated by the district mental health officers who may be clinical officers or nurses.
The district mental health officer in Karatu is a nurse, or least was several years ago when we encountered them regarding a clearly psychotic patient who had been brought into one of our mobile clinics by her husband. She was not doing well at all and we had suggested a course of medication to the husband who promptly called the health officer to let them know. He was told that we were not to be trusted and that we were trying to poison her. Interactions like this with government health workers or district or regional medical officers have been extremely rare and, for the most part, have always been very positive. But, as you can see, things can go differently on occasion. With our patient at mobile clinic, all we could really do was simply explain that we supported a different approach to the situation than the mental health officer as we certainly didn’t want to destroy their therapeutic relationship given that we’re here only every six months.
Cat and Phillip partnered on the talk today and both contributed explaining that not everything psychotic is schizophrenia and going through the definitions of all the disorders in which you can see psychosis as well as how to treat them. They did provide a very nice chart that included all the different diagnoses with distinguishing features and primary treatments for each. In the end, the main medication we have here to treat any patient with psychosis is olanzapine and so the majority of treatments pointed in this direction.
After the lecture on psychosis and morning report, we rounded everyone up for the drive again to Rift Valley Children’s Village. We were anticipating the same numbers today, but sometimes you can be surprised as patients may come out of the woodwork, or coffee fields as the case may be, to be seen for their medical care which is always fine with us given that’s the reason we’re here. We did have a little more time in the morning as things were slower, but somehow ended up with extra afternoon patients requiring them to split into four rooms, taking Africanus’s office as the fourth. Philip had been working in there to keep up with the patient database, but that worked out as he simply sat in working on his computer without disturbing anyone.
I had forgotten to mention yesterday that one of the highlights of our visit to RVCV is always the lunch that we’re served. Normally, there are always a number of volunteers here at RVCV, but now with the pandemic, there are no volunteers and everything is pretty much being done by the full-time staff with the help of some of the older “children” from the village. In the pre-pandemic era, lunch was always served for all of the volunteers, which included us on our visits, having been home cooked by the mamas who have been doing this forever. In addition to our lunch, they are constantly baking bread and cookies as well, but the lunches are always delicious and fresh and like nothing else you can get in Tanzania.
Yesterday, we had vegetarian chili over rice with salad and fruit and today we had the most scrumptious fresh buns with chicken salad , fresh salad and fruit. Though I do love the lunches at FAME – rice, beans and mchicha five days a week, pilau and coleslaw on Thursday and Ugali, meat and mchicha on Tuesdays – the lunches at RVCV are on another level. Speaking of the lunches at FAME, for some odd reason, they didn’t serve ugali during our entire time there this month which was the first time ever and I’m really not entirely sure why. Cat, Denise and Emily were all looking forward to it, but it never showed up.
We did have a chance to spend more time with the children today as you can see from the photos. It’s always a pleasure to be there and an incredibly refreshing experience. It has always been one of the highlights of the residents visit to Tanzania. We were all excited today as we would be leaving for the Serengeti in the morning. We had booked two nights at a tented camp in the Central Serengeti which is just such a magical place that it shouldn’t be missed. In March of 2020, the group had missed this trip, in addition to the money we had paid, because of having to scramble out of the country with the oncoming pandemic. It was a tragic loss and I hope someday that they’ll make it back here, but know that probably won’t be. Because of the size of the group, we had booked an extra vehicle besides Turtle, along with two drivers. We also planned to visit Oldupai Gorge on our way. We decided to make sandwiches once again rather than buying box lunches. I gave Turtle to Vitalis, our driver, in the evening after returning home so he could give it a good cleaning and we’d be off in the morning at 8 am, or so we thought.