Tuesday, March 22 – A visit from our friends in Tarangire…

One of our many young patients

Our morning started early with an educational talk that had to do with treating tuberculosis and was given on Zoom by a government health worker. The talk had to do with treating TB in a setting where anaerobic cultures, or any cultures for that matter, are unable to be done and starting therapy is often based on the patient’s symptoms rather than any specific testing. The treatment for TB lasts many months and there are patients who may not respond because they have drug resistant TB. Save it to say that it’s a complex topic and one that probably shouldn’t be tackled by a general neurologist whose internal medicine training took place over 35 years ago.

Natalie and Eliza evaluating a child
Announcement of our upcoming epilepsy lecture

Educational talks are typically held on Tuesdays and Thursdays at 7:30 am and have always been a mixture of volunteers and FAME doctors delivering them with more of an emphasis on the former given the fact that FAME has relied on their volunteer doctors from day one. I have always expected the residents who come with me to give as many lectures as the FAME doctors have requested during their time here and that plan has always gone incredibly well. After the pandemic hit, though, there was a question as to whether or not volunteers would be coming back on regular basis and, if they did, when. I was here with a group of residents in March 2020 when the pandemic hit and, following that, we decided to begin giving neurology educational lectures by Zoom. Though I had returned in September/October of 2020, I had no residents with me and given all of the social distancing, there were no large gatherings taking place indoors, or elsewhere for that matter.

One of the children seen to be evaluated
Eliza, our Tarangire chief and a patient from their village

The main issue with the Zoom lectures, though, was the time difference as the education lecture here at FAME always occurs at 7:30 am which is either 11:30 pm or 12:30 am the night before for us at home. Staying up until midnight to deliver these lectures turned out to be a real challenge for those of us doing them. We had a similar program in Puerto Rico that was incredibly more successful given the convenience of the same time zone. Meanwhile, having started our program back up in March 2021, we were able to do the lectures once again in person, though the potential for delivering educational services and lectures in this manor was not lost on us and there remains plans to develop a more robust virtual problem similar to what others have done in this arena. Though the pandemic was an incredibly horrific and devastating event, there were many silver linings such as this that have now become part of our normal way of life.

Natalie and Eliza with a pediatric patient

In addition to our regular patients today, we were expecting a visit from the group of patients who live near Tarangire and are brought by their Maasai chief every six months. Many of them are return patients and a number of them are new. By far, the majority of these patients have a diagnosis of epilepsy which is often the case here. It was in September 2020, during the time I was here without the residents, that he brought the two Down syndrome boys to see us and following that visit, Kitashu and I began searching for a vocational rehab center for them, finally locating a great program in Usa River. The two chose their eventual occupations, one to become a tailor and the other a welder, who are now each in their second year and doing incredibly well. I get regular reports from the school as to how they are doing and am thankful to all those who helped contribute to my Go Fund Me campaign that raised the necessary money to cover their entire education.

One of the patients that the chief brought to us today who had well-controlled epilepsy and was being seen in follow up, also had another pretty serious problem that was a bit out of our normal range of expertise. The gentleman had suffered a crush injury of his index finger about five weeks ago that had also caused a laceration and was now significantly infected such that not only was his finger swollen, warm and tense, but so was his arm to just above his elbow. This was all very concerning and needed to be managed today as any delay could risk his infection worsening or possibly developing osteomyelitis. We discussed sending the patient over to the general medicine clinic but were informed by Kitashu that the chief had brought only enough money to cover the clinic cost for his patients (5000 Tsh or a little over $4) and no extra. There was a discussion of admitting the patient to the ward where he could be properly treated by the Dr. Manjira (our new surgeon) after receiving IV antibiotics. In the end, though, Dr. Manjira offered to treat the patient without admitting him and could debride the wound that afternoon.

Savannah had been treating the gentleman in the clinic and so she, Natalie and I watched as Manjira injected the man’s finger with a boatload of lidocaine and then proceeded to open the wound, remove the fingernail and basically open up the digit so that it would heal from the inside out. It was a pretty brutal and rather bloody affair and at one point, one of the nurses asked Savannah if she felt OK, but in her defense, she looked just fine to me and promptly declined any help or to sit down. After pouring a ton of iodine solution over the finger, it was time to wrap the wound as the patient would be heading back to his boma where there was certainly not going to be anything close to reasonable hygiene. The good news was that we were planning to be in Tarangire National Park over the weekend and could stop by on our way out on Sunday and evaluate him to make sure that his finger still looked like it was healing properly.

Thankfully, we finished with all the remaining Tarangire patients as well as our own regular FAME patients in time for me to attend the monthly FAME Board of Directors meeting that I was actually in charge of as the chair of the Board. The meeting was to begin at 4:00 pm our time, though we do have Board members scattered across the time zones including the west coast meaning that it was 6:00 am for them. As the meeting was only to last an hour (and we were able to finish it on time, we were all looking forward to a quiet evening and maybe a movie.

Ke Zhang, another member of the board had also arrived today, and would be here for our two remaining weeks at FAME. Ke has been a fixture here at FAME since even before my time, having been introduced to Frank and Susan while doing volunteer work in the area on a college trip. Over the years, he has been responsible for designing and maintaining all of the IT infrastructure, which I should say is very impressive in itself given our dependence on having an intact network over the years that now supports our EMR (electronic medical record), but when you consider that he’s managed to graduate from MIT, finish an MD/PhD, and is now an interventional radiology resident in Boston. How he has managed to get all of this done while staying so involved with FAME is beyond me.

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