Tuesday, March 21 – A very slow clinic and managing acute stroke as an outpatient…

One of the mamas cooking chapati at the Black Rhino Academy where Jill is working

Coming home from the Serengeti is always tough. You’re in the middle of this incredibly magical place, driving roads that are truly endless and go on forever with not another vehicle in sight for as far as one can see. And then throw in the millions of wildebeest making up the Great Migration, and event that is seen only one place in the world. Now we are back at FAME, itself a magical place in a much different way. Everyone’s happy to be here, but somehow there’s a longing for more of the Serengeti. There’s always the Nat Geo channel or Animal Planet, but somehow that’s not quite the same.

Mark happily donating his blood

On our way home from the Serengeti, we had encountered a considerable amount of rain, and this continued throughout the night making things a muddy mess into the morning. This is a very good predictor of a slow day in clinic as the patients, many of whom would normally walk or take a boda boda (motorbike taxi) to clinic which is always a problem when the roads are as slick as ice due to the lack of absorption of the red clay here in Karatu. Similar to the issue that we had in Serengeti, it takes very little for a vehicle here to easily swap ends and wind up in one of the many deep drainage ditches on the side of the road. Riding on the back of a boda boda as a passenger can have an equally deleterious outcome with far less body protection and walking on the roadside even less so.

Usha giving her blood

With everyone tired from the long days over the weekend, having a slow day in clinic wasn’t necessarily something that anyone complained about, though given the shortened three-week rotation now for the residents, I always feel badly when there is a day with fewer patients as their experience just isn’t the same. Regardless, there is very little that we can do about the situation when few patients show for clinic other than to just make do which typically means for the residents to do some didactic teaching with our Tanzanian clinicians.

A subacute left middle cerebral artery infarction

At morning report, one of the patients being presented was in need of blood transfusions and there was a call for compatible volunteers to give blood that morning. Both Usha and Mark had the appropriate blood type and were more than happy to come into the lab to give blood which worked well given the slow day for us. I think Usha got a Fanta soda for her troubles, but Mark seemed to have missed the memo and didn’t receive one much to his dismay. Blood transfusions are an ongoing issue here give the fact that we don’t have the storage capacity for a full-service blood bank, though we will often have family members and patients donate blood for upcoming surgeries should they need a transfusion.

Wells and Allan

One interesting patient that did come in today was someone who had developed unilateral weakness three days prior to seeing us but had not sought medical attention to evaluate their problem or to receive treatment. It was pretty clear based on the history that this was a stroke as it had been of very sudden onset and she didn’t have a headache at the onset which would have made us worry about a hemorrhage, so at least we didn’t believe there was a significant concern for that process. Given her clearcut history and examination, there wasn’t a sense that she required any urgent or emergent treatment, and, in fact, it was debated as to whether there was even a need to obtain a CT scan as it was very unlikely that it would have any impact on their future care. In the end, we did obtain one that was entirely consistent with the infarct we suspected and explained the neurologic deficits that had brought them to see us. There was no clear reason to admit her to the hospital as she was perfectly stable, and no further evaluations were required. Certainly not something that would happen back home, but without the availability of further testing, having her as an inpatient would only increase the cost to her family and they were more than happy to bring her home.

Mark making Allan laugh

The end of the day saw another visit to Teddy’s to pick up the clothes she had been working on over the last week. It’s always a joy to visit and now, with her little son, Allan, it is even that much more pleasure. We’ve been using Teddy to fashion clothes for the residents for several years now, ever since I was introduced to her by one of the long-term volunteers here at FAME. She has always done a great job for everyone and bringing home the clothes made of the colorful East African fabrics is something that seems to be very much appreciated by everyone. It’s an activity that I love given how much the residents enjoy it, but it has been some time since I’ve had anything made. I usually drive everyone there and then plop myself on a chair on her porch with my computer to type away on a blog or answer emails while I’m waiting.

Mark and Allan with me in the background typing away

Leave a Reply