Morning report, now overcrowded as I have discussed earlier such that only one or two of us attend, is where we hear about any new patients that came in overnight requiring our services and we also hear updates on the patients currently admitted who we are involved with. LJ has been following a very unfortunate, and very sick, young Maasai who is four months postpartum and came in with weakness among her myriad of other issues that included severe anemia, severe hyponatremia, and heart failure. Her weakness, the neurologic problem that had prompted our involvement in her medical care, was in a particular pattern in being that it was only proximal (shoulder/hip girdle), and she had good distal strength. She also had significant pain in movement. LJ has been working vigorously and relentlessly on her case pretty much since her arrival (both LJ’s and the patient’s) and it eventually involved calls to home (Penn) to discuss the case with both hematology and infectious diseases. She is determined to crack this case and I have little doubt that she will given the current level of her involvement and sleuthing. I’m sure that we’ll have more on this later.
The other inpatient we are involved with is the gentleman with the spinal cord injury that I spoke of yesterday. He is a young man with multiple traumatic injuries, but most significantly is his complete spinal cord level of L1 and possible transection given his imagine. He has received steroids, which is pretty much all we have to offer here, though will require stabilization of his spine to prevent further problems and we have referred him to KCMC for continued management of that issue, though were told this morning that his family was insisting to take him home to a local healer for their care.
This is not an unusual circumstance here as a large percentage of the population will receive at least some of their medical treatment from a local healer, or shaman, for an extensive list of ailments. When I first came to Tanzania in 2009, I had been introduced to a wonderful Maasai healer that was running a clinic at Gibb’s Farm, mostly for the local Iraqw who worked at Gibb’s, but also for the surrounding villagers. At his clinic, Menyengera Lazaro Labiki treated patients for varied conditions with a host of local plants and always had a large carafe of “healing tea” in the clinic waiting room for patients and passersby to drink. With an afternoon free from our volunteer work that I was doing with Daniel and Anna, we asked to go on a nature walk with Labiki and, over the next several hours walking around the grounds of Gibb’s Farm, he shared with us many of the local plants that were used by the Maasai and others for medicinal purposes, many of which we tried. Walking through the forest chewing on leaves used for indigestion and similar “more benign” ailments.
Though Labiki was a very traditional Maasai, he was also quite comfortable with the intersection between the type of medicine he practiced and the Western medicine we were delivering at FAME. He understood that there were many conditions that he could not treat and would refer these to Western clinics rather than trying to treat them himself, yet he would also fully assess the patient and would often treat them in combination with Western medicine. Labiki had also worked closely with an ethnobotanist at the university in Nairobi to chemically study the plants that were used for traditional healing by many of the tribes in East Africa, and what was found was rather impressive as a huge proportion of the plants had a chemical makeup eerily similar to the medications being used in the West for the very same purposes. One that I specifically recall was a plant compound they were using for memory loss that had significant cholinergic effects and was probably providing some benefit for patients like the cholinesterase inhibitors that we’ve been using for the last twenty years for Alzheimer’s disease.
I had stayed in touch with Labiki for several years and believe that he is now running a traditional medicine clinic in Arusha with his brother, who is also a healer, but it has been year since we’ve communicated. There is certainly a place for both traditional and Western medicine in the care of patients here in Tanzania and FAME has run programs with traditional birth attendants for this reason. Rather than alienating those who are trying to make a difference, whether it be traditional or Western, cooperation is a much better solution and has a much greater reach into the community.
One of the inpatients here who we were not involved with, was a tourist who had injured themself while on safari and now that they were stabilized, medical transport to Nairobi and then home had been arranged. Thankfully, FAME now has a wonderful new ambulance (new to us but purchased used) that had been funded by several FAME board members last spring and is now available to transport patients to other facilities or to the airstrip for flights out to Arusha or Nairobi. I believe that I’ve mentioned it before, but there are really no ambulances here that transport patient to a primary medical facility, just to be perfectly clear. All of us have evacuation insurance here that will cover medical transport out of the bush (yes, that includes FAME) by air to a tertiary center either in Dar es Salaam or Nairobi, the two closest centers that have the capability of providing true intensive care medicine. Having a dedicated ambulance that is fully capable of transporting the sickest of sick patients is a huge plus for FAME and will be necessary with our new 10-bed emergency room that will be completely shortly. I am certain that a second ambulance will soon be necessary (imagine having an emergency arrive to the ED when the single ambulance is on the road to KCMC, three hours away) considering the likely volume that we will see in the new ED – if there are any donors interested in such a project, please let us know!
Meanwhile, we had a midday visit from Teddy, our fantastic tailor, who has made so many wonderful outfits for the visiting residents over the last four years since I was first introduced to her. She was here visiting the RCH (reproductive and child health) clinic with her baby and had brought some fabrics for the residents to choose from while also measuring some of them for their custom-tailored clothing. Our plan was also to head into town after work to look at some of the fabric stores and then bring things over to Teddy’s as she would be waiting for us.
We had planned to have a conversation with the family of the child we saw several days ago who had hydrocephalus and the horrible porencephaly/hydranencephaly (essentially complete loss of both hemispheres except for a small rim of cortex in several areas) on their CT scan. Providing a VP shunt would do nothing for the patient’s function or prognosis, but it would potentially make them more comfortable and extend their life. Dr. Anne handled the phone call to the parents as they weren’t planning to come back to clinic, which always makes these types of conversations much more difficult. Despite telling them that a shunt would in no way prolong their baby’s life or improve its function, they seemed to be interested in having the procedure done (which, of course, they would have to pay for here) as there was some sense that a shunt could potentially make the child more comfortable in the end. I had already spoken with Kerry Vaugh, the visiting pediatric neurosurgeon who trained at Penn and is now at KCMC for the year as a global health fellow. Having her here during our visit has already made a significant difference in the management of our patients requiring neurosurgical intervention as we can rely on her for curbside and formal consultations, both for patients remaining at FAME as well as those that may require transfer to a larger facility such as KCMC.
Having finished neuro clinic at a reasonable time, we had wanted to head into town for a fabric run and then our visit to Teddy’s. As a large group of mzungu (Swahili for stranger, but more often now used to mean a white person), we stuck out like a sore thumb, especially when it comes to shopping, and this was quite obvious by the crowd we quickly attracted. It was just before sunset which a time of the day that many are out and about doing their shopping for the day. I delivered the group to the fabric shop we usually buy material from, and it wasn’t long before many others decided to join us as they were sure they had things that the group would like in some nearby shop that they were connected to. Eventually, they decided to walk down the block to one of the other shops, of course being escorted by others who wanted to sell them additional material. I followed behind, making sure that everything was legit for the last thing I wanted was to lose one of them in some seedy shop where they shouldn’t be. In the end, that was not the case, and everyone found the fabrics they were looking for.
Once their purchases had been made at the various shops, we loaded back in the vehicle, now well past sunset and made out way to Teddy’s. As expected, she was there waiting for us with Allen, her toddler who is not a bit over a year old. It was a very nice evening and I sat on her porch in a plastic chair playing Wordle and the New York Times crossword puzzle while Teddy measured each of the residents and make sure of what clothing designs they wished her to make for them. Throughout the evening, local children would come to visit Teddy’s shop, which sells staples in addition to her tailoring business. I wasn’t sure if the children were coming to visit or whether they were coming to see the mzungu crowd, but either way, they were delightful and incredibly polite.
I was also so pleased to see Dorthea at Teddy’s as she is someone who I have known now for twelve years as she originally came to me as a patient in 2011 with uncontrolled seizures and had been unable to attend school. We were able to get her seizures under control without too much trouble and she returned to school, eventually completing secondary school. I had introduced Dorthea to Teddy at the end of our last visit here in April and she is now apprenticing with Teddy and learning a trade. I am so thankful to Teddy for having taken Dorthea under her wing like she has, and it has been wonderful seeing Dorthea having such success. It was a simple plan that has been very successful and, for that, I am incredibly happy.