Tuesday, October 17 – Back to Mang’ola, but this time to Mbuga Nyekundu…

Dennis giving a lecture on how to identify seizures
An aerial view of the clinic at Mbuga Nyekundu from Dennis’s drone

It had been a wonderful visit to Lake Eyasi yesterday afternoon, though it did set us back just a bit on our schedule such that we arrived home just in time for the Monday noon conference back in Philadelphia that just happened to be one of our global health sessions. Malya Sahu, who had been to FAME this last spring, was presenting her experiences having traveled to Zambia for a month-long rotation and had just returned home. Considering that I’m the director of the global health program in neurology, I had wanted to hear what Malya had to say, though I was certain that it had been a good month for her in Zambia as the program there is very robust and full of opportunities given the faculty who are there currently. I am sure that the experience for her was quite a bit different than it had been here at FAME, and I will be interested in meeting with her after my return specifically to discuss some of those comparisons.

Sunrise on Kelly’s run

Given that it was Tuesday, there was another educational lecture schedule and today it was given by Dennis on epilepsy, but rather than speaking about the different types of epilepsy and treatment options, he was planning to show videos of different seizure types and it was up to the audience to tell him whether they thought it was a seizure or not, and, if so, what type of seizure it looked like. If it wasn’t a seizure, most often it was PNEE, or a psychogenic non-epileptic event, sometimes referred to as “pseudoseizures” in the past, but these are events that are not caused by abnormal electrical activity in the brain, but rather are considered a functional neurologic disorder, or FND, and are not treated with anti-seizure medications. If the video did depict a patient having a seizure, then it was whether it was a focal onset seizure, that is coming from one place in the brain, or a generalized convulsion, one involving the entire brain. Focal seizures can certainly generalize, meaning that it will involve both sides of the brain and the patient, by definition, should be unresponsive.

Caroline and Dorcas working together
Discussing a nerve block

It was an excellent exercise and, for the most part, everyone was on the same page, but the important thing was that Dennis was able to give some good pointers on how we typically determine clinically if someone is having a seizure or not, for the most accurate way to tell is to have them on an EEG and be recording when they are having an event. Unfortunately, we don’t have EEG capability at FAME at the present time, though there are some rather inexpensive units that we are looking at currently. Having a patient come into the ED or to the FAME Hospital who is unresponsive and one wonders if there’s a possibility that they are having something called non-convulsive status epilepticus, i.e., the brain is seizing, but the body is still, then the very best way to detect this is to obtain an EEG as it will show the continuous abnormal activity that can then be intervened upon.

Dennis and Hussein evaluating a patient together

As we really needed to get on the road as early as possible today so as not to arrive late as we did yesterday, it was decided with would try our very best to depart at 8 am right after the lecture. I think we actually came rather close this goal, though it was probably more like 8:30 am, but either way, we were off on another long drive to the Mang’ola region and the village of Mguba Nyekundu where they have a brand-new clinic space that was far more comfortable than what we’ve had in the past. After last spring’s visit here, I have had a number of pieces of office furniture made, nearly identical to what I gave to Barazani, so they could outfit their new space and we would have a bit better working conditions when we’re there twice a year.

Eliza and Me along with Fauster and Phillipo

The village itself is a mere smattering of houses and small structures with no real center of town, and it’s incredibly hot and dusty there. Early in the day, the weather was nicer, and Dennis even got to fly the drone he brought with him, though later in the afternoon, the winds picked up and began to blow pretty steadily with lots of dust and a storm front in the distance over the lake that never really materialized over our clinic. Christopher, our nurse for the clinic, insisted that the storm with never make it to us due to the strong wings (quite the opposite of what I think of at home), though in the end, he was right, and we were never touched with any rain.

The volume of patients that came to clinic was a bit lighter than expected and, even more disappointing, the patients who we had asked to come from Barazani to see as they weren’t able to be seen yesterday, didn’t show up. There were still a number of new and follow up patients, though, so that it was worth the trip here, and some were a bit more complicated such as a patient that Caroline saw with the history of TB that had reported been treated, but it was unclear whether they had completed the full treatment course or not. Unfortunately, we had little to offer the patient there at Mbuga Nyekundu as we had no labs or other testing, which she very much needed. We spoke with her about coming to FAME to be seen so that we could evaluate her more completely, and there’s still hope that she’ll make it to Karatu to see us, though it’s impossible to be sure.

We departed from Mang’ola at a very decent time so that we would arrive at home by around 5 pm, and I had contacted our friend, Phillipo, earlier to see if we could visit his home and family to buy some coffee from him. I hadn’t heard back, but figured we’d still drive up there and was glad we did as he was home, as was his wife and daughter, and the residents got the full tour of roasting coffee and then we got to purchase the freshly roasted coffee, though only after spending lots of time and tasting his coffee in a French Press or, as he refers to it, a Phillipo press! His family is always a joy to visit with and I’ve watched his daughter Eliza grow over the last several years. Whenever I show up, she loves for me to put her on my shoulders and walk around and, when I do that, she always has the biggest smile on her face that it’s worth the trip just for that.

As I’ve mentioned before, Phillipo doesn’t sell his coffee anywhere other than from his home and I’m happy to see that he now often has other tour vehicles there when we arrive. Though I would have loved to have kept him for ourselves, that’s a bit selfish, and I’m glad to see how successful he has been. While we were at his home and under a big roof where he entertains guests, a thunderstorm blew in from over the crater rim and we had lots of thunder and lightning along with some rain that lasted a short while and was fun to watch from our dry little cocoon we were in. The storm quickly passed and when it was time to say goodbye, it was already beginning to dry up outside and we made our way home to have our dinners that were waiting for us. We had planned on third mobile clinic for this group tomorrow, but the location fell through, so instead, we’ll be at FAME, which will certainly be fine with us as well as the other doctors here as they’ll have us home should there be consults to see.

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