Wednesday, June 24, 2015
The Monday morning of my second week in Tanzania began with rounds in the infectious diseases ward at Muhimbili Hospital. I was fortunate enough to see a patient being discharged and the interactions she had with her doctor. This patient, a young woman living with uncontrolled HIV had been suffering from cryptococcal meningitis. Crypto, as it is colloquially known, is usually a harmless organism, however, in people living with HIV it can cause a deadly form of meningitis characterized by an unrelenting headache. Fortunately, this patient had sought medical care and the blindness she had experienced due to the crypto had been almost entirely reversed.
Patient follow-up remains a huge challenge in many parts of Tanzania. Many patients at Muhimbili travel great distances. This patient in particular had travelled eight hours by bus. She required a lengthy course of medications and there was little to no chance she would be able to afford the bus ticket back to the hospital for follow up.
On Tuesday morning, I attended the emergency medicine rounds, where each week a case is presented and subsequently dissected by fourth year medical students. The case presented was a 39-year-old woman who had been living with HIV for 12 years. She was not taking antiretrovirals and had presented to the ER with abdominal pain, right flank pain and vomiting. The differential diagnosis put together by the medical students listed more than 20 diseases. The attending physicians used this as an opportunity to drive home the point that abdominal pain is a very non-specific presentation and therefore requires a very broad approach and perspective. Peculiarly, the patient's hemoglobin was 11g/L (yes 11, almost an unbelievably low level). The test was triple checked. The eventual diagnosis was nephrolithiasis, however, no one could account for the very severe anemia the patient was experiencing.
The doctors at the hospital gave us Friday afternoon off. Taylor Bechamp and Rob Soegtrop, both Medicine Class of 2018, and I decided we would go golfing at the local golf club, Dar Es Salaam Gymkhana Golf Club. About halfway through the round of golf, we were searching for an errant ball in some long grass when our caddy casually said, “you might want to hurry, there could be cobras in there”. Welcome to Tanzania.
Check out Matt's Twitter feed from his second week at Muhimbili Hospital.