A Day at FAME Medical, Karatu, Tanzania

By Volunteer, Dr. Todd Sack

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8/2/2019 Fri: FAME Day 20:  Ulcers:  At Morning Report, we learned that the Maasai baby with pneumonia also has hepatitis (Aspartate Aminotransferase 830) likely due to village herbal treatments. I went back to her room in the inpatient ward later with Kitashu, our Kimaasai translator, to caution her not to give herbs to her family. We discussed an 81-year-old diabetic woman with diarrhea and mild sepsis; a woman with ascites whose abdominal CT by Barbara, my wife and radiology volunteer, seems to reveal TB peritonitis; and a man who traveled 10 hours to us for care of a dental abscess and is doing well after a FAME doctor drained a cup of pus from under his right jaw this week.

During an endoscopy, I found benign duodenal ulcers in a 21-year-old man with five years of epigastric pain. These likely are caused by Helicobacter pylori, themost common bacterial infection in humans. A man in whom I found a large stomach ulcer last week came back and was admitted because he is still vomiting. We hope that he’ll improve if we administer his medicine intravenously, but we also fear that his failure to improve may be because he has stomach cancer rather than a simple ulcer. Unfortunately, we cannot routinely do pathology testing of endoscopic biopsies due to the cost.

Every patient in clinic today seemed to come in with one problem but more emerged. A minor stomach upset was also accompanied by a urinary retention from prostate disease and a massive forearm lipoma. A bad cough was accompanied by low back problems and charcoal stove-induced chronic lung disease (the #1 cause of lung disease in African women). I spoke with a woman with cough, fever, upper abdominal pain and mildly abnormal liver blood tests.  After blood tests and a normal ultrasound by Barbara (it’s fun working together), I prescribed doxycycline for possible Leptospirosis.

A 41-year-old man came to the ER very weak with a blood pressure of 75 systolic and distended abdomen.  Within minutes and before any of his blood test results were back, Barbara had done an ultrasound (necrotic liver masses), I’d done a paracentesis (blood-tinged ascites), and antibiotics were given for liver abscesses.  These cases were a small part of a very busy, fascinating day.

There were lots of good-bye hugs from nurses, doctors and technicians, as our three weeks end tomorrow.  Barbara and I had a nice vegetable curry at our house, with a South African Pinotage. We stepped outside into the cool night for a spectacular sky of stars. We look forward to returning to Karatu and FAME Medical next year.

 
Robert Kovacs