By Dr. Barbara Sharp
When I arrived at FAME, I found two very capable and industrious X-ray technologists, Onaely and Japhar, who introduced me to the equipment: a sixteen slice GE CT scanner, a PACS system, and two ultrasound machines, one for body work and one for vascular studies. It is quite special to find such sophisticated equipment in rural Africa. I found the African doctors to be compassionate, inquisitive, and interested in providing the highest possible care with the available resources.
In case it is interesting to you, here is what a Monday as a radiologist at FAME is like.
I began the day by getting up to make breakfast of French toast, local honey and wonderful coffee from Arusha, Tanzania, brewed with a French press. There is a kitchenette in our quarters, which we used frequently, and is quite serviceable.
I then proceeded to morning report to learn about the interesting cases admitted the day before and to learn about progress of the inpatients.
Many interesting cases were admitted and we learned more about each patient in ward rounds. I have found the clinical correlation with X-ray findings really great, which doesn’t happen in typical Radiology practice in the US.
My radiology skills were needed for four inpatients on this particular day:
One was a 66 yr old male admitted for alcoholic hepatitis. His family said he drinks a lot of moonshine. I did a kidney and abdominal sonogram and found his real problem was an enlarged prostate with bladder outlet obstruction, bilateral hydronephrosis and shrunken kidneys due to chronic bladder distention due to prostate enlargement causing obstruction to the flow of urine. He had other findings such as fluid in his abdomen (ascites), fluid in his lungs (large pleural effusions) and cardiomyopathy (large heart).
Next patient was a three-year-old boy with loss of consciousness and seizures. His Maasai family brought him to FAME after two weeks of trying to eliminate his symptoms with traditional remedies. Many people from the Maasai community live traditionally, herding cattle and living in houses made of dried cow dung. They drink cows milk and eat goat meat. A non-contrast Head CT revealed a bleed in the brain on the left. Contrast was administered which revealed TB meningitis (for you radiologists, meningeal enhancement, left basal ganglia bleed due to involvement of the lentriculistriate arteries, irregular, thickened tentorium and falx enhancement. Diffuse ventricular enlargement and transependymal periventricular edema).
My next case was a 23 yr old woman who is 3 feet and 6 inches, weighing 32 kilograms, and is 26 weeks pregnant. I did an obstetric ultrasound and found an active baby with somewhat delayed fetal growth.
Last inpatient was an infant, also from the Maasai community, with seizures due to tetanus infection. One traditional practice within the Maasai community is to cover the infant with mud poultices at birth. This happened when the umbilical cord had not yet healed, and is the likely route for infection with tetanus. The nurses had to remove caked dirt off the baby on admission. I helped ascertain nasogastric tube position with X-ray.
From the outpatient center I had many normal chest X-rays and an elbow fracture.
On my way home I encountered Kelly in the hallway. She is an American surgeon who is working at FAME for one year. She said my patient with the large bladder needed a catheter placed through the skin of the pelvis as his large prostate would not permit the placement of a normal drainage catheter. I detoured into the procedure room with Dr. Kelly. I found my services once again useful when the patient’s heart stopped and my free hands could check for a femoral pulse and pass syringes. After 5 minutes of CPR, I did a transxyphoid ultrasound and found a nice heartbeat.
Voila! A nice day. I then proceeded home to enjoy a delicious dinner on our back porch, looking out over the beautiful trees, ridges, and farmlands of Karatu.