I see monthly statistics only for the limited time I am here. The death rate is down 30% this year on the adult medical wards compared to last year. I can't say what is causing the difference. I don't take credit since I was not here for most of the first 6 months. We still see bewildering problems.
I recall a dramatic case last year of a patient feeling sick and consulting the local herbalist, a common practice. He took whatever the herbalist prescribed and becoming comatose in 1/2 hour. He was then brought to our hospital. Since we didn't know what was in the herbs and have no toxicology testing available, our only treatment is supportive care and waiting for the liver to detoxify the body. That patient never woke up and ended up dying. We recently had a nearly identical situation occur. This time, however, the patient woke up three days later with all vital organs intact and ultimately walked out of the hospital. Herbalists, by the way, are not witch doctors (who do exist in the Maasai villages, but are a different type of practitioner). Herbalists have learned from their elders how to use local plants so it is knowledge that is passed down through the generations. We only see their treatment failures and they don't publish placebo controlled, double-blinded clinical trials of their products in the New England Journal of Medicine, but they must have some successes or they would not have any customers. There are researchers, medical anthropologists, who study the herbs used by traditional herbalists to look for therapeutic pearls there that can be incorporated into western style medicine.
Speaking of traditional health practitioners, there are also traditional birth attendants who attend most of the deliveries out in the bush country. They have learned their art from older birth attendants. There are not nearly enough obstetricians and western medicine trained midwives in the country so the traditional birth attendants provide a valuable service. I recall visiting a Maasai village, by coincidence, where a baby had been delivered the night before. The traditional birth attendant didn't live in that village, but was fortuitously visiting her relatives. The labor was not progressing so cow's cream was given to the mom to try to stimulate labor. When that didn't work, the attendant decided that the problem was a transverse lie; the baby was sideways. She performed an abdominal massage to rotate the baby head down and the baby was born without further difficulty. Without that intervention, both mother and baby would probably have died.
We recently saw a woman at Selian that had strange symptoms. She complained of numbness and weakness in her arm and leg on the right, but didn't really have demonstrable abnormalities on exam. Things were not right, but it wasn't clear what was going on. She also had a strange thing about her scalp. It was spongy like fluid under the scalp. We asked to have a CT scan of the head done which is a big deal since it is very expensive for pastoralist Maasai and involves transporting the patient to another hospital where they have a CT scanner. That revealed a 9 centimeter in diameter meningioma, a tumor of the membrane wrapping around the brain. It had eroded through the skull so there was leakage of cerebrospinal fluid underneath the scalp. Never seen that before. She was referred on to the neurosurgeons who are unfortunately far, far away in Dar es Salaam.
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| Adult medicine in the right side of the building and pediatrics on the left. The ground has a purplish cast to it due to the fallen petals from the large jacaranda trees in the courtyard. |
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| Medical lecture in the cafeteria.
Arti, the woman in blue, is from the University of Minnesota which sends out Chief Medical Residents from their Global Health Department. They come out to be teachers and also to get more personal experience in tropical medicine.
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great post
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