AZAfricana

Wednesday, February 22, 2017

Week 4 and 5

Over the past month I have seen variety of cases, infectious and non infectious disease. Malaria is endemic in the surrounding area. RVI/OI is the commonest cause of in hospital admission and death. Cardiovascular disease is on the rise due to sedentary life style in the cities. Below are few of the interesting and sad cases I saw in my 4th and 5th week here in Adama;

1. 32 years old female admitted with LOC 24 hours after given birth. Delivery was at home, she had witnessed seizure by family member while giving birth.  presented to ED with LOC. GCS of 4/15. BP 210/120. Admitted to ICU with working dx of eclampsia and now fighting for her life. concern for intracranial hemorrhage..imaging is not available in the hospital. Heartbreaking to see a mother die from pregnancy and child birth related complication

2. 25 years old female came in encephalophatic, foaming and hydrophobic...
Hx: 20 days a go she got bitten by a street dog on the neck... Rabies is under reported killer in east Africa. Main victims are women and kids beaten by street dogs. Rabies immune globulin is not available in the country. There is no national vaccine program. The community usually kills street doges by stoning or shooting them.

3. 36 years old male Recent DX of RVI at a health care center/base line CD4 not available to us came with headache which started a week after starting ART. Head MRI shown below. V/s stable, no latralizing sign on exam. DDx Toxo, creptoccocoma, Tuberculoma, PML... not settled yet.



cephalic tetanus from a head wound 
another tetanus case from a nail foot injury 
4. 19 years old male came with cranial nerve disfunction and ultimately developed generalized tetanus. He is being managed in a dark room along with one another patient. His frequency of spasms has reduced from 20 to 1 per day now, has been getting diazepam and CPZ. His laryngeal spasm was minimal and did not require tracheotomy!! Will be discharging soon. Tetanus is another common preventable cause of death in Ethiopia
my favorite snack in Adama
multi purpose wheelchair stocking the pharmacy  





went to visit a land that I inherited from my grandpa. With God's will I plan to build primary school in his name.







I made peace with the dogs and new puppies in my compound!



The residents office progress 





Zeritu kebede my favorite Ethiopian artist /https://www.last.fm/music/Zeritu+Kebede

Monday, February 13, 2017

Weeks two and three 

I have well settled by now...attending morning reports, rounds with medical students and residents, attending and moderating seminars...




 Most of the weekdays were spent working with resident and medical students.  Morning reports start at 8 Am and ends around 9. we go to cafeteria afterwards. The cafeteria is located outside the compound, so you put your white coat by the gate with the guards.

trying to hang a white board 


I purchased and hanged a white board for morning case presentation 
leading morning report 
















26 years old female with pulm Tb and parapneumonic effusion...


Lots of exciting cases. 25 years old previously health women recently dx with Pulm TB sputum positive. superimposed PNA with  para-pneumonic effusion. Effusion tracking up on the left side.Frank puss after chest tube..patient did well with antibiotics and was discharged home on anti TB with follow up.










doing LP on a 23 year old Stage 4 RVI patients with cryptococcal meningitis 


I have one room with hot shower!!!
At the end of my second week  I finally got a guest house that was promised to me…bummed about no internet assess at the guest house..otherwise nice compound except  two dogs barking all night.
One of the dog just had puppies and did end up scratching me as I was waking by her puppies.Latter  I learned the owners was giving away some of her puppies...then she started to be aggressive to strangers. 

Does this dog has rabies??? .....hard to say 
I have not gotten my rabies shot..and I have seen 2 cases of rabies. My scratch was small..no bleeding. I was able to observe the dog for 10 days...we are both health and alive at day 10 after the bit.!!!!!.I have learned my lesson  








my dog scratch






dog alive after 10 days of scratching me

Week four… I found my self being part of a national working group for residency matching ..I met few of my medical school graduating class. 

future medicine resident office /old bathroom 
papaya/tella and tej time 







Ethiopian orthodox sunday church 
evening bedside teaching




afternoon buna/coffee time 

skype time 

found bacon in adiss!!!



bajaj getting a bath 
---to be continued