Case Spotlight

The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.

It is the business of children to play.  Whether in the United States or Mufindi, Tanzania, children run, jump, climb and get dirty.  Cuts and scrapes abound, and usually, heal with a quick clean and bandage.  Yet sometimes even the most innocuous injury quickly develops into a more serious complaint. This is when the difference between where those children were playing matters. One group of children has access to qualified medical professionals ready to treat them quickly and effectively.  The children in Mufindi may not have that same access and thus have a longer road to healing and playing again.

A 5-year-old boy presented to a partner organization in Mufindi, Tanzania with a complaint of pain and swelling in his middle finger.  The clinic initially treated the finger with minimal intervention to include careful cleansing and application of antibiotic ointment.  The issue seemed to resolve, but two weeks later the patient returned with swelling that reached halfway down his left middle finger.  There were no obvious breaks in the skin, and soaking the finger and application of warm compresses did nothing to relieve the pain and pressure.  The patient was started on cephalexin, a common antibiotic used to treat skin infections, yet the pain and swelling continued to progress.  The staff at the Tanzanian clinic turned to The Addis Clinic for advice on how to proceed.  The patient’s case history, as well as pertinent photographs, were submitted to The Addis Clinic via our telemedicine platform, and it was allocated to an Addis Clinic volunteer internal medicine/pediatric specialist.  

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The Addis Clinic volunteer replied with detailed recommendations on how to proceed in the patient’s care. The first step was to change the patient’s antibiotic to a medication with better coverage against certain types of resistant bacteria, then to continue with warm compresses three times daily and elevate of the affected hand.  The physician also recommended that if this did not result in improvement, an x-ray should be obtained to exclude a foreign body in the finger, and an incision and drainage should be performed to drain pus and relieve pressure in the finger.

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The patient’s pain and swelling continued to increase, and he was sent to the hospital for an incision and drainage.  Two days following the procedure, the little boy returned to the clinic for a dressing change, and the clinician noted that despite the procedure, there was little improvement in either the swelling or pain.  After reviewing the updated information to include pictures of the little boy’s hand, our volunteer physician recommended a hospital admission for IV antibiotics, as well as continued cleaning and dressing of the wound. While a trip to the hospital was too far, the local clinicians were able to administer three days of intramuscular antibiotics and then ten days of an oral antibiotic, while also paying careful attention to cleaning and dressing the finger.  The result was a complete recovery for the patient with full function and range of motion of his finger!  Instead of clinic visits, bandages, medicine, and procedures, this little boy is back to playing, jumping and getting dirty – just as he should.

Meet a Physician - Dr. Amit Sharma, MD

Dr. Amit Sharma signed up to volunteer with The Addis Clinic in 2017 His specialty is Dermatology and he resides in Arizona. We took the chance to ask him a few questions about his work for The Addis Clinic. 

Q: Physicians are known to have a busy schedule. What motivates you to spend extra time to consult other health care workers far away?

Amit:  "To me, the role of the physician is three-fold: 1. provide excellent care, 2. educate others on health-related matters and 3. move the field of medicine forward. The Addis Clinic provides a unique opportunity for me to accomplish all three of these goals in a manner that makes such a significant difference in the lives of others. As a dermatologist, I strongly feel that telemedicine will be a large component of our future practice. With Addis Clinic, I am not only helping provide care but also shaping the way we treat patients. Though my day-to-day practice is busy, I feel the few minutes spent monthly helping the Addis Clinic have the greatest impact."

Q: How have you used your specialty (Dermatology) so far in your work for The Addis Clinic?

Amit: "I have received many cases through the Addis Clinic in which the primary complaint is a dermatologic condition. The photos the healthcare workers provide are very helpful and I often look at them first. Often it is a diagnosis of cutaneous infection, but that's not always the case. One patient, in particular, comes to mind: a young girl with recurrent ulcers of the scalp. Infection was on the differential; yet, her ulcers were angulated with surrounding hairs at different lengths. Furthermore, there were no signs of infection surrounding the ulcerations. Thus, a diagnosis of self-induced ulcers with trichotillomania was put forward. Appropriate wound care instructions were provided, systemic antibiotics were stopped and a more directed history was taken. Cases like these not only give us the opportunity to provide care for the patient but also help us teach the health workers about diagnoses that may not otherwise be considered."

Q: What have you gained for your professional AND personal life so far by volunteering for The Addis Clinic?

Amit: "Through the Addis Clinic, I have found a renewed sense of service, which has translated to a new professional direction. Within the Addis Clinic, there are opportunities to evaluate and optimize telemedical applications. Given the growth of telemedicine over the past few years, I am excited to be able to contribute to and shape the field. Also, given my interest in education, I am working on incorporating telemedicine into the curriculum for residents and medical students.

The Addis Clinic has also had a positive impact on my personal life. My fiance also volunteers with the Addis Clinic and we often discuss our cases. We are planning to visit the Addis Ababa, Ethiopia in 2018 and look forward to meeting the wonderful health workers in person."

 

 

Dr. Sharma, we appreciate you taking the time to tell about your experience with The Addis Clinic. Thank you for all your work!

Case Spotlight

The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.

Pain is one of the most personal and subjective experiences a patient can have, which can make diagnosing its cause very difficult. There are no medical tests to measure or locate a patient’s pain.  It is only through taking a careful history and asking the patient about the pain’s type, timing, and location, that a clinician can begin to work with the patient to identify the pain’s cause, and hopefully, a method of relief.  In America, the National Institutes of Health cites pain as the most common reason patients access the health care system, and for patients in areas of the world with limited access to health care, pain can become exceptionally debilitating.

A couple of weeks ago, a young woman in Ethiopia sought care for chronic pain she had been experiencing for almost a year. She explained to her nurse that for all that time, her joints had been becoming progressively more painful, causing her to become less active each day. The frontline nurse took a thorough history, painting a more complete picture of the patient’s pain experience.  What the patient described was an aching stiffening of her ankles, knees, wrists, hips, shoulders and fingers. She told the nurse that when she woke in the morning, the stiffness in her joints was so great that she was almost unable to get out of bed. For a woman who cleans for a living, these symptoms cause both great personal and professional difficulty.

To get to the bottom of the causes behind this pain, the nurse forwarded the case to The Addis Clinic through our telemedicine platform.  The case was allocated to one of our family medicine physician volunteers, who responded to the nurse with some more questions of his own. After further back and forth and analysis with the nurse, our physician volunteer concluded that the patient was most likely suffering from rheumatoid arthritis (RA), and it was a flare of these symptoms that caused to her to seek care. His recommendations included the routine medications of methotrexate and meloxicam for disease management, and a short course of prednisone to alleviate the immediate inflammation causing her distress.

As a result of this interaction between the nurse in Ethiopia and an Addis Clinic physician volunteer in the U.S., this young woman is able to give the reason behind her pain a name, and move forward in its treatment.  Another less tangible outcome is the education of the nurse in Ethiopia.  From now on when she interacts with patients who present with chronic pain, this nurse will have a new body of knowledge from which to draw, and a new differential diagnosis to consider. This Addis Clinic teleconsult benefits not only the nurse’s current patient, but many potential future patients as well.

Case Spotlight

The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.

The economic burden of disease can be great for any family when the primary wage earner is unable to work due to illness or injury, but even more so for individuals with limited access to health care. The inability for a patient to receive appropriate treatment in a timely manner can have significant financial and emotional impact, as families are unable to provide basic sustenance while out of work.

A 34-year-old single mother of seven presented to our partner clinic in Belize with a large mass on the right side of her neck. It had started to develop over a year and a half ago during pregnancy, growing over time.  Even after multiple attempts to drain it, the fluid returned and the mass enlarged. Due to the size and appearance of her neck, the patient had isolated herself at home with her children and was no longer working.

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The physician in Belize consulted The Addis Clinic, as the nearest specialists were located almost 6 hours away. One of our Ear, Nose, and Throat (ENT) physician volunteers took the case, and through our telemedicine platform, engaged in careful questioning and back and forth analysis with the physician on the ground.  He concluded that the mass was most likely benign and the result of a lymphatic malformation in one of her major salivary glands. The vessels of her lymphatic system were in some way impaired, causing fluid to accumulate, and not drain as it should. The ENT advised that surgery to remove the malformation would be the only definitive solution.

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As a result of this consultation, our partner in Belize was able to encourage the patient to pursue surgery, and eventually, an emergence from isolation and a return to the work force.

Case Spotlight

The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.

Delivering a child is a life-changing experience, especially if it is your first one. Mothers everywhere rely on postpartum care and support to help navigate this new phase of life. If you happen to give birth in a community with limited access to health care, your risk of complications is much higher.

A few weeks ago, a young mother from Ethiopia was seen by an Ethiopian nurse. Three days after she delivered a healthy baby girl, she developed breast lesions and tenderness on both sides of the breasts. A large number of new mothers experience a painful side effect from breastfeeding called mastitis, a bacterial infection in the breast. In countries with a fully functional health system and appropriate postpartum care, it’s usually treated with antibiotics and additional lactation support.

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If proper treatment is not available due to lack of access and resources, a breast abscess may occur, a very rare but very serious health concern. Women may experience sharp pain, a swollen breast lump, high temperature and flu like symptoms. In this case, our patient complained for two month about her pain but wasn’t seen by a health care provider. When she finally came to the clinic,  the abscess had already drained through the skin causing extreme pain and discomfort and inhibiting the mother’s ability to feed her newborn. Through our telemedicine, a consulting volunteer physician directed appropriate tests and a 10 day course of antibiotics as part of the treatment plan.

We are happy to report that after completing the recommended treatment plan, the patient’s abscess has healed and she has been able to continue feeding her young baby. The collaboration of a local, caring nurse and a specialty physician half way around the world allowed for an accurate diagnosis and treatment plan for the patient despite the limited access to health care services.

(picture: ValeriaRodrigues)