July brought The Addis Clinic cases from Ethiopia, Kenya, and Cameroon. Many were submitted by long-established partners, while we also received several referrals as a result of new partner relationships cultivated during our Executive Director's visits to Addis Ababa in Ethiopia and Nairobi and Migori County in Kenya earlier this month. While we continue to find that the many of our cases require primary care specialties such as family medicine (25% this month); and pediatrics (17% this month), we also had increased need for specialty consultations from physicians in fields such as pediatric urology and nephrology which you can read about in this month's case spotlight.
Sometimes, as the saying goes, “It’s all about who you know.” That sentiment proved true this month for one girl in Ethiopia whose referral to The Addis Clinic started with an email from a woman in Tennessee to our founding physician in Pittsburgh. This woman and her husband support an organization in rural Ethiopia serving impoverished children and she heard about The Addis Clinic through a mutual contact working with our longest standing partner, Ethiopia ACT.
Once the case made its way from our founder to our clinical team, we learned more about this girl in great need of specialized medical care. In their email to us, these concerned supporters told us how during a routine medical exam, the eight-year-old was found to be suffering not only from malnutrition but many other medical problems. Further testing revealed that she was born with only one kidney and that it was failing. Unsure of where to turn next, they hoped that The Addis Clinic could facilitate guidance and advice from specialists most suited to her case.
It became clear that this young girl would need the expertise of a nephrologist and we did not have one on our team of volunteer physicians. We immediately put out the call through our supporters and volunteers, and they delivered! Within hours we had three nephrologists contact us with a willingness to assist. Simultaneously, we worked with this girl’s caregivers to officially bring their organization on as a partner of The Addis Clinic and trained their staff on how to submit an asynchronous telemedicine case. It took many emails and conversations, but by the next morning, we had this new partner set up in our telemedicine system, while our new volunteer nephrologist was onboard and prepared to receive her first case.
As timing would have it, most of this transpired while our Executive Director, Michelle Turner, prepared to fly to Ethiopia and conduct site visits. Within the first few days of her arrival she assisted in referring the case and even more wonderfully, she was able to meet the sweet girl who we are so grateful to help. In the U.S., our Clinical Operations Manager, Meghan Moretti, connected the case with our volunteer nephrologist, who immediately responded with her thoughts and recommendations. These included the belief that a pediatric urologist should also add his perspective. Thankfully, The Addis Clinic is already connected to a pediatric urologist who is happy to lend his expertise when needed, and he was quick to do so on this case.
Now that this girl’s caregivers have the professional opinion and advice of two very specialized physicians, they are much better informed to navigate and consider her medical options. We and our volunteers will continue to support them during this overwhelming and difficult time.
The ability of The Addis Clinic to connect with a new partner and bring on a new and very specialized physician volunteer all within a matter of hours took the quick work of our entire team. We are grateful that so many people share in our passionate belief that telemedicine can successfully connect the world’s most underserved individuals with skilled and appropriate medical care.
Dr. Ann Colbert is a family medicine and palliative care/hospice physician who is currently based out of Kentucky. Dr. Colbert has served as a family medicine specialist volunteer for The Addis Clinic and has also referred cases to The Addis Clinic as the medical director for Hillside Health Care International in the Toledo District of Belize. She has a unique perspective as both a specialist and a referrer, and we are excited to share her experiences with The Addis Clinic!
Q: As a practicing physician, you have a very busy schedule and many responsibilities. What motivates you to spend extra time to consult on cases for other health workers far away?
A: First, consulting on the cases takes relatively little time. Second, with each case history, I am reminded that both life and medicine are very different and very much harder in these other places.
Q: How have you used your specialty so far in your work for The Addis Clinic?
A: As a specialist volunteer, I have mostly answered primary care management questions. As a referrer to The Addis Clinic while in Belize, I used dermatology, pediatrics, gastroenterology and orthopedics.
Q: Why do you think an organization such as The Addis Clinic is needed?
A: Using technology makes the most sense in addressing the disparities of unequal health care throughout the world. Having traveled internationally to work as a physician, I see that temporary physician visits are not a permanent solution to providing quality care to remote areas. Using telemedicine, whether within a country or globally, makes a lot of sense to fill the gaps.
Q: What have you gained for your professional AND personal life so far by volunteering for The Addis Clinic?
A: I like being associated with an organization that I can fully support and feel I have gained a new perspective on global health because of my association with the group.
Q: Is there one case you remember that was particularly impactful?
A: I remember we had a 5-month-old baby in Belize who had been born with bilateral severe club feet and his parents were not able to take him to Belize City for treatment. Our physical therapy director put in a consult and within days she had a complete treatment plan from one of the orthopedics. The consultant had included a detailed description of the Ponseti method with helpful warnings and advice. We were able to start the casting with weekly recasting at home for a few weeks until the child eventually was able to get to the larger center. I saw the baby a few months later and his feet were nearly straight. It was a condition I rarely would manage in the US.
Q: What would you tell other physicians considering volunteering with The Addis Clinic?
A: That the commitment of a maximum of 3 cases per month is very manageable and if you want to ecologically responsibly help distant patients, this form of global work may make more sense than the short term "mission" trips. This is because The Addis Clinic system can help to build the capacity of a local medical team to provide quality health care in their own country.
Q: We know you recently returned to volunteer at Hillside Health Care International, a partner of The Addis Clinic in Belize where you previously served as Medical Director. How was your trip?
A: I returned to Hillside Health Care International in southern Belize for two weeks in late May of 2018. I went to volunteer as a physician preceptor for the Physician Assistant students who were on rotation at the Hillside Clinic. I had been the Medical Director at the clinic in 2016- 2017 so the trip was a reunion with the staff and many patients. We were quite busy seeing patients both in the permanent clinic and on daily mobile clinics to remote mostly Mayan villages. It was nice to share my previous experience with the students who were in their first weeks of the 4-week rotations.
I worked with two physicians from England the first week and we were happy to be able to send at least two cases for dermatology consult through The Addis Clinic and I was able to call up one mother the very next day to tell her what new therapy was suggested. That is what I like about working at Hillside Clinic - getting to know people from all over who either come to volunteer or come as students plus getting to know the Belizean staff who are the constant. I was also able to reconnect with 3 of the long-term volunteers I had worked with and we arranged to camp in a jaguar reserve one weekend next to a mountaintop waterfall. Belize is a beautiful country.
Our case spotlight this month comes from northern Haiti.
Children often present to their health care provider with abdominal complaints, and these are usually viral, treated with time, rest, and rehydration. However, for parents of children in Haiti, the causes behind vomiting and diarrhea can mean illnesses more difficult to address due to a lack of sanitation and clean drinking water.
A community health worker in Haiti reached out to The Addis Clinic with the case of a 10-year-old boy with a 1-week history of vomiting up to four times daily accompanied by a cough. No one else in his home complained of similar symptoms, and he had previously been treated for an infection of worms from which he had recovered. The health worker needed assistance with how to proceed, and we allocated the case to a volunteer family medicine physician practicing in New Zealand. Despite the large time difference between Haiti and New Zealand, our volunteer was quick to respond with detailed follow-up questions and recommendations.
The volunteer believed it most likely that the little boy was suffering from an infection of worms (a parasite living in the intestine), which can sometimes go to the lung and cause irritation leading to a cough. These are usually caught by children through water, food or soil and can be spread through feces. They can lead to poor nutrition and weight loss.
The volunteer detailed the appropriate course of treatment for worms and recommended his entire family take the treatment at the same time. This physician provided dosage adjustments based on age range, as well as the restriction of the treatment in the first trimester of pregnancy and in babies less than 1-year-old. This volunteer, by consulting on the case of this one child, addressed the health of his entire family.
While the boy had previously been treated in this way, this family medicine physician educated the health worker that it can be difficult to keep the infection from returning. Sometimes, taking the prescribed medication in a preventative manner is the only way. He recommended an interval of 6 months between treatments and even provided resources to the health worker for obtaining the medication from clean water initiatives working in Haiti. The volunteer emphasized the importance of regular hand washing with soap and water, keeping nails short, and how to best avoid contamination of food.
Finally, this volunteer provided the Haitian community health worker with a detailed list of warning signs that would signal the patient needed urgent care. The community health worker confirmed his understanding of the plan and will update the physician on the boy's status in a couple of weeks. The Addis Clinic is honored that we were included in the care of this boy and his entire family, and look forward to hearing about his clean bill of health soon!
What types of cases do we receive at The Addis Clinic? Take a look at the breakdown from May.
In a change from the previous few months, the top needed specialty in May was Dermatology. 27% of our cases required consults from dermatologist volunteers at the Mayo Clinic and University of Pittsburgh as they advised nurses, physicians and community health workers in Ethiopia, Kenya, and Belize on the care of patients presenting with difficult to treat skin conditions. Additionally, we were excited to onboard our first pediatric ophthalmologist this month, and put him right to work on a case sent by a nurse in Ethiopia. The availability of over 22 specialties in our team of remote volunteers ensures we are able to provide expert guidance for whatever type of case is sent our way.
One of the biggest challenges encountered by our physician volunteers is responding to cases with advice that takes the limited resources of our referring clinicians into consideration. The way these physicians might respond to a patient in their own clinical practice can vary greatly from how our international partners are able to respond. An emergency pediatric case we received this week perfectly illustrates how our volunteers must be always mindful of the situations in which they offer guidance.
Earlier this week The Addis Clinic received an urgent message from one of our Kenyan partners. This clinician notified us that he was submitting the case of a 2-year-old boy, who presented with a 3-4-day history of elevated temperature, elevated pulse rate, and elevated respiratory rate. Additional information revealed that the child had some twitching and stiff neck and appeared lethargic, with a cough and wheezing. The patient also tested positive for malaria.
The Addis Clinic reached out to an emergency medicine physician volunteer, and he was able to immediately respond to the case via our asynchronous telemedicine platform. In the clinical environment in which the patient is being treated, some usual tests such as urinalysis, blood tests, lumbar puncture, and chest x-ray are not available. Our physician volunteer had to construct his response so that his advice to this clinician took the treatment constraints of the rural location into consideration.
As the child presented to an outpatient clinic, the ER physician decided to focus on the management of this patient for a brief period of time, hoping for a positive response. However, in the event of no response within 48 hours, he recommended that the child be immediately taken to a medical facility where a higher level of care can be provided. In his response to the Kenyan clinician, The Addis Clinic volunteer physician addressed the two critical conditions that could be giving rise to the fever and are responsive to antibiotics. First would be pneumonia, as the child presented with an elevated respiratory rate and is having difficulty breathing with some reported wheezing and a cough. Meningitis is also a consideration in this age based on the elevated fever and if indeed the child is demonstrating a stiff neck, this would indicate quite an advanced level of this condition.
The physician’s recommendations for the first 48 hours encompassed three elements: hydration, fever management, and antibiotics. The physician volunteer recommended that every effort should be made by the caregiver to hydrate this child, with the hope that he consume approximately 40 ounces of fluid in a 24-hour period and have adequate urine output. He also recommended the appropriate acetaminophen dosage to be repeated every 6 hours for the first 48 hours. Finally, in his communication with the Kenyan clinician, the emergency medicine physician volunteer recommended ceftriaxone 50mg/kg per day intramuscularly. The Kenyan clinician acknowledged these recommendations and quickly worked to put them in place.
Two days later, we have heard that the boy is responding to treatment – his temperature has normalized, he is more interactive, is taking fluids, and his neck stiffness has decreased. Our volunteer physician will continue to keep track of this patient in the coming days, as he and the clinician in Kenya work to get this little boy back home with his mother soon.
What types of cases do we receive at The Addis Clinic? Take a look at the breakdown from April.
The Addis Clinic connects physicians to frontline health workers, allowing for specialty care in the most remote and underserved areas.
In April, 9% of cases submitted to The Addis Clinic required consultations by infectious disease (ID) physicians. The Addis Clinic is grateful to have two ID volunteers on our team, ready to take these cases as soon as they are allocated.
A 22-year-old HIV positive woman presented to a local clinician in rural Kenya with complaint of a severely infected wound on her left foot that first appeared 3 weeks prior. She reported a long history of rash and skin infections over the previous decade, though she did not possess records of her treatment history for either her HIV or chronic ulcerations. The pain and drainage associated with the current wound kept her from walking, which was especially problematic because as a young widow with two children, it prevented her from meeting her responsibilities. The Kenyan provider submitted the case using the The Addis Clinic’s Adult Referral template on the Collegium Telemedicus app, and the case went to an infectious disease physician volunteer for consultation.
The ID volunteer quickly responded that given the acute nature of the wound, it appeared to be a likely bacterial infection with staph or strep, and he recommended specific antibiotic treatment for at least 14 days. Additionally, he recommended that given the patient’s history of chronic ulcers, the African clinician should also consider leishmaniasis, buruli ulcers, TB, and maybe even cutaneous anthrax, diphtheria as potential causes. The health worker took the physician’s advice and immediately started the patient on both an oral and IV antibiotic. Four days after the consultation, the health worker reported back that the patient was able to walk unassisted, which was a marked improvement in her condition.
The patient will continue to require aggressive wound care, as well as further testing to determine the cause of her chronic ulcers. However, today she is mobile and infection free in great part due to The Addis Clinic connecting a passionate frontline health worker with a generous physician volunteer.
What types of cases do we receive at The Addis Clinic? Take a look at the breakdown from March.
March brought with it an interesting variety of cases submitted to The Addis Clinic! Cases from Ethiopia, Kenya, Tanzania, Cameroon, and Haiti required 11 different types of medical specialists. However, as follows from previous months, family medicine and pediatric consultations comprised 55% of our volunteer work. This is not surprising, as even in the United States 51% of physician office visits are made to primary care providers. (Source: National Ambulatory Medical Care Survey: 2015 State and National Summary Tables, tables 1, 11, 16). Despite the fact that The Addis Clinic reaches patients in some of the most resource-limited and remote areas of the globe, they still experience the same common medical problems that bring most people to the doctor. Childhood ear infections, abdominal pain, lower back pain, conjunctivitis, urinary tract infections and headaches were only some of the complaints consulted on by our primary care volunteers this month. Check out our March cases by specialty below:
Over the past month, 180 people from all over the world took on a fitness & fundraising challenge in support of The Addis Clinic. The Addis Clinic got people moving in Germany, Afghanistan, Texas, Kentucky, Colorado, Washington D.C., Boston, North Carolina, Georgia, California, New York...the list could go on and on!
In detail, the challenge was to run/walk/swim/lift/cardio/dance 100 miles (or 1000 minutes) per participant throughout the month. Some even literally went a few extra miles (even an extra 100!). If you do the quick math these dedicated individuals walked 18000 miles, or ⅔ of a way around the earth, to raise awareness and support clinicians and patients in Africa, Haiti, and Belize. We are so honored by and proud of each person who enthusiastically tackled such a daunting task. Not only did they commit to the physical challenge, but also to donate at least 10 cents per mile complete. These generous gifts enable us to continue to expand our work as we use telemedicine to increase access to healthcare for underserved populations across the globe.
The Addis Clinics wants to thank all participants of this challenge. Your support is incredibly encouraging!
If you were unable to participate in the #Run4AddisClinic challenge but would like to donate in support of our efforts, please check out our challenge link here: https://donorbox.org/run4addisclinic