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)

Case Spotlight

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

Summer time in Ethiopia is not much different than in the U.S. Children are more active and injuries are more frequent. Even common wounds can result in complications when not treated properly. For people with limited access to health care, the delay of this care can result in further pain and infection.

This was the case this month when a 15-year-old boy was suffering from swelling and pain in his left knee and leg. He reported that a month earlier he fell and suffered skin abrasion. The family was not able to afford to bring him to the local medical center.

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The local health worker submitted a consultation, including pictures, and the case was assigned to a volunteer physician in our network. It was determined that the young man was most likely suffering from Pre-patellar bursitis with localized cellulitis extending to the ankle, including multiple chronic infected abrasions and ulcers, secondary to a previous fall injury and localized infection around the knee.

Translated in non-medical terms: the boy’s leg, especially the knee, was inflamed and infected all the way to the ankle due to improper care of the injuries he sustained from a previous fall.

Pre-patellar bursitis is commonly known as “Housemaids Knee.” Historically, it was a typical injury for people who would spend long periods kneeling on the floor. It can also happen due to a fall or direct blow onto the knee.

After proper diagnosis, the recommended treatment plan consisted of antibiotics to treat the infection, ibuprofen for pain relief, an update for tetanus prophylaxis, and specific instructions for daily cleansing of the wounds.

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After two weeks of this care, the boy’s wounds were healed, the swelling disappeared, and he could bend his knee 90 degrees. Thanks to the collaboration between the local health worker and our volunteer physician, it is expected that the boy won’t experience any further complications and can return to his daily routine!

Meet a Partner- I-HOPE Foundation Kenya

Since April 2016, The Addis Clinic has partnered with I-Hope Foundation in Migori County, Kenya. Migori is nestled in between hills in south-western Kenya, a 7-hour trip from the capital Nairobi. Almost half of its population of around 50,000 people live below the poverty line and earn less than $1 per day. In this complex environment, the I-HOPE Foundation, a Kenyan NGO, is working to “improve rural health through creative and innovative approaches” targeting the most at-risk population of Migori.

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Their willingness to embrace innovation has made them an ideal partner for The Addis Clinic. The opportunity to implement telemedicine to better serve patients at the rural Sori Lakeside Hospital, bringing access to specialty physician care, has been welcomed by I-Hope. Allowing the local Kenyan physicians to collaborate with multiple specialists on complex cases through technology has had an immediate impact on the local community. Through our partnership, The Addis Clinic has provided specialty consultations in Cardiology, Pulmonology, Infectious Disease, Pediatrics, Dermatology, and many others. This partnership displays the importance of physician to physician consultations for doctors serving entire communities without the help of a team of local specialists.

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Additional creative approaches that I-Hope participates in is their in-school Water, Sanitation and Hygiene (WASH) Program, preventing students from exposure to diseases such as Cholera, Typhus, and Malaria. I-Hope not only teaches about the importance of handwashing, but they have installed over 30 water tanks and regularly supply soap for around 2,000 students and their teachers.

Poverty and access to simple personal hygiene items, like sanitary pads, make it difficult for girls to attend school. I-Hope supports these students by distributing personal hygiene items and teaching proper disposal. David Maganya, the Director, doesn’t shy away from difficult conversations. He and his team talk to students about their sexual and reproductive health, HIV, and other topics that directly impact the daily life in Migori. Many children are AIDS orphans or have parents who are not able to sufficiently care for them, leaving these children at high-risk. They cover the costs of education for local children through their I-HOPE Fellows Scholarship, ensuring their youth receive a proper education, leading to university education and laying grounds for a better life.

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Gold mining is a common occupation in the Migori Region, a dangerous profession when not trained properly in safety precautions. It is not uncommon for miners to handle mercury with their bare hands in this process. Because they have not been taught of the health risks, I-HOPE stepped in and is working to teach local miners the importance of safety gear (gloves, goggles, respirators, etc.).

The Addis Clinic is proud to partner in the critical work being done in Migori Country by I-Hope and looks forward to growing our impact in this region.

David Maganya, I-Hope Director, talks about the challenges of medical access in Kenya.