Volunteer of the Month, Dr. Ann Colbert

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!

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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.

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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.  

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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.

 

 

 

Case Spotlight

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.  

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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!

Graph of the Month

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.  

 

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Case Spotlight

  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.  

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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.  

 

CASE Spotlight

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.

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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.

Graph of the Month

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:

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#Run4AddisClinic

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.

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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

 

Case Spotlight

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

This month we introduce you to a patient in Haiti who has experienced an ongoing rash on her hands and wrists “for a long time” that is very itchy and painful and has not responded well to initial treatment.  In the past, she applied topical hydrocortisone with no results, and at one point was given an oral antifungal medication, which only resulted in a small improvement.  She came to her local community health worker seeking help because she is “absolutely miserable” with the painful itching.

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The community health worker believed all available local resources had been utilized and submitted the patient’s detailed medical history and pictures of the rash to The Addis Clinic for allocation to a dermatology volunteer.  The Addis Clinic is grateful to have four active dermatologists in our volunteer network and one of them graciously and immediately took the case. The patient’s history as reported by the health worker included the fact that she did not present with rashes in any other areas of her body, she did not report any fever or other complaints, and that no one in her family or village reported a similar complaint.  The woman lives in extreme poverty, and water is not easily accessible in her neighborhood, making it difficult to maintain good hygiene.  The health worker knew that a U.S. medical team was set to visit the town the following week and hoped to contact them to bring medication for the patient if she required something that was not available locally.

After utilizing The Addis Clinic’s asynchronous telemedicine platform to discuss the patient with the community health worker, the dermatology volunteer believed that the patient suffered from a combination of Dyshidrotic Eczema and Lichen Simplex Chronicus (LSC).  According to the physician, “More than likely something in her environment is irritating the skin.  After scratching for long periods of time, the skin becomes thickened, which leads to the LSC.”  His recommendations included the application of a more potent topical steroid like betamethasone dipropionate 0.05% or clobetasol propionate 0.05% to the affected areas on the hands and wrists. Following application of the steroid, the dermatologist recommended the application of a moisturizer with 10-20% urea. Urea is part of the natural moisturizing factor of the skin, and when a patient has eczema, the amount of urea is greatly decreased and needs to be replenished. He instructed the health worker to have the patient complete this regimen three times a day for up to four weeks.  The health worker will follow-up with the patient after this time and was given further instructions if the rash remained resistant to treatment.

The Addis Clinic looks forward to following the progress of this patient and we are hopeful that the advice from our dermatology volunteer results in improved quality of life for this young woman.

Meet a Physician - Dr. Charles Groomes

Dr. Charles Groomes started volunteering for The Addis Clinic in the fall of 2017 as a pediatric specialist. As a physician and U.S. Navy officer who is stationed overseas, he has a unique perspective on telemedicine, as he often uses technology to obtain specialty consults for his own patients. We are grateful for people like Dr. Groomes who see the need for and invest their time in The Addis Clinic.

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As a physician and U.S. Navy officer stationed overseas, you have a very busy schedule and many responsibilities. What motivates you to spend extra time to consult other health care workers far away?

Currently, I serve as the "town pediatrician" for the approximately 500 children living on U.S. Naval Station Guantanamo Bay, at the very southeastern tip of Cuba. Specialty and critical care pediatric services are a 700 mile flight away in Miami, so I know firsthand what it's like to be far away from subject matter experts. Fortunately, Navy Medicine has a rich history of successfully navigating the inherent challenges of providing medical care in isolated and austere settings. Remote military clinicians use a telemedicine network called the Health Experts onLine Portal (HELP) to receive timely specialty consults from experts all throughout the Military Health System. I use HELP regularly, and am always sincerely grateful to receive expert guidance from my colleagues all over the world. Volunteering for The Addis Clinic allows me to pay that gratitude forward to frontline healthcare workers in places far more remote and austere than here.

How have you used your specialty so far in your work for The Addis Clinic?

The funny thing is, common things are common! Whether the patient is living in a large U.S. city or a small village in Haiti, kids get sick in many of the same ways. Most of The Addis Clinic cases on which I have consulted are for diagnoses I see a couple times per week in my regular pediatric practice. Of course, there are the more challenging cases that require geographic consideration, but I am finding the foundational elements of pediatric medicine are unchanged.

Why do you think an organization such as The Addis Clinic is needed?

Technology is making the world a smaller place. Being able to instantly communicate with people in the furthest reaches of our planet is incredibly exciting for sure, but it also brings us face-to-face with the profound, widespread need in less developed countries. I think The Addis Clinic realized something could be done about that, and I'm proud to be a small part of the solution.

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

I absolutely love my day job. Serving the very deserving children of the Guantanamo Bay community is truly a treasured responsibility.  When I get an email notification that an Addis Clinic case has been assigned to me, however, it is just as special! I cherish the opportunity to expand my "community" to Haiti (about 120 miles east of here), Ethopia, and beyond. In many cases, I can recommend a very simple treatment that will dramatically change a child's life, and that of her family and community. I imagine the frontline health worker feeling empowered to make a difference in the same way that I do when a subject matter expert answers my consult request in the HELP network. It's cool to know that I can have that same bolstering effect as "just" a general pediatrician. Finally, I have a 4 and 2 year-old. After I complete consult for The Addis Clinic, we go look on the map to locate where the child lives. It makes them really excited and proud of their dad; I'm glad I can model an "others first" priority to them.

Is there one case you remember that was particularly impactful?

Each individual case is impactful in its own way, really, from the simple to the more complex. However, while it's certainly nice to help one kid with his condition, each case also provides a convenient context in which to give a little education to the frontline health worker. That happened recently on a case in Haiti where I explained the slightly different ways that scabies can present in very young kids. The frontline worker later told me that because she had just dealt with that case, she was quick to identify scabies in an entire family she encountered a few days later. Educating people that are "in the trenches" is a cool way clinicians like me can make a difference for years to come.

What would you tell other physicians considering volunteering with The Addis Clinic?

Do it! If you're worried about the time commitment, don't be. In the grand scheme, it's a drop in the bucket. But also, the time investment doesn't feel like a net negative. In fact, it is just the opposite! Also, don't feel like you have nothing to offer because you are "just" a generalist. The cases aren't intimidating challenges from deep in the annals of tropical medicine, they are largely the bread-and-butter things you do in your practice every day. Take the leap!

Thank You, Dr. Groomes!