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.