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.