Case Spotlight

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We are often asked, "How do you utilize surgeons in asynchronous telemedicine?"  as we have a variety of surgical specialties on our team of volunteers to include general surgery, orthopedic surgery, breast specialists and even a neurosurgeon.

Early in April, The Addis Clinic received a case from a health worker in rural Kenya. A 9-month-old boy was brought to him in distress. Three months prior, the boy had a cerebral shunt placed to manage his hydrocephalus, a condition in which excess cerebrospinal fluid builds up within the brain and may increase pressure within the head. The shunt was meant to move the excess fluid in the brain to the boy’s abdominal cavity. In the days preceding his clinic visit, his mother noticed he was more irritable, and there was “swelling on the area overlying his shunt”. Far from the urban center in which the surgery was performed, the health worker looked to The Addis Clinic for guidance and expertise. Thankfully, just a few months earlier, we brought on a neurosurgeon working in Addis Ababa, Ethiopia who wanted to volunteer with our organization. He was eager to take this case and provide any guidance he could from a distance.

After examining the pictures and history provided by the health worker, the surgeon concluded that the area around the shunt was infected, and the shunt needed to be removed immediately. Knowing this would mean a long trip to the hospital where the surgery was performed, the surgeon provided advice on how to manage the acute needs of the patient. He recommended getting a Shunt Series of X-rays , as well as starting IV antibiotics at a dose high enough to prevent infection from affecting the brain, and finding a clinician in the area who was trained in tapping of the shunt (removal of a certain amount of cerebral spinal fluid to decrease intracranial pressure) which would give the boy some symptomatic relief.

This was a very complicated and serious case, and without the availability and input of this volunteer neurosurgeon, our partner clinician would have no one else to turn to for guidance. The rest of our team of surgeons provides advice similar to this every month, and our partners are always grateful for their expertise.