Case Spotlight

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

It is the business of children to play.  Whether in the United States or Mufindi, Tanzania, children run, jump, climb and get dirty.  Cuts and scrapes abound, and usually, heal with a quick clean and bandage.  Yet sometimes even the most innocuous injury quickly develops into a more serious complaint. This is when the difference between where those children were playing matters. One group of children has access to qualified medical professionals ready to treat them quickly and effectively.  The children in Mufindi may not have that same access and thus have a longer road to healing and playing again.

A 5-year-old boy presented to a partner organization in Mufindi, Tanzania with a complaint of pain and swelling in his middle finger.  The clinic initially treated the finger with minimal intervention to include careful cleansing and application of antibiotic ointment.  The issue seemed to resolve, but two weeks later the patient returned with swelling that reached halfway down his left middle finger.  There were no obvious breaks in the skin, and soaking the finger and application of warm compresses did nothing to relieve the pain and pressure.  The patient was started on cephalexin, a common antibiotic used to treat skin infections, yet the pain and swelling continued to progress.  The staff at the Tanzanian clinic turned to The Addis Clinic for advice on how to proceed.  The patient’s case history, as well as pertinent photographs, were submitted to The Addis Clinic via our telemedicine platform, and it was allocated to an Addis Clinic volunteer internal medicine/pediatric specialist.  

Case spotlight October II.jpg

The Addis Clinic volunteer replied with detailed recommendations on how to proceed in the patient’s care. The first step was to change the patient’s antibiotic to a medication with better coverage against certain types of resistant bacteria, then to continue with warm compresses three times daily and elevate of the affected hand.  The physician also recommended that if this did not result in improvement, an x-ray should be obtained to exclude a foreign body in the finger, and an incision and drainage should be performed to drain pus and relieve pressure in the finger.

case spotlight october I.jpg

The patient’s pain and swelling continued to increase, and he was sent to the hospital for an incision and drainage.  Two days following the procedure, the little boy returned to the clinic for a dressing change, and the clinician noted that despite the procedure, there was little improvement in either the swelling or pain.  After reviewing the updated information to include pictures of the little boy’s hand, our volunteer physician recommended a hospital admission for IV antibiotics, as well as continued cleaning and dressing of the wound. While a trip to the hospital was too far, the local clinicians were able to administer three days of intramuscular antibiotics and then ten days of an oral antibiotic, while also paying careful attention to cleaning and dressing the finger.  The result was a complete recovery for the patient with full function and range of motion of his finger!  Instead of clinic visits, bandages, medicine, and procedures, this little boy is back to playing, jumping and getting dirty – just as he should.