Case Spotlight

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In June 2019, The Addis Clinic received 93 unique cases from Kenya, Cameroon, Ethiopia & Uganda. Most of these cases were handled quickly by our specialists and only required one or two exchanges between the referrer and physician volunteers. Occasionally, however, the cases we receive are quite complicated and require more intensive communication. In June, one such case was that of a young woman affected by TB for the last 5 years. Her TB had been inactive due to her adherence to medication, but a few years ago, she was diagnosed with lung collapse that lead her to breathing complications including shortness of breath, exhaustion on simple activity including laughter, wheezing, and decreased oxygenation. We allocated the case to one of our volunteers who specializes in pulmonology and critical care medicine for review.

Upon further discussion with the referrer, we learned that 2 weeks prior to the referral, the patient was hospitalized with vomiting of blood, a resistant cough, and malaise. Her TB tests were inactive, her CBC, chest x-ray, blood tests and urinalysis were all fine. The referrer was looking for short and long term management recommendations for her disease. From the distance of 7500 miles, our volunteer specialist responded with an extensive list of further questions, to include a request for more recent imaging and the patient’s vital signs and oxygenation levels. She also diagnosed a very large, right-sided tension pneumothorax based on the images included with the case. It is likely due to rupture of a bleb or bullae in her right lung, which formed due to her TB. According to our pulmonologist, it is quite common for this to happen, even in patients without active TB. The immediate issue at hand then became how to treat the pneumothorax, for which the pulmonologist recommended the input of a thoracic surgeon.

The Addis Clinic needed to add a thoracic surgeon to the case, but we do not have one on our current team of volunteers. We reached out to our extensive network of supporters, and were connected to one in Boston who said he was interested in helping. We are still working to bring him on board so he can lend his expertise in this case. In the meantime, the patient was sent for updated CT scans which our pulmonologist is reviewing before offering updated recommendations and thoughts. The patient continues to be monitored by her physician at home, while a whole network of staff and volunteers works to get her the answers she needs from continents away.

Nothing The Addis Clinic does is automated. Each case is personally reviewed by a staff member, and the right specialist is carefully selected and matched to the case. Whether a case requires 1 hour of work, or 6, we will always ensure each patient and referrer who turns to us is provided high quality and appropriate telemedicine consultations. It is why we exist.