Wow! Not only was March our month for the most amount of teleconsultations provided by our physician volunteers (117), but it also holds the record for the largest diversity of medical specialties utilized (15 different specialties!). While the typical "favorites" remain family medicine, pediatrics, and internal medicine, we also facilitated consultations that needed the assistance of cardiology, neurology, psychiatry, pulmonology and hematology specialists. We are lucky to have each of these physicians, as well as many others, who are ready to be utilized when a case comes along that requires their expertise.
The majority of our cases are referred by frontline health workers, yet we do receive a number of cases each month from physicians who need second opinions from physician volunteers. Providers who operate in large hospitals or outpatient clinics have constant access to professional colleagues with whom to share ideas, discuss patients and collaborate on treatment plans, but this is not the case for our partner physicians. They are usually the only doctor at a rural hospital with hours of travel between them and another colleague, so they rely on The Addis Clinic teleconsultations for virtual professional discussions.
A 5-day-old infant was brought by his parents to a rural hospital in East Africa because he seemed quite sick. The physician on duty immediately completed a full assessment, noting that the baby was having difficulty breathing, was grunting, and irritable. His heart rate was elevated, and upon examination of his lungs, the physician heard crackling sounds. He initially suspected severe pneumonia, and started the patient on two different antibiotics, a nebulizer and a pain and fever reducer. However, after 3 days of this treatment the patient was not improving. This East African physician transcribed the details of the case into our telemedicine platform and sent us the case, asking for pediatrician input. A pediatrician volunteer with significant global health experience immediately responded that the baby seemed very sick with neonatal sepsis and pneumonia. She recommended changing one of the antibiotics to one more appropriate for a newborn and asked some additional questions about the baby’s heart sounds, recommending referral to a larger hospital if the referring doctor heard a murmur. Our volunteer pediatrician also recommended starting the baby on some IV fluids with dextrose until he was able to nurse or take a bottle.
While this case was just referred, and we do not yet know the outcome for this patient, we do know that the referring physician learned something new and now has the expertise of a pediatrician at his fingertips thanks to our telemedicine system and volunteers.
As in most months, pediatric and family medicine physicians were our top utilized volunteers in February, though 17% of our cases were consulted on by dermatologists, making this specialty come in #3 in the rankings. We facilitated the diagnosis and treatment of scabies, infective dermatitis, tinea pedis and eczema among various other skin conditions. To meet this increased need for dermatology consultations, we have been working hard to recruit new specialists and are excited to have added another dermatologist to our volunteer team this week!
In the final days of January, we received the case of a 28-year-old male in Cameroon with “wounds on his legs”. Eager to find out more about this patient and how we could assist the referring health worker, our staff replied with additional questions about the patient’s medical history, current status, and asked for pictures to help us better understand his status. What we received back showed a young man in need of urgent wound care and the assistance of a physician volunteer.
When a case comes in on a weekend we often have to work harder to find an available volunteer, but when we saw this case we knew exactly who to ask. The Addis Clinic is lucky to have a number of very dedicated volunteers who make time for our partners no matter the day of the week, and the experienced emergency medicine volunteer who was assigned the case quickly responded that he would be happy to take it.
The history provided by the referrer revealed that 8 months ago the patient noticed swelling of both lower extremities. He sought out local treatment and the left lower leg swelling subsided, but the right lower leg developed sores that now engulfed the entire leg extending from the foot to the knee. When the physician reviewed the picture sent by the referrer he saw a large granulating ulcer and determined that it should be treated as a second-degree burn and should heal with conservative treatment.
In an educational and thoughtful response, our volunteer not only provided guidance on how to manage the man’s wound, but also discussed the potential reasons behind this man’s chronic ulcers and requested additional information so he and this health worker could get to the bottom of this together. We look forward to learning more about this patient and his progress as this volunteer and dedicated health worker work to treat his acute complaint as well as manage his ongoing health.
In January 2019 The Addis Clinic provided 129 volunteer physician teleconsutations on 93 cases submitted by our clinical partners across the globe. This is the same number of cases that we received in the first THREE months of 2018. With news of our positive work spreading, we are thrilled to meet the needs of so many frontline health workers and their communities. Even as we continue to bring on new partners and train new frontline health workers, the type of need remains the same. Family Medicine (30%), Pediatrics (23%), Internal Medicine (20%) and Dermatology (10%), continue to be our most utilized specialties.
In December The Addis Clinic added 3 new partner organizations and a number of new referrers. One of the first cases sent by a new frontline health worker came from Cameroon, where a 35-year-old male presented with complaints of chest pain for one year and headache. While at first glance these complaints seemed very broad, The Addis Clinic staff replied to the referrer with additional questions and worked with her to paint a more detailed picture of the patient’s medical history and his current status. Once we had all the information we needed, the case was then referred to an internal medicine physician volunteer and he and the referring health worker continued the conversation about the patient, his current symptoms, and history.
This dialogue revealed that for the last year the patient experienced a burning chest pain located below his sternum, and it was related to the timing of his meals. He denied any personal or family history of heart disease or cardiac problems and revealed that he had previously been diagnosed with H. Pylori, a type of bacteria that infects the digestive tract and over time can cause ulcers in the stomach or upper part of the small intestine. Our physician volunteer carefully guided the health worker through the course of treatment for this type of infection to include antibiotic treatment and a proton pump inhibitor, as well as explained guidelines on re-testing after completion of treatment. He also concluded that the patient’s headache was most likely caused by tension and could be treated with a medication such as Tylenol, as needed.
While this patient’s complaint and diagnosis is not uncommon, the detailed conversation between the referrer, the staff at The Addis Clinic, and our volunteer physician occurred over about a dozen messages sent through our online platform. They were all aimed at training this new referrer on best practices for asynchronous telemedicine AND getting her patient the best care possible. This perfectly illustrates our mission in action - to support frontline health workers as they provide patients in their communities with quality and culturally appropriate care. In the days following this case, this health worker has sent 13 other cases on which we have facilitated successful consultations, and we look forward to even more opportunities to assist her and her patients!
In December 2018 we facilitated the most physician consultations since our founding. Physician volunteers across eleven medical specialties provided 80 consultations on cases referred to The Addis Clinic by frontline health workers in Kenya, Cameroon, Somalia, and Haiti. Many of these were submitted over the Christmas and New Year holiday, and our ready team of volunteers did not hesitate to provide needed guidance despite their own very busy schedules.
60% of our cases in December 2018 were consulted on by the “usual top-3” of family medicine, pediatrics and internal medicine. However, a few patients had very specific needs and required us to call on the expertise of a neurosurgeon working in Addis Ababa, Ethiopia, a pediatric endocrinologist in California, and cardiologists in Pennsylvania & Connecticut. We are very lucky to have such a diverse network of volunteers!
Earlier this year, The Addis Clinic and one of our partners, Mr. Joanes Jang of Child Aid Development Foundation International (CADFIN) in Cameroon, submitted a proposal to the Start Free Challenge sponsored by ViiV Healthcare. This positive action challenge recognizes the potential of innovations implemented at the local level to rapidly reduce new HIV infections in children.
We were excited to announce late this summer that our Positive Telehealth proposal was one of the four 2018 winners! Positive Telehealth was developed through a collaborative effort of The Addis Clinic andCADFIN in an attempt to break the barriers of preventing maternal to child transmission of HIV and providing the most effective antiretroviral treatment available for every child, adolescent, young woman, and pregnant or breastfeeding mothers living with HIV/AIDS in the Mezam Division of the North West Region of Cameroon .
With the funding of this program, we were able to get Positive Telehealth off the ground this month! CADFIN has coordinated additional partnerships with 5 health centers in North West Cameroon, and they have all started training on how to utilize teleconsultations and The Addis Clinic services to better reach their HIV/AIDS patients. We are excited to progress further in this initiative and are grateful for the support of ViiV Healthcare and the Start Free Challenge.
For one of our final cases in November, The Addis Clinic received the urgent referral of a 2-year-old boy in Kenya who presented to his local clinic with a 4-day history of seizures, high fever and jaundice. While at the clinic he developed difficulty breathing and became increasingly dehydrated as he actively seized. The clinical officer treating him ran an initial panel of tests which revealed that the young child was positive for malaria and had a low level of hemoglobin in his blood. The clinician was concerned about potential cerebral malaria and sent the case to The Addis Clinic, as he knew the patient needed to be treated quickly and might not have the opportunity for transport to a higher level of care.
The case came in over a weekend, and despite this, we quickly found multiple volunteers available and willing to consult on the case. A volunteer pediatrician responded with multiple recommendations on how to approach treatment based on the detailed case information sent by the clinician in Kenya. Using our asynchronous telemedicine system, the physician walked the clinical officer on the ground through multiple methods for breaking the patient’s seizures, treating the malaria, rehydrating the child and monitoring his blood count. The volunteer’s detailed assistance took many variables into account, to include medication and testing availability, which is very important when critical care is being managed in such a remote and low resource setting.
Two days later we were thrilled to receive an update that the boy was rapidly improving after receiving the treatment recommended by our volunteer. We look forward to following his continued recovery and are grateful for the hard work and dedication of time and talent by everyone involved in this case!
In November, The Addis Clinic utilized 8 different medical specialties as we facilitated consultations between global frontline health workers and physician volunteers. 30% of the cases this month were pediatric patients and our pediatric volunteers guided referring clinicians through diagnosis and treatment plans for severe conditions such as epidermal necrolysis (a severe skin reaction) and cerebral malaria, as well as more common pediatric complaints like ear infections. This teamwork between physician volunteers and referring health workers is crucial in an area of the world where there is a severe shortage of physician-level health care.