Preparing to move on...

So today was our last day in moshi before our rural field trip. I'm off to a sleepy seaside town called Pangani at 6am tomorrow.

Today was a mixture of fever, ethics and neurology. Interesting point - we diagnose malaria far too often, when on average less than half of those we treat for it actually have it. We also miss the other causes of a fever, most importantly bacterial sepsis.

Take home message - in a low prevalence setting, believe your negative malaria rapid test and treat with broad spectrum antibiotics if sick.

We also had a very interesting session on the ethics of medical placements abroad - i've ranted for a few years about the issue of not really benefitting the host country when we are abroad.

http://www.ajtmh.org/content/83/6/1178.abstract

John Crump summarises issues that occur commonly when we are sent abroad eg on elective, but interestingly enough the field of ethics in this domain is a rather new one.

Finally we spent the afternoon back on the wards with Dr Howlett (one of Tanzania's two neurologists) seeing cases ranging from a space occupying lesion causing several neurological sequelae, to a haemhorragic CVA with subarachnoid transformation in a 20 year old. Sadly, haemhorragic strokes account for approximately 40% of CVAs here.

We asked our fellow African students why Tanzania has so few neurologists. The answer was not surprising, "it makes you no money. You cannot do much for most of your patients".

In reality, Dr Howlett highlighted that whilst we were in in Faith-based hospital Africa, little more than a full blood count was free of charge, and CT scans too exorbitantly priced (at $100) for most of our patients. He also reminded us that whilst certain conditions (eg TB) have been prioritised by the international community to make treatment available for free, we forget that high blood pressure is being ignored. With urbanisation and lifestyle changes, we are missing this growing problem.

Yet it impacts more than half of over 50s in Tanzania and we know how important a risk factor it is for several serious conditions.

So another take home message could be:

Just because we're in the tropics doesn't mean that people aren't frying strokes, heart attacks and COPD.