By Jacob Manske, MD, and Teresa Lee, MD
The University Teaching Hospital (UTH) in Lusaka, Zambia, is the largest hospital in the country. With over 1,600 beds, it serves as the main referral hospital and trains many of Zambia’s medical students, residents and nurses. Through a partnership with several American neurologists working at UTH, Rush University Medical Center (RUMC) in Chicago began sending two neurology residents per year to work for a month at UTH in 2017. Drs. Jacob Manske and Teresa Lee, currently fourth year neurology residents at Rush, were the first residents selected for this opportunity.
The month was primarily spent consulting on patients with neurologic problems hospitalized on the various medicine wards and in the intensive care unit (ICU). With only 10 adult ICU beds, the intensive care unit was primarily reserved for patients who required mechanical ventilation. Ischemic and hemorrhagic stroke patients were typically monitored on the regular medical wards. In many cases, a computed tomography (CT) scan took several days to perform. Similarly, laboratory studies performed would often return several days later. A common dilemma for acute stroke patients was the decision to give or withhold aspirin prior to CT. This was challenging, as typically in the U.S. we would be able to wait for CT results in order to determine if the stroke was hemorrhagic or ischemic. In cases of significant headache, coma, seizures or severe hypertension, we were more likely to hold aspirin. Given these limitations, the overall experience was incredibly beneficial to the development of our history taking and physical exam skills.
With an HIV prevalence of 11.5 percent among adult Zambians1, we cared for patients with neurologic complications not commonly encountered in the United States. This included cryptococcal, bacterial and viral meningoencephalitides, as well as varying presentations of tuberculosis, neurocysticercosis, progressive multifocal leukoencephalopathy (PML) and toxoplasmosis. In developing a differential diagnosis, the single most important history detail was an individual’s HIV status.
In addition to patients with vascular and neuro-infectious diseases, we treated many patients with epilepsy. The most commonly used antiepileptic medications were carbamazepine, phenobarbital and diazepam due to cost and availability. Levetiracetam and phenytoin could be used if the patient or family had financial means. During our time, a medical student from the United States was performing epilepsy research at UTH and acted as an electroencephalogram (EEG) technician.
Aside from clinical practice, a large portion of time was spent teaching neurology to medical students and residents. We gave lectures on many subjects including the neurologic exam, acute stroke, management of seizures and neuro-infectious diseases. We performed bedside rounds with students, teaching physical exam and localization skills. Residents and students also attended neurology clinic with us one day per week to learn about outpatient neurologic problems.
The trip also afforded us the incredible opportunity to explore a new area of the world. Highlights included a trip to Victoria Falls (the largest waterfall in the World), a safari in South Luangwa National Park and visits to the local markets in the capital city of Lusaka.
Beginning in 2018 with the support of Drs. Omar Siddiqi of Beth Israel Deconess Medical Center and Igor Koralnik of RUMC, UTH now has its own neurology residency program. Future residents from RUMC rotating at UTH will have the opportunity help train and learn from these new residents.
#NCSRoundup #December2018 #International #Zambia #JacobManske