Epilepsy clinic

This afternoon I accompanied Dr. Diane Young and Cathy to the epilepsy (seizure) clinic in area 25 of Lilongwe. It is a village like 'suburb' of the city. Cathy is from Canada and has worked here ~13 years. She has a school for special needs children. She does physiotherapy with the kids - at the school and at their homes if needed. She has all ages and conditions of kids. She also holds nutrition clinics and this epilepsy clinic every other week. Dr. Young is at ABC clinic and comes on every other Thursday to be the doctor at this clinic. The patients are generally young, but even older adults with seizure disorders come in. Some of the medicine is supplied by the government, but a large amount of it comes out of Cathy's own pocket. I have found that most of the missionaries here give their personal monetary support to much of what they do! When they come to clinic (they mostly walk here), they present their health passport - a little booklet that they are supposed to keep with them for all medical visits. Every doctor / clinical officer / hospital writes a note in the book when care is given. Just something short - vital signs, weight, complaints, findings, medications, etc. Usually less than 1/2 of a page. Really ill people may have several of the little books. They are very convenient when they come for care (even at ABC) - I call them the EMR (Electronic Medical Record) OF MALAWI! Ha! But just as our computers sometimes crash, they sometimes lose their books, or they burn up in a fire. However, if they have their book, they turn it in at the start of clinic - their place in line depends on when they turn in their book - first come, first served. If they forgot or lost their book, they are at the end of the line. As for the patients - a great many are due to cerebral malaria as a child. We saw a couple of what we are presuming were birth injuries and some ?? who knows what triggered them. Many of the adult patients had had seizures all their life - now they are on medications and they have a new beginning. Unfortunately, most schools will not let children with seizures attend - too disruptive. So many of the children have not gone past 2nd or 3rd grade. And most of them have old burns, where they have seized and fallen into the open cooking fires. The patients line up outside the tiny room that is the clinic. They come in when their name is called. They are asked about continuing seizures, if they are taking their medicines, if they are unwell, any other problems... the children are weighed, medication is adjusted if necessary and dispensed. Any other significant problem may be addressed by referring to another facility, as they only do the seizure meds at this clinic. (Today we saw a patient with a nasty abscess, and another one with possible filariasis.) At the end of their visit, each patient is prayed for by the team. Enough medicine is given to get them to their next appointment. Many of the patients had not made their last appointment and had been out of medications for some time. Just the logistics of getting to the clinic is overwhelming for some. They may have to take several minibuses and walk long distances to come in. We take so much for granted with our good roads and transport availability!! Some of the women whose children are in the special needs school / programs have been taught how to sew or knit. They have little items for sale. Of course I had to buy some! It is good to support people who are trying to support themselves! The pictures are of me with a couple of items I bought, and one of the ladies who does knitting. The gentleman on the left is one of the helpers at the school. The young lady with the gorgeous smile is Clara, she helps in the clinic. They keep their own records, in case the health passport is lost, and Clara is a great help finding the previous notes, etc. Two of the patients - Amoni is the little guy, he is a twin. His brother is fine, but he was breech and apparently had anoxic brain damage at delivery. He has multiple problems along with his seizures. The two children are Shadrack and his sister. Shadrack has seizures from cerebral malaria. His sister was the accompanying family for him. She is young, but another patient came alone, got his meds and left - he was 12!!! The last picture is Cathy, holding a stack of the health passports. You will notice her record book is laid out on the table. We had a good day, the patients were all either holding their own or had improved with their seizures. I am again reminded that you can only do what you can do..... for the doctors out there - no drug levels, no definitive testing on the mystery patients to see why they had seizures, no checking liver enzymes..... just treating as best as you can.

Jose did his last CPR class for the ABC academy today. They all did well, asked lots of good questions and seem to really 'get it'. Paul Chinchen, the president of all the African Bible Colleges, attended and (thankfully) passed the test!

Tomorrow, after morning clinic, we are planning on going to the village of Dzuwa until Sunday. We hope to do an all day clinic on Saturday for the villagers. Should be interesting. One of the patients I saw last time had a weird rash - I took photos and consulted one of the clinical officers at ABC - he thinks it might be leprosy. I hope to get some better photos. I also will refer him to the clinical officer to get a hands on opinion and possibly medication. Anyway, we will be out of touch for a few days! Keep us in your prayers.