Often my medical work is little different from my UK practice, except that most of my patients are a lot poorer than the population of affluent St Albans.  I live and work in a big city at high altitude that doesn’t suffer the same degree of tropical disease as more remote and lower places. However sometimes things come my way that take me by surprise. Here are three short examples from my work today that my medical readers in particular will appreciate. it’s interesting to reflect on what might happen were these situations to arise in the UK. One in particular would make national headlines.

Case 1 – Extreme Anaemia

A colleague shared  this with me. A 20-something young woman (few people here know their date or even year of birth) had gradually become very weak and pale. She was anaemic of course; probably as a result of bleeding into her stomach on top of having AIDS and a past history that included TB and having been near death several times.  Stick-thin and weighing perhaps 35 Kg she couldn’t walk and was carried to a vehicle and taken to the ALERT hospital. This hospital was founded by SIM many years ago as a specialist leprosy and TB hospital but now independent has a role as an infectious diseases service and manages many people with HIV/AIDS. This poor woman was admitted to the emergency department where she stayed because of a problem familiar to all British GPs – a lack of beds. Blood tests showed she was the most anaemic person I have ever heard of who has survived – her haemoglobin was 2.1 grams/dL (most of you reading this will have a haemoglobin between 12 and 15 grams/dL). She is being transfused very slowly and is beginning to look better. Her outlook is of course bleak, but she has my colleague on her case and will be getting as good care as anyone could reasonably hope for in Addis Ababa.

Case 2 – High Blood Pressure

A missionary associated with SIM called me yesterday to ask if I could advise her what to do about a young woman she had just met in the street. Sa’at was being helped over the road because she couldn't walk; having been totally well 2 weeks ago. I arranged to see her today. Sa’at’s sister and a friend helped her into my room – she was tall, thin and unable to walk. She was also unable to look to the right at all, and had to look sideways to see anything. I asked her how she was. Sitting there unable to see straight, walk or use her legs properly she smiled and told me she was fine. The language barrier prevented me getting a good story, but she had been fine until 2 weeks ago when all this happened apparently fairly suddenly. She lives in the Gurage area of Ethiopia and had been brought to Addis to see her sister. I found her blood pressure to be 230/160 – the highest I have ever seen in a 20 year old. Several of the muscles that make her eyes move were paralysed. I could make neither head nor tail of her legs but they were uncoordinated and held stiffly straight. My missionary colleague ensured Sa’at was urgently admitted to the Korean Hospital for investigation and management – I suspected she had had a stroke at the back of her brain but an explanation is needed for the blood pressure – possibly a condition called fibromuscular dysplasia.

Why am I telling you this? Well, the day before I saw this tragic young lady she had been taken to St Paul’s Hospital in Addis Ababa where her blood pressure was measured, she was told it was high, they gave her some pills and sent her away. No examination, no follow-up, no further care. The medics among you will especially be reeling at this appalling neglect of a very needy patient. But you haven't heard my third case yet…

Case 3 – Circumcision

This morning during my clinic at Bingham Academy (I do it once a week on a Wednesday morning) a female employee came to me to ask me to authorise reimbursement for medical expenses for her son. I was slightly surprised, as I hadn’t seen him or recommended any treatment but that’s not hugely unusual – the employees often attend local clinics when I’m not available or during a weekend. She had a bill for 1500 Birr (£50 or so) for a circumcision. he was 7 ½ years old. Why, I enquired, had he needed a circumcision? Because the school he just started insisted on it– if he remained uncircumcised the other boys would tease him they said. They would only let him attend school if he had it done. A general anaesthetic (mercifully; it’s often done with a local anaesthetic), a lot of pain and a risk of infection – to avoid possible teasing.