Second day on the wards. I split the female ward with Dr. Diana (the physicians here go by their first names, signing the same way in their charts) and was actually able to get through my half, including a new admission, who was a 32 yo female with LLQ abdominal/pelvic pain. She had had an ultrasound but the report said she needed to have a repeat once her bladder was full. Unfortunately, but the time this occurred, the ultrasound machine was down, which is evidently a not uncommon occurrence here.
Our other new admission here was also very interesting. When I first met her, I thought the young 17 yo female girl had nephrotic syndrome due to her facial congestion/edema. However when I asked Dr. Diana, she said that it was a condition known as EMF, endomyocardial fibrosis. Evidently EMF was first discovered in Uganda in 1940 and is a form of restrictive cardiomyopathy. Here’s the paragraph on Epidemiology for this condition:
EPIDEMIOLOGY — EMF was first recognized in Uganda during the 1940s and accounts for as much as 20 percent of cardiac cases sent for echocardiography in that country in contemporary series. Although accurate epidemiologic data are lacking, EMF is estimated to the most common form of restrictive cardiomyopathy worldwide
According to the physicians here, the hallmark sign is abdominal edema without pedal/lower extremity involvement. I actually saw 2 patients today with this. The second was also a known EMF patient who shows up at the hospital once a month for paracentesis. She had stick-thin legs and an extremely swollen belly, just as described.
We did an EKG on the patient, which was very interesting for 2 reasons. Evidently the Ugandan physicians do not learn EKGs in medical school (more on their training later, it’s actually very impressive). Dr. Diana had seen 3 in med school. I walked her through the diagnosis — unfortunately the patient had Mobitz II 2nd degree heart block as well as very prolonged QT syndrome. She’s not doing well at the moment. After reading about it, EMF patients are treated like diastolic restrictive heart failure patients, which is very difficult. The true treatment is surgery, for which we have to refer her to the main hospital in Kampala. However she is too unstable at the moment to make the 2 hour journey over rough roads.
The second reason the EKG experience was so interesting was that in placing the EKG leads. None of the nurses knew how to do it and turned to me to do it! Although I know about reading them, I don’t know much about actually placing them. Luckily there was a British medical student present who walked me through it. Those were the 2 most interesting tidbits from today: EMF and EKGs. 2 more days on female ward and then it’s off to Murchison’s Falls for the weekend. More to follow…