Acute Neurological Care at University Teaching
Hospital in Lusaka, Zambia
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.
Reference
1. http://www.unaids.org/
en/regionscountries/
countries/zambia
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