Case of the Week : 10th Sept

September 10, 2018

This is another case from our volunteer Dr Nikki at Kivunge Hospital.

 

Please note that this case contains some graphic images, that people may find distressing. 

 

Whilst the management of this case was quite straight forward, it highlighted, for me, the massive differences between Zanzibar and the UK as to when people seek medical advice.

 

FHI is a lady in her 50’s/60’s (it is quite common here that people do not know how old they are) who presented with a painful swelling on her back. This has been present for 4 months and has started over the centre of her spine and gradually increased in size over that period of time. She complained of having some intermittent fevers and feeling increasingly tired. She was otherwise well, and was not aware of any other medical conditions. 

 

On examination, she was quite frail and had a very high blood pressure (196/115mmHg). The swelling over her back was extensive, covering most of the top half of her back. We felt that the most likely diagnosis was of an abscess and we referred her to our surgical team to have it drained. 

 

We also considered why she had been so susceptible to an abscess of this size. Diagnoses for us to consider that would increase her risk of infections such as HIV, diabetes and TB, were all checked for, and thankfully there was no evidence for any of these. 

 

This patient amazed me, not only in how long she had waited before presenting to health care professionals, but also how she dealt with her condition that we know to be very painful. Timing of presentations is a very varied thing both here and in the UK, and I would speculate that we could only guess at a handful of reasons as to why people wait a lot longer here before seeking help – distances they need to travel, the cost of doing so, fear, a greater faith in traditional healers that they would seek treatment from first etc 

 

We started her on intra-venous antibiotics and oral medication for her blood pressure. She remained stable on the ward over the next 5 days before being discharged with advise to attend out-patients for dressing changes and blood pressure clinic.  

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