Tropical Pathology: Mossy Foot and Travels

We had dinner last week with the US embassy’s medical officer Dr. T. He treats embassy employees over a large swath of Africa, from Nigeria in the west to Kenya in the south and up north to Egypt. He is constantly travelling either to do regular check-ups in various places or for any medical emergency that arises involving an embassy employee. I do not envy his job at all! He seems spread pretty thin. However, his stories are fascinating.

He says he is quick to medivac folks because he doesn’t trust the medical system here at all. In a little over a year here he has hospitalized someone locally only once, an acute appendicitis case in the middle of the night in need of urgent operation. He also says Dr. Y is the best and most thorough pathologist in Addis. From the sounds of things, it turns out I really did luck out having Dr. Y as a mentor here.

Dr. T introduced me to an intriguing Ethiopian pathological entity I had never heard of before. I haven’t actually gotten to see it with my own eyes, but I thought I would share it with you, my dear blog readers.

Although it may have the cutest name of any disease I’ve encountered, Mossy Foot is a serious problem here in Ethiopia. Its more scientific names are podoconiosis or nonfilarial elephantiasis. It occurs in a people who work barefoot in volcanic soil at high altitudes. Microscopic particles of volcanic silica penetrate the pores and clog the lymphatic system, causing swelling of the legs followed by development of sores and keloids (overzealous scar tissue). The feet often become infected with fungi and bacteria, eventually giving them a mossy look.

People with Mossy Foot are often treated like lepers and rejected from society. There are an estimated 1 million people suffering from Mossy Foot disease in Ethiopia. I got most of my info about Mossy Foot from the web site of an NGO working on the treatment and prevention of the disease in southern Ethiopia. Interesting photos and more details of their work can be found at mossyfoot.com.

It turns out I’m spending a 3rd week hanging out with Dr. Y at Bethzatha and ALERT. When we contacted the folks at Black Lion this week they said they weren’t ready for me. I’m not complaining because it’s so fun working with Dr. Y. Every day I am more impressed with his patient interactions and his ability to render a good diagnosis with limited resources.

Dr. Y drying bone marrow aspirate slides in the sun.

Yesterday we did an FNA on a patient with a "testicular mass" which turned to be TB involving the epididymis. Sorry folks, no pictures of that one! We also cut in a ruptured eptopic pregnancy specimen that was quite advanced.

Me grossing specimens and finally putting to good use the TB mask FAHC gave me at the beginning of the student pathology fellowship.

Ruptured ectopic pregnancy specimen.

On the personal front, last Friday was Nicolas’ 1st birthday. I was able to leave work early and partake in an Ethiopian coffee ceremony that the house staff put together for him (ok so he didn’t actually have any coffee, but we adults each enjoyed 3-4 cups of it). One of the compound guards gave Nico a gigantic zucchini from his garden.

Nico with birthday zucchini.

Coffee Ceremony

Nico's nanny Tewabich serving coffee, accompanied by sweet popcorn (in basket at right).

Over the weekend we flew 1100km north to Axum, capital of the ancient Axumite empire and only about 40km from the Eritrean border. It was nice to get away from the hustle and bustle of Addis. The landscape there is impressive: pale yellow-brown jagged, rocky hills intensively cultivated with terraces of tef, the grain used to make injera (Ethiopian sponge bread) and occasional scrubby trees. I would love to go back in the rainy season when everything must be lush and green. We saw ancient tombs, incredibly old churches and a newer building that supposedly houses the Ark of the Covenant. We also saw what is thought to be the ruins of the palace of the Queen of Sheba.

Field of obelisks.

Me and Kayo in front of fallen obelisk.

Landscape outside of Axum.

This northern region of the country was one the hardest hit by the severe drought in the mid-80s that turned Ethiopia into the posterchild for famine. That situation was worsened by Western govenments’ delay in sending aid (they were reluctant to help the socialist country) and then the Ethiopian government’s unwillingness to get donations to the far north when they finally came. About one million people died in total. An absolute tragedy. However, it is amazing to me how deeply that media campaign affected the image I had of Ethiopia before I came here. No subsequent images of the country ever replaced or modified the mental association I had that Ethiopia = starving children in a desolate landscape. I’ll bet the same is true for a lot of people in the States. Yet there is SO much more to Ethiopia! It is geographically and culturally extremely diverse and rich. I hope this blog is able to convey a tiny sliver of that. However, I realize that by showcasing the country's pathology here, I may be far from acomplishing that goal.

Because of the revolution in the 70s and the Derg regime through the mid 90s, Ethiopia got a late start at development. It now seems to be making up for lost time. There is HUGE amount of construction going on right now in Addis and elsewhere (there was plenty in Axum). In fact, I’ve never seen so much construction and road work in my life. The majority of the projects seem to be financed and managed by the Chinese… perhaps American investors are missing out! I think it will be fascinating to come back in 5 years and see how much has changed.