Thursday, 4 April 2013


Practicing neurology in Zim has been one of the hardest things I have ever done.

With no confirmatory diagnostics, limited therapeutics, and rare oversight, cases have been extremely challenging. Not to mention +HIV in >13% of the adult population. So if you see a CN 7 palsy in HIV+ patient, can you claim a self-limiting Bell's palsy and leave it at that? Actually, Yes.

My handwritten "plan"
How about acute onset myelopathy in a 75 year old female, hx of treated pulm TB, with no history of trauma. No, you can't have an MRI.
She is empirically on TB meds, prednisone, and B12.  Too bad there are no IV steroids in stock at the moment.

Empiric therapy is the rule. Every HIV+ patient with neck stiffness is on CTX -- then it's stuck for 7 d. TB meds for questionable CXR is understandable.

Most common challenge is acute strokes with no imaging and high BP (we're talking 250s/120)? ASA? I have been going with Yes.
Unless there are some major clinical signs that indicate hemorrhage
Occasionally, you can convince a family to spend $200 on a noncontrast head CT at a neighboring private hospital to please help you rule out a hemorrhage and manage appropriately. We even got one on this TBI case, a young 21 year old male hit by a vehicle in a presumed RTA (road traffic accident).

As Zim was previously colonized by UK, most of the Shona-speaking patients thankfully also speak English.

The medical training system also mirrors the UK.
Undergrad=med student: 5 yrs
JRMO=intern: 1 yr
Govt experience/house officer: 1-2 yr
MMED/registrar=resident (e.g. IM): 5 yrs 

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