Oh my aching mugango!

Mugango in Kinyarwanda means low back. It is one of a few words I have picked up because it is either the chief complaint or one of the “by the ways” of over one half of people thirty or moor e years old. Neck pain and headache is also very common. Of course these problems are very common in the US also. There multiple types of conditions and causes of these problems, however one notes many conditions that may cause the problems here. Transport of heavy objects on the head is very common, especially by women. Many people work stooped to wash, cook and work in the fields. People cut grass and weeds using machetes with a 45 degree bend at the cutting end. This saves gasoline and pollution but requires some back flexion.

In the clinic we are limited in imaging (x ray, CT, MRI) as I wrote earlier. We are able to see x-rays a few days later in cases that are more serious or resistant to treatment. The patient must travel by ambulance four to sixty miles to have the procedure. Due to budget limitations, we must select only the most serious cases to referee for x ray. We must think about saving resources for all other patient problems, especially those that are serious and amenable to treatment. Most cases of back, neck and headache pain receive ibuprofen or acetaminophen and posture recommendations.

This week we have been treating a fifteen year old boy with congenital heart disease using digitalis, spironalactone and low salt diet while waiting for approval of referral to a specialty hospital in Kigali for heart surgery. He probably has a ventricular septal defect and aortic insufficiency and possibly other problems. We are not able to monitor basic parameters such as the potassium level and became more uncomfortable as his shortness of breath increased and his pulse rose during the week. The UNHCR declined to fund the referral so we referred the patient to a teaching hospital in Kigali where surgery will not be possible, however better medical management will be possible, at least in the short term.