HISTORY AND PHYISICAL EXAMINATION

Patient Name: Shaymani Yasini Yunusi

Date of Birth: 16/11/2016

Data Source: Patient

Nationality: Tanzanian

City: Kilimanjaro

Admitting Diagnoses

1.History of Paralysis

2.Renal Stones/calculus

3.Urinary Tract Infections(UTIs)

4.Urinary incontinence

CHIEF COMPLAINT: Urinary Incontinence

MEDICAL EXPENSES: The amount of money which is 11,203,768/= Tanzanian shillings is an accurate estimate of Shaymani’s treatment. The money will cover the surgery for the problem of urinary incontinence as well as cost of the clinic that patient will need to attend the clinic after the surgery for 2 months in order to monitor her progress and be given exercises that will help to restore the condition of walking properly with her both legs. Also to take other important tests for the further investigation to find out if this problem has not affected other system in the patient’s body. Looking further to investigate about (Spinal MRI, Chest Cardiogram, PCR, RFT, LFT, KUB, ESR, CRP, ANA (Anti Phospholipids’ Antibody Panel, Urinalysis), To rule out KIDNEY STONES,UROLOGICAL DYSFUNCTIO SECONDAR TO TRANSIVERSE MYELOPATHY (TRANSIVASE MYELITIS), SYTEMIC LUPUS ERYTHROMATOUS, ACUTE PYELONEPHRITIS).

TREATMENTS: Surgery of urinary incontinence which is most necessary but management can include rehabilitation, facilitative techniques and maneuvers, catheterization and pharmacologic therapy.

HISTORY OF PRESENT ILLNESS:

Female patient, shayman Yassini girl of 7- years old bought to the hospital by her biological mother from bomang’ombe, hai Kilimanjaro who is sambaa by tribe came with complain of passing urine without control for 2 years with stable vitals, Dr Simon Wilson specialist of urinary system is evaluating her urinary condition. The patient has a history of paralysis starting from the waist to the left leg associated with numbness and loss of sensation but previously the baby had constipation for several days. After several months the baby started to experience passage of urine without control (urinary in continence).Where she use 3-4 diapers for 2-3 hours, with no pain in urination, no blood in the urine, the problem that contributed to the patient suffering from urinary incontinence. Voiding disorders are usually a result of neurologic condition, such as spinal cord injury (SCI) or disease, cerebrovascular accident (CVA), traumatic brain injury (TBI), multiple sclerosis (MS), or dementia. Incontinence can cause social embarrassment and added morbidity, such as infection stones or renal injury. Evaluation of bladder dysfunction can involve laboratory studies, radiography, ultrasonography, cystometry and electromyography.

PATIENT HISTORY:

Mother reported complains of her child started suddenly with paralysis on 13/07/2020 it was the morning as usual as a mother to take my responsibility to wake up and prepare my children to go to school. When I wake up, I found her twin sister ready for school preparation, then I called Shayman and she failed to answer. When I got to her bad, I found her crying and telling me “mother I can’t help myself to get out of bad’’ She was crying and complaining of severe pain under her stomach, at first I thought maybe it was a joke when I lifted her to stand by herself she did not manage to stand even by holding her for a while, her legs seemed to lack strength like paralyzed legs. This situation scared me a lot and made me look forward for the procedure to see a doctor as soon as a possible, when I arrived at Hai district hospital, the doctor of the hospital gave me a transfer to the KILIMANJARO CHRISTIAN MEDICAL CENTER (KCMC) regional hospital after seeing that Shayman’s problem is serious and needs a more professional doctor. After arrived to KCMC Hospital I was received by the doctors and I was booked to see specialist children’s doctor and then a doctor took the tests and wrote me to go to the urology doctor. Dr Simon Wilson and was given her x-ray’s test and was found to have a problem of KIDNEY STONES.

After the tests, Dr Simon Wilson reported that Shaymani will need surgery soon to be able return to her normal state, after then he gave me a medical procedure including the medical costs which is Tanzanian shilings 11,203,768/= for her entire treatment. The medical expenses were high so I couldn’t afford contribution of treatment, and then a doctor gave me an advice to follow so that I can continue to help my daughter to get out from paralysis condition. I took my daughter and returned at home with her and started to give her the exercises that a doctor gave me, then after ten months “in fact” the progress of walking from paralysis condition was successful although not for her both left and right legs. For the whole time she was still suffering with urinary without being able to control (urinary incontinence) and this problem is the major obstacle for my daughter.

Her mother also reported that Shaymani would not able to continue her studies due to school being far from their residence which is 1.5km from home to school, even her mother tried to allow her to go to school and due to the condition of her left leg. She has to walk very slowly so that she used to leave at home very early dawn to be able to focus on the right time for her studies; it was not very safe for little girls like Shaymani to walk during that time. However the problem of her leg which is caused by paralysis has become a biggest challenge because she has also fallen frequently while she walking to school.

In the beginning, I was dressing her in diapers the challenge is that she was needs an extra care because she must to change diaper in every 30minutes where she use 3-4 diapers for 2-3 hours and it was difficult for her to do it by herself, another challenge is our government schools has no babysitters service. The situation that makes Shaymani to use only 2 diaper within 8 hours while she’s at school, this caused more diseases to her including Urinary Tract Infections(UTIs) frequently which thing makes her doctor to completely stop her using a diapers to prevent putting the patient at risk of getting more diseases.

PAST HISTORY: Child was born at term on 2016 and they were twins with 2.5 kg cried immediately after birth no any complication after birth; Paralysis two years ago; Shaymani has no history of previous admission, blood transfusion, surgical procedure and any food and drug allergy; patient has no recent history of fistulas. That child was fed cow milk for the first 6 month. Instead of getting exclusive breast feeding because mother didn’t produce enough milk at that time; she is not paralyzed now, she has already recovered from paralysis but she had an effect on her left leg after the paralysis because before she was unable to walk at all. When the problem started, her mother says that she was paralyzed all the way down and she was not even able to help herself to get up, but after the doctor's instructions and several exercises, she was able to help her get up, but her left leg showed that she still had problems and her doctor reported that there is a high possibility that her leg will continue to cause problems because of this urinary problem to be still exists, if she gets surgery she will have to attend the clinic for 2 months to check the progress of her leg and all progress in general. The actual surgery is for urinary incontinence to remove the effect called kidney stones.

SOCIAL HISTORY: Twin girl; she’s fourth generation out of seven children; patient has been in Tanzania for her entire life; she was studying at Kambi ya Raha primary school before she got this problem; they take clean water; she lives in high-risk environment.

FAMILY HISTORY: No known family history of urinary incontinence or cancer; Family can’t afford food 3times a day; living in a small house in which is crowded; Child has six siblings they live with their mother who was divorced due to the child problem. Her family can afford medical expenses