On March 30, 2021, Physician Tian Juan, in the middle of ward round of Department of Internal Medicine of Mzuzu Central Hospital in Malawi, suddenly received a telephone call from John, Director of Department of Internal Medicine, asking for professional guidance on treating a scleroderma patient from Outpatient Clinic because this female patient was the first case of scleroderma in Mzuzu Central Hospital and local physicians had no relevant experience in the treatment of this disease.
Before admission, the 40-year-old female patient developed skin darkening and thickening accompanied by finger and facial numbness for 6 months, and suffered from multiple joint pain, limited finger extension and limited mouth opening for 4 months. She was diagnosed with scleroderma in a local hospital from South Africa. However, the patient's condition was gradually worsened due to irregular treatment. Two months ago, she presented with dysphagia and inability to walk for 2 weeks. Subsequently, she was admitted to Mzuzu Central Hospital for proper treatment. Nevertheless, none of the local physicians had experience in treating this disease. Hence, Director John from Department of Internal Medicine immediately asked Physician Tian Juan from Department of Rheumatology and Immunology of China Medical Team to Malawi for professional assistance. After detailed inquiry and careful physical examination, the female patient was eventually diagnosed with scleroderma, and then she was prescribed with prednisone combined with methotrexate, supplemented with omeprazole and calcium carbonate to mitigate relevant symptoms and alleviate adverse events.
This is the first case of scleroderma in Mzuzu Central Hospital. Tian Juan gave a special lecture on scleroderma to deepen the understanding of scleroderma of local physicians. In her presentation, she mainly introduced the epidemiological characteristics, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, treatment and prognosis of scleroderma, receiving widespread recognition from local physicians in Mzuzu Central Hospital.
A physician from China Medical Team to Africa should not only complete routine diagnosis and treatment, but also make efforts to improve the diagnosis and treatment level of local physicians. Since no specialist in rheumatology and immunology is available in Malawi, local patients suffering from rheumatology and immunology-related diseases cannot be effectively treated. After arrival in Mzuzu Central Hospital, Physician Tian Juan has treated multiple rheumatology patients, such as rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis,etc. During the treatment process of these patients, she delivered training and guidance to local physicians to make them have preliminary understanding of rheumatic immune diseases.