Monday morning was my last full day in clinic and we had neuro patients waiting for us at the get go. Doug and I decided to work together for the day and it was a typical Monday morning meaning that FAME was packed with patients. We were also planning to a skin biopsy on a young child in the ward with horrible eczema who had come in months ago with terrible contractures of all of her limbs and after antibiotics to treat secondary infections and two cleansing bathes per day along with moisturizers and vasoline applications was able to see some progress. Doug was going to do the biopsy as he had seen them done in residency and had done one himself previously.

We saw a smattering of new patients as well as several return patients (all doing well on their new seizure medicines or new dosing of medications) during the morning, but of course took our chai break as it was my second to the last day to experience this simply scrumptious chai masala they make here. In the afternoon we brought the young girl back to prepare her for her biopsy. Suhawa (our nurse anesthetist) gave her some several very potent drugs and she just starred at us and remained wide awake. He next gave her some propofol to put her down and she remained awake and responsive for some time and then seemed to be in a trance with her eyes wide open and blinking, but not responding to our voice. Doug initially didn’t feel all too comfortable performing a procedure on her with her eyes wide open so I suggested he pinch her hard enough to be certain she didn’t feel anything and sure enough, she didn’t. He proceeded to do two punch biopsies on her arm and stitch up the sites. I will bring the specimens back with me to give to a dermatologist at Penn who does tropical medicine and infectious disease as well and send the other to Atlanta to a dermatopathologist.

Doug (surgeon), Dr. Luigi (assistant) and Sahawa (anesthetist)

The first of two punch biopsies

The look of success

After the procedure we were pretty much finished with clinic and I had messaged Daniel Tewa earlier in the day about stopping by for an hour or so. Daniel Tewa has been a close friend since my first visit to Tanzania on safari. I was with both my children, Daniel and Anna, and had decided that doing several days of volunteering would not only be a worthwhile endeavor, but would hopefully leave a lasting impact on my children (which it has). We were schedule to help with some work at a local school that turned out to be in Daniel Tewa’s village and he helped us with the work of painting. We later visited Daniel at his home where he has built an underground Iraqw house and gives cultural demonstrations for visiting safari groups. A year later when I returned for my first visit to work at FAME I contacted Daniel to see if he would remember me and he surprised me when he also remembered my Daniel and Anna. He is a wealth of information about local culture, Tanzanian history, American history, politics and is one of the most generous individuals I know. He treats me and whoever else I bring as honored guests every time we visit and always insists on having a family dinner when I’m there. Because of scheduling we were unable to spend a dinner with him this trip, but I know that Doug and Kelly will be back in my absence as Daniel made it very clear that they were welcome again.

I awakened on my last day for this visit early for another of our early morning walks. We did a little less than three miles in 40 minutes averaging 4 mph. Doug was giving a lecture on the pediatric neurology exam to the doctors this morning and I would only be able to attend half of it as I had an 8:30 am meeting scheduled with Susan (co-founder and director), Caroline (development coordinator) and William (outreach coordinator and human resources) to discuss the future of the neurology program at FAME. It was a very productive meeting and from it we will develop a timeline of growth and expansion of the neurology program.

Doug lecturing on the pediatric neurologic examination

I arrived at clinic a bit late, but rounds had been long so I didn’t miss anything. Stole (pronounced “Schtole”) who is the Norwegian gentleman with the orphanage in Mto wa Mbu arrived with the two brothers with muscular dystrophy who I had seen in March with Megan as well as several other children needing neurologic assessment. The two brothers are interesting as the older brother who no longer ambulatory has significant contractures making one think of Emery-Dreifuss muscular dystrophy, but the distribution isn’t right and his contractures are more likely from muscle weakness and lack of physical therapy. The younger brother has clear pseudohypertrophy of the calves and had a classic Gower sign getting up to come in our office. The two brothers most likely have Duchenne’s muscular dystrophy which is quite unfortunate.

My ride arrived to take me to Kilimanjaro International Airport around 2:30 pm and I ran around the campus to say goodbye to everyone knowing I’d be back in six months so it is no long quite as difficult. It is a big family and it is so clear the pride everyone has in FAME and what FAME means to each and every employee and their family. There is still much work to be done, but we have come so far. I have been particularly blessed to be a part of such a worthwhile project as FAME that has had such an impact on so very many lives in this incredibly wonderful region that is so underserved. I thank everyone who has helped make this possible for me and for FAME.

Until next trip (March 2014),

Mike