Kambi ya Simba – Day 1

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Monday morning was the beginning of a four day stretch of mobile clinics. For those of you who have not read my previous emails or blogs, the mobile clinics we do are in the villages of the Karatu district in a region called Mbulumbulu. FAME had been doing a large funded mobile clinic every month to the Lake Eyasi region of Tanzania which was a five day long adventure and living in a very primitive conditions while providing general health care to areas that had none. I had gone on three of these clinics during my time at FAME and realized that we could do a smaller scale specialty clinic to villages not too far away so that we could return home each night. We started the neurology “mini mobile clinic” in April 2011 and have been doing them every six months since then. The larger mobile clinic ended when its three year grant was over sometime in late 2012 or early 2013. We have traveling to two villages in the Mbulumbulu regions, Kambi ya Simba and more distant, Upper Kitete. This region is out along the rift in an area that is not traveled to by any tourists and very few Westerners.

It takes about an hour to get to Kambi ya Simba so it is necessary to get a reasonably early start. Sometimes that is easier said than done, though, as there are many parts of this operation that are often difficult to sync. It’s also important that we have all our supplies packed as it is not possible to drive back during the clinic or have someone else come bring something that was forgotten. We finally rounded up all the troops and I think we were probably on the road out of the FAME compound around 10 a.m. Very little here is as simple as it seems, though, and after hitting town we had to first stop at the Mushroom Cafe to get our lunch that consisted of beef samosas, kitumbowa (spelled phonetically here but are little sweet, greasy rice cakes), and chapati with peanut butter and banana for Payal as she’s a vegetarian. Then we stopped at another shop for all our drinks and water for the day. I think we ended up making one or two other stops and were finally heading out of town after a little over 30 minutes.

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The road to Kambi ya Simba is incredibly bumpy and equally as dusty. This was supposed to be the rainy season, but as I explained earlier in the blog, the monsoon rains have yet to come. The land here is amazingly fertile and green everywhere. The soil is a rich volcanic mixture and most of the land is well utilized for farms. The requisite cattle and goats are being herded along the roads often by children who seem like they only recently began to walk. We arrived at Kambi ya Simba around 11:30 or so and began seeing patients shortly thereafter. The “crew” consists or William, our outreach coordinator, Dr. Anne, our clinical officer, Sokoine, our interpreter (along with Anne), Patricia, our nurse and pharmacist, and Ema, our driver and fundi (expert) in case anything goes wrong along the way. And then there are the three neurologists.

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Our mobile clinics, as well as our neurology clinics at FAME, are funded, meaning that we charge a very small flat fee that includes the neurology consultation, any labs and any medications prescribed. The charge is 5000 TSh (Tanzania shillings) and the equivalent of less than $3 USD. If someone can’t afford to be seen we reach in our pockets and pay for their visit or it is covered by a general patient fund that the volunteers here are constantly adding to. We keep track of any patients who are seen by the neuro team and the full cost of their care including testing and medication so that we are aware of how much the neuro program is costing. There is little question as to the impact we’ve had here over the last several years with treatment of epilepsy and stroke as well as assessing young cerebral palsy patients who require rehabilitation, but can’t go without a doctor’s referral.

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Our clinic at Kambi ya Simba is in a government health center which is a step above a dispensary. They have a clinical officer there and both a labor and delivery ward as well as a postpartum ward. Unfortunately neither of the wards have been used at least in the six months since we were last there, most likely due to a lack of supplies and staffing. Simply providing a building doesn’t insure that it will be used. In any event, we’ve held our clinics in the wards which are quite roomy, though devoid of chairs or desks and only have beds. We had to drag a desk from across in the nurses office along with some chairs. Despite these hardships, it has been a comfortable place to evaluate patients.

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There wasn’t much in the way of pediatrics for Payal that day and we only saw around 15 patients total. Clinic didn’t start until probably close to noon so we didn’t get out until after 4 p.m. which meant we arrived home after the clinic was closed.

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Christyn and Payal had decided to run and Leonard, my good friend, was up at Gibb’s Farm with a safari group so we were heading there later to say hi. He also hadn’t met Christyn and Payal yet and since they had met the rest of his family and we had stayed at his home I thought it only proper that they meet him as well. Before we left, though, Payal was asked to see a young leukemia patient on the ward who was complaining of a headache. When she was finished we were on our way to visit. We sat up at Gibb’s under an incredible sky full of stars until almost 9 p.m. and then said our goodbyes.

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