The second site for our mobile clinics has been Upper Kitete. It is a village almost twice as far as Kambi ya Simba and near the end of the road on the rift. The region is made up of beautiful farmland and borders with Maasai-land – a region that stretches from Ngorongoro north through the Lake Natron region, Loliondo and across the Kenya border into the Masai Mara. Cattle are grazed throughout the region and herded to markets that are held in small towns and big alike. The market in Arusha is a five day trip from this region.
The drive to Upper Kitete is obviously much longer and though it is probably just as bumpy, being twice as long makes it seem worse. We have the same crew together, now including Payal again, and Natalie, a pediatric nurse volunteer who decided to come along to help as well as to see what we were up to. We had ordered lunch boxes for the volunteers, but unfortunately Nixon, who runs the Lilac, was up until 1 a.m. watching a soccer match (his team won the match, but didn’t score enough goals to advance in the playoffs) and had forgotten to have them made. That meant samosas, kitumboa and chapati again for lunch.
There were a fair number of patients waiting for us at Upper Kitete as we drove up to the dispensary. The accommodations are far less comfortable there than at Kambi ya Simba and we have more patients on average. The two rooms we work out of include the nurse’s office, that has an opening in the ceiling with a colony of bats up in the attic that are constantly squeaking while we’re seeing patients and the room smells of bat urine, and a second room which is the labor and delivery room and has only two beds separated by about 1-1/2 feet with no other room to spare. In that room, the doctor and interpreter sit on one bed while the patient and family member sit on the other bed. They are quite suboptimal, but we’ve always gotten the job done one way or another.
After finding some chairs to use in the rooms and screening the first patients to see we were off and running. We have to screen patients who come to make sure they have neurologic issues and not other complaints. Sometimes the community hears that we’re neurologists and other times they just hear the word specialist and think that we can deal with any problem under the sun. Not only is it true that we only wish to deal with neurological problems, but the other issue is that there is a government clinical officer available in the village and we should not be providing general medical care.
Our patients varied from migraine headaches, back pain, neuropathy and perhaps the most disabling of all, epilepsy. We had a number of pediatric patients for Payal and plenty of adult patients for Christyn. We also planned to bring some sugar and tea as well as some canga cloth to the widow of a patient who I had cared for over the last three years with Parkinson’s Disease and who passed away a few weeks ago. This is the tradition here and something I felt we should do having known the family for several years and the last visit or two were house calls as they live essentially across the road from the dispensary where we’re working.
At the end of our first day of clinic we drove out to the overlook. This is a small spot that sits at the edge of the Great Rift and looks over the Rift Valley for many miles to the north and south and is a breathtaking view. There is small road that goes through an historic socialist village from the early days of Tanzania after the independence and leads out to the overlook, where there a few homes. I suspect the occupants are unaware that they have perhaps one of the more spectacular views in the world right outside their doors. We always joked that this would be an amazing location for a resort and even an infinite pool, but then it wouldn’t be Tanzania. I think I like having this place all to ourselves and just the way it is.
Day 2 at Upper Kitete was more exciting for a few reasons. No, the bats didn’t decide to leave, but for one it was well baby checkup day with the nurse so the dispensary was overflowing with the cutest little babies and their mothers. Considering we had a pediatric neurologist and a pediatric nurse with us it was an opportunity that didn’t go to waste. Each baby was being weighed in its own home made harness that each mother proudly put their baby into. We were able to use the nurses office for a little while, but then she needed it for immunizations and we were down to one exam room.
During this time, we were called out from for someone who was having a seizure. A young woman was on the ground having a generalized convulsion and her sister was keeping her sitting up. We quickly laid her down on her side and protected her head while Payal ran to grab some valium to give her rectally if she didn’t stop. It only last a minute or so and then she was postictal. Since we only had the one room, Sokoine carried her into Christyn’s exam room while she was finishing up a patient and we laid her on the bed. Christyn apologized to her patient and then just continued on with her patient. The seizure girl eventually awakened and it turned out that she was a small dose of phenobarb that the family ran out of in January. I don’t recall what we started her on, but it was one of our better medications for her and hopefully her seizures will slow down.
Payal later saw a young boy (clearly delayed) who was having frequent episodes of very brief alterations in consciousness associated with brief posturing of his arms and head turning that were clearly ictal events. He had not been treated for these episodes previously and she put him on levetiracetam that I had brought with us this trip and glad I did since we have used it so often.
We went to the widows house as we were leaving town, but unfortunately she wasn’t home so let left our gifts with her sons. Then we went to the overlook again and this time climbed the small hill that’s adjacent and had an even better view than we did the day before. It’s just such an amazing country both based on it’s geography as well as its people here. We always have so much fun on mobile clinics as we spend the four days together as a team and with a great purpose.
We arrived home long after clinic had closed and caught up on emails since Upper Kitete is off the grid for cell service. A quiet night of dinner and catching up on things.