Young Daniel arrived early on Saturday morning from Rift Valley Children’s Village ready for another day of work with us. He was really a breath of fresh air and it wasn’t difficult for all of us to relate to that period of our lives when we had all considered medicine. It had come very late for me, well into my graduate work, but it was much the same when one becomes passionate about medicine and begins the process of choosing it as a career. Whether Daniel continues that course or not, it is still exciting for all of us to spend time showing him how rewarding it is and why each of has choose this path. Here in Tanzania it is difficult as schooling is government funded which means you don’t necessarily get to decide what you will study, but rather it is decided for you by others and how well you do on testing. There is always the private route, but that is very costly and depends on whether you have a sponsor. Daniel may have a better chance coming from Rift Valley as Mama India will undoubtedly be looking out for him as he pursues his studies.

I ran out in the morning as I had to go to the bank to put money in for a trip we had planned the following day to Empakai Crater. The Ngorongoro Conservation Area gate doesn’t accept cash as much of it was diverted in the past so you have to first go to the bank to put it in escrow, then to the NCAA office where they stamp your receipt to acknowledge that the money has been deposited and then you’re good to go. It didn’t take long and I arrived back a bit after 9am as Jess and Jackie had already gotten started. Anne was working with Jackie today and Jess had Daniel interpreting for her. I can sum up Jess’ patients for the day by merely telling you that by the end of the day, Daniel knew everything there was to know about headaches and amitriptyline. He became proficient in not only asking our headache questions of patients for their history, but also in telling them about the side effects of amitriptyline, the most common medication we use here for chronic headaches. I think Jess may have had one patient complaining of memory loss, but it wasn’t dementia and they also had headaches.

Jess examining one of her headache patients

Jess teaching Daniel how to do the neurological examination

Seeing a young man from Shalom Orphanage with probable birth injury

After a few adult patients, one who did truly have early dementia, Jackie and Anne had some good pediatric neurology cases. Shortly after the day started, I had a visitor arrive who was Daniel Tewa’s granddaughter, Renata. I have known Renata since she was 7 years old and she is an incredibly bright and capable young woman. She is now 13 and has been talking about medicine for a year or two and I have offered in the past for her to spend the day here at FAME with me to see what we do. I initially had her spend time with me bouncing between offices sitting in with both Jess and Jackie while they were seeing patients. Late afternoon, though, we had a young epilepsy patient come with her grandmother who only spoke Iraqw. I walked into the room just as the bebe was walking out to find an interpreter for her among the other patients when I realized that Renata not only spoke Iraqw, but was also fluent in English and Swahili. I asked her if she felt comfortable translating for us and her eyes lit up in a split second. To say that Renata shined as an interpreter would be an incredible understatement. She was superb and the visit proceeded with her help as she spoke all three languages brilliantly and seamlessly not only translating questions from Jackie, but also from Anne in Swahili to make sure that we didn’t miss anything. The young girl had been doing well with her epilepsy and hadn’t had a seizure in two years so it was decided to give her a trial off medication and if she had another seizure, we would obtain an EEG and start her back on a better long term and broad spectrum anticonvulsant as she was on carbamazepine currently. Renata explained everything to her grandmother in a fashion that was so impressive. After we were all finished, you could see how very proud she was and I knew it would make her grandfather incredibly proud. I called him later to have her picked up and I told him what she had done and how impressed we were with her. I know that he was bursting with pride on the other end of the phone.

Evaluating our Iraqw epilepsy patient with Renata translating and everyone else looking on

Renata translating

Jackie examing and Renata translating

That night we had made reservations to go to Gibb’s Farm for dinner which is always one of the highlights of our visit here. It is a gorgeous resort that I have spoken of many times in the past and is a favorite of many a volunteer I have brought with me. We had drinks on the veranda before dinner looking out at the spectacular view into the distance as the sun was setting and listening to the beautiful sounds of the African landscape. It is easy to fall in love with Africa and the wonderful people here. I was greeted with hugs by all the workers at Gibb’s, many who have family members I have treated over the years and some who have questions about family members they would like me to see. Defay, who is one of the waiters, came to me about his brother and described about as classic a resting tremor as you could and when I asked a few additional questions, it was clear he had Parkinson’s disease. I told him to bring him to us and we have medications that could help with his symptoms. I am hopeful that we will see him this week as he does live far away. Relaxing at dinner was a special treat for us and I think we all left for the evening with a further appreciation for why this country is so special and unique and why we are so happy to help them in any way we can.

Charlie and his best friend recovering from abdominal surgery after eating a rock