The weather here is unseasonably cool and wet as we are at the tail end of the dry season. Though it was 93 deg F on my arrival Monday, the last weeks have been not been the “spring-like” weather one comes to expect for late September and October where the flowers are blooming and some green is coming back after the dry season of the earlier months. East Africa doesn’t have the seasons we’ve come to know, but rather the seasons are dry, wet and wetter. The short rains don’t begin until December and January with the heavy rains coming in April though it feels as if the short rains may start very early this year. Probably not a matter of global warming I suspect, just the normal variability of the weather as it does some years. I always have my rain gear with me, but extra fleece is another matter. I’m sure we’ll survive and you never know, the weather may decide to change again.

Leaving Arusha today, Leonard and I made visit to another friend who had had a stroke a number of years ago and who I had seen a few years ago. He has made an excellent recovery, but still has a great deal of spasticity and hasn’t been doing his stretching exercises as he should. His shoulder was frozen and his Achilles’ tendon was tight so I’ve instructed him to see the physical therapist I met yesterday to get a refresher course on proper stretching techniques. Strokes in the younger population (under 60 as I’ve recently reached that milestone myself) are very prevalent in the setting of untreated hypertension which is so often the case here. It is a silent killer as there really are no symptoms until it’s done its damage and one suffers a stroke, kidney failure or a cardiac event. So few here seek regular medical care as most of medicine is directed at symptomatic illnesses – stomach disorders, headache, back pain, achy joints. It is only when a patients comes in complaining of something that the blood pressure issue is discovered. They are prescribed a medication for something they cannot feel and the patient discontinues it after the first month’s supply is up. The cultural bias against regular medical care and regular medications is a huge hurdle to overcome for a multitude of reasons that also includes cost and accessibility. This is our issue with managing epilepsy here. Patients will take their medication for a period of time and then stop despite the amount of education they are given at the time of their visit. Regular follow ups are required which has been the purpose of our project here not only for epilepsy, but also for many other chronic neurologic illnesses.

So I left Arusha mid day and traveled alone across sometimes barren landscape to reach the town of Mto wa Mbu (mosquito River) that sits smack in the middle of the great rift. Lake Manyara and the national park of the same name are accessed at the far end of this interesting village that is bustling with activity like a frontier town in the old west. Lake Manyara is the setting for Hemmingway’s “The Green Hills of Africa,” a short non-fiction novel about a hunting trip of his in the 1930s. They were hunting rhino which used to roam the countryside all around and have now been relegated to only a few select areas of the Serengeti and Ngorongoro Crater. The Black Rhino, much rarer than the White Rhino in the south, was almost hunted to extinction, but has been making a comeback with the help of government conservation.

I climbed the escarpment to reach Karatu, even more a frontier town than Mto wa Mbu, and several thousand feet higher in the Ngorongoro Highlands along the crater rim. FAME is situated several kilometers outside of town along a dirt road that rises gradually and is always passable, albeit with varying degrees of bounce and slip depending on the weather and it’s state of repair or disrepair. As with everything here, the rain can make any road challenging as the orange clay turns into a slip and slide as I’ve found out the hard way in the past.

The Keonig House

My arrival at FAME is a journey home. Things are so familiar (after all, it is my thirteenth visit here), yet it is ever growing and I immediately noticed the new maternal health building going up next to the not to old administration building. After making my rounds to greet everyone (it really is a homecoming), I finally made it back to the volunteer housing and there in front of me is the Raynes House sitting proudly on the hillside and overlooking the coffee plantations in the distance. The structure for the roof is almost complete and the roof will hopefully go up during my time here, but it is already a beautiful structure that will serve to house our neurology team when we’re here during the year and provide additional volunteer housing in our absence. With the extra space it will allow us to bring additional residents as the interest in global health is only increasing. For now, though, I’m staying in the Keonig House and looking forward to the time when the Raynes House is complete and ready for our occupancy. It is all so very exciting and is the result of the hard work and dedication of many individuals who have worked so hard to make FAME what it is today. But for this day, it is most importantly the generosity and support of the Raynes family.