It is always an adventure here whether it be with the African wildlife or just spending the day in clinic seeing our patients. The day began quietly with my walk to the hospital in the cool air of the Ngorongoro Highlands that is so very refreshing though will soon relent to the equatorial sun as morning passes into the midday hours. The songbirds, too many to distinguish, are pleasantly making their calls, filling the air with such refreshing sounds that civilization seems a universe away. It is just another day at FAME, but it is difficult not to realize how very lucky I am to be here and to have had the opportunity to share this paradise with so many of my colleagues.

Morning report was a cacophony of patients in the hospital ward from the simple to the very complex. A young child who had suffered second degree burns over their face and hands and had been hospitalized for many weeks at a local hospital where very little had been accomplished and her family finally brought her here to FAME. Her tiny eyes and a small opening for her mouth are all that is visible through the bandage that covers her entire head. A complex patient with a history of neurocysticercosis (pork tapeworm that creates cysts in the brain and causes seizures) and severe electrolyte abnormalities who was very worrisome from a neurological standpoint – I was very relieved after we obtained a CT scan and ruled out hydrocephalus. A young woman with epilepsy and who had fallen into a fire suffering a severe burn of her leg that had happened three months ago. Her family had not sought medical care until bringing her here to FAME. A young boy with marked swelling of his abdomen and ascites of unclear cause who was to undergo a pericentesis (sampling of the fluid collection in his abdomen) today to gather further information. Several uncontrolled diabetics with various problems related to their diabetes. A tiny malnourished young infant weighing only five pounds with hydrocephalus requiring large amounts of oxygen to remain stable. Once they are stabilized we will have to send them off for evaluation and treatment of the hydrocephalus. And that is just a small sampling of our inpatients who will come and go during our stay here at FAME.

Clinic for me started a bit late in the morning due to work on the wards. It was my last day to see patients alone as Laura and Kelley would be arriving later today to join me at FAME and complete the neuro team here. Everyone is not used to seeing me alone here any longer and all day long I was continually asked “where is your team?” Thankfully, we will be at full force tomorrow. A good number of our epilepsy patients, most well-controlled on their medications, were again a highlight of the clinic and clear evidence that we’re making a difference here in the lives of those who we are able to see. Perhaps the most interesting patient of the day for me was a middle aged Maasai gentleman with an eight year history of a progressively unsteady gait. He had come to clinic to see Dr. Frank as they had traveled from Loliondo, a district a day’s travel away and closer to the border with Kenya. Frank had videotaped his walking and upon showing it to me I immediately agreed that he was a patient for me to see. Based on the video, I initially thought that he very likely had neurosyphilis and tabes dorsalis, a disorder that causes loss position sense with a classic “tabes gait.” His examination was far different than expected, though, as his deficits were almost entirely cerebellar in nature along with some other findings that clearly defined his disorder. He had a spinocerebellar ataxia which instead is most often a genetic disorder and is neurodegenerative in nature. He had no family history, but it was clear what his problem was. His family had said that they had been to numerous hospitals where they were only told that nothing was found and, therefore, “nothing is wrong.” I explained to them what the disorder was and that no test could be done here to confirm the diagnosis, but rather it was based on his history and examination. That is not an easy thing to understand for anyone in the western world, let alone here, but I did my best to make them understand that it wouldn’t help to continue going to other hospitals where all they would get would be more medical bills for unnecessary tests. I was so disappointed that the residents weren’t here to see him as it is not a diagnosis that one encounters or is able to make every day.

Waiting for Laura and Kelley in front of the admin building

Kelley and Laura were scheduled to arrive late today and were taking a “fast Noah” (the type of private shuttle we use here when you’d rather not share your seat with a chicken or goat) from Arusha to arrive around dinner time. I thought that I had communicated with Samwelli adequately that they would need dinner tonight, but alas their meals were nowhere to be found when I came home after clinic. They arrived safely, of course, with exciting news that they had seen elephants and giraffe along the road from Arusha as well as baboons in Mto wa Mbu. It is a constant reminder that animals here roam freely and one can encounter them in almost any situation. The parks are merely where the animals congregate, but they migrate between parks frequently and enjoy freedom, for the most part, to travel where they wish. Besides, who wants to argue with a small herd of elephants?

Since dinner was missing in action and they were starving, we all decided to go out to the Happy Days Pub which has been a stable fixture here in Karatu since my arrival in 2010. Alex, our volunteer coordinator came along as well and we all enjoyed good food and drink along with good company. It was a relaxing evening and I am so happy to have “my team” now together at FAME and ready for a good clinic day tomorrow. We will, of course, also be planning what we will do on Sunday for our day of adventure. It will either be a safari at Lake Manyara or Taragire, a hike down into Empakai Crater or a visit to Oldupai Gorge. We have three Sundays to plan for so they will get to see a fair amount of Tanzania in addition to our work here at FAME. Regardless of where we are, though, each day will be a new adventure….