Since we were planning to work on Saturday, this wasn’t the last day of the week for us. We did have plans, though, to visit with Daniel Tewa and his family during the evening and have dinner with them, who there was much anticipation throughout the day. More on our evening with the Tewa family and dinner later.
As for patient updates, our 95-year-old Bebe was much more cooperative the following morning and was now willing to take food and medications. We were able to give her a mild antipsychotic medication (olanzapine) orally now and she continued to be more cooperative throughout the day. Her family was quite happy with the result of her treatment though, of course, her dementia will be no better as that is an irreversible process.
One of the main complaints that patients come to clinic with is often memory loss, perhaps not much different than we see in the States. When you’re dealing with an 80-year-old your initial impression will be to screen them for dementia, but when they’re younger it requires a bit more questioning to tell exactly where the problem is. When they’re in the 40-60 year-old range it’s most often poor attention and focus which is usually the result of depression and anxiety. We see many patients here who are depressed as I’ve mentioned in prior blogs such as the mother of five who lost her husband to cerebral malaria and is trying to figure out to cope. But something we have seen here more often than we get to see in our clinic at home are the 20-year-olds who are brought in with the chief complain of memory loss. When we get further history, it is more one of confusion and agitation and you immediately know what you’re dealing with.
Today was Kelley’s turn to deal with a patient such as this and whose diagnosis was schizophrenia. The patient had been brought in by his father and it was clear that he was getting more agitated the longer the interview took place. She was working with Dr. Ken today and by the time the interview was over (which was shortened due the patients growing restlessness), Sokoine had been called in to assist and the patient wanted nothing more to do with Kelley or Ken. I came back in to check on things and they made it clear that they were concerned about the patient’s status as far as his agitation and wanted to get a medication on board faster than was possible with an pill and it was likely he wouldn’t take one regardless. Thankfully, we have injectable haloperidol here (what I had used previously on Bebe) and we loaded up a syringe to give him the medication. As I mentioned, he wanted nothing to do with Kelley or Ken and would very likely not let them near him with a syringe. Sokoine isn’t a nurse, so that left me as the one to give him the intramuscular injection. I sat with him for a minute and then we asked him to uncover his upper arm from under his shukas (the traditional Maasai blankets they wear) and his jacket. He was very compliant and I gave him the injection without trouble whatsoever. Shortly thereafter, he calmed down enough for us to get some screening labs and we sent them on their way with an oral antipsychotic medication (olanzapine) to use on a standing basis. Unfortunately, his condition will not change going forward and the best we can hope is to manage his symptoms.
Our clinic day came to a close early enough today for everyone to make the regular FAME bus down to town which they were all very excited about. For us, it meant some time to sit in the volunteer office and catch up on emails and work before heading off for our evening with the Tewa family.
I’ve mentioned Daniel Tewa numerous times in my blog on previous trips, but for those of you who haven’t been following, I met Daniel in 2009 while on my original visit with my children and we reconnected on my return to FAME in 2010. We have been friends (family) since that time and I have spent time with his family on every return visit then. Daniel is an amazing individual with eleven of his own children and one adopted (after the mother died in childbirth) and he has put them all through college over the years. To say they are an incredible family is an understatement. Daniel and his wife, Elizabeth (who speaks no English and mainly Iraqw) are cultural ambassadors for the local Iraqw tribe and safari tours as well as college students come to visit with him so he can share stories about the history of Tanzania and more specifically, the Iraqw. In the 1990s he built a traditional underground Iraqw house, similar to what he lived in until he was 20 years old. They lived in these houses, along with all of their livestock, to protect them from the Maasai who they were in constant conflict with as the Maasai had the belief that God had created cattle for them and they were merely taking back what was rightfully theirs. That conflict didn’t end until a treaty was finally signed in 1986 after being approved by the Maasai and Iraqw elders. I bring the residents here to sit with Daniel while he shares his stories as part of the cultural experience for their visits. But in addition to his stories of Tanzania past, he is also always up to date on world politics and loves to question us about what are thoughts are about whatever is going on in the US at the time. Obviously, the current election on everyone’s minds this evening so it was the topic of discussion.
We sat with Daniel outside his home having drinks and enjoying each other’s company until well after dark. As we sat, young people from the neighboring secondary school continually marched by on their way to get water or do chores as they were all Iraqw and well-known to the Tewa family. At one point, young Renata, Daniel’s granddaughter who is now 12 and who I’ve known since 2010, came running up to give me the biggest of hugs. I introduced her to Kelley, Laura and Alex (our volunteer coordinator who we had invited to come along) and she eventually went off to help her mother prepare our dinner for later.
After all our talk of the history, politics and a thorough tour of the underground house (which he doesn’t live in as it is only for demonstration), we walked a short distance to his daughter’s house for dinner. Isabella and her husband, Christopher, are both teachers and have hosted us for dinner over the last several years as the group has become too big to eat in Daniel’s tiny living room as I did during my initial visits here. Danielle Becker was the last to each there when the dinners were traditional Iraqw as they have now become more Westernized and probably appreciated by the visiting residents. When we arrived, we were warmly greeted by everyone as they consider our visits to be a tremendous honor to their family, when it actually we who are so honored to be taken in to share dinner with their family. Daniel has referred to me as “professor” since we first met when my children and I were volunteering at the school in his village of Ayalabe. We sat for a bit in their living while we all couldn’t help paying attention to the television in the background playing Al Jazeera news, the first television we had seen since our arrival here weeks ago.
Isabella, Christopher and several other family members kept bringing out dishes of vegetables, rice, and meat and after all were in place we each took a dish to serve ourselves. At the moment we started serving, the electricity went out, but they had a battery powered light in the living room so all was well. The food was delicious and amazing, the best we’ve had here in Tanzania, and as we all finished our first plate, Daniel began to pass around the pots for everyone to take seconds. And he made sure no one went without seconds! It was just us and Daniel at the table even though there were extra seats as this is how honored guests are served. Christopher sat on the couch with his plate next to Renata while Isabella continually came in and out out of the room fussing with plates and preparing desert. Women don’t normally sit with the men at dinner as they are preparing food and that part of their tradition has continued. We were stuffed well before Isabella put desert on the table, but we all managed to have some. After dinner, Daniel presented each of us with a bag of coffee as a gift when each of us felt that it was us who should be giving them gifts. We walked back to Daniel’s house in the light of a nearly full moon that left strong shadows of each of us along the dirt roads so there was need for additional lighting. It was another incredibly lovely evening that we all remember. More importantly for me, it was another opportunity for me to connect with a man I will always admire and a family I will always consider as my own. This is why Tanzania means so much to me and to all of those it has touched over the years and find themselves returning again and again.