October 18, 2016 – On to Upper Kitete…..

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Every Tuesday morning is reserved for an education meeting with the doctors and it is typically given by the visiting volunteers whether it be neurology, on/gyn, cardiology, medicine, or infectious disease. Usually, FAME has only one specialty come to visit at a time as it can otherwise become a bit unwieldy as resources here such as the doctors and nurses are quite limited. FAME’s mission is for western volunteers to share their knowledge and expertise with the staff here whether nurses or doctors.

Morning lecture

Morning lecture

The request for this morning’s lecture was Parkinson’s disease so Kelley and Laurita spent the evening (and some of the night for Kelley who stayed up quite late) preparing a PowerPoint presentation for the doctors. Dr. Msuya is in charge of the educational programs and Dr. Lisso, who is the head doctor, oversees all of the programs here including which doctors we work with on given days. The morning lectures are supposed to be 30 minutes long and we were running a few minutes late this morning so it was already going to be a challenge to get everything in. Dr. Lisso is usually a stickler with time and I have seen him cut off presenters in mid-sentence before, so when they were pushing 45 minutes for their lecture and Lisso hadn’t yet interrupted them, it was clear that they had everyone’s attention. Both did a great job with their presentations and there were tons of great questions afterwards which was a clear sign that they had also done an excellent job stimulating interest.

Our patients waiting at Upper Kitete

Our patients waiting at Upper Kitete

After morning report, we began organizing for our trip to Upper Kitete. This is another village along the Great Rift in the Mbulumbulu region that is past Kambi ya Simba on the same road and about twice as far. The scenery on the drive is equally stunning, and perhaps even more so, as the border of the Ngorongoro Conservation Area and mountain range that marks it closes in towards the rift narrowing the plateau of rich farmlands we are traversing until it is no more. This is where the mountains that include Empakaai Crater meet the escarpment of the rift and drop off to the floor of the Great Rift Valley leading northward to Oldoinyo Lengai, Lake Natron and, eventually the border with Kenya. Upper Kitete is the second to the last village along this plateau with Lositete being the last and along a rough and often impassable road.

We also attract a following of children....

We also attract a following of children….

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The health center in Upper Kitete is quite old and a new building that was recently completed was not yet ready for our use. We had a number of patients waiting for us as we arrived and others came once the word of our presence seemed to circulate. The clinical officer there was trying to be helpful, but was a bit too enthusiastic at times and gave a long speech to the patients telling them what we were there for and how the clinic would proceed. I don’t think it was very helpful, though, and we had to once again screen our patients to make sure we were seeing neurological problems and not just everyday aches and pains. We started off using the medical officer’s office and one of the rooms we normally use that I affectionately call the “bat cave.” In the corner of the room there is a large opening in the ceiling where you can often hear the bats as they spend the day in the attic. The smell of bat urine and guano is also noticeable, but only mildly so as it’s not all too offensive. I’ve never seen a bat flying or otherwise in all the times I’ve come here so I think we’re pretty safe in not encountering one as we work. The labor and delivery room, which we normally use as our second room was unfortunately occupied by a patient and not available to us.

Dr. Badyano and Dr. Laurita evaluating a patient in the bat cave

Dr. Badyano and Dr. Laurita evaluating a patient in the bat cave

Kelley and Laurita began seeing patients, Laurita in the bat cave and Kelley in the office. Sokoine had showed me a young girl who was screening and who had a “crooked neck” that he wasn’t sure was neurologic or not. I took one look at her and unwrapped the fabric she had covering her head and neck, and it was quite clear that she had torticollis, a very definite neurological disorder. Laurita ended up seeing her, but I didn’t tell her my diagnosis so she could make it herself, which of course she did in very short order. It had come on acutely a month prior and was very uncomfortable for her. We have very few of the medications here to treat it, but we did have diazepam (Valium) that was prescribed in very small doses. We also told her to use warm compresses along with the diazepam and asked that she return to FAME in two weeks to see how she was doing.

Our young patient with torticollis

Our young patient with torticollis

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The rest of the patients were a smattering of typical pathology – headaches, seizures, numbness and tingling being the most common complaints. At midday we had our lunch of Tanzanian street food again with a few new items having been added to our menu. One was a skewer of goat meat, a few vegetables and boiled, peeled potato that wasn’t bad. The samosas, though, were the best of the bunch and very much appreciated by each of us.

At one point during the day, Kelley came looking for me as her patient was in need of occipital nerve blocks and she needed my assistance in performing them. I went to the vehicle to get the medications and when I came back she was no where to be found. I went to every room looking for her and asked the others if they knew where she was. No one knew. I proceeded to pop my head in every room to look and it reminded me of something from a slapstick comedy. The nurse was seeing babies in the medical office, Laurita and Badyano were in the bat cave seeing patients and when I opened the door of labor and delivery, I unexpectedly walked in on the clinical officer performing a pelvic exam on his patient. I called Kelley’s name several times with no response and was getting pretty angry at one point that I couldn’t find her and none of our support staff were aware of her location. I called for Kelley on one last occasion and heard a faint reply coming from the new building which I had been told wasn’t ready for us. She and Selina had been directed there after the medical office had been needed again for baby visits. I finally relaxed a bit after learning that I hadn’t actually lost one of my residents in Africa which would have been difficult to explain, especially to Dr. Price, our residency director. I fear that he would make me cover the remainder of their duties which isn’t something I’d even like to think about.

A clinical discussion

A clinical discussion

Following my brief lapse in sanity, I helped Kelley with the occipital nerve blocks which are something we often do in the US for patients whose headaches are from inflammation and can often be relieved with a combination of a steroid and a local anesthetic. The patient tolerated the procedure just fine and was on his way in short order.

A moment of down time

A moment of down time

We finished seeing patients at not too late an hour and decided to return directly to Karatu and FAME. The drive back was on a different road that parallels the escarpment that falls off to the Great Rift Valley and the views are spectacular. You can see for many miles down to Lake Manyara and up towards the village of Engaruka, a very important historical and archeological site in the history of the Maasai in this region. I know it seems like everywhere we go here in Tanzania the scenery is totally amazing, but that is the truth. This country has possibly the most diverse and beautiful of any on this earth. No matter which direction you turn you are seeing something entirely new.

After dropping all the FAME staff off in town other than Ema, our driver and who lives next to FAME, we returned to catch up on email after which we sat on the veranda and watched another colorful sunset. It is so relaxing to just sit and look off into the distance with its lovely jacaranda trees of unique purple lavender and the coffee plantations beyond. The distant mountains are all overlap in a gorgeous sketch marking the horizon and lands beyond. We are all so lucky to be here and to experience this land and these gracious people in such a fashion. We are their guests, but are truly treated like family and for that we are so grateful. This experience is like no other.

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