March 22, 2017 – Our first visit to Qaru in the Endabash area….

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Today we were continuing our week of mobile clinics and after servicing the Mbulumbulu area to our northwest, we were not going to travel to the Endabash area and village of Qaru which is to the northeast. We had been looking for another site to have a mobile clinic and the district medical officer here had been supportive of it after having seen what we had been doing at Kambi ya Simba and Upper Kitete. Last fall, Alex and Sokoine had approached the dispensary at Endabash, but they had initially asked us to pay them for every patient we see there which was totally unreasonable since we are subsidizing the neurology mobile clinics to begin with. After lengthy discussions with the town council, they were unwilling to budge from their position and were eventually told that we had no intention of paying them for the privilege of providing neurological care and medications for essentially nothing other than a very small fee that the patients pay and which does not even come close to covering the cost of the clinic. The village of Qaru, on the other hand, was more than delighted to have us come to their dispensary and care for their residents and realized what we were providing to them. So it was set that we would spend two days in Qaru for our visit visit and see what came of it without knowing the volume of patients we were going to see, only that they were happy to have us there.

A typical wheelchair

Glen Gaulton, who had been visiting with us since last Thursday evening, was planning to leave this morning as he was departing from Kilimanjaro International Airport this afternoon. Glen and I met with Susan and Frank yesterday morning to discuss future plans for our involvement with Penn as far as neurology was concerned as well as other services that might work for both FAME and Penn. The big topic of conversation for us, though, was the laptop ban for carry on luggage from primarily Muslim countries that had been recently announced. Thankfully for Glen, it would not affect him as it wasn’t going to be enforced until several days from now, but for the rest of us flying through Doha, Qatar, it would mean that we won’t be able to bring our laptops, tablets, cameras or any other piece of electronic equipment larger than our cell phone with us on the flight. Yikes! Each of us had been planning to do work on our devices on the long flights home and will no longer be able to do that. It will mean that we have to read a book or watch non-stop movies on the 7-8 hour flight from Kili to Doha and the 13 hour flight from Doha to Philadelphia. Jamie will be heading to Namibia after we finish at FAME and she will have an even longer flight to Doha. I did read somewhere that Emirates (who is also affected by the ban) is planning to allow people to bring devices on the inbound flights to Dubai connecting to the US and then would pack anything there in locked cases for no charge. It is said that the ban was based on specific intel, but there is also a suggestion that this is an economic retaliation against middle east airlines that receive government subsidies and can therefore offer lower fares which the US airlines can’t compete with. Regardless of the reasons for the bans, it is going to pose a significant hardship for all of us, not to mention the fact that I am going to have to check all of my camera equipment and hope that it will arrive at home with me and not disappear. The fact that all of these electronic devices will now be stored in checked luggage surely won’t go unnoticed by unscrupulous baggage handlers along the way. The consequences of this ban in the long run remain to be seen, but for our flights home it will be a real hassle.

Angel screening patients wating to be seein

Sokoine screening patients

The drive to Qaru leaves from the tarmac immediately opposite of the FAME road and travels northeast through a somewhat different landscape than that of Mbulumbulu, but it is equally breathtaking with long vistas of green fields among low rolling hills and occasional kopjies (Dutch for “little heads” and referring to the large boulders poking above the ground, often the home of many animals in more remote places like the Serengeti) scattered across the countryside. This is an equally poor area of Tanzania where small villages along the road are made up of a few shacks that account for not only the homes of the inhabitants, but also the small places of business. We finally reached Qaru after perhaps 45 minutes to an hour and drove through town to reach the dispensary. It was a very nice facility with a who separate building for their “inpatient” ward that was empty and looked as if it was rarely used for anything. There were two wings, a male and a female, along with a central office that were all for us to us. The nurses were so happy to have us there that they directed moving desks to each of the wards along with extra chairs and, in very short order, we were set up for three lovely offices in which each resident could see patients along with their interpreters.

Chris seeing a patient in Qaru with Particia’s help

Nan evaluating a seizure patient with Sokoine

Jamie and Dr. Mary evaluating a patient

The patients were already there waiting for us as we arrived and the residents each jumped right in to see them so we were off and running quite early. One of the most important parts of these clinics is the pre-screening of patients before they are seen since we are there to see patients with neurological disease and not those with arthritic or orthopedic issues. Our role is not to do general medicine when we are there as they have clinical officers at the dispensaries for that and since we are charging only a small fee that doesn’t come close to covering the cost of the visit and medications, we cannot subsidize anything but neurology. Early during the clinic, Nan came out of her office at one point with a bit of a frustrated look saying that she couldn’t evaluate her 37 year-old patient who was complaining of chest pain. Clearly, that would not be considered a neurological problem on the face of it, but after reassuring her that it was unlikely that the patient had an acute cardiac condition, I sent her back into the room to ask a few more questions and after a some further assessment she not only found that that woman didn’t have a cardiac condition, but very likely had a neurological complaint that she could actually treat. Alls well that ends well.

Chris examining a patient with Angel’s help

Patricia and our pharmacy at Qaru

Jamie saw a woman with a clear psychosis who has been under the care of the government psychiatric nurse and receiving long acting antipsychotic medications, but we were unaware of the actual medication she was on and both she and her husband were asking if we had anything other medications to suggest as she had been having side effects. A call to the government dispensary to gather information didn’t go as planned as they were apparently unaware that we were in the area and wouldn’t provide us with any information. In the end, the patient was directed back to the dispensary since we were unable to treat her without knowing what she had been treated with previously and what she was currently receiving.

Jamie and Mary evaluating a patient

Chris examining a patient with Sokoine’s help

Lunchtime came and we put shukas down on the grass in the shade of a tree next to some boulders where our care was parked. This was a small kopjies and the trees were growing out of the rocks with their roots exposed. It was a lovely spot and while looking for lizards, I found a beautiful chameleon that was colored an amazing green and black at the moment. He threatened me with open jaws that were merely for show and puffed out his throat to make him look bigger. In the end, though, he settled down and we were able to handle him gently so that everyone got a chance to have him walk on their arm and marvel at his independently moving eyes, each moving in a 360° circle separately. Everyone other than Angel thought he was so cute as she went screaming around the car and wouldn’t return until he had been released back to the bushes near where we found him. As soon as we let him go, he immediately turn to color green that exactly matched the bushes as camouflage in the manner we’d expect of any respectable chameleon.

A nice close up of Mr. Chameleon

Jamie holding our chameleon

Taking photos of the chameleon

We had a few more patients after lunch and were able to get back to town in time to stop by the fabric store we had visited before and Jamie picked out some fabric for a skirt they were going to make for her. At the same time, I saw a Thomson Safari vehicle parked just up the road from where we were and decided to see who was driving it. When I asked whose vehicle it was, a familiar looking gentleman stepped forward and I realized it was Mohamed, who had picked me and my kids up at the Manyara Airport in 2009 after we had returned from the Norther Serengeti while on our original safari. I’m not sure if I’d seen him since then, but we clearly remembered each other so we sat and shared a drink to catch up on things. What a very small world this can be. I showed him pictures of my kids from our safari as well as where they are now and he was so happy to see them as well as knowing that I’ve been coming back every since to help out at FAME. It reminded me of my first visit to FAME that was the result of volunteering for a few days in Karatu, and what FAME was at the time. From a simple outpatient ward then to the complex of patient care facilities that it is today, we have grown together over the last seven years.

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