It was Friday and our final mobile clinic of the Spring 2017 trip to FAME. I’ve written so many times about Rift Valley Children’s Village, but it’s very difficult to say too much about this amazing place. RVCV is not an orphanage, but rather a home to approximately 100 children of all ages were have been orphaned or unable to be cared for by their family and have been adopted by Mama India and her business parter, Peter. They grow up at RVCV which is their home and they go to school at the primary school that is next door. Eventually, they have the opportunity to go to collage and most do.

Tanzanian market weaver male weaving a new nest

The reason that FAME is in Karatu is that Frank and Susan met India when they first came here with the idea of opening up a facility and India convinced them that Karatu would be the perfect place and that would also allow them to provide care for her children and the surrounding community which she would subsidize as she realized that her children would be healthier if the local community were healthy. FAME continued to provide these regular medical clinics at RVCV until very recently and now patients are sent to FAME as it is about a 45 minute drive to the Children’s Village from FAME. We have been tagging along with the FAME clinic over the past, but today we would be going by ourselves, though we would have a clinical officer with us to help with medical decisions other than neurology.

Nan and Sokoine evaluating a young woman with cognitive delay

Nan examining her patient

The drive to RVCV is absolutely spectacular (as are all of our drives anywhere around here) as you leave the tarmac just below the Ngorongoro Gate and travel along a slight ridge in between fields of green that go on forever. There is no sign indicating that the road leads to our destination, though there is one for the Crater Forest Camp nearby along with a sign stating “rough road,” typically ominous here considering that other than the tarmac, all the roads are rough. There are several lodges visible along the way just before we begin descending into several valleys and eventually climb up into a coffee plantation that we travel through a short distance until we reach the primary school and, behind it, Rift Valley Children’s Village where we’ll spend our day. There are always patients waiting for us sitting in front of the offices, though today, since we are here by ourselves rather than with the FAME general medicine clinic, they are all for us. There have been times when it’s been a bit overwhelming, though today are list is manageable. We unpack the medications and supplies from the vehicle and immediately get to work creating a list and getting rooms set up.

Chris and Angel evaluating a patient

Jamie evaluating a young woman with epilepsy

Considering one room has a bunch of stuffed animals, that will be Nan’s as she has been seeing children whenever possible. I should have mentioned previously, that for all of our mobile clinics, we keep separate records from FAME as it’s impossible for us to know who will be coming so we don’t have access to the FAME charts. Even when we have some form of an EMR at FAME, there is no cell service at Upper Kitete and the bandwidth on the cells is not great. We keep notebooks of all of our mobile clinics with past records so when patients return we can find their previous clinic notes. Not ideal, but it works 90% percent of the time or more. RVCV, on the other hand, keeps meticulous charts for all their children in addition to the patients who come from the town, so it is very easy for us to find our notes, though we still make copies of all our handwritten notes that we bring back with us and keep them in a binding the same as the other clinics.

Nan evaluating another pediatric patient

RVCV also has a wonderful nurse, Gretchen, who has been there now for 18 months and is quite familiar with all of the patients including those from the local village next door, especially the children. She is able to fill us in on lots of back information that is not always readily available in the chart nor do the patients always offer it to us considering it is often very sensitive, dealing with all types of abuse. As such, we are often doing a fair amount of counseling here and, unfortunately, much with children who are quite commonly the victims of this abuse. Some of the stories are quite gut wrenching and, though there are authorities to deal with these instances, it is not always the most simple or effective. There is a social worker at RVCV who we are able to discuss these cases with and pass on the information we gather to her, but it still leaves us with a feeling of sadness often in not being able to rescue everyone, similar to how we feel with many medical cases that are not able to be treated here for lack of resources or otherwise.

Chris evaluating a patient with epilepsy with Angel’s help

Patricia counseling a patient on how to take his medications

Nan is in heaven considering the number of children we see at the this clinic and she wastes no time in getting started. We saw a number of epilepsy patients during the day and it so difficult at time as patients rarely know what they are taking, or how much or how often, when we ask them and we have to bring out tablets to confirm with them what they are taking. We were last here in October and many patients, as is commonly the case, have stopped they medication in the interim because they were “finished,” meaning that despite our constant education, most often in triplicate, they didn’t understand that they had to continue the medication for it to continue working as we are not “curing” their problem, but rather treating it.

Nan being Nan evaluating a pediatric patient with Sokoine’s help

One of the benefits we look most forward to at RVCV more than the other mobile clinics is lunch. This is extra important for Nan, who is always thinking about food and where will the next meal be served. When traveling to Empakai last Sunday, we all secretly place odds on when she would first mention lunch in the morning, but she fooled us all by lasting until 11am before asking about food. She was more than happy to discover that today we would be eating a delicious home made lunch in the volunteer dining room where the “mamas” always make an incredible meal for us. Today it was broccoli soup, salad, and cheesy pasta along with fresh fruit, including everyone’s favorite, mango. Lunch is always served at 12:30 so we didn’t have to worry about when to take a break.

Jamie providing a psychiatric assessment to Dr. Mike and Elmo

After lunch, we visited the gift shop while waiting for our Tanzanian counterparts, who eat a more traditional lunch along with the staff here, to come back ready for our afternoon session. Having three rooms seeing patients allowed us to plow through the patients rather quickly and we were done shortly after 3pm, which was good because some of the younger boys were kicking a soccer ball around nearby and I know Jamie had been mentioning wanting to play soccer here for sometime, but it was readily apparent that Chris was also more than ready to play. Even Nan pitched in guarding the goal for a bit and it was great to watch the three of them running around with the children who were all so happy here at the village. It is a place of miracles and you can’t but help know that everyone of these kids was rescued from a harsher life had it not been for the India and Peter, The Tanzanian Children’s Fund and Rift Valley Children’s Village. Saying goodbye and leaving this magical place to head home is always tough. I know that I’ll be back as I have so many times, but for residents, this is likely their only chance to experience this place.

Chris playing soccer with the RVCV kids

Jamie trying to steal the ball

Fancy footwork

Nan playing goalie

Chris playing defense

The weather today has been lovely and the drive home was so peaceful after having seen our patients, played soccer (the residents, not me, of course) and had a great lunch (Nan is very happy!). We arrived back to Karatu, our home for the last three weeks, early enough for Jamie to pick up the skirt she had made and then do some shopping as we’ll be heading into the bush tomorrow on safari. Yusef, our guide for this safari to Lake Ndutu in the Southern Serengeti, had called and was waiting up at FAME for me to give him the Land Cruiser so he could check it out before heading off to such a remote location. Nan and Abbey immediately went to the maternity and pediatric ward where they promptly assisted in finding a delivery going on so when we walked in a few minutes later, we found Nan holding a newborn and beaming from ear to ear.

Nan with a precious new baby

Meanwhile, I received a text from Frank shortly before getting back to FAME informing me that somehow, Dr. Lisso had told them about a patient still “waiting” for us despite the fact that we didn’t have clinic. It was a huge imposition after having nine days of clinic here, finishing five mobile clinics and preparing for four more clinics at FAME that we had to see a non-urgent patient after hours. After briefly venting (a single text) to Frank (who was also pretty frustrated by the event) Jamie and I saw the patient, who actually turned out to have psychosis and had just been treated at the local hospital days earlier, receiving some injectable medication that they didn’t know the name of and didn’t have their discharge papers from the hospital with them. Argh!!! We just kept repeating “TIA” (This is Africa) and explained to the patient, who, by the way, was doing better after the injection that we really couldn’t treat him as he had very likely been given a long acting medication that we didn’t know the name of, and, besides, it was helping him. They were happy with the visit, though we were a bit perplexed as to why they had come, not to mention being still bend out of shape as to why we had to see this patient at 6pm on a Friday evening.

Jamie’s birthday cake – it was delicious!

We eventually got home to eat our dinners, albeit a bit late, and got down to the work of preparing our lunches for the safari tomorrow as we wouldn’t be getting to our camp until dinner time. It was also Jamie’s birthday (sworn to secrecy on how many) and we had ordered a birthday cake from the Lilac Cafe which was running late, so Denis from the Lilac brought it to us during dinner. I had the desired effect either way as Jamie was quite surprised and we all sang happy birthday to her on Joyce’s veranda where we were eating. Later, I worked on my blogs while the Chris, Jamie and Nan made sandwiches, arguing about important things like the “appropriate” amount of peanut butter in a PB&J or PB and Nutella, the latter everyone’s favorite but mine preferring to stick instead with the more basic version of this American classic. Nan cut up a pineapple to eat with lunch and we each went off to pack for overnight in the Serengeti. We each slept with dreams of the wildlife we’d see the following day and the adventures we’d experience, having to awaken quite early for a 6am departure to head through the Ngorongoro Gate when it opened.