We were all exhausted after our incredible adventure over the weekend and went to bed earlier than normal I think. At about midnight, though, we had a tremendous thunder storm come through the area that lasted the entire night and into the wee hours of the morning. I think after our ordeal at Ndutu, we were all a bit gun shy and skittish of the heavy rains given what the roads become in very short order here, but the weather let up a bit in the morning long enough for us to walk to the clinic and then later in the morning the skies became clear with bright sunshine.
On the mornings where it’s rained all night, clinic is usually slow first thing, but today we had a number of patients already waiting for us. What we discovered, though, was that many of the patients had come from Arusha this morning, having driven the tarmac which is much more dependable than the dirt roads most patient use to get here from the nearby communities. Though Arusha and its surroundings is a city of probably a million people, there are no neurologists there and only one in all of Northern Tanzania at Kilimanjaro Christian Medical Center in nearby Moshi, and she is primarily dealing with hospital patients there so I’m not sure what type of outpatient practice she has. The patients that came this morning from Arusha were primarily of Indian descent as there is a very large Indian population in Tanzania who have been here for many generations after having arrived here in the 19th century as traders on the coast and in Zanzibar.
Patients seen today included a general smattering of the usual complaints including headache, back pain, extremity numbness and the such. One woman who saw Chris, though, brought an MRI with her that revealed an extra-axial mass of the right sphenoid wing compressing the right anteromedial temporal lobe. She was complaining of a right sided headache and the MRI had been taken at Muhimbili Hospital in 2015, though she reported having had a repeat MRI done within the last several months, also at Muhimbili, and that she had given a disc with the study to Frank.
Chris’ exam was very concerning as she now had right sided ptosis and impaired vision on the right that we felt was referable to the lesion we saw. Frank was out so we had the patient wait until he returned and reviewed the study on his computer. The report of the repeat scan did not describe the lesion nor did it suggest that they compared it to the original study and after looking at the scan we felt the lesion was still there and was responsible for her headaches and the change in her examination. We suggested that she return to Muhimbili, which is in Dar es Salaam and a day’s bus ride away, and we gave her a letter from us indicating that we felt she still had a problem and should see either the ENT who she had seen before or the neurosurgeon (of which there is only one in the country). As she had been seen numerous times there before we were certain that she had the means to make it there which is so often the limiting factor here as most everything has to be paid for and most often patients just don’t have the ability to do that.
Since this is our last week here, I had promised Daniel Tewa that we would stop by his home to visit with him before we left. We had agreed on today and it was also agreed in advance that he would not provide us with dinner, something that he loves to do because he feels that it’s an honor, but also something that I am sure is expensive for him and very time consuming. We went after work and probably arrived at his place around 5:30pm or so. The chairs and table were set up outside as they always are among the eucalyptus trees in front of his home. This is where he entertains groups of safari goers from the different countries, educating them about the history of Tanzania and the Iraqw people. His wife, Elizabeth, brought us delicious African coffee which is boiled with milk and really, really amazing, even if you’re someone who normally drinks your coffee black.
As we began to discuss politics (always entertaining with Daniel), Elizabeth began to bring out additional plates containing sandwiches of cucumber, tomato and beef that were incredibly tasty and despite our objections considering his promise not to feed us dinner, he argued that they were merely snacks and couldn’t be considered dinner. When the plates of fresh fruit and avocado arrived, though, I think his argument was quickly falling apart which was of no concern to him as he continued to insist that we eat. I had asked him for some coffee beans to take back with me and insisted that I pay him for them as he usually gives me several, but I had asked for a few more for friends this time. It took some doing, but I was eventually able to give him some money for the coffee and I don’t think that he was offended. In addition to saying goodbye to Daniel and Elizabeth, we were also able to see his granddaughter, Renata, once again before we left and I look forward to seeing her again in October. I have seen her grow from a six year-old happy to eat her grandfather’s leftovers (an honor) to a now thirteen year-old doing great in school and a pleasure to have work with us at times. Her aunt, Bernadetta, had also worked with me at FAME several years ago before going off to college, so the family has been very close since coming here.
We came home from Daniel’s not quite hungry for dinner so stored all of our dinners (roasted chicken and potatoes) in a Tuppeware container for another night, though we’re running very short on remaining nights here. We have three more days of clinic and three more nights as we are planning to head to Tarangire National Park on Friday before arriving to Arusha later that evening. The residents will spend the night there and fly out on Saturday while I will be flying out on Monday. It always seems to go so fast when we’re here, but we’ve gotten so much in.