We had survived our trip to the Central Serengeti, including my kite attack on the crater rim, and had seen spectacular sights there that included the wildebeest migration. It was now time to get back to work seeing neurology patients at FAME. We had asked a number of patients who we had seen at FAME in the first week and a half of our visit to return during this final week to follow up on therapies we had instituted. This included seizure patients in who we had made medication adjustments or needed to check additional labs.

It was probably not quite as busy at the start today as it had been during our first scheduled week here, but the volume was quite steady throughout the day necessitating that we again run three rooms. Dr. Ivan was going to work with us today and he was paired with Neena, while we had Baraka and Emmanuel working with us one again. These two translators have worked with us tirelessly for the last several weeks and have been indispensable. Without them we would not have been able to see the number of patients we have seen. We’ve also been able to work with at least one clinician everyday instructing them on the neurologic examination and neurologic diseases.

An interesting patient seen by Sara today included a young boy who was accompanied by his caretaker and had been unable to walk for the last five years. They had originally stopped me outside to show me his MRI scans that had been taken to ask me if there was anything we could for him, but without taking a history or examining him, there was little that I could tell them. After Sara took a good history, it was clear that the boy had had tuberculosis that had affected his spine (Pott’s disease) and he had suffered complete collapse of his fifth thoracic vertebrae with compression of his spinal cord. Essentially, he had a nearly complete transection of his cord at the T5 level with paraplegia and a T5 sensory level. Their question, of course, was whether we could do anything for him or whether there any chance of him improving and we had to give them the news that he would never walk again. We were able to give him some symptomatic medications, though, for his spasticity, that would hopefully be helpful.

Another child Sara evaluated today was a young girl from Dar es Salaam with a very severe epileptic disorder that we’ve seen in the past and who has been on a multitude of medications. One of our previous pediatric neurology residents has continued to be involved in her case and it was believed that she likely had a progressive epileptic encephalopathy, though she had responded to medications after her last visit and was now improving somewhat suggesting that her cognitive issues may well have been related to her frequent seizures rather than a degenerative disorder. That was certainly very good news and, though, she was still not a normal child, she was still functioning significantly better than when she was previously seen and her prognosis was better than previously believed.

Another group of patients today had been brought by Dr. Elibariki Lucamay, a very caring general surgeon in Arusha who I had met last March and who had asked about bringing some of his neurological patients to FAME to see us when were here. He brought three seizure patients for us to evaluate, all of whom had been diagnosed perfectly appropriate and were on the correct medications. We made some minor adjustments in doses and recommendations for labs to avoid toxicity, all of which we not only communicated to the patients, but also to Dr. Elibariki who will continue to follow them going forward. We will very likely see them again in March when we’re here, but I’m very confident that they will have excellent care in the meantime.

Sara continued to have a busy day as a group of children had been brought from a special school for neurologically impaired children south of town in the direction of Qaru where we had been last week. These children don’t live at the school, but rather with their families and are assisted in their care by the workers at the school who work for an NGO. One of the young girls was clearly autistic, while another young boy had seizures, and a third child was quite delayed with some focal abnormalities and probable cerebral palsy. Interestingly, the mother of the young boy with seizures was very insistent on having a CT scan performed even though the boy had a normal examination and his seizures were not recent nor were they difficult to control.

The day was busy and I believe we ended up seeing another 30 patients which is pretty much our maximum for day here and can be seen in a reasonably comfortable manner making certain we are able to have lunch. They do have teatime here in the British fashion as this was once a British colony and this is no doubt left over from that era. They serve chai masala, a very sweet African tea with lots of cardamom and other spices that is simply to die for (as every resident who has been here with me can attest to) and coffee along with white bread and butter. I’ve never quite understood the bread and butter, but we’re always happy to grab some of the chai while working seeing patients. The mandazi that is so remarkable ended up not being made during the month as the normal cook, Samweli, who I have known forever here, was on his annual leave while we were here.

We had decided to spend the evening working as Whitley was giving her lecture on epilepsy tomorrow that she wanted to finish and we all had some things to do. It’s so very relaxing at the Raynes House and it has been a genuine pleasure to have us all stay in one house and spend so much time together. We’re always able to catch the sunset from our veranda or the kitchen window at the end of the day, reminding us of how lucky we are to be here doing what we’re doing. We are in the final stretch of our time here and only have a few more days to see patients.