We had originally planned to leave Arusha late morning to arrive in Karatu by lunchtime. It’s always nice to arrive with half a day to get oriented for the residents and for me to make my rounds greeting everyone once again as I return home. Leonard was flying in from the Serengeti, though, and wouldn’t be arriving until noontime so we decided to stick around town a bit later than usual so I could introduce the others to him and for Susan to meet the person who had helped plan her short safari for after we were finished at FAME. Besides, I had to get the rear door of the Land Cruiser fixed before we left town on our way to Karatu, as it would be tremendously more difficult to get the work done there. Everyone, save Johannes, was up quite early as the girls had apparently awakened at 3:30 am and were up talking all night, and I had decided to get up early to work on my blog which is a labor of love. Johannes was quite happy to snooze away, and rightly so, as it was going to be a very slow morning as we were planning to have breakfast before heading out for the day. Breakfast is usually a fairly big affair here, I’m sure mostly related to my visiting, and this morning was no different. We had huge bowls of cut fresh fruit that included pineapple, mangos and watermelon along with sweet bananas from Kilimanjaro, scramble eggs, toast and pancakes, all of which more than satisfied our hunger that morning and could have been our only meal of the day.

After breakfast, we went out to meet Jones to take the car to someone who would fix the back door. I left the others along main road in Arusha so they could walk around a bit of the town while I drove with Jones to find the repair shop where they were going to get the back door open and, hopefully, provide the necessary repairs so that it would open. The “shop” was down a back street and consisted of a group of men standing along the side of the road working on various and a sundry types of vehicles in every state of disrepair, but each vehicle with the expectation that they would have their lives extended at least for a few extra years. We waited for one of the fundi (or specialists) to be free and come by to take at look at the back door. I was very thankful that it didn’t just pop open to make me feel foolish, but it didn’t, and the fundi had to get into the back seats of the Land Cruiser, that are separated from the boot by bars like those in police car, and reach through to unscrew a plate at the door latch and then reach inside to release the door. If there had been luggage back there like there was in October when I drove everyone to the airport, it would never have been possible. Once open with the door latch exposed, he cleaned out all of the dirt that had collected and lubricated the hell out of the mechanism so that it would last us for some time…hopefully.

The Neuro Team – Johannes, Susanna, Mindy and Susan

Having the back door finally open and fixed, I dropped Jones off at the nearest corner (again, to disappear into the foot traffic on the street) and went to pick up the others who had been wandering around downtown Arusha. Leonard was arriving and was at the Arusha Coffee Lodge and I wasn’t sure whether he needed a ride home or not. As usual, the communications were a bit faulty and Pendo told me to go ahead to the Lodge to pick him up, but when I got there after traveling all the way across town at the height of traffic, we found out that he still needed to have lunch with some safari guests and wouldn’t need a ride home regardless. These events I believe are somehow connected to Africa Time and it’s due to the style of communication here which is very laid back and mostly on a “need to know” basis, so extraneous information that may cause someone to worry is not shared unless it is necessary. We drove back across town to pick up our luggage and say goodbye to Pendo, then drove all the way back to the Coffee Lodge to say goodbye to Leonard and take care of some last minute business.

…and their fashionable Crocs required for the ICU

So, having originally planned to be in Karatu by lunchtime, and then by 5pm, we ended up finally arriving here as the sun was setting sometime around 6:30pm. We drove straight to the Raynes House, found Alex for our keys and began to move our things in and get settled. Thankfully, there were dinners for all of us as we were all starving having had our last meal at breakfast and just made the long drive here. We were all quite happy to be here finally, probably most of all the residents who were probably anxious to finally see that FAME really existed and they would indeed have someplace to spend the next month. I guess having found out otherwise and being stranded in Northern Tanzania wouldn’t be the worst thing to happen to someone, as this really is a paradise when it comes down to it. Now, though, it was a paradise with an amazing medical center ready and waiting for the new neurology team to begin their work.

Johannes and Susan evaluating the young Maasai in the “ICU”

We were planning to go out to Happy Day, our local pub as Wednesday nights are the night for all the volunteers in town to meet, for a beer after dinner, but first, there was a patient for us to see who had apparently come in a day or so before and was apparently in the ICU. The only problem, though, is that FAME does not have an ICU, or at least they had never had one before and I was completely unaware that there had been any changes in my absence. The reason there are no ICUs here, is that there are no ventilators here other than those used for surgery and there is really no way to have a patient on chronic ventilation should they end up needing that. This is really a distinction in many African countries regarding initiating this type of care, as you cannot sustain it. This was an eleven-year-old Maasai boy who had complained of headache for several days, then began having seizures at home where he remained for two days before he was brought to the FAME. He was given diazepam that stopped his seizures, but shortly after stopped breathing and was put on a ventilator. That had been done the day before as had a CT scan that was concerning for meningitis. He hadn’t been tapped yet, but was on the proper antibiotics and acyclovir to cover for herpes meningitis, but hadn’t perked up. In fact, he was very much devastated as he had fixed and dilated pupils, no oculocephalic responses, no gag and no response to pain. I spoke with his father to tell him that we were very concerned that he had suffered a major brain injury and very likely would not improve or survive, but we would re-evaluate him the following morning. It was not a very uplifting first experience for everyone, and especially not for Susan, who bore the brunt of the care for this child on her shoulders as there was little I could do to help her with things other than to agree with her assessments. We would evaluate the child again in the morning so we felt that going out for that beer after this experience would actually be quite therapeutic for us all.