Friday, March 23, 2018 – A short clinic and then on to Tarangire….


Johannes and Baraka examining a patient together

We had scheduled today as another half day of patients as it was another of the residents “wellness days” and, in fact, we were leaving for an overnight safari to Tarangire National Park after lunchtime. I had arranged to have Yusef come from Arusha to drive us for the weekend and we were booked for two nights at the Simba Tarangire Lodge, a beautiful lodge of permanent tented rooms just outside the southern entrance to the park which meant that we wouldn’t have to pay for the park fee today, a savings of about $75, for each day you are in any of the parks you can expect to pay an entrance fee whether you are doing a game drive or not. The park fees have gone up over the last several years and probably rightly so as this is their main source of funding conservation and the objective is to keep the parks as they are for as long as possible and, hopefully, forever.

Susanna and Dr. Caren evaluating a patient together

We had all packed for our trip before we left the house for morning report so there would be no last minute delays or forgotten necessary safari items later. Somehow, though, Johannes managed to forget his sunglasses, so spent the entire weekend with a bit of a squint that had nothing to do with his eyesight. Everyone was incredibly excited about the prospect of seeing animals this weekend and, having been to this lodge before, I knew that they were in for a surprise given how nice it is there. I had stayed there with Laura and Kelley in October 2016, so was looking forward to seeing the place in the wet season.

The often difficult sensory examination here

Our clinic was a bit light this morning, but there were still enough patients to keep everyone busy and I had planned to meet with a visiting doctor who was here to possibly set up a global fellowship program in cooperation with FAME. Despite the quiet clinic, there seemed to be lots of things going on this morning that kept us all quite occupied. During morning report, I told about a young boy who had been here the day before with a history of having been struck by a cow and fallen, striking his head and having about four hours of unconsciousness. This had all happened about a week ago, but they had done a CT scan on the child that had revealed a small subdural hematoma, not big enough to be causing a problem, and had sent him home. I went to review the CT scan after report and, indeed, the subdural was quite small, but just the same, was there, and I requested that the boy come back to see us on Monday so we could more thoroughly evaluate him. If, in fact, he was normal neurologically, then we wouldn’t recommend doing anything else and the subdural would eventually resorb over time. There was no mass effect or evidence of skull fracture on the CT scan so the boy had been very lucky. Even though the general surgeons in Arusha can drain subdural hematomas, it is not overly reassuring that the only neurosurgeon in Tanzania is in Dar es Salaam, some 10+ hours away by bus.

Mindy taking a history

Dr. Caren was working with us for the morning which was nice as she had not had a chance to work with us before and, even though, it was only for the morning, she received some necessary instruction regarding the all so important neurological examination. I had to leave for a bit for a meeting which is always a problem considering the residents do need to staff all of the patients with me, so that did create a small backup in the patient flow, but all seemed to work well and it didn’t end up throwing too much of wrench into the system. I met at the Lilac Café, the very nice and comfortable little cantina here on campus that serves meals to visitors and anyone else who might wander by looking for a good cup of kahawa, or coffee, or even a cappuccino. When FAME built their hospital, they realized that they would have to feed the patients and patients’ families somehow, so the Lilac came into existence and has served everyone well. We sat outside for our meeting and the weather was absolutely gorgeous as the rains had seemed to let up and we were having a lovely streak of days with mixed sun and clouds which is exactly what you hope for here.

Driving to Makuyuni – Susan in the front seat, Susanna, Mindy, and Sokoine

We actually finished with clinic a bit early and so were able to head back to the house before lunch. This was a good thing as I noticed in the morning that one of the Land Cruiser tires was flat and would have to be fixed prior to our departure. Yusef has been delayed in coming to Karatu so having him fix the flat was not an option, unfortunately. George, one of the driver mechanics here was nice enough to have changed the tire for me in the morning, a job that isn’t technically demanding, but in the hot sun and humidity, leaves me needing a shower every time I do it. You can’t travel on safari with only one spare as punctures were are so very common, so I would have to have the other tire repaired before we left. I drove down to the tire shop that we usually use to repair our tires where they found the leak and plugged it, then put it back on the vehicle swapping it out for the spare. He checked the pressures on all four tires after that and pronounced that we were now prepared for our safari. When I asked “how much,” I was told 5000 Tsh, or less than $2.50, an amount that would be unimaginable at home.

Thumbs up for the accommodations at the Simba Lodge

I returned home within 30 minutes, having repaired the tire, and we all went up to the cantina, essentially stalking it waiting for lunch to be ready. I’m not sure if it was the fact that we were hungry (the lunches here are amazingly delicious) or that we were all chomping at the bit to leave for Tarangire, but everyone devoured their lunch and we were soon on our way to town to meet Yusef. We were also picking up Sokoine, who was heading back to Arusha, so we would drop him off in Makuyuni which would be halfway there and then we would head on our way to the southern gate of Tarangire.

A lesser hornbill just outside of the room

Tarangire is considered the home of the elephants here in Tanzania and a park that is much larger than people think. We passed the road to the main gate and continued along the tarmac until we reached the turnoff for the southern gate and the Tarangire Simba Lodge. The drive takes you through some very remote areas where there are small enclaves of population who are many kilometers from the tarmac and there are fields full of crops. This is a huge flood plane and the road is raised with frequent drops to allow the floodwaters to pass without fully washing out the road during a hard rain. Closer to the park entrance and our lodging, we enter the woodlands that make up this region and as we pass the gate, we have our first encounter with the dreaded tsetse flies that live here during various seasons. They had been plentiful when I was last here in October 2016, and I had hoped that perhaps they wouldn’t be now, but this wasn’t to be the case and our vehicle was quickly enveloped in a cloud of these little beasts.

A wellness day like no other – the pool at Tarangire Simba Lodge

The tsetse can carry a very serious disorder, trypanisomiasis, or African sleeping sickness, but they do not here, as there have been very few cases reported over the many years in Tanzania. It is endemic in other regions such as areas of Central and West Africa, but here it has virtually been eradicated. Needless to say, though, the mere fact that we’d be seeing them triggered extensive Internet searches on our way down including a map of the incidence of the condition in order to prove to Mindy that it was highly unlikely that any of us would contract this African sleeping sickness. That’s what I get for traveling with a group of highly educated, academic neurologists with an occasional touch of neurosis.

Enjoying the pool

All throughout Tanzania, and primarily in the areas with heavy tsetse infestation, there are “tsetse traps” that hang in the trees which are essentially a cloth of dark blue and black that attracts these flies. No one wears similarly colored clothing on safari for fear of sending the welcome message to the flies, but despite this, they still manage to find you. As we pull up to the gate, there was a Maasai askari there dressed in a dark blue and black shuka and we all had to wonder whether what we were being told about the colors wasn’t some practical joke they were playing on all the mzungu visiting here. Thankfully, though, it was confirmed by a quick Internet search and everyone was relieved with that news.

Susan and Susanna enjoying the sunshine

We pulled up the lodge after our long and dusty ride and were greeted by staff with cool washcloths to refresh us and a cool tropical juice. The tsetse flies were still buzzing around our heads, but thankfully were thinning out so we could at least enjoy our cool clothes and juice and then sat down in the open lobby where the staff gave us our rooms and reviewed other information regarding dinner, internet and power, all questions that were quite pertinent to us. The girls were staying on one tent and Johannes and I were staying in another. We walked to the tents with the staff carrying our bags, as they always insist to do, and proceeded to settle in, but we had definite plans to be at the swimming pool as quickly as possible to refresh ourselves and to watch the sun beginning to set.

Our escort back to our tents with his shotgun

The pool here is pretty amazing, mostly for the fact that it has an incredible view to the west of the setting sun over the treetops. In all my visits here, I had never been in a pool in Africa, so this was a first for me and I decided to make the best of the opportunity. The water was cool and refreshing, but even more refreshing were the cold drinks we were served at poolside and enjoyed while floating in the water. I had a beer, though others enjoyed an Amarula colada that uses a cream liquor from South Africa made from the marula fruit that is known to make elephants loopy and ataxic when they eat it. I don’t believe that any of us became ataxic after drinking this tasty concoction, but I do know that we all felt quite relaxed and this was a perfect activity for the resident wellness day. We stayed in the pool until just before sunset, sipping on our drinks and just enjoying the wonderful African atmosphere. It was eventually time to get out, though, so we could prepare for dinner that was going to be served at 7:30 pm that night. We had given our choices of fish or pepper steak earlier while in the pool and were all looking forward a relaxing time for dinner to continue our wellness theme for the day. As expected, dinner was excellent and after dinner we all stood outside near the pool checking out the unbelievable amount of stars in the sky, naming constellations with our iPhone apps and amazed at what we could actually see. Perhaps the most well recognized was Orion, but the most special was the Southern Cross, seen only in the southern hemisphere.

Our escort with his spear

It was finally time to head back to our tents as we were leaving early for our game drive in the morning and everyone was a bit shocked when our escorts showed up to walk us to the tents, one hefting a long shotgun and the other a long spear. The fact is that there are wild animals everywhere in Tanzania and even more so in these areas of the national parks or adjacent to them. One must always be vigilant here and, in fact, the askari had indicated that they had recently had to shoot a lion in camp so we were happy that they were armed as they were. Given the beauty of this place, we sometimes neglect the fact that it can be a dangerous place in other ways than we would imagine living in an American city.


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