We were all quite energetic this morning (or at least I was energetic as the Hannah and John have running every morning) and decided to go out for a walk in the fields beyond the FAME property. FAME sits 2.7 km out of Karatu proper and is pretty much the last establishment on the road before you run into all the coffee plantations that back up to the border of the Ngorongoro Conservation Area. This is a huge region for excellent coffee given all of the volcanic soil and the Ngorongoro Highlands is particularly lush and rich in this regard. From our veranda we look out over fields of coffee as far as we can see into the distance as they run up the many hills and ridges here.

The area that we walk is partially along a dirt road and then onto some trails that cross the fields and are used by the local workers to get to and from work and home. This time of year, the trails are well worn flat and easy to follow or even run on, but in the wet season the fields and trails become a quagmire, so much so that you usually have about a pound or more of clay caked to your shoes. This is fine from an exercise standpoint, but if can difficult to walk with that much muck on your shoes. The morning was absolutely gorgeous and my fleece vest lasted only about fifteen minutes before I was sweating and had to take it off, carrying it with me the rest of the way. We left at about 6:20 am and walked at a brisk pace so that we covered about 3.5 miles and arrived home after an hour, time enough for us to shower and make it to morning report on time.

There were no exciting patients that had come in overnight and we had no clinic patients as were leaving as soon as possible for the village of Oldeani and Rift Valley Children’s Village (RVCV). India Howell (Mama India) founded the children’s village in 2004, and over the years, they have continued to grow such that she now has nearly 100 children that call this their home and call her Mama. The children are all adopted and between she and her Tanzanian partner, Peter, the children are cared for and raised, attending the local schools, then secondary school and eventually college. She has partnered with the community to improve their schools by helping to fund certain programs and she has offered healthcare to the residents of the surrounding community as they knew that a healthy community would only improve the chance of success for their children.

It was on the backdrop of India creating her children’s village in Oldeani that Frank and Susan decided to locate FAME here in Karatu for several reasons, though an important one was its proximity and the fact that they could provide medical care to her children and the community. I guess you could say that the rest is history. Having FAME on the Northern Tanzania safari circuit where it would get some exposure to visits to the area who were interested in the community is perhaps the main reason that I am here having visited in 2009 while volunteering in the village of Ayalabe outside of Karatu. Nancy, our architect/nurse at FAME, came through while on safari several years later with Leonard Temba who was our guide and ended up coming back to FAME to stay after speaking with me in the States and deciding this is what she wanted to do. India had come to Africa in the same fashion. Having climbed Kilimanjaro, she returned to manage a safari lodge and then decided to create a home for orphaned and abandoned children here in Tanzania. Many, many of the expats and volunteers arrived here in the very same fashion, having fallen in love with this country and its people after visiting, not knowing that it would change their lives forever, and, of course, for the better.

We all loaded into Turtle, now repaired and running well, and began our drive towards the village of Oldeani along a lovely route through cultivated fields and eventually arriving to the coffee plantations that surround the children’s village. Working in the coffee fields is the main employment for the local villages here which is steady, though very physical, work. There is a very stark contrast driving past the homes of the adjacent village and then through the gates of RVCV where the buildings are brick and in good repair and the grounds are well kept. There are close to 100 children living here until they are ready to go away to school and possibly the university. Daniel, who grew here and worked as a translator for us over the last several years just found out that he would be attending clinical officer school which is a fantastic achievement and made everyone proud. Emanuel, one of our previous translators (not the current Emanuel working with us) recently graduated from nursing school and is now applying for jobs. Most of the children here excel in school and go on to college which is no small achievement here where the government decides who gets to go and who doesn’t and is based on their oft-changing rules.

Driving into the parking circle in front of the administrative offices, there is a huge gathering of patients sitting on benches and waiting to be seen. Our first thought is how we are possibly going to see all these patients in one day starting at 10 am and we’re all relieved to find that the patients are not all neurology as nurse Gretchen is seeing patients today in their regular clinic. Still, as we arrive to the area where we’ll be working, it seems there are quite a few patients for us so we make sure with Kitashu that the patients are going to be properly screened and I revisit the criteria with him that we use here. We try not to see back or extremity pain, but rather weakness and numbness as these are neurologic complaints and not osteoarthritic in nature. We have worked hard to train those that help supervise these clinics where it is essential for multiple reasons that we’re seeing neurology and not pain or orthopedic problems. First, it’s not what we’re here to do and it gives us less time to work on what we’re good at doing. Secondly, we have limited funds and if they see us for the reduced single fee that covers labs and meds also, it takes away resources from those that may have needed it. Triage, though, it really tough. We commonly have patients come through who have told the nurse one thing and then it changes when they come in to see us. At FAME, it’s easy for us to send them over to the outpatient department, but here they would have to see Gretchen and she was definitely going to be a bit overwhelmed today.

Many of the patients here we’ve seen before, some for as long as I’ve been coming. We see some of the children from RVCV with epilepsy or ADHD, but there are more patients from the community that are seen. This is an Iraqw community and so almost all of the villagers we see are from this tribe which is very similar to our other mobile clinics which are also in Iraqw communities. We probably see a larger percentage of epilepsy patients here than at other clinics, but otherwise, there is the typical smattering of diagnoses. Several of the patients are new to the clinic and we’ve diagnosed them with chronic illnesses such as epilepsy and they will require continued medications going forward. One of the patient had unfortunately come from a very long distance near Lake Eyasi meaning that they were out of the catchment area for the clinic and their continued care would not be covered as it was for the other patients. This is always an unfortunate position to be in because the medications can be expensive and it doesn’t serve much of a purpose to put a patient on a medication that works, but is not sustainable in the long run.

One of the highlights of our visit here is lunch as it is served in the kitchen house where all the volunteers at the children’s village eat every day. It is always fresh and delicious and there are often home baked desserts, but unfortunately not today. After lunch we went to the small duka (store) where they have for sale items made by the Rift Valley Women’s Cooperative, a group that is being supported and managed by the RVCV and has their handicrafts in lodges and shops throughout. It is beautiful work and I think all of us made sure we purchased something there. As we were shopping, we could hear the band playing for a local wedding. The wedding party typically is in a car followed by a van or truck loaded with musicians who play tunes that almost like a mariachi band to me – drum, trombone, and trumpet blaring while they are driving through town. After we walked back to clinic, the wedding procession came into the children’s village and parked with the bride and groom getting out to take pictures right in front of the administration building. One of them had apparently worked here in the past.

We had planned to finish early, but somehow the time got away from us and the afternoon stretched to after five. It wasn’t late for us, but I felt bad for the FAME staff that were with us as they would be getting home rather late. John had plans to cook dinner tonight and as soon as we arrived back home, everyone went into action with John calling out the orders. Hannah and Amisha went to cook rice at Steve’s while Lindsay and I stayed here to help John. Dicing ginger and onion, hot peppers and tomatoes while John worked on the cooking the chicken, sliced eggplant and green beans. We ended up having a real feast and all sat around the table enjoying our spoils. Peter had difficulty getting here on time, but there was more than enough for him to eat. He was going to spend the night here since we’d be leaving before dawn to drive to Tarangire in the morning. It would be another exciting game drive in the home of the elephants.