Thursday, October 18, 2018 – If it’s Thursday, this must be Upper Kitete, our last mobile clinic of the trip….

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Amisha and Hannah doing their Neurology in Pregnancy talk

It was off to Upper Kitete for the day, a trip of less than two hours, but out to the far reaches of the Mbulumbulu area and the top of the escarpment where one can travel only a few kilometers further before running out of land. Before our trip there, though, we had another lecture to give and this morning’s topic would be neurology and pregnancy. This would be an excellent topic for the doctors at FAME considering their focus on maternal and infant health and the increasing number of deliveries every year. Hannah and Amisha, of course, did a wonderful job and at the end of their talk received the “pasha, pasha, pasha, choma” cheer (essentially meaning, warm, warm, warm, burn) from everyone in attendance.

Two young children attending the well-baby clinic

I had planned to bring Turtle up to the clinic this morning to ready for our trip today, but unfortunately it didn’t want to turn over and so I had to track down one of the FAME drivers to jump it for me. I had been concerned about the battery not charging since our trip to Tarangire last Sunday and the plan had been to have a fundi (mechanic) come from Arusha to look at it, but that was going to be later in the day so Turtle had forced the issue just a little bit early. She jumped just fine and seemed to be running well, so it was just a matter of not stalling on the drive to Upper Kitete and then I would have to park her on a hill so we could bump start her for the return trip. More on that later and as they say, best laid plans of mice and men….

Amisha and Dr. Shaban in the bat cave

Weighing a baby at the well-baby clinic

After our lecture and morning report, we finally loaded into the Land Rover and were off for our day in Upper Kitete. I had invited Steve to come join us for the day as I had wanted him to see one of our mobile clinics and also thought he might enjoy the day out in the countryside. Turtle has nine seats, but with the coke crates we had borrowed from the Lilac Café, we were able to fit an additional two bodies and so departed with a crew of eleven heading over some of the most beautiful countryside in the world. We took the same road we use to get to Kambi ya Simba and then continue beyond for an equal distance making it almost twice as far as the closer village. Upper Kitete is in the heart of the Iraqw farming communities of the Mbulumbulu area and just outside the village proper there remains some small bungalows there were once a small farming community that had been started as an experiment in socialism here by Julius Nyerere, the founding father of Tanzania. There is a small monument signifying this experience that dated from 1966 and was never purely successful, but remains a testament to the lengths that the early government and Nyerere went in trying to move this country of 120+ tribes and various villages and political systems into a nation that would succeed.

Amisha enjoying the gen peds side of things

Kitangile and crew screening our patients

Dr. Anne and Lindsay evaluating a patient with knee pain

Steve helping out with our patient with knee pain

Today, though, Upper Kitete remains a small farming village with a few scattered shops here and there, and families that have been in this region for at least a few generations which is actually a long time here considering the amount of influx there has been in Northern Tanzania. Above us are the tall mountains of the Ngorongoro Highlands and the Ngorongoro Conservation Area and below us is the escarpment overlooking the entire Rift Valley where one can see far north towards Lake Natron and the Kenyan Border and south towards Mto wa Mbu and Lake Manyara. It is truly a magical place that sits at the crossroads on so many levels – culturally, politically, agriculturally and geographically. If I were to consider settling down anywhere in Tanzania, this region would be on the top of my list and that list would not be extensive even considering how beautiful this country is.

Hannah instructing a patient on the Epley maneuver using Dr. Shaban as her assistant

Hannah demonstrating the Epley maneuver using Dr. Shabon

We arrived to the Upper Kitete dispensary, which is essentially unchanged from my first visit here other than a new small building adjacent which has yet to be fully furnished, only to find a huge mass of patients that were thankfully not all for us as it was also their well-baby visit day. By scheduling our clinic well in advance, I had hoped not to conflict with their regularly scheduled clinic, but somehow this did not happen meaning that the examination areas would be very tight for us, unfortunately. I must say, though, that seeing the well-baby visits and how diligent these mothers are in bringing their little children with their growth charts and making certain they keep up with their vaccinations. After some negotiation with the clinical officer here we eventually ended up using the two offices that we normally use (the nurses office, otherwise referred to as the bat cave for the distinct smell of guano coming from the opening in the ceiling, and the labor and delivery room that was not currently being used) along with the outside area that we normally use as our pharmacy, but would now serve as our third examination room. The pharmacy was bumped to the end of the outdoor walkway and we just moved all of our patients to the other side of the building to wait for us so as to maintain some notion of privacy.

Patient being carried in by family members

Lindsay and Dr. Anne working in our “open” examination room

Dr. Anne and Lindsay evaluating a patient

The clinic was a bit slower than usual and similar to the other mobile clinics this season (other than Rift Valley Children’s Village) and it wasn’t entirely clear to me why. We got through our patients, though, and had our lunch around midday with still a few stragglers to see afterwards. One of our later patients was a gentleman who was brought to us sitting in a chair (not a wheelchair) and we were told that he had been unable to walk for well over ten years. His examination was myelopathic suggesting some sort of cord problem and we felt he most likely had a cervical myelopathy as it had been gradual in onset. We discussed the possibility of an evaluation, but were realistic with him noting that it was very unlikely that we would find anything that would be treatable at this late stage and, therefore, it would not benefit him functionally. The family understood and we did treat him with some baclofen for his spasticity which was the least that we could do for him. As with our patient at Kambi ya Simba who was also paraplegic, he was eventually helped onto the back of a motorcycle by his sons and began his trip home.

Amisha Lindsay and Dr. Anne with one of their adorable patients

Lindsay taking a breather

Dr. Mike taking a break

One of our traditions at Upper Kitete is to visit a spot called the overlook that was first introduced to me by Paula and Amiri when I had first come here in 2011. It is an incredible location that essentially sits at the edge of the escarpment with a steep two-thousand plus foot drop to the valley far below. In the distance, one can see dust devils rising from the valley floor or rainstorms with lightening that are almost below you at times. I always want to share this with everyone and since none of the people on the trip had been to this spot before it was decided that we would take the five-minute drive to the overlook.

The view from the Overlook

Lindsay at the Overlook

Steve doing his Karate Kid imitation at the Overlook

First, though, we had to bump start Turtle, which entails having everyone push downhill and getting enough speed to pop the clutch in second gear and start the engine. It worked like a charm, but now the challenge was to drive to the end of the earth at this precipice known as the Overlook, without stalling the car as we’d be facing the wrong direction to bump start it again. I decided not to drive all of the way out and stopped about 100 yards from the edge where I could remain with the car and keep the engine running. This worked reasonably well and gave everyone a chance to experience the Overlook, spend some time taking photos, and then we could eventually be on our way. I kept the engine running while successfully turning our behemoth vehicle, which has the turning radius of a supertanker (I had later mentioned the Exxon Valdeez to the residents who had absolutely no idea what I was talking about), around to get us moving in the right direction. Not an easy task even in the best of circumstances and certainly not with a steep ravine on one side of us.

Everyone putting in their two cents regarding Turtle

Talking to Soja on the phone

Once on our way heading back to Karatu with our engine still purring we were looking forward to getting home for dinner and arriving well before sunset. Well, that was our plan until Turtle developed a rather nasty sound under the hood that was clearly engine related and didn’t seem to want to go away. All I could really do at that point was to keep driving and hope for the best, but apparently that was not meant to be. After a few minutes of a pretty nasty screeching sound, Turtle just died and regardless of putting the clutch in, I could just not keep her running. We got out and lifted the hood to see a bunch of smoke coming from the alternator which had decided to give up the ghost not very far from Upper Kitete which meant that we were well over an hour from Karatu and essentially in the middle of nowhere. The alternator had seized up (i.e. its bearings had frozen), but Lindsay fondly coined the phrase, “alternator dege dege,” where dege dege means seizure in Swahili. And you will also recall that there is absolutely no cell service in Upper Kitete, but thankfully, we had a few bars that allowed us to send an SOS to FAME. I first texted Frank, who in turn contacted Moshi, who essentially keeps FAME running and deals with all the infrastructure there. Moshi contacted Soja, FAME’s mechanic, who I eventually spoke with and said he would see what he could do.

A selfie during our downtown with Turtle

Hannah enjoying the view from the top of Turtle

So here we were, stranded on a road that ends just past Upper Kitete, with barely any cell service, a beast of a vehicle that was unfortunately lacking a functioning alternator, and ten passengers in addition to myself with the sun setting in the next hour. Life tells us to always make the best of things which is what everyone did. Of course, there were locals that were walking up and down the road, everyone checking in to see what was going on along with constant motorcycles and a few other vehicles traveling in either direction. Hannah and Lindsay decided to climb on top of Turtle and relax a bit, while John decided to spend his time practicing his climbing moves by circling Turtle using hand and foot holds without touching the ground. Steve took a few walks and everyone else just sat around biding their time.

Replacing the alternator

Working on the alternator

Thankfully, Soja found a used alternator he could borrow and called to tell us that he was on his way. It would be at least an hour from when he called, though, to reach us so it was just a matter of continuing to occupy ourselves in the interim. Soja arrived with the spare alternator which he and his assistant managed to install in an amazingly short amount of time as well as installing a new belt for us and had Turtle once again purring, albeit after another bump start considering our battery was still dead as a doornail. Once again powered and ready for action, we loaded everyone back in and were on the road within two hours of our initial breakdown. Considering where we were, not only in East Africa, but well over an hour off the tarmac and in need of an alternator, and with no AAA in the same hemisphere, it was a small miracle that we were able to be rescued successfully and would be sleeping in our own beds tonight.

Supervising the repairs

The drive home was, of course, a bit on the difficult side considering the sun had set long ago and driving here after sunset is not something that you would elect to do if given the choice. Dusty roads, tons of people walking and appearing as merely shadows, combined with oncoming vehicles all adds up to a challenge that gives one a sincere sense of accomplishment when arriving home safe and sound. Once again, everyone could breathe a huge sigh of relief that we were home safely and everyone would have incredible stories to tell about the experience. Tomorrow we would have a half day of clinic in the morning and then head to the Serengeti for the weekend. It was certainly something to look forward to and especially considering what we had just been through.

Dispensary sign at Upper Kitete

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