It had been a wonderful party the night before and everyone I think everyone had a sense that this had been their home away from home for the last month. It goes without question that FAME has become my second home considering that this is my seventeenth trip here and I’ve now spent well over a cumulative year of my life having lived in Karatu, but I believe it is equally so for those who have made this their first trip. FAME is not only an incredible medical facility, but it is also a self-sustained community that now includes 150 “residents,” many of who have been here from the very beginning. Outside of the coffee plantations, whose work is seasonal, FAME certainly has to be the largest stable employer in the region and so there are many, many families who depend on FAME for its continued existence along with the community, which is healthier because of their presence.

Kitashu and Amisha evaluating a Maasai patient

It was a morning to sleep in an extra half an hour since there was no lecture today and we could contemplate what we have accomplished for the month with the satisfaction of knowing that we’ve contributed to this great work that is so rewarding to the soul. At morning report today, we discussed one of the surviving hypoxic-ischemic encephalopathy (HIE) babies that had been born last week, this one to the mother who was in status epilepticus during delivery, virtually assuring that the baby would have suffered significant birth trauma. In fact, this baby had appeared to have suffered a severe HIE injury, while the other baby that passed away had appeared milder. The baby had no suck and no means of nutrition and a decision had to be made as far as what to do for it going forward.

A discussion had occurred yesterday with the parents and had included Kitashu as he is also Maasai and he would be best at communicating the nuances that were required when discussing these things. The child had absolutely no hope for any independent life even if it were able to survive and would most likely be bedridden and non-communicative at best. The family had chosen not to continue care for the child and everyone at report felt very comfortable with the family’s decision. It was also decided that the baby would be moved in with the mother, which had not happened yet, so that they could bond before the baby finally passed, and, of course, exquisite attention would be paid to the baby to assure that there no signs of suffering.

Lindsay, John and Abdulhamid evaluating a patient

I related a story to everyone that I had been told by one of the FAME clinicians when I first began working here, that just a few years ago it was the custom of the Maasai and many other tribes living in the bush, to let these birth injured babies die of starvation by feeding them animal fat so they would not be hungry, but also would not survive as their life was harsh and they were unable to care for them. There are no value judgements here, just the harsh reality of trying to survive in a world that few of us could ever know. At that moment, though, with all of us sitting together in report, I think each one of us in our own way came just that much closer to possibly understanding.

It was now time to see what was waiting for us in our “waiting room.” It was the last day of our advertised clinic and though one would have suspected some manner of procrastination by patients, waiting until the last day (I know that I would have likely taken that strategy) to be seen, there was a much smaller crowd than we had been accustomed to over the last weeks. It was a bit surprising, though, in that even with the small number of patients we had, they seemed to multiply and continued to accumulate. By no means did we have anywhere near the numbers that had during our first ten days, but it was still a presentable tally for the day.

Walking by the vegetable garden on the way to clinic

We had no plans for the later in the evening as both John and Amisha would be packing for their departures tomorrow, John to Kilimanjaro and Amisha off on safari again with a friend who was arriving into Arusha this evening. Tomorrow was a half day of unannounced clinic and Friday was a free day for those of us remaining at FAME so we were on our home stretch. The weather was supposed to be turning as well with rain beginning tonight, so no one knew what tomorrow would bring. We had had the loveliest weather so far for the entire month with temperatures that barely varied from day to day, cool overcast mornings that broke into beautiful sunshine, amazingly star-filled nights earlier in the month without the moon and lovely moonlit nights for the remainder. No matter what was in store for us, nothing could take away what we’ve had and what we’ve experienced together.