Thursday, October 25, 2018 – Our last day of clinic and the departure of both Amisha and John…


The entire FAME medical team, Tanzanians and volunteers

It was an exciting day for many reasons that included it being our very last clinic (a half day unannounced) for the season as well as he fact that both Amisha and John would be departing today on their own journeys. It had rained all night and for the very time this visit, we had to pull out our rain shells to walk to clinic for lecture and morning report. Even with the often dense morning clouds each day, there just hadn’t been any real moisture. It was as if we receiving a message from someone that we had completed our mission and it was now time to depart. Karatu in the rain takes on a completely different personality and having experienced each on numerous occasions, I have come to know them well.

Abdulhamid drawing up the medications for the occipital nerve block

Anne demonstrating an occipital nerve block for Abdulhamid

This is just a little blip in the weather, though, and not a full change of seasons. That will occur in January and February with the short rains, then followed in April and May by the heavy rains or monsoons. In the dry season, Karatu is warm and dusty (I mean, really dusty) and the hot afternoons (never over 90 degrees though) can suck some of your energy, but overall it remains just lovely. With the rain, the dust is gone, but you are left with a tremendous muck that sticks to everything. A short walk outside can leave you with several pounds of mud on each shoe that is great if you’re wishing a hardcore workout, but otherwise is a real nuisance to scrap off. Running can be treacherous on uneven ground and you have to be very careful not to twist anything when falling while a mud bath can be almost a sure bet.

Abdulhamid performing an occipital nerve block

Abdulhamid performing an occipital nerve block with Dr. Anne

Amisha’s friend who she will be traveling with for the next two weeks arrived in Arusha last night and would be doing a game drive in Manyara today before coming to FAME and then heading off to the Crater. We received messages throughout the day and knew there were scheduled to arrive to Karatu later in the afternoon having plenty of time to get to the Serena Lodge on the Crater rim to spend the night before descending into the Crater itself. John, who would be climbing Kilimanjaro starting tomorrow, would need to leave for Moshi to spend the night prior to beginning his trek. We would be dropping him off to take a public Noah, which is slightly larger and faster than a dala dala, but equally crowded. John is a seasoned world traveler and quite adventurous. He also discovered that he would be the only climber on his trip, which I think we were all very jealous of considering the quite solitude of seven days on the mountain with just you, the guide and four or five porters. Lots of reading and meditating was in his future.

Charlie guarding the walkway between the hospital wards and the operating theater

So, as we walked through the steady rain towards our final lecture and clinic, each gaining pound of mud with every step, we were all able to begin reflecting on the month we’ve had here at FAME. We knew that we were approaching the 400 patient threshold for our month which would be a first and really has little to do with the number of residents seeing patients and more to do with the fantastic outreach effort that FAME has done for us with kudos to Angel, Kitashu and Alex. The lecture this morning was to be given by Mark and Monica and despite the topic being far removed from neurology (they were covering the guidelines on fetal monitoring that determines when a baby is doing just fine and is happy where they are (comfy in mommy’s tummy), versus when things aren’t going so well and time is of the essence in getting the baby out. There is a need for them to speak a common language when they are speaking to each other and that is what was covered. I actually found it very interesting despite being about as far removed as one can be from baby catching at this point in my career,  other than the occasional pre-ecclampsia/eclampsia patients that we deal with and are often a neurologic emergency.

A wet day at FAME

After morning report, we walked over to our now well-familiar neurology area where we have been stationed for the last month and has been our home at FAME. Both Kitashu and Angel were there to help us as they have been so essential to our work here and have really made this all happen for us without as much of a hiccup. Abdulhamid (Dr. Shaban) was also there for his last day of translating (which has been so incredibly helpful to us) and discovering neurology. He is still convinced he wants to be a cardiologist, but for the moment, we can continue to fool ourselves and are content in knowing that he will be the very best neurologically trained cardiologist in the country if he does indeed continue on that path. Grace Mshana was also there again to help us and it was so great to have had her work with us for these last four days as we were down one translator with Emanual having had to leave for school. Grace’s father, Dr. Mshana, now retired, was the first doctor I had met here in 2009, when he, Frank and I had sat down to “discuss” a few cases and which has now literally become thousands of neurology patients since that first fateful visit.

A view from in front of the laboratory

Lindsay trying on John’s sleeping bag for size before his departure to Kili (in the Raynes House)

Writing this now, days later, I can’t recall the cases we had seen that morning, though there were a number of them, once again trickling in as the morning went on. We had one patient with a fairly classic occipital neuralgia and we were able to have Anne do one more injection under our supervision as she will be the go to doctor at FAME for these in the future. I will be leaving the medications for her to do them before we return in March. Abdulhamid actually assisted her and I believe has a very good feel for these as well, so much so that I suspect he will wish he had access to them in the future when he is seeing patients and wishes we were there.

Hannah at the Maasai market

Sugar cane at the Market

The plan was to have lunch and then drive John down to the bus station in Karatu where he would find his Noah. One last wonderful lunch at FAME for him (it was pilau day which is everyone’s favorite lunch) and then home to pick up his gear for the climb. He would be shipping the remainder of his things home with us as would be Amisha and they were sharing one of my large duffels so that she wouldn’t have to lug the stuff around with her to the Serengeti, Zanzibar and Capetown (rough, I know, but someone has to do it). I also needed some extra cash here as I still had to pay for Turtle’s repairs and drawing out 400,000 TSh (or about $177 USD) out of the ATM at a time was becoming cumbersome. Go figure how the resident is able to make several withdrawals in the same day while the attending can only make one. I will look into that once I return.

Chopping sugar cane

The bus station in Karatu is a large square of pavement surrounded by small shops and transportation offices with services traveling anywhere you’d like to go in Tanzania. There are little white signs on stands (like in NYC at a taxi stand) that I didn’t spot, but either Lindsay or Hannah (along for the ride) did and sure enough, there was one that said Arusha/Moshi. John got out into the muck, walked up to the back of the Noah and in two seconds flash, his pack was stored in the back (thankfully not on the top or in his lap) and he was climbing into the vehicle. The cost of public Noah. Is 7000 TSh to Arusha, or just over $3, but I will warn you that they fit probably 20 seats into the space that we would put 7, or maybe a max of 9. Thankfully, he is very experienced, very tolerant, and, despite being 6’ 2”, very thin. No way would I ever consider that journey and it makes me anxious now writing this just thinking about having to use the bathroom crammed in there. Nope, not me.

Eyes wide watching the skill of the machete

Enjoying their sugar cane

After leaving John at the station, we drove to Soja’s home so that I could drop of the rest of the money to his wife for our repairs and as we drove by the market grounds, I realized that it was Maasai Market Day, which occurs on the 7th and 25th of each month in Karatu. It had been raining all morning night and morning and as we drove by, you could just see that it was a huge mud pit of several acres in size. Lindsay and Hannah, though, asked me to drop them off there so they could go adventure for the afternoon, much to my surprise. I never would have let one of them go by themselves as being the only mzungu (foreigner) walking through the market with goats, cows, food cooking on open fires, bales of donated clothes from the US and every nick nack you could ever imagine for sale would be just incredibly daunting, but the two of them together would be just fine and was confident that they would enjoy themselves.

A muddy mess

They said that they would catch a ride home which wouldn’t be an issue given the weather and every mode of taxi driver waiting at the entrance to take patrons of the fair home or bring them there. They tried some sugar cane, which I think they equated to chewing on sweet wood, but I recall spending lots of lazy afternoons as a child in Southern California enjoying the delicacy. So much for my memories. Hannah had joked with me about buying a goat before jumping out of the car and, even though, I trusted that she wouldn’t, I do recall shouting something out the window to her (I think it included profanities so I won’t repeat it) given her wild side and even the remotest possibility that something like that might happen. Thankfully, I’m very confident that our bags were animal free after packing them. The two of them shared a bajaji home (the little three-wheeled, half car, half motorcycle) sans goat or anything else resembling wildlife.

Lindsay and Hannah on their ride home in the bijaji

Amisha’s friend and guide rolled in around 3:30 pm if I remember correctly, and it was time for her to depart for the Crater. Their guide was the person who had arranged much of our quotations (invoices) for the Conservation Area and Serengeti on our trip the weekend before and I had spoken with him on several occasions both this trip and several before, so it was nice to finally meet Quoro. His first name is actually Englebert, and his father was a significant politician from the area and someone that Daniel Tewa had worked with previously. I had also met Quoro’s wife at Tanangire two weeks prior as she is a warden there and upon my registering us, she was asking me questions about our work as she was very interested in it. I had given her my card and later learned that it was his wife which he discovered when she reported having met me and given him my name. It is an incredibly small world here.

Hannah and Lindsay’s bijaji up at FAME

With John and Amisha now gone, there were five of us left including Peter and Steve. We had absolutely no plans for the day tomorrow other than my debriefing meeting with Susan, Caroline, Alex and Angel and trying to get up to Gibb’s one last time for lunch. I had also wanted to visit with Daniel one last time and would do that in the evening. The rain continued into the evening and throughout the night for our final full day at FAME.








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