I can’t recall the last time (if ever) that I’ve had a full free day at FAME to do with as we please. That is such an incredible luxury given the normally packed schedule that we have here or frantically trying to fit everything in before we leave. I had felt bad that I had been under the weather for several days and perhaps not best of hosts for the residents during that time (mostly, I had dearly missed attending Lindsay’s birthday party at the Golden Sparrow) and now we were down to a smaller group with both Amisha and John having departed yesterday each on their own journey. It was our last day to attend morning report, so Steve, Hannah and myself walked over to the conference room at 8 am with Peter meeting us there since he was staying in town. Meanwhile, Lindsay had decided to take the opportunity to remain at the house and catch up on things. She has constantly reminded me that she’s not a morning person, so I guess this was her opportunity to take advantage of our schedule.

Despite the fact that we did not have clinic this morning and, therefore had not planned to see any patients, work seemed to have tracked us down and there were two consults waiting for us in the ward. The first was a gentleman who came in overnight after having suffered what was believed to be a stroke. The other was a young child who had jumped from the third floor of a building to escape a fire and had apparently not suffered any fractures or serious injuries. After morning report, Hannah and I went to the ward to divide and conquer. We only had one set of tools since I had already broken down the ophthalmoscope kits I had loaned the residents and Hannah didn’t really think she’d need her other tools so left them at the house. I must have had some intuition as I had brought my bag with me and loaned everything to Hannah who would be seeing the man with the possible stroke. The young girl who had jumped to safety was amazingly intact neurologically after having plummeted three stories, suffering only some bruising and a swollen upper lip where she had bumped her face when she hit the ground. Despite the fact that she seemed to be doing well, Dr. Gabriel had requested that I evaluate her neurologically just to be certain that they weren’t missing anything. So, while Hannah worked on the other consult request, I had a wonderfully reassuring visit with an incredibly pleasant young girl who was sitting in bed playing with a surgical glove blown up like a balloon. She was moving everything quite well with only some minor soreness of her left ankle and the swollen upper lip to give any hint of the trauma that she had recently suffered.

The gentlemen that Hannah was evaluating had a bit more of an interesting history in that his wife and sons clearly described what would have been a seizure when he first presented, but still had focal unilateral weakness. A simple explanation would have been that he had suffered a seizure and following that, had persistent weakness on one side that is otherwise known as a Todd’s palsy and can be seen following a moderate convulsive seizure and can last for hours to days. The seizure, though, hadn’t seemed significant enough to have caused a prolonged Todd’s paralysis and therefore, that didn’t seem to be the answer. There were other complicating factors as well and so we recommended that he undergo a CT scan to make sure that he didn’t have an underlying lesion that would have made seizures more likely than not. The scan would have to be done two hours away in Arusha, unfortunately, as the CT scanner at FAME was still down due a power supply issue, so his family would have to take him by private vehicle to have this done.

As every visit to FAME seems to have its own unique successes and hurdles, we usually try to set up a debriefing meeting at the end with all parties involved to sort out what we need to focus on for the next visit and what we need to change. I had arranged to meet with Susan, Caroline (development coordinator), Alex and Angel at 11 am at the Lilac Café, which is located just a short walk from reception and is not only a lovely place to have such a meeting, but is also great for breakfast, lunch or dinner. Their coffee is to die for and if I am ever searching for the residents in the morning, it will usually be a good bet that they are having coffee at the Lilac. As good as their coffee might be, their cappuccinos are even more so and that’s exactly what I ordered for the meeting. Denis, who is the wonderful artist who painted a portrait of me for my sixtieth birthday, runs the Lilac most days and sells his artwork out of the café. I have a number of his pieces in the Raynes House and I have supported his work over the years by bringing him supplies such as staple guns and staples, as well as canvas.

Our meeting this morning ran quite long and the group had planned to go to Gibb’s Farm for lunch on our last day in Karatu and it always very difficult not to entertain a visit a to this magical place. I ran home after the meeting and gathered everyone up to pile into Turtle and make the drive to Gibb’s. We had hoped to walk to Gibb’s, but with the continued rain overnight, even though it wasn’t raining heavily at the moment, we knew that it would be incredibly messy to have made the 30-minute walk down through the quarry and then up to Tloma Village with Gibb’s just beyond. Despite the earlier rain, it was still quite lovely there and the weather opened up long enough for us to eat out on the veranda without getting rained on with any consequence. The gorgeous jacaranda tree that sits just off the patio there was now missing about half of its luminescent blossoms as they had plummeted to the ground in the heavy rains that fell overnight.

We all once again enjoyed the truly wonderful buffet lunch that chief Andrew had prepared and it would be difficult to recall all of the incredible dishes that were included. Most everything is grown on the Farm at Gibb’s so it all is amazingly fresh. After lunch we went to visit Katongo, the artist, in his studio there at Gibb’s to see what recent projects he was working on and it was so great to see him once again. He is so talented and the fact that he has been given space to work by the Gibb’s Farm management is an excellent opportunity for him as many, many guests come by to shop.

On the way home, Steve had reminded me that he wanted to look for a pair of Maasai sandals that are made out of old tires, and so we once again headed downtown to the market area. Thankfully, the sun was out, but that wasn’t nearly enough to dry up the mud and puddles of water that had accumulated after the rains of the day and night before. You had to be very careful where you walked so as not to slip, but more importantly, not to step into muddy hole that would engulf your shoe and quite possible yank it right off of your foot. In our search for the right sandal kiosk, we bumped into Daniel Tewa’s daughter, Isabella, who had made us dinner a week or so before, and a friend of hers helped to find us the right shop. Steve picked out a pair that he liked after trying on several and then the bargaining began. The seller had quoted initially 35,000 TSh (about $15.50), but Steve wasn’t interested in that price and so after a few rounds back and forth along with Isabella’s friend telling the sellers that we were important doctors who worked at FAME (I’m not certain if that helped or hurt to be honest and it was probably the latter) the price came down. The rock bottom price from the vendor came down to 25,000 TSh, though Steve and he were finally able to settle on a total of 20,000 TSh, or about $7.85. The sandals were very, very nice and will probably last a lifetime.

We were home a bit after 4pm and settled in to getting packed and ready for our departure the following day. I had planned to head over to Daniel Tewa’s home at around 5:30 pm that evening as I wanted to say goodbye since I wouldn’t see him again until March 2019, when we would return in the spring. I wasn’t sure who would be coming with me and, as it turned out, everyone was either a bit pooped or wanted to get work done, so I drove over to the other side of town by myself in the rain. The roads by now were again becoming quite slippery so I decided not to take my shortcut which can become quite adventurous in the rain and getting myself stuck (quite unlikely driving a Land Rover, but it’s happened before) the day before we were leaving was not something that I was enthusiastic about doing.

I arrived at Daniel’s and it was immediately clear to me that he had expected more of us and, in fact, had had his wife Elizabeth make coffee for eight. I felt bad that they had gone to this much trouble for us and jokingly said that I would drink enough coffee for several of us. He took me seriously, I think, as he continued to refill my coffee mug as we sat and talked about American politics, the upcoming elections and some of the craziness that had been going on in the news. Daniel’s perspective, though, was also on international politics and I felt some uninformed as we chatted, realizing just how little we as Americans pay attention to politics outside of our little sphere. It was now well past sunset and I had had at least three strong cups of his coffee that would quite likely have me wired for some time and hopefully not keep me up all night, but it was time for me to depart. We do this each time I come, knowing that it will be another six months until I return, but also with the confidence that we have truly formed a very special and lifelong friendship that can only come from mutual respect and admiration for one another.

 

Our plan was to leave in the morning as close to 8 am as possible so we would arrive in Arusha with plenty of time to do some last-minute shopping and still visit Pendo and her family. Everything was packed and what wasn’t would get thrown in our duffels in the morning. It was sad to leave, but we’d been here for a month and it was now time for us to return to our day jobs. The experience here had been amazing for the residents and it would be something that they would always remember, as well as being incredibly formative in their education.