It seems as if I had just left, though it’s been a solid five months home. I guess that’s a good thing as it must mean that I have the proper balance between these two vastly different, though somehow similar, parts of my life as it exists today. Flying over here has now become virtually routine for me which is pretty impressive considering the sixteen hour layover in Doha that we now have thanks to a schedule change likely the result of a smart marketing executive trying to expose travelers to this country. I had already made the decision not to let anyone fly through Nairobi again as our last visit was a real nightmare with a luggage debacle that was not very much fun. We all had to spend the night at the Nairobi airport which leaves much to be desired, but I do understand that they are updating their services which I’m sure will be a major plus for those that travel I the future. For now, though, we’ll just steer clear of the place. The luggage debacle, for those that don’t recall, occurred because the flight from Nairobi to Kilimanjaro was on a significantly smaller plane that didn’t seem to be able to accommodate all of our luggage. I arrived without either of my duffels and Lindsay arrived without her duffel of personal gear. John’s duffel containing items for FAME showed up long after our arrival to FAME necessitating that it be sent by bus from Arusha and thankfully arrived.

As usual, I had planned to depart on Friday, with the residents following me a day later so that I would have time to get situated here before picking them up. I awakened on Friday morning in Philadelphia to a fairly good snowfall and an accumulation on the ground. It brought back memories of my flight last year that was delayed by six hours due to a massive Nor’easter that had dumped boatloads of snow and gale force winds onto the city as I was preparing to depart for the airport. The Uber price to the airport had suddenly risen by a factor of five, but since I had no choice needing to get to my flight, I bit the bullet and ordered a vehicle to pick me up. Upon entering the car, a gust of wind caught the door and literally ripped it off of its hinges. We were able to close it somehow and make our way to the airport with the driver insisting on opening it up for me on our arrival with some trepidation. I made it to my flight with plenty of time to spare, only to have my flight delayed by six hours leaving us the only passengers in the international terminal as the airport closed (including the American Express Centurion Club) early in the face of the massive flight cancellations. I didn’t get to visit Doha that trip given the flight delay, but was very much looking forward to visiting the city this time around.

With the sixteen hour layover, which seems like an inordinate amount of time, Qatar Airways has graciously (recall that smart marketing executive) offered to have passengers spend the night in the city at one of the hotels there for free, or to upgrade to a five star hotel for a mere $23. It’s basically a little mini vacation on our way here and the residents loved it a year ago, sending me photos, perhaps to rub it in just a bit considering the flight troubles that I had experienced. So, I was obviously very much looking forward to this brief exploration of a Middle Eastern, something that I hadn’t been able to do previously. There is much to see in Doha, which will be holding the World Cup soon, but my main interest was in seeing the Souq Waqif, a traditional marketplace in Doha that is at least 100 years old and was restored to its more authentic current state in the last two decades. I arrived to my hotel, just across the street from the Souq, just before sunset and refreshed myself with a nice shower after my 12+ hour flight, airport time and taxi ride. I arrived to the marketplace in the dark only to find myself in the midst of wonderful maze of appropriately lit alleyways, all branching off from a larger main passage way and then themselves branching again and again. Thankfully, there are small green lit signs indicating how to get back to the main thoroughfare for anyone who might become a bit anxious or lost amongst the wonderful shops that are all organized into different sections. There are the perfume shops, the fabric shops, the tailor shops (for everything Arabic), cookware shops, food shops, and just about any other specialized item that one may possibly need. The shops selling the more touristy items are all on the main drag as are most the many, many restaurants and hookah bars.

Finding a restaurant was no small task as there were so many of them and I finally took the plunge after identifying one where there enough locals to make me feel comfortable. I had a meal of way too much chicken and turmeric rice, chick peas and some curry- pasta dish that was also quite delicious. Later, while continuing to explore, I found what looked like a truly amazing restaurant with tons of locals and some tourists and sent the location to the residents on my phone like any good chief resident would do. They found it the following evening and found that it lived up to the hype I gave it so it will be certain that you’ll know where to find me during my fall visit here on my way to FAME. While exploring the various passage ways, I heard an incredible squawking very close by and followed the sound, quickly arriving to one of the alleys, or actually several of the alleys, where the pet shops were. Birds greatly outnumbered any other type of animal there and the bird shops had cages full of African Grey parrots along with just about any other rare parrot that you could image coming from Africa and then some. I also found fish shops, with many of the same fish I used to keep, and small rodents like hamsters. There was even a cage full of sugar gliders, which the shopkeeper was seemed very impressed that I recognized, but given my long history with animals of all types, it wasn’t much of a stretch. I left the marketplace at around 10 pm while it was still going strong, but I was still quite exhausted and considering I had spent another three hours there walking around, I was quite ready to seek the horizontal position and to close my eyes. The marketplace had not disappointed in any way and I’m looking forward to going back again in the near future.

I had arranged for the same taxi driver to pick me up at 6:30 am to give us enough time to get to the airport, and received a text from him right around then that he couldn’t make it, but had sent another driver to get me and all was well. We made it there in plenty of time so that I was able to some window shopping at the many upscale stores in the newly renovated Doha airport before making my way to my gate among the seemingly hundreds of other gates at this massive airport. The flight to Kilimanjaro was thankfully shorter than the one to Doha, but still longer than a typical transcontinental North American flight and, with no entertainment whatsoever onboard, it gave me plenty of time to catch up on some necessary work that needed completing.

I sat up front in economy so was into the terminal very quickly and able to get my business visa form filled out and processed much ahead of the other travelers. I grabbed my bags and whisked through customs only to find that Leonard and Pendo had been waiting in their car a bit longer, thinking that I would be delayed, as is usually the case, at some point along the process. Within minutes, though, we were skirting along the tarmac heading back to their home in Njiro, where I would be reunited with Gabby, now four, and Gabriel, now almost two. Their other two children, Lennox and Lee, had unfortunately left that morning to head back to boarding school in Nairobi.

It was an uneventful evening for the most part, but Leonard had wanted me to stop by and visit the family of a good friend who had recently lost his father. Funerals here are huge affairs that will usually last 3-5 days with the immediate family hosting all the extended family and friends and feeding everyone continuously for the several days. I had been to Leonard’s mother’s funeral a number of years ago that was held at the plot of land where they had lived when he was young and was high up on the slopes of Mt. Kilimanjaro. The local villagers all met to discuss who would now be in charge of the family, including the grown children, now that she was gone. I felt so privileged to have been invited to this incredible ceremony and touched by the wonderful sense of family and friendship that existed there.

As we arrived at the family’s home so that I could give my sympathies to his friend’s father’s wife and family, I was brought around the back of the house where huge pots were stacked on the ground in front of the kitchen building that had been used to feed the upwards of 1000 guests over the last several days. As I met his auntie, I immediately noticed her shaking hand, for that’s what we neurologists do all the time. We notice those things that others may not, simply because it’s what we do for a living. I am constantly telling the residents that we miss much of our exam these days by having our patients roomed for us and not greeting them in the waiting room to walk them back. Observation is very much of neurology, and there are many diagnoses that can be initially considered by merely watching someone get up out of chair or walk back into your exam room. Our history and examination are there to confirm things for us, but to miss this first observational period is a real crime and a victim of those practices that serve to make us more efficient and revenue neutral, but often at the expense of what medicine was meant to be.

I quietly and privately asked his auntie how long she had had the tremor and she said it had been there for several years, but was worsening over time. I hadn’t wanted to intrude, but she was clearly interested in speaking with me about it and didn’t mind doing so in front of her family. They were all astonished when they asked me what kind of a doctor I was and I simply replied, “that kind of doctor.” We all chatted for some time, Leonard’s friend, his mom, his auntie and several other family members as I was trying to figure out just how I was going to examine her which would be necessary to confirm her diagnosis. I had suspected that this may very well be Parkinson’s disease, but it would take further questioning and an examination to confirm things. It turned out that she lives on the coast in the district of Tanga, a six hour drive in the opposite direction from FAME, so I offered to come back with the residents to see her on Tuesday morning prior to our departure for FAME.

It always seems that these thing occur for a reason and I was clearly brought here tonight for a purpose that no one had realized in advance. Planning is important, but one must always have the ability to be flexible and to make things work even if that wasn’t part of your initial plan. I think we all had smiles on our faces that evening, realizing that our meeting was not one of happenstance, but rather one of a higher meaning. The residents would be arriving tomorrow and I would be picking them up in the late afternoon. It was the start of another month of global neurology and it had already begun for me a few days early.