Tuesday, March 12 – A ride in a bijaji….

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The group on a walk from yesterday

It was another education morning, but today we were off the hook. Ann Gilligan, the nurse practitioner working with Every Mother Counts and who has also been working here at FAME to educate the doctors and nurses on birthing position, was placed in the lecture slot. And rightly so as she is incredibly passionate not only about the subject matter, but also the need for education in this area. Without going into detail, as I would undoubtedly oversimplify the subject, it pertains to the fact that how babies are traditionally born is not the most natural, nor the safest, of positions for either the baby nor the mother. She gave a wonderful lecture that completely held my attention for it’s entirely which is saying something considering that not only am I a neurologist, but also long past having any more children of my own. Everything just made so much sense and in the short time she has been here at FAME (one week) she has been able to teach a number of the maternity nurses how to assess babies in this fashion and actually worked with a mother all day yesterday to help her towards what was an incredibly smooth and quick first delivery. Hopefully, Ann will be able to come back in the future to work more with the doctors and nurses as this has been so well accepted on its initial run through. Kudos to Ann.

Ann Gilligan giving her talk on birth positions with her algorithm on board

This was Dan and Marin’s first full day in clinic to see children and they were of such great help considering the number of children we see here. Children make up about 1/3 of our neurology patients here with the vast majority of them being either epilepsy cases or static encephalopathy and it is certainly great to have Dan and Marin available to see at least the latter cases, if not all. Marin evaluated a 2-year-old child with developmental delay who weighed only 6 kg and wasn’t not feeding very well at all because of her severe neurologic deficits and swallowing dysfunction secondary to oro-pharyngeal dysmotility. The child was repeated aspirating which was a huge issue and had gone from 10 kg a year ago when seen by us to her now 6 kg. There was very little that we had to offer the child from our perspective, but they were clearly in need of assistance with feeding and I had remembered that in the past we had looked into referring a child to Selian Hospital in Arusha as they had a program to help these patients. I spoke with Kitashu, our social worker, who subsequently contacted the social worker at Selian, who then spoke with the pediatrician there. After a short delay, we were able to confirm that they were willing to work with the family. Though it may have only been a small success, it was one that we were all more than willing to take for it is these small success that are often the most rewarding. It is one step at a time.

Sheena and Adys working together

Though we had seen a moderate number of patients for the day, including children to keep Dan and Marin happy, we were still able to finish early and everyone had made plans to go to town to the one of the seamstresses that Katherine has been using to make her clothes. As I had work to do and blogs to write, I opted to stay back at the house. Besides, the mechanic had picked up Turtle (my Land Rover) earlier in the morning to fix a few minor things that included the emergency brake that had stopped working on Sunday. Not entirely necessary as long as you park in the right place and remember to leave the vehicle in gear, but still something that’s nice to have when needed. As I wasn’t of any use to drive anywhere without a vehicle, it offered a good excuse to accompany them and, besides, they had Katherine with them. I was told that it took some time to get everyone measured for everything that was ordered and, to be honest, I can’t say that I was sorry that I missed it since shopping for clothes isn’t one of my favorite things, unless, of course, we’re talking about REI in which case I’ll be the first to sign up. After they had finished with their shopping, everyone rode bijaji’s home from town.

A bijaji at its finest

A bijaji is a three-wheeled vehicle that is like a combination motorcycle and small car. The driver rides up front and you can squish three into the back seat. They have a motorcycle engine in them so that they are grossly underpowered and it wasn’t until the last several years that they’ve appeared in Karatu. They were first in Mto wa Mbu for a number of years and slowly migrated up the hill just like swarm of bees. From another driver’s perspective, they are incredibly annoying as they drive on the side of the road most often, clogging up the flow of traffic and are usually in your way in the most inopportune times. They drive slow while at least the motorcycles, which are also annoying , drive at a greater speed and though they weave in and out of traffic, it isn’t necessary to watch out for them as they watch out for themselves. Leave it to say that I rued the day when the bijajis showed up in Karatu and they have in no way redeemed themselves over time.

A selfie in a bijaji – Katherine, Adys and Daniel

Having finished their “fittings” for their Tanzanian clothes, everyone decided to take the leap and ride the forementioned, infamous bijajis back up to FAME and, thankfully, everyone made it back in one piece. To honest, though, I have no issue with riding these vehicles as I am unaware of any significant risks, which is not to be said for the piki pikis, or motorcycles. Motorcycle taxis here are a huge business and probably transport the majority of passengers needed to get from point A to point B within Karatu and most cities and towns. At every small intersection you pass, there is always a cadre of piki pikis ready for hire, and, from what I understand as I have never ridden one, it is very, very inexpensive. On our last visit, Peter, the medical student who accompanied us and was living off-campus, used this mode of transportation on a daily basis and clearly survived to talk about it as he is alive and well in Philadelphia and without any PTSD from the experience.

A look back over the fields during our walk

After arriving back to the comfort of our houses here at FAME, it was time for a bit of rest and relaxation. That is until Kelly, Vic and Katherine came walking by our house on a walk and asking us if we wanted to accompany them. It was an absolutely gorgeous evening with the sun about to set in an hour or so and an offer we just couldn’t refuse. Within minutes, we were all out of the house heading down the trail to our back gate to join the others on a relaxing walk through the fields behind FAME. There are small roads and trails that travel everywhere here as villagers use them to walk to work, in town or the fields, every day and even those that cross the fields and are tilled on a regular basis, are quickly reformed within days after their disrupted. The trails crisscross everywhere and, if you don’t know where your going, it’s very easy to get lost, especially if you are in a depression or small valley where you can’t see the hills to get your bearings. Worse yet, when the sun sets it becomes even more problematic as darkness falls quite rapidly and it’s easy to become disoriented. On my first trip here, I had decided to take a long hike to a distant ridge in the west to watch the sunset, later realizing that I had no flashlight and there wasn’t much of a moon. I had to walk the near hour back in total darkness through old coffee fields, imagining at times that the bushes were wild animals which do roam the area, and thankfully arriving back to my house well-after sunset, only to receive a strict tongue-lashing from Joyce and Carolyn, who were my housemates at the time and were worried sick about me.

Our wonderful sunset

This walk was far more reasonable, though Sheena and I did take off on a fairly brisk pace ending up far ahead of the others who later texted that they were turning around and heading home as the sun was setting. Having spent more time here now, I knew that we still had plenty of light to make it home and, more importantly, I had a flashlight. We walked to the top of the hill where there is a neighborhood so we could watch the wonderful sunset off to the west and bask in the warm rays of the setting sun. We were actually not that far from FAME so there was no opportunity for a reenactment of my earlier lapse in judgement. We walked home at a pretty good clip, partially to make it back before dark, but also as Sheena has been considering climbing Kilimanjaro at the end of her time at FAME and wanted some extra training. We joined the others sitting out on Joyce’s veranda, though by this time the mosquitos were coming out and the bats were circling our heads. Those were both excellent reasons to retire to the comfort of our living room, which we did in short order, to enjoy our dinners. Chef Daniel offered to take our vegetable wraps apart and to stir fry the veggies while also making fried rice, which most of us felt was a marvelous idea. His creation was worthy of a culinary award and quickly devoured by all.

A colorful centipede

A colorful centipede with Sheena’s hand for comparison (notice how I used her hand rather than mine for this possibly poisonous beast)

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