Thursday, March 14 – A visit with Daniel Tewa….

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Vic’s white board thesis on burn wound treatment

Vic Davis giving his lecture on burn treatment

For those of you who have read yesterday’s blog, there is no need for me to introduce Dr. Vic Davis. If you’re new to the blog, Vic is a trauma surgeon who has tremendous experience all over the world in war-torn torn areas and just happens to be here visiting FAME and Dr. Kelly on a short break from a stint in Dar es Salaam at Muhimbili University. Vic had offered to speak this morning for the education session on the management of burn wounds. Not something that we necessarily encounter on a daily basis in neurology, but something that is definitely worth relearning given the area that we’re in and the fact that we could certainly be asked to assist in managing these patients if the need arose. Vic had first completely filled out the white board with the points that he wanted to cover in his talk and did a wonderful job of getting to everything in the short time he had allotted this morning. It was again a complete pleasure to hear him speak from a place of absolute confidence and experience in the subject.

One of the more puzzling cases of the day didn’t involve anything neurologic, but it was a young 9-month-old child with a severe rash that had been seen previously at FAME and treated with topical steroids and antibiotics with continued worsening. It had been present for about six months and looked horrible. Both Dan and Marin (our pediatric peeps) were asked to take a look and weigh in with their thoughts. We did have some ideas, but in the end sent off photos to several resources in Philadelphia. I emailed the photos to Carrie Kovarik, who is at Penn and an expert in dermatology, dermatopathology and tropical medicine. Dan and Marin not only emailed the photos to their Jim Treat at CHOP, but also called (with the time difference, I think it was like 6 am!) to see if they could get additional information. The feedback we received suggested that this was “unusual/ fulminant acropustulosis of infancy,” that usually occurs on the hand and feet, but can also affect the face, nose and ears and can often be mistaken for scabies when it involves primarily the feet (trust me, all of this was from Carrie as this is not my shtick by any stretch). It should respond to high potency steroids and will often burn itself out over time.

We continued to see patients throughout the day, but having Dan here to not only staff the pediatric cases but also some of the adult cases, it has allowed me the freedom to spend some time at the Lilac Café this trip and that has been a real luxury for me. In the past, I’ve had Danielle Becker with me, though on one of those trips, she was focusing primarily on the epilepsy cases. Dan has adapted incredibly well to the style of practice here which is a real compliment given the unique nature of practicing medicine in East Africa and it has been wonderful to have him here working with us, and not just because of the freedom to take my Lilac Café forays.

Daniel Tewa explaining his Iraqw house

The sleeping platform for women and children

The Lilac Café was created when the new hospital opened several years ago as it became clear that there was a need to feed the inpatients and their families beyond what the FAME cantina could handle. It is a lovely place for us to meet and have coffee in the morning when things are slow and, today, I took the opportunity to spend some time here outside on the porch with a wonderful cappuccino. Susan and Frank also happened to be here at the same time discussing logistics for their upcoming fundraising trip in the US. I took the liberty of introducing them to the concept of AirBNB, something they have not tried in the past and something that I have been using extensively over the last several years. Two years ago, I spent a week in the Galapagos Islands in the town of Puerto Ayora on the Island of Santa Cruz, so it is clearly possible to find something just about anywhere in the world. For those of you who haven’t looked into it, I would strongly suggest giving it a try. I continued to enjoy the warm rays of the sun sitting out on the porch enjoying my cappuccino and remembering just how incredibly lucky I am to have this opportunity to come to FAME and share this experience with others.

Daniel explaining how an Iraqw family lived in their houses in the past

Two Iraqw warriors??

We had arranged to visit Daniel Tewa and his family tonight for dinner. As many of you know, I first met Daniel when I came to Tanzania with my children in 2009, and have visited with he and his family on every trip back to FAME since that time. Daniel is a remarkable man who is a self-taught historian of not only Tanzania, but also of the world and is far more knowledgeable about our own country than most Americans are by far. And though Daniel and I have become family over the years, it is really that fact that he has opened his home to those residents and others who have accompanied me on our visits without hesitating and has continually insisted that the honor is his and that he would not have it any other way. What began as simple visits by myself have now morphed into his entertaining our entire group for the evening which this time added up to seven of us including myself.

Marin and Sheena modeling Iraqw wedding skirts made by Elizabeth Tewa

In Daniel Tewa’s home

When we arrive, he has a table arranged for us outside among the trees in the middle of his beautiful farm with African coffee (coffee and milk boiled together) that is some amazingly delicious and is made with fresh milk from his cows. We sit and talk as he goes around the circle asking everyone where they are from and then telling us some fact about our city or state that we often don’t even know. We talk politics and given the fact that we don’t watch any television here or even keep up with the news, he usually tells us something that we weren’t even aware of. Tonight, he asked what we thought about Beto O’Rourke announcing that he was running of which none of us were even aware of at the time. After sitting for some time, we walked over to the underground Iraqw home that he built in 1994, and which is a replica of the type of house that he grew up in before they were outlawed by Julius Nyerere after the country’s independence and the need to bring all 126 tribes of Tanzania into villages together to create a country. The houses were underground so as to protect their cattle, sheep and goats from the Maasai during the night. The Iraqw and the Maasai were at odds with each other until a truce was finally signed in 1986.

A “daily wear” goat skin dress as opposed to the wedding skirts

In addition to Daniel’s Iraqw home, he also shared his methane gas collection system with the others which provides gas for cooking and lighting his home. It is a 10 cu. ft. collection tank that uses the waste from several cows to produce more than enough methane for his own use while also providing fertilizer for his fields from the byproducts of the process. It is an ingenious system that he has had for many years and that I had first seen in 2009. Later, we all walked to the nearby home of his eldest daughter, Isabella, where we were greeted as honored guests and served a wonderful dinner that was prepared specially for us. It has been this way for many years between us and there has been a relationship of mutual respect and gratitude. Though Daniel has continually reminded me of what I do for his community by bringing doctors here and providing care and that the honor is his, I constantly remind him of what he has done for us by sharing his home and family and teaching us about his culture. It is these relationships that we must treasure in life for they are the most genuine. There are no pretenses or expectations, only respect and love.

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