Tuesday, March 26 – Our days are winding down….


The residents have now been here at FAME for three weeks and their time is winding down. I know that it’s a very different experience for me as I never have to say goodbye to everyone here, knowing that I will be back in six months and stay in touch with them in the interim. For my residents, though, they will have to say goodbye, at least for the moment, and whether they will make it back will be up to factors often out of their control. As they say, “life happens.” Spouses, children, careers can often get in the way and it’s not always as simple as it may seem. Global health came to my life very late and, looking back, I can honestly say that it would have been tremendously more difficult for me to have done it earlier in my family life and career. That’s unfortunate, but it’s also reality. Who knows, though, if had had a similar experience earlier in my training similar to what we are able to offer today.

Our morning started as all our Tuesday mornings do here at FAME, with a teaching session and it was Sheena’s turn to take the helm. She did an excellent job putting together interactive case presentations that required some involvement of the staff and she made it clear to everyone that she would call on people if no one volunteered. Thankfully, we had a decent amount of discussion over the cases so it worked reasonably well.

A full room with Sheena giving her lecture

Our patient volume was a bit more moderate today and there were fewer children, thankfully, considering that Dan and Marin were now in the air on their way back to Philadelphia and quite incommunicado as far as we were concerned. There was one return patient I hadn’t seen yet during this visit and that was my Maasai friend whose wife I have treated now for probably five years and I was concerned about how she was doing. We had been to their boma two years ago for a goat roast which he had given us in our honor and despite having found his wife’s chart from prior visits, we were unable to reach him by telephone. Every Tanzanian, including the Maasai carry cellphones with them and considering the Maasai where mostly only their shukas (plaid blankets), the cellphones are often carried in small pouches that they wear around their necks. As their bomas have no power to recharge their phones, you can often spot small solar panels on the roofs of their huts, large enough to recharge their phones.

A family coming to be seen by us

During the morning, I was given two letters addressed to me that had come from Rift Valley Children’s Village and were sent with one of our two translators who had been with us for the month and had grown up at RVCV. The letters had been sent in appreciation for the time we had spent with two very amazing young individuals who are both contemplating careers in the health field and had spent time helping us with translation during our clinic there. In reality, though, we are the ones who should be expressing our gratitude, for it is not only in directly helping patients here that we can make our greatest impact on the health of this community, but rather it is by sparking that interest in the next generation of caregivers that we can truly capacity build. I have no doubt that these two individuals, and the many others who we have worked with during our time here, will go on to become the future of healthcare in Tanzania and that the success of this country will be in their hands. This is what moves us and the reason we come.

One of our two thank you letters

Thankfully, my friend showed up to clinic today, but was without his wife which was initially a bit disconcerting until he told me that she was doing quite well. Thankfully, she has remained seizure-free for the last five years under our care and has had two successful pregnancies and his children are doing fine. When I had first seen her, we switched her to lamotrigine, a medication that has the best safety data for pregnancy and she has done fantastic ever since. Her previous medication, carbamazepine, had not been controlling her seizures nor was it the best medication for a women planning pregnancies. He had wanted to come earlier with her, but they were unable to mostly because of the expense, but he had come today because he wanted to make sure I knew how appreciative he was for our continued care of his wife. We stood out in front the emergency room, polar opposites as he was tall and proud and dressed in shukas, I in my western garb looking as I normally do. We chatted and hugged, and then hugged and chatted more for what must have been for such a long time, but didn’t seem so to either of us. Both from such different backgrounds, yet brought together here at this moment out of a common interest. Though Kitashu was there translating, there was little need for we were speaking a common language of mutual love and admiration that was unmistakable and did not require years of formal education or instruction for it was universal and innate. We go through life, not necessarily seeking those moments that will stay with us forever, but this was one as it spoke to me as a reminder of the commonality of man and the fact that we are no more than the acts we choose and the paths we follow.

One of our two thank you letters

It was lunchtime and it reminded me that we only had a few remaining. The lunches here are my favorite meals, not counting the lunches and dinners at the lodges, of course, and I look forward to each and every one. Five days a week we receive a meal of beans and rice and a helping of a very green vegetable that is very similar to spinach. I’ve always called it “mchicha,” but I’m not certain that’s correct, so don’t quote me on it. Everyone at FAME eats lunch together in the cantina that has been since the beginning and has not changed one iota. It’s served around 1 pm and continues until everyone has eaten or the food has run out. When Kelley and Laura were here, they said that the beans and rice reminded them of a standard dish in Puerto Rico and, if that’s the case, I could easily live there for the sole reason. For many of the workers, lunch at FAME may be their biggest meal of the day and their portions are heaped high on their plates, something I could never imagine consuming without taking a long siesta later in the day. What really makes the meal, though, is the pili pili sauce that is made from freshly chopped local peppers that are incredibly spicy and are blended fresh most every day. We heaping spoonfuls of the sauce on top of our beans and rice and it takes an amazing meal to a totally new level. On days when there is no pili pili, the meal is just that little bit less and it’s noticeable.

Our waiting area

Tuesday’s lunch, though, consists of ugali, the local stiff porridge that is made from maize and is ubiquitous throughout Sub Saharan Africa, though often by other names. It can also be made of cassava, but here is made from Maize. It is served for lunch with a meat stew in broth that is put over the ugali and then served again with our green spinach-like vegetable and, of course, lots of pili pili. Tanzanians eat their ugali with their right hand, but, I must admit, we use a spoon and it is often difficult to cut the chunks of meat in half with the spoon as they are not the most tender in the world as one might imagine. The other lunch, other than beans and rice and ugali, is served on Thursday, and that is the pilau. It is a brown rice that is mixed with chunks of meat and seasoned to perfection. And, yes, it is also served with our dark green vegetable to top off the plate. And, yes, we heap lots and lots of pili pili on it as we do with most of our meals here. Residents who have come have a varied response to the lunches, but I’d have to say that, by far and away, the majority of them have very much appreciated the meals.

Tonight, we had decided to relax at the Raynes house and to catch up on work that we’d love over the last days. Tomorrow night was Wednesday, a night that we would typically go out to visit with other expats volunteering here, so no one felt a strong need to venture into town to socialize.


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