Today was another educational lecture and Ray had volunteered to do one. He presented the patient who had the subdural hematoma and did it from a perspective of why it wasn’t a stroke. Knowing Ray, who wins teaching awards right and left and is a master clinician, there was little question that he would do a brilliant job of it and he did. We only have 30 minutes to do the presentation and even with his 32 slides, he managed to finish with time to spare. We opened up the clinic door and readied ourselves for clinic, though it seemed that were fewer patients here at the beginning of the day.dd

I had hoped to do some more work in the morning after report, so went with Leah down to the Lilac Café, where I could type without being interrupted. Ray had agreed to cover clinic and only if there was a specific issue that needed my attention, would they be contacting me. Though I most usually partake in coffee here which is served in a French press, I chose this morning to order a Caffé Latte on Leah’s recommendation. It was served in beautiful layers and in a tall glass with a wonderful top layer of steamed milk and a personalized message on it that was written in chocolate. Denis is also a very talented artist who I have brought supplies for over the last trips to keep him painting. He did a wonderful portrait of me for my sixtieth birthday that I have hanging in my apartment at home and was given to me at an amazing surprise party at the Highview Inn that Jackie, Jess ad Paulina had put together.

We have always had an issue with our clinic as far as triaging patients that has occurred for several reasons. Here at FAME, it is much more appropriate medically for patients with non-neurological disease to be seen at the general outpatient clinic (OPD) despite the fact that we have Dr. Annie working with us, who is certainly qualified to treat anything that comes our way. When we make our announcements to the community and on the flyers that are placed around the district, we list the types of neurologic symptoms and conditions that we treat and those are again repeated when the patient is registering. Despite all of this, we will still have patients come complaining of a clearly non-neurological problem – groin swell, goiters, throat pain, etc. Part of the problem is also that we have a flat fee to be seen in our clinic where the patient gets their visit, one month (or sometimes more), and any necessary labs for a flat rate of 5000 Tanzanian shillings or slightly over $2. Their visit is, therefore, subsidized as these services would be costlier if done through the OPD and, hence, the incentive for patients to be seen in the neurology clinic.

When this occurs (a patient with a non-neurological disease) it will often depend on whether the patient is being seen by Dr. Annie with a resident in which case we try to take care of it on our own as long as it’s not going to be too expensive. This morning, Andrea and Annie diagnosed someone with probable cholecystitis and refereed them for an ultrasound and then to be followed up in the OPD. We also tolerate some of the musculoskeletal patients, though have little to do for them other them some ibuprofen.

Today was also exciting as we were expecting to see Abdulhamid Shaban, who Is a senior medical student at Muhimbili University and had worked with us last October as an interpreter, but ended up discovering just how much he loved neurology (how could he not having worked with the likes of Lindsay, Amisha, Hannah and John). Abdulhamid grew up in Karatu and has known FAME for many years, as well as having a family connection there. He is now coming back to work with us again as an interpreter this month as he is on leave, but most importantly, he will be returning with us to Philadelphia where he will be spending a month at Penn for a neurology observorship with our department. This was made possible through the Center for Global Health at the University of Pennsylvania who have graciously agreed to cover the cost of Abdulhamid’s travel and living costs during his stay. It all came about through everyone’s connection with FAME and is a tremendous opportunity for Abdulhamid in his professional career.

In the afternoon, several of us listened to a talk that Marin Jocobwitz and Dan Licht were giving for neurology grand rounds at CHOP about their experiences here working with us last March. Listening to the lecture live from across the globe (thankfully the timing worked out) was truly remarkable and made even more so by the fact that we had Kitashu here listening as well. He was featured in the talk on several occasions and mentioned frequently. We had visited Kitashu’s boma while Dan and Marin were here and seeing his face when she was discussing that visit and other times she referred to him during the talk was really priceless.

Our plans for the evening included dinner and drinks at The Manor Lodge nearby. It is one of the high end resorts in the Karatu region for those who are either coming and going to the Crater and is one of the Elewana Collection of resorts in East Africa. It was designed to look like the South African wine country, which I’ve never visited, but regardless, it’s a beautiful estate with well-manicured lawns and private cottages for the guests. They have a stable with horses, a pool and a large Manor house where the dining room is in addition to a billiard room downstairs that Ray and Kyra were apparently quite happy to see. Looking out from the veranda on the back of the Manor house and looking west, the sun was slowly setting in a nearly cloudless sky. We sat out back on the deck with fire pits burning nearby to help warm as the temperatures dropped along with the sun. They had wonderful drinks (the Moscow Mule is my favorite as it is everywhere here) and hors d’oeuvres and we spent a long time enjoying both before heading off to dinner which we were quite thankful was just across the deck outside rather than in the more formal dining room.

Their dinner is a fixed price five-course meal with choice of entrée. The entrées included a winter beef stew, red snapper, and an eggplant/mozzarella dish. All the dishes were delicious and well-received by everyone. There was more silverware on the table than I’ve seen in any restaurant I think and with each course, both a fork and a knife were removed from the setting in succession. The service was impeccable and the timing of the courses were perfect such that we spent a very long time at dinner which was what we had wished for in such a beautiful location. We had arrived before 5:30 that evening and remained there until after almost 10 PM. It was a night to remember and we had brought Annie with us as she deserved it having worked with us now for over a week.

We arrived home and everyone was pretty exhausted so went to their rooms to hit the sack. Within a few minutes, I heard something out of Leah and Kyra’s room and it turned out that they had muddy water coming out of their sink. When I went in to investigate, I found that the hot water in the sink was the culprit and when the mud quickly cleared, it became like a steam vent at old faithful. Either that or something that we could use to steam milk for our cappuccinos. In any event, there was an issue with the hot water and it was unclear what was the issue and what needed to be done. We would have to wait until the morning to get someone to look at it and discover the situation.

I think everyone slept a little more soundly that night.