Wednesday, September 11, 2019 – Neurology clinic and an evening at Happy Day….

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Thankfully, Wednesday is a morning for us to sleep in. Between our educational talks at 7:30 AM and arising at the crack of dawn for our game drives on Sundays, it is always a joy to get that extra sleep as the mornings here are so delightfully cool. After morning report, I had planned to meet with Leah at the Lilac Café to discuss some aspects of the work she was doing here with us. The Lilac Café is a small restaurant on campus that came into being with the opening of the inpatient hospital ward as it would be necessary to not only feed the inpatients, but also their families who were visiting. The café is a lovely and relaxing place to spend time and the mornings are even more so. It is so relaxing that you can feel the stress drain from your body half way there. Leah has been spending her mornings there working (I’ve told her that it’s her office) and then coming to shadow us in the afternoons. I don’t think she has yet tired of the Caffé Lattes nor will she do so soon. The Lilac is also where many of FAME’s smaller administrative meetings occur as it’s very conducive to getting things done.

As we left the house on our way to morning report, it began to drizzle just a bit which is really the very precipitation that we’ve had since we’ve been here and very likely the reason the day started a bit slow as patients may have decided to come on another day. If it does begin to rain more seriously, the roads become very muddy and more difficult to travel, but even so, most people here seem to ignore the heavy rains and do what they have to do. It always amazes me at how everyone travels through the mud and dust to get to clinic, but somehow don’t look like they have when they get here. Just walking to clinic on a rainy day, I seem to accumulate a pound of mud on each of my soles making walking just a bit difficult.

Views around our house

With the slow day, the patients trickled in and we still ended up seeing eighteen neurology patients, so not all was lost. An interesting patient that Mike saw today was an older gentleman with a chronic history neck pain that was worsening and he now had difficulty walking. The symptoms had been going on for over two years and he was now myelopathic on examination meaning that we were mostly concerned about him having spinal cord compression secondary to cervical spondylosis or arthritis. The is a very common condition in which the arthritis causes severe narrowing of the spinal canal over a long period of time and eventually compresses the spinal cord. The only treatment for this is to do surgical decompression and fusion of that segment of the cervical spine where you’ve operated. He would need an MRI to confirm the diagnosis prior to any potential intervention. We were back to the same question as before as far as whether the family could afford the surgery and, if they could not, there would be little reason in getting the MRI scan.

I contacted the neurosurgeon again in Arusha at ALMC, or Selian Hospital, and she got back to me rather quickly with a price of 2,000,000 shillings, or about $869 depending on the days exchange rate, for the surgery and fusion, but not for the MRI scan as he would have to get that done first. To be honest, a price of less than $1000 is pretty amazing when you consider that to have the same surgery done in the US would yield a hospital bill of at least $200,000, though that’s not necessarily what the hospital would get paid. That’s the problem with making those comparisons as the hospital wouldn’t really get paid that total amount, but probably something closer to a quarter of that total amount. Regardless, it is still significantly cheaper here in absolute terms, but not in relative terms when you consider what the average per capita income is in Tanzania and even far less here in Karatu District. Mike spoke with the son who indicated that the family was going to sell everything they had to raise money for the MRI and we weren’t able to give them the amount for the surgery, but they were aware that would be an additional amount.

As we had seen all of our patients before lunch (2 PM), we were considering a trip to the village of Manyara where the African Galleria is so that everyone could buy gifts for home. I had also asked Ema to check out Turtle to make sure that she was in excellent running order for our game drive on Sunday as well as the mobile clinics we are planning for next week. He had called Angel while we were at lunch to let us know that he wanted to take Turtle down to town to top off some fluids and when I told her that tomorrow morning would be best, she noted that he was actually already with the car downtown so that we had to scratch our plans to go to the Galleria and would do it another day. I remained back at the clinic to see whether any new patients came in the afternoon (they did not) while everyone else went back to the house to relax. I was happy to sit in clinic and get some typing done which is what I would have been doing at home, so it really wasn’t any kind of a burden.

As I had mentioned previously, connectivity to the outside world here has always been an issue for everyone, including me and my accompanying residents. That’s not to say that there is a lack of infrastructure here to enable one to so, just that it can be a bit complicated at times. To begin with, and to orient those who are not familiar with the communications infrastructure here, everything is based on cell technology. For all practical purposes, there are no land lines here and there is cable technology. On the flip side, there are a great number of cell towers and the coverage overall is excellent. Deep in the Ngorongoro Crater and in the middle of the Serengeti, cell service is excellent and you can make calls and get your email with ease. On the other hand, cell technology can also become easily overloaded depending on the number of people accessing your local cell tower. Sitting in Citizen’s Bank Park (The Phillies home stadium) for a ball game is like being in a cell wasteland as 30,000+ fans are all trying to access the same cell tower.

We had gone to town the other day so that everyone would have local sim cards mostly to access everyone’s email and WhatsApp (our main communications app here) and that seemed to be taken care of. Ke Zhang, FAME’s networking guru and otherwise all around amazing guy (currently a first year interventional radiology resident in Boston), had spent his last visit here working on revamping the WiFi network at FAME and also linking in the volunteer houses which was going to be godsend. They had needed some network switches which I brought when I came, but after plugging in everything, there still was no internet at the houses and so Sangale was working on trying to get things more operational. He eventually found a problem in one of the pairs of fiberoptic cables and once replaced, everything worked like a charm, and we had internet down at the Raynes House. It was like a new era here at FAME.

The gang at Happy Day

I made it back to the house well before 5 PM and shortly thereafter, Ray, Mike and Kyra went out for an afternoon hike. They were gone for a good bit of time, always a concern here where you can actually run into some stray Cape buffalos or elephants as we’re just on the border with the Conservation Area and many animals will stray over into the coffee fields and towards FAME. Of course, they eventually returned safe and sound having only made a few wrong turns along the path I had shown them last week. Ema was not yet back with Turtle and we had planned to go to Happy Day tonight, so I was getting just a bit worried about that. Of course, he showed up with more than enough time to spare, so at 7 PM we all piled into the Land Rover and departed for town. Happy Day is a small little Pub where, on Wednesday nights, all of the ex-pats in the area will meet to relax and share stories. On arriving there, it was immediately apparent that Happy Day had received a significant remodeling upgrade since my last visit there. The deck now had lovely and colorful outdoor couches rather than the picnic benches that I had become accustomed to over the years since coming to FAME and enjoying evenings at Happy Day. It was quite a welcome change, though, considering how comfortable they were and it easily brought the pub up several notches on the luxury scale in everyone’s mind. It was a great relaxing evening enjoying stories among our group, Reema and Margaret and our friend, Nish, owner of the African Galleria, as most of the other ex-pats had departed earlier.

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