The resident rotation to Tanzania not only includes an amazing amount of neurology given the number of patients seen here and the diversity of the neurologic disorders, but it also includes exposure to this countries rich cultural heritage, as well as its equally impressive wildlife. We’ve already visited two parks for day drives, Lake Manyara first followed by Ngorongoro Crater, which we did both on Sundays as we have traditionally not worked those days making it perfectly reasonable to spend them either at the parks close by or spending them doing something outdoors (such as our hikes down into Empakai Crater that we’ve done in the past. To get to the Serengeti from Karatu, though, it requires a minimum of two nights given the distance as that allows for a full day of game viewing in between the long drive on the other two days. But before I get to the Serengeti, we have a half day clinic that we have to tend to.

It was the end of our mobile clinic week and we have traditionally done a half-day clinic so that we could leave sometime after noon to arrive to our camp in the Serengeti before dark as driving in the park after sunset is very much frowned upon and actually against the law. Unfortunately, while we were away, many patients were told to return on Friday to see us as I’m not certain that everyone knew that we’d only be there in the morning despite my having supplied a schedule specifically to avoid any conflicts. Thankfully, though, the turnout was still manageable with some strict discipline by everyone along with some strong encouragement on my part. Kitashu had been at his brother’s wedding the weekend before near Loliondo, a predominantly Maasai region far north on the Kenyan border, and had told several people there to come see us on Friday for their neurological issues. Mike ended up taking care of the entire group that comprised four patients, but since they were all family members they really could be split up due to the language and history taking necessary.

In addition, the gentleman who we had seen previously with the large meningioma had returned to go over the results of his scan. This was a bit complicated given that he was going to require surgery so we contacted the neurosurgeon in Arusha (the only one outside of Dar in the country) to find out how much such a surgery would cost. He would also need to have an MRI done prior to surgery which would be an additional cost. Kitashu helped with giving him all of the information not only because the patient was Maasai, but also due to issues with cost and whether he would be able to consider it. Thankfully, the patient indicated that he was going to go home and sell some livestock along with other family members to have his surgery. I speaking with the neurosurgeon, we discovered that the older gentleman who we had seen with the large chronic subdural hematoma had not followed through with seeing the neurosurgeon which was very disappointing given the fact that he will not have any chance of recovery and will very like succumb to it in the end.

We finished the morning with about 15 patients or so and were finished by around 12:30 PM. There were still some labs to check and Dr. Annie would take care of giving those patients their results while we were on our way to the Serengeti. Somehow, one of the patients that Marissa and Andrea had seen in the morning and was depressed, so they had given the patient fluoxetine (Prozac), turned out to be pregnant (how Annie discovered this after the initial visit I’m not entirely sure) and this prompted a vigorous WhatsApp discussion while we were en route regarding what we could do for the woman. Unfortunately, not of these medications are safe in pregnancy and certainly not to start a medication unless there were extenuating circumstances. In the end, the decision was that she really couldn’t be started on a new medication and it would have to wait until after her pregnancy and possibly even breast feeding due to the selection of medications that we have here.

For our trip to the Serengeti, as in all the trips we’ve taken there in the past, I find a guide to drive us as I’m not comfortable navigating the vastness of this park and its extreme remoteness. Having a breakdown in the Serengeti can be a disaster for many reasons, not that having a breakdown anywhere in Tanzania isn’t a major problem given the fact that there is no AAA here to come help. For this trip, I had asked a someone I had met recently to drive us as I had an immediate feeling that he was very knowledgeable, experienced and dependable. His name is Samwell Bariye Dodo and after taking care of the particulars, he had agreed to come to Karatu to pick up the vehicle in the morning, fuel it up and have it cleaned as well as check it out to make sure that it was worthy of the trip. He had taken care of all of that and met us at our house to load our bags and get under way.

We would be driving to the Central Serengeti where we had booked two nights at the Thorntree camp just north of the Seronera, which is where the small airport servicing the Central Serengeti. The Serengeti is an incredibly large park that is divided into the Southern, Central and Northern sections, as well as the Western Corridor that is a strip jutting out to the west and follows the Grumeti River. The Western Corridor is the least visited region of the park. The Northern Serengeti runs to the Kenyan border where it extends north and becomes the Maasai Mara, which is the name of the game park in Kenya containing this contiguous area. The Central Serengeti’s geography is dominated by the famous Kopjes that are small, rocky hills jutting up from the flat plains that go on forever.

Before our trip, it was necessary for me to go the NMB bank in town to pay for our transit across the Ngorongoro Conservation Area. The road to the Serengeti is the very same road we travel to the get to the crater and, in fact, you drive around the crater rim road all the way to the opposite side of the crater where the descent road is before continuing on rather than down into the crater. Everything went smoothly at the crater gate and we were soon on our way past all the sites we had seen the weekend before. The visibility was tremendously better than it had been previously given that it was now afternoon. As you leave the rim road and begin your descent down to the plains below, the immensity of the region suddenly becomes apparent and this is just a small sample of what we’d be seeing one we reached the park. You drive past Olduvai (or the proper spelling of Oldupai as I like to use) Gorge, the single most famous anthropologic site in the world and the home to the discovery of oldest man many years ago by Mary Leaky. Unfortunately, we wouldn’t be visiting this site today, but I have been there many times before and it is a simply magical place that clearly deserves its place in history.

From the Olduvai region, you travel along until you reach the road to Lake Ndutu which is the place to be in the rainy season as all of the wildebeest herds are there with their new calves having been delivered on the way down from Kenya during the great migration. At this point, you enter Serengeti National Park, though the entrance gate is still another 20 minutes or so at Naabi Hill. Both Dodo and I went in to take care of the entrance payment, though in typical the typical bureaucratic fashion here, there was an issue that arose. I had been sent two quotes for the NCA transits (there and back) that I had paid for at NMB, but every time in the past, I had paid for the Serengeti quote with my credit card. Apparently, in the time since March, they had changed the procedure and were no longer allowing payment at the gate for any guided vehicle, only self-drive vehicles, meaning that I was supposed to have paid at the bank in advance. The only other option was for me to obtain the log in information for the company who booked the quote and then to make payment on the website with my credit card. It sounded very arcane, though I know they had their reasons for it. What should have been a several minute transaction ended up taking us about an hour with multiple back and forth phone calls to get the necessary information. Everyone remained very calm and we eventually got all the information to load into the computer, though the first credit card I tried didn’t work due to security  reasons, my good old Wells Fargo debit card came through and we were good to go.

We were now about an hour behind schedule which was a bit disappointing for me as up until then I had managed to keep everything moving on schedule, and we still had a long way to get to our camp and do some game viewing on our way. You are not supposed to be driving after 6 PM in the park, or at the very least sunset, but since we were on our way to our camp and had been held up at the gate, I was pretty sure that no one would be hassling us about that. It was a gorgeous sunset that took quite a long time to happen as there were multiple layers of clouds in the distance. The sky began to change to every shade of orange imaginable and we had to stop Dodo multiple times for everyone to take photos.

At one point as we were driving, a hyena suddenly appeared on our left, darted across the road and grabbed a dead Thompson gazelle that was off to our right. We’re not sure how the gazelle had died as we didn’t see any other predators in the vicinity (hyenas will often chase off cheetah and even a single lion), but sure enough, the gazelle was dead when the hyena reached it. It began tearing immediately at the abdomen of the gazelle and began to devour the animal in very short order. A second hyena came up to feed, but kept its eyes on us as we were only several meters away and it was spoked by our presence. We were so close that we could easily hear the bone crunching by the hyenas who have the most powerful jaws of all the animals here and, even more so, we were close enough to smell the gazelle’s abdominal contents once it had been opened up. It was not very pleasant making me think that the gazelle may have been dead for at least a short while before the hyenas came upon it. As we were on our way to camp for dinner and truly looking forward to it, we all wished to keep our appetites, so eventually drove off prior to the arrival of any vultures to finish off the carcass.

The sun continued to set in the most spectacular fashion and as we rounded a marshy area where you will often see lions, we came upon a large pride, all of who were lying comfortably in the final rays of sunshine except for one female that was sitting on her haunches, facing off to the west, and clearly looked as though she were admiring the beautiful sunset. It was a glorious sight with the orange glow of the setting sun, the lions, the green of the marsh in the foreground and the endless plains in the distance. We were all in awe of the moment and now one wanted to leave this spot. Both Dodo and I knew, though, that with the setting sun, it would soon become pitch black and we still have at least 30 minutes to camp. We left this magical sight of the lion admiring the sunset and continued our trek north towards camp.

Dodo knew the Serengeti like his second home so there were no wrong turns and he knew exactly where camp was for us. As we arrived, we were given cool wash clothes and fresh melon juice to wash down our dusty throats. We were in plenty of time for dinner and even had enough time for Mike and I to go to our tents to shower. We sat around our large table finally able to relax from the long drive here and very happy that we make it through safely. It was time now to enjoy a cold Safari beer for Mike and me and wine for everyone else. Dinner was a delicious affair of probably ten dishes that were brought to the table by the camp staff for each of us to serve ourselves. The homemade soup was amazing as it always is and every other dish was equally cooked to perfection. We retired to our tents, all exhausted form the day, and prepared for a very restful night. Some of us were a bit more concerned about the animals surrounding our camp, though I reassured everyone that the animals have no interest in coming into camp. The fact, though, that Andrea asked the camp staff four times what the emergency whistle was for and why it was there may give you some indication of was going to sleep more soundly that night and who wasn’t.