Our trips to Tanzania have been for the purpose of developing a neurology presence here in Northern Tanzania and at FAME while also providing education to the doctors here so that in between our visits there would be a better chance of these disorders being appreciated and treated more effectively. It has been clear with the data that we’ve collected that we are making a difference over time and there has been much better appreciation for neurological disorders here, such as epilepsy, so that patients can be assessed and treated. Though I must admit, that when I first came, neurology was not on FAME’s radar as a specialty that they were targeting, and it still is not part of their 5-year plan (reproductive and child health, and surgery have held those spots from early on), though it has become evident over time that there is an incredible need in a region and country where there are few neurologists and very many neurological patients with a significant amount of disability. When looking at the global burden of diseases, neurological illnesses, when you include stroke, meningitis and HIV-related neurological complications make up a huge percentage of this number and have an even greater impact on disability-adjusted life years, or DALYs, as a great many of these diseases do not kill, such as cancers, but leave their victims disabled for the remainder of their lives. So, it goes without saying that the need here for our work is great.

The first question you must ask yourself in any sort of global health program, or global program of any sort, though, is whether it what the recipient perceives as necessary for their well-being and progress. Trying to convince someone that what you’re trying to do will often end in failure, or worse, if it’s not what is needed, it will end in failure with certainty. Thankfully, the need for a better understanding of neurological illnesses was something they recognized here at FAME immediately during my first visit as, even before I developed the neurology clinics, I was being asked by every doctor here to come see a patient with them to help manage the neurological aspects of their problem. Once we passed that test, that is, making certain that what we were doing was something that they both wanted and was needed, and it was clear that having a recurring clinic was something that would build trust in both the doctors and patients, I was then free to think of ways that I could make it more efficient. After Daniel Becker, the first resident/fellow to join me, came in 2013 as she had heard so much about it during her time with me in residency, it became clear to me that residents and fellows could provide the same training to the doctors here that I was doing and it would only increase the number of doctors and patients that we could work with if I build a program.

Even better, while providing something here that was so badly needed, i.e. neurology education, we could establish a program for the residents that would introduce them to global health and health equities by practicing in a resource limited area with entirely different cultures and values than our own. Every trainee that has come to work here has left with an appreciation not only for what we have in the United States, but, more importantly, how you can help in a region where they do not have what we have, and where the value systems are often very different than our own. As a result of this experience, it is impossible not to become a better neurologist, scientist, person, and citizen of the world, as it forces one to think in ways far different than we often do on a daily basis at home and changes the perspective of how we often approach complex, or even simple, situations that arise every minute of every day.

In building the program, though, it was very clear to me in the beginning that it would be necessary for the trainees to experience not only the practice of medicine in a different region than our own, but to also understand a culture that is very often far different than our own. Therefore, in addition to our typical six-day a week working schedule, we also take time off to visit friends and get out into the countryside as this is a country with an incredibly rich heritage that is made up of well over 100 vastly different tribes, each of who speak a different language, and a country with perhaps the most spectacular and varying geography of any in the world, and that never fails to amaze me no matter how many times I visit. Clearly, in spending a month here, you can only scratch the surface of this remarkable country, but it should not be overlooked that I have three of my group this trip who have returned for a second visit, mainly because they have been bitten by the same bug that captured me over ten years ago and ended up changing my life for the better. All of Africa can be said to do this, and on my recent trip to Mali I can now vouch for this, but have chosen to place my roots in Tanzania and, for that, I am a much richer person.

Saturdays are typically a bit slower in general and, given that we had plans this evening to have dinner out (we are not supplied dinners on the weekend giving us the opportunity to go out and eat), we were looking forward a slower pace and earlier departure from clinic. We had no neurology patients to see in the ward today, though there was one interesting patient that we do typically see at home. Someone in the Ngorongoro Conservation Area had been attacked by a rhino (not a common even in Philadelphia) and had suffered a chest injury with fractured ribs and a hemothorax among other injuries. We didn’t have to see the patient as they had no neurological consequences of the rhino vs. pedestrian encounter, but it was certainly something to keep in mind for future visits to the conservation area.

We had fewer patients first thing in the morning who were lined up to see us, but it certainly wasn’t a bust and patients continued to flow in throughout the morning. It finally gave us a moment to catch our breath which was good as we were all exhausted from the prior two days of huge volume. The spread of diagnoses that we saw were pretty typical of our standard patient population – headaches, epilepsy, numbness – with a smattering of children, but never to the satisfaction of Amisha who prefers a steady stream of little ones and reminds on every occasion about how much she enjoys seeing adults which is not at all. Thankfully, Marin is here, but she is really only to see children as her training is exclusively in pediatric neurology, unlike Amisha, who has done rotations in adult neurology back home as is required of all pediatric neurology residents and vice versa. There has never been hiding the fact, though, that there is a clear comfort level by each of the residents, adult or pediatric, in seeing patients that they hope to see for the rest of their careers and, for that, I cannot really blame them (though I will not admit that to Amisha).

The somewhat slower than normal day did give Dan and I some time to spend outside on the benches by radiology in our “office” as the day was pretty much crystal clear and gorgeous. This bode well for our plans later in the evening which was to go to Gibb’s Farm for dinner. I have spoken of Gibb’s so many times in the past, but it is a remarkable place where one feels that all of the weight of the world is slowly lifted from your shoulders for every minute that you spend there. It is an old coffee plantation that later served also as a lodge and its own village where all the food was grown locally, all the furniture was made on site, and it was essentially its own little village. Over the last decade, Gibb’s has been transformed into a destination resort that has still managed to retain its old world charm and not matter how many times you’ve visited, it never fails to impress you with its sense of tranquility nestled in the Ngorongoro Highlands where it borders the conservation area. The view from its veranda, overlooking Karatu and FAME in the distance and the acres of coffee plants hugging the rolling hills is just simply spectacular, though the view of the garden areas from the open air bathrooms as you walk in from the small parking lot are equally impressive and not to be missed. Gibb’s for me and the rest of the group is a must and something not to be missed by anyone traveling to this region.

We were able to finish clinic at a decent time and all head back to the house to get ready for the evening out. We did need to head into town to pick up some supplies as we would be traveling to Ngorongoro Crater and were planning to make our lunches to bring as well as needing water for the trip as you never plan to travel anywhere here with an adequate amount of water as breakdowns and dehydration can occur with equal frequency. We would be traveling through town on our way to dinner as the shortcut that I normally take to Gibb’s Farm road can be iffy at best, and given all the recent rains, there wasn’t a reason to chance getting stuck and missing out on our plans for the evening of drinks and dinner at a wonderful resort. Remember, there is no AAA here, so getting stuck for the better part of the evening was not something I wished to consider.

After a short visit to the market in town for our supplies, we were able to make it to Gibb’s quite early enough for everyone, save for Dan and me, to take a walk down to the vegetable gardens below as they are very lovely. We, on the other hand, made a bee line for the veranda with the excuse that we were going to take pictures of birds, but the intention was to immediately order our Moscow Mules, a drink that is incredibly refreshing wherever it’s ordered and, even more so, here in Tanzania. Dan and I strolled around the grounds looking for birds while our drinks were being prepared, and the others slowly filtered back up from the gardens in small groups until we were all back together sitting at our large table on the patio, overlooking FAME far below and taking in all that is good in the world, while everyone’s drinks seemed to miraculously appear for them. There are always several artists in residence at Gibb’s, including our good friend, Athuman Katonga, who has created paintings for so many of our team that have visited here. Everyone visited Katonga in his studio to look at his works in addition to the other artist there who also had wonderful pieces that would be worthy of bringing home and framing.

 

While we continued to enjoy our drinks and the sun slowly set in the distance, the soft glow of the evening light waned while the shadows transitioned into darkness. It was an evening well deserved given the number of patients we had seen over the last several days and everyone took full advantage of the opportunity to relax and share stories. Sometime after 7 pm, it was announced that our dinner was ready to served, so we all moved into the dining room where a large table for the nine of us had been set up. The dining room is formal, as are the place settings, but the ambience of Gibb’s is more relaxed and comfortable than one would imagine just by the sight of things, and, after the we were all seated at the table, the courses of food began to be placed in front of us. We did, of course, have to order from the menu as three of the four courses (salad/appetizer, main entree and desert) were to be ordered with nearly all of the delicious selections being locally grown and incredibly difficult to decide which one each of mouths was watering for at the moment. It was such a pleasant evening with hours spent in this relaxing and rejuvenating environment. When we finally departed sometime around 9 pm, we were all just simply fulfilled, both physically and mentally, and I don’t believe that any of us could have imaged a more worthwhile place to have spent the evening, nor group of friends that we would have liked to have spent it with.