Tuesday, March 10, 2020 – If it’s Tuesday, it much be education day….

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Alice presenting on kizunguzungu

It was to be our first day to present a lecture and the doctors here had asked us to do some case based education rather than didactic sessions as we had most often done in the past. I will admit, though, that a case based presentation has allows allowed for more participation by the audience and, therefore, has had a better reception than the more typical lectures that are given where everyone sits silently unless called upon. Alice decided to speak about kizunguzungu, or dizziness, and what are the key points of the presentation and evaluation that will help to determine the differential for the patient’s signs and symptoms. She did point out to everyone that dizziness is disliked by almost all neurologists (except perhaps Ray Price) and one of the emergency room consultations that is most frowned upon by the residents who are doing them. Upon that background, she dove into several cases that each were an example of patients presenting with a complaint of dizziness, but each patient’s symptoms were very different as were their exams and their differential. The last patient she presented was a case of labyrinthitis and it took me a few seconds before I realized that the case she was referencing was actually mine! Perhaps it was because she aged me a few years that I didn’t pick up on it sooner, but either way, it allowed them the opportunity to hear about my experience with this condition and I was able to describe things for them in detail as I still remember the day quite well despite the fact that it was nearly four years ago. The episode itself had been incredibly disabling, but the kizunguzungu finally resolved after a bit more than a week, though, unfortunately, I never regained the hearing in my left ear which has become more than just a nuisance to me.

Alice’s presentation

Alice’s presentation

A baby with jaundice had been presented at morning report following Alice’s talk, though when Dan and Marin went to see the baby, it appeared to have the much more serious condition of kernicterus that would require the baby to receive an emergency exchange transfusion. The baby had been at an outside facility for four days where they had been monitoring it and then they were finally transferred her to further care. The bilirubin was apparently quite high and the baby’s jaundice was quite apparent when looking at it. Based on the high bilirubin and the length of time that it been present, the baby needed to be transferred to Arusha “sasa hivi,” which means “immediately,” or “right now” in Kiswahili. There the baby could receive their transfusion.

One of Amisha’s and Angela’s patients

Angela and their patient

It was our second slow day in a row, with perhaps 15 patients, and becoming more concerning to me as the day wore on. We clearly had some banner days last week and had hoped that it would continue in that fashion, but for whatever reason, the patients were not coming to clinic over the last several days. The general OPD was equally slow so it certainly nothing that was related to neurology in particular, probably just the weather and the roads. We were heading tonight to Daniel Tewa’s home so this would at least mean that we would be getting a decent start to head over there in the daylight to visit outside with him.

Marin, her patient and mom

Working on our computers. Yes, I may closed my eyes for a split second

I have written about Daniel Tewa numerous time before as I have been visiting him ever since my first trip to Tanzania in 2009 when I was here with my children and we volunteered in the Ayalabee School to help paint the facility and Daniel was an elder there. He is a remarkable individual who is from the Iraqw tribe and is somewhat of a local historian and ambassador for his tribe, having done cultural presentations for many years for visiting safari guests. When I first returned to FAME in 2010, I had contacted Daniel and he remembered both of my children’s names even though it had been a year and countless other guests who had been there since our visit. I went to visit him in the late afternoon and as it became dark, he insisted that I stay for dinner as it would unheard of here for a guest to leave his home without having been fed.

Alice and Molly deciding who will throw the spear better

Frances readying to throw the spear

This would be the first of many, many meals that I, and now my residents, would share with Daniel and his family. As the groups became larger, the meals have moved over to his older daughter, Isabella’s home and they have become somewhat fancier, but have the same meaning to Daniel and his family. I now bring up to six people with me for each visit and we sit out in front of Daniel’s home, a small structure that he build himself many years ago, and we drink real African coffee meaning that it is boiled with fresh milk from his cows. It is different coffee than I have ever drank anywhere else in the world and is truly delicious and very easy to keep drinking long into the evening.

Molly taking aim

Daniel enjoying spear throwing lessons

One of the remarkable things that Daniel has done, among many, is that he has built a replica Iraqw house similar that in which he was raised and no longer exist as they were all destroyed when Tanzania became independent and Julius Nyerere, their first president, made the decision that all tribes needed to move into villages together and live in Bantu style houses so that the country could develop its much needed infrastructure. Daniel spent three years building his traditional Iraqw house, finishing it in 1992, so that it would stand as a reminder of his heritage and be used by historians as an example of how the Iraqw used to live. The houses were underground as protection from the Maasai, who the Iraqw were at odds with unit a treaty was signed between the two tribes in 1986. Prior to that time, the Iraqw believed that housing their cattle underground at night in their houses would prevent the Maasai from stealing them. An entire family would live in this house, along with all of their livestock, cows, sheep and goats, safe for the night without risk of being stolen.

Molly receiving spear throwing instruction from Daniel with a rainbow in the background

Each group that has come with me to Daniel’s home to visit with his family has uniformly found the experience to be one of the most rewarding of their time here in Tanzania. We arrived with plenty of light and enough time to inspect Daniel’s original Iraqw home and his lessons on Iraqw culture and history that included courtship and marriage. Afterwards, the residents received lessons from Daniel on throwing spears as a wonderful rainbow reached high above to the south. As we later sat outside under the darkening sky and eucalyptus trees, everyone shared their place of origin with Daniel so that he could share with us everything he knew about each location, most often more than each of us knew about our own home state or country. We discussed the current US Democratic race and where things stood at the present time between the candidates.

Me, Daniel and Carrie

Daniel, Carrie and Frances

We all walked to Isabella’s home, only a short way from Daniel’s to have our dinner that his family had prepared for us. His son-in-law, who lives in Dar es Salaam and who had been in Moshi for the day, had also come to eat with us as that was how significant our visit was to his family, and how equally significant it was to us. They had spent the evening preparing this meal for us and were clearly honored to be serving it to us. The fact of the matter, though, is that we were equally honored, or perhaps even more so to be sitting in Isabella’s home with her father, Daniel, and the rest of her family sharing it with them. It was a wonderful dinner and as we walked home to Daniel’s house in the light of the moon, and our flashlights, we were all quite full and ready for sleep.

Sitting in Daniel’s living room

We had one short adventure remaining, of course, and that was the drive home. It hadn’t rained for most of the afternoon nor the entire evening while at Daniel’s, so I thought it would be fine to take the normal shortcut I have between FAME and his house that bypasses having to go through town on the tarmac. There are no lights on the main road and at night, it is nearly impossible to see people crossing until you are directly upon them, and all of this is occurring while motorcycles and cutting across in front of you or traveling the wrong direction on the shoulder. It can be a bit intimidating to say the least. The short road across from Daniel’s that takes us across a large ball field and is where I pick up another small road to head towards fame. The initial short road was quite treacherous with large ruts and crevasses that cut across and made for a very rough ride for everyone in the back. As we came to large ball field area, though, we discovered that the cross road had turned into a river that may have been reasonable to attempt crossing during the daylight, but certainly not late at night where becoming stuck would have been a major fiasco. I turned around, which is not an easy thing to do in a stretch Land Rover that has the turning radius of the Exxon Valdez, nor in the dark of night, but it was eventually successful and we were on our way home to the comfort of the Raynes House.

Our group in Isabella’s house after dinner

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