Since we would be leaving very early for mobile clinic on Thursday and there was a good chance that a number of us would be on our way home by next week, today was our last day to provide neurology education to the doctors. I had mentioned that it was requested that we provide more case based instruction and after discussing the options with Dr. Ken, he had requested that Marin discuss a rather complicated pediatric case that had come in with hyponatremic dehydration. Now this probably doesn’t sound like a neurology topic to most of you and, in fact, you’d be correct in that assumption. But the complications of the condition can be very neurologic and Marin did an excellent job running through how to calculate the exact sodium deficits that exist and how quickly they should be replaced. The talk was very well received by all of the doctors and given the fact that even I could understand it, she had clearly done an excellent job explaining the subject.

Today, we would be heading to Rift Valley Children’s Village, a magical place that I’ve described numerous times here and would encourage everyone to look at the website www.tanzanianchildrensfund.org. In a story quite similar to Frank and Susan’s, India Howell came to Tanzania in 1998 after climbing Mt. Kilimanjaro to manage a safari lodge, but quickly recognized the many children at risk who had either been orphaned and were on the street or whose families were unable to care for them. She created RVCV in 2004 along with her Tanzanian partner, Peter Mmassy, as a permanent home (not orphanage) for their children for who they are their legal guardians and the children remain at the village until they are ready to go off for college. The village is now home to over 100 children with many having gone off to college and returning for the holidays to help with their brothers and sisters.

The location of FAME in Karatu has everything to do with RVCV as from the beginning, it was India’s plan to provide her children with the very best medical care which was initially supplied by FAME as twice monthly medical clinics to not only RVCV, but also to the surrounding community of Oldeani. The latter was essential as the children from RVCV and Oldeani all went to school together and she recognized that without the health of the surrounding community being improved, it would difficult for her to maintain the health of her children. RVCV also partnered with the Tanzanian government to improve school conditions and has assisted in managing both the primary and secondary schools. The graduation rates of the schools has far exceeded the national averages for both RVCV and local children alike.

In 2010, I first began to accompany the regular bimonthly medical clinics from FAME and quickly realized the need for neurology given the number of children with epilepsy and learning disabilities that needed further attention. Beginning in 2013, we have now been providing completely separate neurology clinics for RVCV as part of our mobile clinic week during which we provide neurological care to more remote communities. Many of the patients who continue to see us here have been with us since the very beginning. As part of their administrative building, there is a wonderful medical wing comprised of small offices where we can see our patients and their full-time nurse practitioner, Katie Anderson, has made it incredibly efficient for us over the last year or so. As we arrive, patients have been registered, divided into adult and pediatric, and we have four examination rooms, each labeled and ready for our use.

The facilities and grounds are, as you would imagine, impeccable and gorgeous. RVCV lies high on a ridge surrounded by coffee plantations which is the main labor for the surrounding community during the picking season. Children live in houses that are organized by gender and age and each has its own house mother who is in charge of their children, getting them ready for school and ready for bed at night as well as during meal times. The primary school is adjacent to the village so they just walk through a gate to get there. Children eat in their own houses where their house mothers cook for them. There is plenty of open area for sports between the houses and there is a large indoor gymnasium as well. Driving through the gates of RVCV is truly an awakening of what can be done with an idea and a will, much as it is driving into FAME for the first time.

The drive to RVCV is another matter altogether. Once leaving the tarmac just below the Ngorongoro Gate, the road travels along a ridgetop for some ways before descending into the first of several valleys with very steep descents and ascents that, in the best of conditions, can be a bit much for the faint of heart. Thankfully, the views from the road are just so spectacular that they do in many ways make up for the extra bumpy and, often, slippery ride. I have loved driving this “road” since my first visit here when I was in the little Toyota six-pack pick-up and turned out to be the only one with experience on mountainous roads with a stick shift. I was asked if I wouldn’t driving and don’t think that I could have answered the question any quicker than I did. That was first introduction to driving in Tanzania – being handed the wheel of that old Toyota at the bottom of one of the gullies. It’s been in my blood ever since, but of course today we had asked one of the drivers and, so, I was missing out on my fun, though sheltered from the stress of trying to drive in a downpour if one had occurred.

The drive is initially along the ridge top with large planted fields on one side and steep hillsides on the other, comprised of smaller planted fields and the occasional homes of the farmers often place precariously, all descending far to the distant bottom of the valley. We eventually make a sharp left turn to begin the first of our steep descents as the road is constantly crosscut by deep gutters and humps that have been dug in an attempt to keep the rain water from running directly down the path, but rather diverting it to the side. Needless to say, it is very slow going. The road is also two way, but, of course, only wide enough for a single vehicle, so when any oncoming traffic appears, you much immediately have a plan of how it will be negotiated. Thankfully, speeds are so slow here, there is plenty of time for this. At times, though, the road is a single lane wide with a wall of dirt on one side and a steep drop off on the other, requiring just a bit more thought into the situation when this occurs.

After the final ascent, we end up in the coffee plantation with its many, many coffee bushes producing some of the best coffee in the world. We travel through the plantation and up a small hill to arrive at RVCV and the small local village that surrounds it. Inside the gates, there are many patients waiting to be see already and, of course, Katie has everything incredibly well organized for us. We have two pediatric examination rooms, two adult examination rooms, a room for our pharmacy and Dan and I have the loveliest spot in the back to sit waiting to discuss cases. One of best things about our day at RVCV, though, is the lunch. The Village has many long term volunteers who all eat their meals together in the dining building that are all cooked fresh by the mamas. It is easily one of our best meals of the trip save for perhaps Gibb’s Farm. Our lunch today happened to be BLTs with homemade rolls, bacon (of course), cheese, tomato, salad, fruit and scrumptious cookies for dessert. I think everyone was incredibly satisfied after that meal – I know that I was.

One of the other programs run by the Tanzanian Children’s Fund is their microfinance and business development that is provided for the surrounding community. One of these groups, the Rift Valley Women’s Group, have been very successful in producing many handmade items from clothing to bags to jewelry that are now being sold in many of the lodges around Northern Tanzania. There is also a small duka, or store, on campus that we always visit now after lunch and there are amazing items that can be purchased, all made by women of the local community. Not only are supporting this incredibly worthy cause, but you are also bringing home a unique and beautiful creation by this remarkable group.

Before coming to RVCV today, there had been some concern about us being permitted to visit as it was anticipated that they would be securing the village in light of the Covid-19 situation. We were thankful to have been able to see our patients there, though upon our departure, Swedi, one of our translators who grew up there and was residing there as the colleges were closed, informed us that he would not be able to join us for the remaining two days of mobile clinic due to their concern and the fact that they would likely be shutting down travel into and out of the village the following day. Though we would miss his help dearly, we certainly understood the reason.

Despite a heavy rainstorm during the day, the roads were no worse for our drive home which was a welcome surprise to everyone. One of the new features we’ve had during our drives in Turtle over the last year, is the addition of a new radio and speakers. Since there are no radio stations to speak of here, we are able to use a USB cable and typically designate someone as the guest DJ for the drive. On our way home, Amisha was the DJ and we were fortunate enough to catch her during a rare rapping session that is now available on YouTube and is previewing on this blog. Just see below.

Dinner at home tonight were vegetable wraps made with chapati (pretty much a staple here), hummus and raw vegetables. Amisha offered to make stir-fry with the vegetables and chicken quesadillas with the chapati, cheese and left over chicken from the night before. They were absolutely delicious and a total hit.

With the time difference being originally eight, and now seven, hours ahead of the us, we were able to come home from work and begin listening to the early news which was obviously all about coronavirus and Covid-19 and where things were heading in the world. The experience in Italy was devastating, though despite all of the news, there had been no widespread outbreaks yet in Africa. We knew that it was only a matter of time and that unfortunately, there was probably a discrepancy in the testing being done compared to the west, and, as a result, the reporting. Meanwhile, FAME had by now installed wash stations in the entrances to every building and had its isolation ward set up and functional. Throughout our trip, though, we have been consulting with authoritative sources at home to help make decisions based on the most recent facts regarding the outbreak and our need to return home early for our own safety. It continued to be the case to this point that there was a greater risk of exposure to coronavirus at home than there was in Tanzania, though it would require constant vigilance and monitoring of the situation going forward.