Wednesday, March 18, 2020 – It’s back to Mang’ola….


The main office of the clinic at Mang’ola

Lake Eyasi is probably one of the more remote locations that I have ever visited, and it is probably one of the most unique places as well. I had already discussed the trips that FAME used to make to this region as part of its malaria education project that ended several years ago, and where we are heading today is a region that is not quite as far as we had traveled for those clinics, but close. Lake Eyasi is home to the Hadza, the last hunter gatherers in Tanzania, that are small tribe and who are slowly becoming smaller over time due to encroaching grazing by neighboring tribes, including the Datoga, whose cattle have reduced the Hadza’s normal prey. Lake Eyasi, which used to be home of large game such as hippos, kudu and other antelopes, has slowly seen a reduction in these animals so that the Hadza have resorted to hunting small birds, dik dik, and baboons for food. They are, unfortunately, a dying tribe of only 1,500 individuals and, once they are gone, not only will we lose their culture, but also their unique click language that is so rare in the world today. Mike Baer wrote a wonderful piece regarding his care of one of these remarkable individuals that is published on the FAME website and can be found here:

Carrie (enjoying her apple) with Molly and Frances readying to see patients

Alice, Africanus and Robert

Marin and Amisha

Lake Eyasi has a number of villages that surround it and the region has been increasing in population due to the very successful onion farms that have continued to grow in the area. Picking onions is the main occupation here and during the harvest season, large trucks full of onions are continuously traversing the often treacherous roads bringing produce to market. Today we will be returning to Mang’ola where we had first visited last September for one of our mobile clinics that was so busy, we needed to come back a second day and ended up seeing over 70 patients over the two days. For today’s clinic, we had tried to anticipate this and scheduled a second day of clinic in a nearby village, hoping those who could not be seen on the first day here could simply travel on the second day to the other nearby village.

Joel and Lobiko waiting to take vitals

The clinic health officer going over coronavirus precautions with the townspeople

The washing station outside our clinic – social distancing was not yet a thing.

Anne, Kitashu and Joel getting our clinic organized

The drive to Mang’ola is through landscape far different than any we’ve seen so far on this trip. I’ve been through the region on many occasions over my ten years in Tanzania, but for the others, the topography appears incredibly alien, as if it’s from another planet. The road initially travels atop a very large expanse of relatively flat terrain, while dipping down into deep gorges every several miles to travel across dry streambeds, that though dry now, were very clearly recently with water from one of the many storms that have come through in the recent days. At the bottom of each gorge, one most often encounters a slab of cement that is meant to offer safe travel across, though their appearance can be all but reassuring at times. The flash floods that travel through these canyons leave a pleasant looking meandering stream bed on the uphill side, but the downhill side typically appears as a steep drop off, having been completely eroded away by the quickly flowing water. Traveling in this region in the wet season is often impossible as these gorges can quickly become fast moving rivers that are impossible to cross.

Joel getting vitals on a patient

Frances working with one of her patients along with Lobiko translating

Africanus and Alice taking a history

Carrie (as a scribe), Abdulhamid and Molly evaluating a patient

The road is quite easy to follow for most of our drive, but as we get closer to Lake Eyasi, there are multiple forks with no signage to direct you that often require some help from the local residents. As we crest a small hill, the Lake comes into full view and is many times its normal size with the recent days of rain that have fallen in the region. Despite this, it is still incredibly dusty as we travel along in tandem along the main road that is often blocked by herds of cattle, sheep and goats or erosions in the drainage areas. There are many, many small traditional homes as we enter the village perimeter and finally see some semblance of the town before we turn left and find the health center we’ll be working in today after a very short distance.

Kitashu chatting with a patient

Joel and Lobiko dispensing meds

Dr. Anne, Amisha and Marin evaluating a patient

A friendly spider

Having been here last September, the setup is still quite familiar to me and everyone gets out of the vehicles to check out where we will be working for the day. The district health officer is the same one who had been there in September, greeting us with enthusiasm and quickly checking as we survey the rooms we’ll make into our examination rooms for the day. He had been incredibly gracious during our last visit here, especially after we had returned the following day to the remainder of the patients, and he’s happy to see us back again as we’re here to help his community and he’s grateful for that. As we arrived, there was a very large group of patients outside of the health officer’s building where it turned out he was addressing them on the coronavirus situation and subsequently demonstrating the handwashing stations that had been set around the health center with one just outside the entrance to our building. Even in this incredibly remote region of Tanzania, there was already growing concern by the general population of the impending pandemic and this was becoming ever more clear with each coming day.

Amisha evaluating a patient

Joel getting vitals

Dr. Anne evaluating extraocular movements

Amisha working on the neuro exam with Dr. Anne

The health center here in Mang’ola is really very comfortable for us as there are many rooms in the buildings were given for the day and we quickly made arrangements for who would be working together and in which rooms. There were benches for some of the patients to sit on while other sat on the floor of the large outer room, and still others waited outside to be called. Everyone was triaged in advance by either Kitashu or Dr. Anne and I think we did very well with only a few non-neurology patients being seen that day. Dan and I sat outside on the large covered porch that bordered the entire front of the building and was a great perch from which to watch the comings and goings of all the townspeople. Both Dan and I were particularly drawn to the many children who gathered outside, some of who were patients of ours, but others were here with their mothers. Many of the children were particularly well-dressed and it was all I could do not to continually be taking their portraits, though I could resist just a few of them. Dan seemed to have made friends with one young boy who sat on his lap forever playing with his phone taking some pretty nice selfies of the two of them.

Dan and his friend

A fine selfie

Curious children

There were many great neurologic cases that we saw in Mang’ola, but the best of them had to be the young woman who came in with a neuropathy that was clearly hereditary given her age and, with further questioning, was quite clear that it was Charcot-Marie-Tooth disease, or hereditary motor and sensory neuropathy (HMSN), a rather common group of genetic disorders affecting the peripheral nerves. With further questioning, it was very likely that other family members also had the disorder, so, like any good clinician with a research background, Dan, who happened to be staffing the patient, inquired about having the other family members come to see us. After the initial thought of sending one of our vehicles to pick up the other family members, it became readily apparent that it was far easier to have Dan go to their home, though that is not something normally done here and required some long discussions with the health officer and a village elder to get permission to do so. Eventually, Dan left with one of the drivers to visit the family, not far from the clinic, though, given the topography, a bit further than I think Dan had expected. I was truly jealous of the fact that he got to do the exploring this time, but he had clearly earned it given his commitment to the program with his second trip to FAME.

Dan’s visit to a patient’s home

Amisha and a young patient (obviously her favorite)

Marin pitching in with Lobiko in an improvised exam room to finish up with patients

Dr. Anne with a patient

Not to be outdone by the bats at Upper Kitete (you’ll have to read my older posts for stories of the “bat cave” there), there were several of these nocturnal creatures under the rafters of the building and quite aware of our presence. They would shuffle along just underneath the roof and between the rafters as you would stop to look at them as it seemed to make them nervous. I’m sure they were not happy with our presence and the crowd of people that had come to see us. Along with the bats, there were also relatively large lizards (not Komodo dragon large, of course) that were creeping along in nearly the same space as the bats, but neither could care less about the other and were far more concerned that I was stalking them for photographs. For those of you who don’t know, my love of reptiles goes all the way back to my childhood and time spent in our family pet shop.

A friendly visitor

A friendly spider

Marin undoubtedly writing directions for a patient

Marin hard at work

A typical mode of transportation for our patients

As we said goodbye to Mang’ola for this trip and began our trek home in the waning hours of daylight, I think we were all contemplating not only another successful day of neurology clinic and mobile clinic too boot, but there is little question that each of us had in the back of our minds growing concern for the impending coronavirus and what our days ahead here would hold for us. It was clear that the pandemic was growing in intensity and even though there were no reports of its presence yet in Tanzania, we would have to pay particular attention to our travel plans in the future. We did have plans to go out to Happy Day this evening as it was the night that all the ex-pats in town met to share stories, but given the long day we had (we left at 7 am) and the time we arrived home, no one had the energy for a night out and we all decided that we would earmark next Wednesday for our last visit with everyone.

Our journey back to FAME




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