I’ve spoken quite often in the past about “Africa time,” but it’s a topic that is always worth revisiting as it encompasses so much of life here on this continent. This concept, of course, is not unique to Africa, nor was it likely conceived here, though I do suspect that if there were ever a World Cup of something akin to nonchalance, we would rank right up there with the best. The antithesis of this, to be certain, is the schedule we keep at home where everything is timed to the minute and to be late for a meeting or an appointment could be considered downright sacrilegious. That’s not to say there are times for that, but in a society where things are tremendously more laid back and travel can be a particularly difficult proposition, it only make sense that one would use a different system to make plans.

I recall a visit to FAME a number of years ago with Danielle Becker when just a few days prior to our leaving for home, there was a massive wall of water that washed down the side of a mountain at the entrance to Lake Manyara National Park, completely severing the only highway, and the only road of any kind for that matter, to get from Karatu back to civilization. And not only from Karatu, but also to the main road to the Serengeti for there was an alternate route to get there, but it would have been at least two days of driving or more to have bypassed this “inconvenience.” Travelers were having to exit vehicles parked on one side of this newly formed ravine, carrying their luggage or, if they were lucky and part of a tour company, have someone else carry if for them to awaiting safari vehicles and buses on the opposite bank of this disaster.

Danielle and I were essentially stranded, as I had a vehicle that I did not wish to abandon, and it wasn’t clear when the government was going to elect to make the necessary repairs to enable us to return. I will have to admit, though, that neither of us was overly concerned about the potential situation of being stuck in paradise as that could never truly be considered a consolation. In the end of course, and perhaps as much to our disappointment as the alternative, the road was mostly repaired enough for us to make our passage and be on our way.

Equally frustrating, and at the time quite frightening, I am sure, was the episode that Glen Gaulton and Sarah Tishkoff encountered when traveling from a remote region of the Ngorongoro Conservation Area, where Sarah was doing research at the time, to FAME to overnight and drop off Glen to spend the week with us. I should preface this by telling you that the single gate leading into or out of the NCA closes at 6:30 pm without exception so that for all practical purposes, missing the deadline means that you get to extend your visit by a day and either find lodging (which is not readily available in the NCA at a reasonable price) or look forward to sleeping in your car on the rim of an extinct volcano at approximately 8000 foot elevation.

Glen and Sarah were scheduled to be here by dinner time and had planned to leave the NCA by closing time, so when the sun was setting and we had no word from them, we began to worry just a bit. Several hours later, we did finally receive some word from their group that they were still coming, but it was not until nearly 11 pm when they did finally straggle in with some incredible stories of having been stuck in several swollen rivers due to flash flooding from unexpected downpours in the area and having had to literally push their vehicle across the river on several occasions. They were all completely covered in mud as was their vehicle and it had turned out that they were granted special permission to pass out of the conservation area after the gate had closed. I have raced towards the gate on several occasions and am quite certain that had I asked for a similar dispensation for my group, we would have just as likely been sleeping with the rhinos in the crater.

I had planned to spend only one night in Arusha and was scheduled to be at FAME today so that I would be well prepared and rested for my first solo neurology clinic in many years. The evening before, though, I had learned that Leonard had actually thought I would be there for two nights and that he had intended to have some work down on Turtle today. Turtle is actually a bit of a hybrid having taken the best parts out of several Land Rover models and, in particular, the engine and gear box are from an older model as they are more dependable, but in the transformation required to fit them together with the remainder of the vehicle, there were some engineering feats that could be more appropriately referred to as patch work. Some of you may recall the episode of driving to dinner at one of the lodges outside of town and having the entire stick shift disconnect in my hand while driving. Yes, that was a result of this engineering marvel and, though frightening at the time, we managed to limp to dinner (we had been invited to dinner at one of the nicer lodges in area and I was not going to pass that up) and then home using on third gear low and third gear high as all I could use to shift was the transfer case.

Leonard informed me that he had planned to have Turtle’s gearbox swapped out for one in better condition, but that it should be finished sometime around noon today. Having been in this position many times in the past, I knew it was likely to take much longer than that and so informed FAME that I was not going to be leaving until early Wednesday morning, but would still plan to see my schedule that day. Sometime around noon I received word that the mechanic felt it would be best to also replace both the pressure plate and clutch while doing the gear box work, which was certainly fine with me, but I knew that this was like to delay getting the vehicle back. So, without a vehicle at home to run errands, I spent the majority of the day with the Temba children and taking a rare midday nap for me. At one point, Leonard’s brother, Jones, and a good friend Vitalis, who has guided me several times in the Serengeti, came by to help me find spare tubes for my new mountain bike as I knew I was bound to get flats. We went to a small bicycle “shop” which was really a small cubby that had a tiny indoor area to work on bikes, but many very classic old frames and bicycles were there and you could tell that there were enthusiasts lurking around in the area based on the number of kids who cruised in on custom bikes that they had obviously built themselves.

The owner of the shop didn’t have my tubes in stock, but, as is usually the case here, made a few quick calls and after perhaps 20 minutes, two new tubes of the slightly odd size I needed appeared to materialize on the street, brought by piki piki (motorcycle) riders and ferried from who knows where. Regardless of how they arrived, I now had my new tubes and was fully prepared for whatever I may encounter on the roads and trails of Karatu. As you can probably imagine, bike shops and supplies are not readily available once I leave Arusha and having someone put something on the bus to get to me is always a questionable proposition as you never know whether the right thing is going to arrive when it finally does. Having these tubes in my hands on leaving town would make all the difference in the world for me.

So, Turtle went off to the “fundi,” or specialist in Swahili, and, in the end, spent the entire day at the shop for repairs. They were able to swap out the gear box, but had then discovered the issue with the clutch and pressure plate as well as a noise in the water pump. These Land Rovers, though simple to work on and fix, and far less expensive in repairs than the alternative Land Cruiser, so need quite a bit of upkeep which I have learned over my years being here. Turtle didn’t arrive back home until about 11pm which meant that I didn’t have much time to test drive it prior to my departure early in the morning as I had patients at FAME to see, but the entire process was quite necessary and, as I’ve mentioned, this is Africa time. Though I was not entirely happy about the situation, my patients would wait for me and we would make do as that is how things are done here.

I had wanted to attend our 4 pm neurohospitalist conference back home which wouldn’t be difficult as it was at 11 pm my time, and though I was a few minutes late, I was able to join in from across the ocean and another continent since all our conferences are now on Zoom or Bluejeans or whatever platform one uses, making life much simpler to be honest. As the mosquitos were particularly thick in the house that night, I sat in my bed under my netting while I watched and listened about the management of patients back home in the hospital, who were undergoing tests that would be beyond comprehension here and using medications that were completely unavailable due to costs. The contrast was quite stark and only reminded me of how far the concept of health equity still has to go. That’s not to say that the medicine that is practiced in the US is the end all as it really can’t be supported financially in the direction we are going, with common therapies costing hundreds of thousands of dollars, but rather we have to develop standards of care that can be justified worldwide, where treatments are available to those who need them and that is not just the “haves” and “have nots.” Considering we haven’t yet settled that question in our own country, where there are many individuals completely without access to healthcare, the quest to do so on an international scale can be seen as a daunting task. Yet, it is this dream of health equity that continues to drive many of us on a daily basis.