I awakened to the sounds of the roosters crowing and dogs barking outside, such an unfamiliar sound for most of the year, but quite commonplace here. It’s either the roosters and dogs here in Arusha at the Temba home, the numerous birds that inhabit the region around FAME, or, when I’m in the Serengeti, often the sound of the male lions trying to locate their pride. These are all sounds I would never have imaged hearing in my previous suburban life, or even my life now in downtown Philadelphia, where the most common sounds for me seem to be the freight trains that run alongside the Schuylkill River and always insist on blowing their horns across the street at the Locust Street crossing. Each and every sound, though, are a part of our lives and make up part of that massive barrage of stimulation our auditory senses receive each day. As for the freight trains, they have become so familiar as not to distract, unless of course I am doing a telemedicine visit from my apartment in which I have to explain to my patient just why it sounds as though a train is about to travel through my den.

It was necessary for me to leave just after sunrise from the Temba’s in order for me to make it to FAME with some hope to fit all of the patients in for the day. I had packed the night before and carried all of my bags, more numerous than I care to admit, into the living room in preparation to load them into Turtle for the next leg of my trip. A long standing tradition here has been for Pendo to get up at whatever time is necessary to make me breakfast despite the fact that I always tell her that it is not necessary. Knowing that it’s a lost cause, though, I certainly did not refuse the eggs, mandazi (small breakfast pastries with little sugar and very tasty), watermelon and small, sweet bananas that she prepared for me in addition to her tea masala that is the absolute best I have ever tasted. Leonard, Pendo and I sat at the table enjoying a quiet breakfast prior to my departure as all of the kids were still asleep, save for Gabby, who joined at some point, but so quiet that I can’t quite remember when that was.

A small house gecko scurrying across the floor after having just eaten a cricket

Ten years ago, on my first return trip to Tanzania, having decided to volunteer at FAME and not knowing how it would change my life forever, I had contacted Leonard to ask him for assistance with my transportation. As you may recall, Leonard was our guide for two weeks when I came over with my children in 2009, and is the one who had actually introduced me to FAME. Leonard had worked, and still does, for one of the best safari companies in Tanzania, Thomson Safari, and over the prior 10+ years, though he had been contacted by past guests, it had never been with the intention of a visit. I don’t recall the exact details of how it occurred, but at some point, Leonard asked me to his home to share a meal with his family and to meet his children. I may not recall the details of how it occurred, but I still remember that first visit like it was yesterday and the fact that at one point, Leonard told me that I was the first white person to have ever eaten a meal in his home and with his family. It is these instances, that come along all too sparingly during our lives, that not only shape who we will become, but will most often also have an equal impact on the others who we share them with.

One of the many hand washing stations placed around FAME

This theme has repeated itself over and over again during the years that I have traveled here and it has not been the result of any long range plan, but rather merely showing an interest in others who we share this planet with and having compassion and empathy for those we meet along the way. For it is through these actions that only good will come and the path you will follow will lead only to success and goodness. Of that, I am certain.

I had intended to leave by 7 am, so a departure 30 minutes late was something of a conquest and I rolled out from behind the walls of the Temba property, as all of the homes here have here, and began my journey to FAME, a route that has now become as familiar to me as any commute I’ve taken in my life.  They live on the east side of Arusha, and to get through town with any semblance of expediency was always an iffy proposition, but in the last year, they have built a much needed bypass around the city for which I am quite thankful for on this morning. Arusha is pretty much like any commercial city you would imagine in a third world country with men pulling wagons alongside the road amidst the congestion of the safari vehicles, busses and trucks that ply the roads. Of course, there are the piki piki drivers also, and the bijajis, the three-wheeled vehicles that came over from India and are an incredible nuisance here, at least to me. And then there are the pedestrians, who far outnumber the vehicles by orders of magnitude, and cross the roads wherever they might find a small opening in the traffic that then quickly disappears. As much as I love the colorful views of Arusha, it is not something that I miss to the degree that I’m willing to take twice as long to get out of the city, and, so, I will be taking the bypass this morning.

FAME’s isolation ward

In the past, there was little in the way of speed limits on the highways, but over the last several years, they have spent a great deal of effort trying to create something close to an organized and, more importantly, safe means of travel on the roads. There are few paved roads once outside of Arusha, and few paved roads in Arusha for that matter, but the one highway that travels in the direction of Karatu, heading west skirting the Great Rift Valley, travels through numerous villages where the speed limit is 50 kph (30 mph) and is strictly enforced these days, and probably for the best. In a region where the domestic animals outnumber the residents, huge herds of cattle, goats and sheep being grazed by the Maasai, are constantly crossing the road and it is not at all uncommon to stop several times in a short stretch to make way for livestock. The same is often true in the villages where herders will be moving their animals back and forth from one side of the road to the other, most often heading to some market to sell some of them.

A pretty blooming bush

The weather was overcast at the start of my drive, but once in the Rift Valley, the clouds parted and a beautiful blue sky loomed overhead inviting me to ascend from Mto wa Mbu (mosquito river) up the steep rift and into the region of Chem Chem (springs) where the village of Manyara overlooks the lake down on the valley floor below. After ascending another steep grade, I reached the village of Rhotia and Rhotia Valley that always so lush and inviting. After passing through Rhotia, I begin the steep descent into the valley and up the other side to reach the town of Karatu where I will be staying for the next month. It has become so familiar to me over the 20+ visits that I’ve had here and the town has grown as well. It is still the dusty frontier town that I first remembered, though, only now there a few three story buildings here and there that weren’t present in the past. Karatutown is the gateway to the Serengeti and Ngorongoro Crater, two of the most famous game parks in the world, known not only for their sheer beauty, but also for their raw and rugged nature.

I drove through town to the turn I know so well and up the dirt and rutted road to FAME Medical that sits outside and above town on the border with the Ngorongoro Conservation Area. I drove past the outpatient department and the reproductive and children’s health clinic on my way to our home, the Raynes House, that sits at the back of the property with the most incredible view that one could ever imagine. Having arrived a bit late, I ran inside, opened my lockers to get my neurology tools and made my way to clinic with unloading a thing from my vehicle. That could be later after clinic. I started right in as I had never left, with Kitashu and Angel checking in patients, Joel taking their vitals, and Dr. Ken and Dr. Revo assisting me with seeing patients.

A hand washing station

We were able to squeeze in twelve patients and still make time for lunch. The big news here, besides all of the changes with COVID-19, is that today was the first day of their EMR implementation. As those of you in the medical field will quickly recognize, EMR stands for electronic medical record and is something that many of us, if given the chance, would run as quickly as we could from as it is an incredibly painful process to make this transition from written charts to a computer based record. Having had the unfortunately luck of being involved with several of these implementations all the way back to residency, in fact, it was something that I viewed with mixed emotions without a question. Many of us in global health long for the days when we can get to our remote clinics so that we can handwrite only what’s necessary and nothing more, but there is little question that this will be a huge advance for FAME and will make things so much more manageable in the long run. Seeing a return patient only once when their paper chart cannot be located is enough to make anyone realized the benefits of having an electronic medical record. In the end, I am looking forward to helping FAME make this transition.