I will be the first to admit that the pandemic has clearly affected FAME, but not necessarily in the ways one might have expected. When things first hit, FAME went into action mode immediately and was the model of system change in this very rural portion of Northern Tanzania. They set up training sessions regarding safety that were not only attended by our staff, but also by other district health personnel and were likely responsible for the fact that things were handled so well here in this region where supplies and health services are very scarce. In cooperation with the district health authorities, FAME became an integral part of this areas response to coronavirus and, in doing so, served to provide the community with the very same quality healthcare they have become known for over the last dozen years.

And, most importantly, this was an all Tanzanian response to this natural disaster. Though FAME’s model for years has been to have western volunteers here to assist the Tanzanian doctors by teaching them specialties that are not always available here or to help with surgical training, it has always been the goal that this will be a medically self-sufficient healthcare facility completely staffed by Tanzanians who are providing all of the services. In March, when the pandemic hit the world for real and it became clear that we had to return to the US at once for fear of having to “shelter in place” for months (or longer it now turns out), I left FAME with our mission nearly complete and was the last volunteer to leave. It is now September, and there have been no volunteers here at FAME in the interim, yet they have continued to perform in a superlative fashion, on their own and completely self-sufficient, even in the face of the looming pandemic while still continuing to provide all of the necessary “routine” healthcare that they have been delivering since the very beginning of this project. That could not have been done without the amazing Tanzanian talent that exists here and, for that, they are to be commended, though I doubt that any one of them would consider themselves a hero, yet, quite simply, that is what each and every one of them has been.

So, I was the last volunteer to leave in the spring and have been the very first volunteer to return. There was little question for me what the right decision was going to be regarding my return and, barring taking any absolutely unreasonable risks, I felt the need to return for a number of reasons. Top among them were my patients, many of who I have followed every six months for many years and who would expect me to be here for they are not watching the news each night, as we are in the US, to know the exact nature of this worldwide healthcare disaster. There has been a level of trust that I have spent years to develop with the patients here, who know that I return each and every six months and, to have not returned, could have damaged that trust irrevocably, which was something I simply could not fathom. As much as my patients have come to trust me, though, so have the doctors, nurses and staff of FAME and I felt a strong sense of commitment to them, knowing full well that my simple presence would essentially be a moral boaster for them. Seeing me in the corridors of FAME would provide a sense of comfort to those I have come to know as family and would restore their connection to the rest of the world. Any concern of abandonment that anyone here might have had would be quickly allayed by my simple response of “marahaba” to their greeting of honor, “shikamoo,” as we passed in the hallway each time. Simply put, FAME has weathered a tremendous storm in the most successful manner possible and there is little question of them continuing to do so for many more years to come.

The African Galleria

I had hoped for a quiet clinic today as I had been invited to lunch by a good friend at his African art gallery, the African Galleria, that is about 20 minutes out of town in the direction of Lake Manyara. I had been introduced to Nish a number of years ago by one of prior volunteer coordinators and we have stayed in touch since. His gallery is perhaps the largest in Tanzania and relies nearly entirely on the safari company traffic that passes by every day on their way to Ngorongoro Crater and the Serengeti. There are usually hundreds of vehicles that pass, many of who also stop to spend some time shopping. Nish and his brother had just completed a major construction project to develop a wonderful outdoor restaurant as well as major renovations to the inside of their shop so that everything inside and out is now perfect, that is other than the lack of tourists and safari traffic that has occurred since the beginning of the pandemic. There are now signs that some of the visitors are coming back, albeit quite slowly, and no one knows for how long as there are still many concerns about the future of this virus in Africa and elsewhere.

The African Galleria

I sat outside with Nish as my pizza was being prepared and we had the place to ourselves. Sadly, there were no other vehicles or tourists for much of my visit there which was a constant reminder of the current time that we are living in right now and the challenges that remain ahead of us. As we sat at one of the tables of his lovely outdoor restaurant, the impact that all of this has had on every aspect of our daily lives was readily apparent, from FAME, to the African Galleria, to the safari companies that are dependent on the tourist travel to this lovely country. All are trying to make do in these times of hardship and some are more successful than others.

The African Galleria

I left the gallery to head back up to Karatu on a nearly empty highway that remained such until I was in town where much of life here seems to be at an almost normal pace with the markets full of shoppers and the normal hustle bustle on the streets that is this place I love. You would be very hard pressed to guess that we were in the middle of a worldwide pandemic if you based it solely on the appearance of downtown Karatu, other than perhaps the near complete absence of safari vehicles plying up and down the main street, coming from or going to the Ngorongoro Gate that leads to the Crater and the Serengeti.

The African Galleria

It was rather late in the afternoon when I arrived back home to my house and I had originally thought that I would be having dinner with Daniel Tewa tonight, though we had apparently had our wires crossed, for he was actually out of town and had expected me a different time entirely. Faced with the sudden freedom of an entire evening to myself, I chose to do some reading from the book I had started here, King Leopold’s Ghost, the previously untold story of King Leopold II and his quest to own a colony that eventually became the Congo Free State where horrible atrocities and genocide of monumental proportions occurred around the turn of the century. It’s a hard book to set down once you get it started and I look forward to reading more each day. It was a relaxing evening of quiet in the Raynes House that night, far different from the house full of residents that I have become accustomed to on my normal trips here. Truth be told, there are advantages to each, though in the end, I much prefer the latter for having my full team here with me allows us to do the most good, see the most patients, teach the most, and ultimately provide the greatest benefit for the people of Tanzania while also allowing those residents and medical students who accompany me to experience the world of global health and health equity.