I know that I’ve mentioned the kuni boilers before, but perhaps it would be helpful to mention the story of the hot water situation here at FAME from the beginning. When I had first come to FAME in 2010 to volunteer, they were completely off the grid and on solar power which meant, of course, that any piece of equipment that was used here could not require any significant amperage of electricity. I recall that in the very first volunteer instructions it had said, “absolutely no hair dryers” and, even though I believe that still to be the case, it is more for practical reasons now than it was in the beginning when an appliance drawing that many amps would either blow the circuits or drain the battery. That also meant no conventional hot water heaters. Needless to say, taking an early morning shower in those days, when there was no hot water, was an exercise in speed and efficiency as our water here is well water that has always been ice cold at the outset.

I do recall that at one point, Frank had experimented with some fancy low power hot water heaters that were mounted to the outside wall (I do believe there was also a notice on each of them that said, “not be installed outside”), but these never worked probably and I’m not sure that I can recall them to have ever worked properly . Therefore, it was still the ice-cold early morning showers that were still the standard fare for everyone. I should probably mention that even regular homes here that utilize a small hot water heater do not have them running all the time for “on demand” hot water, but rather you must flip a switch on the wall to turn them on and then wait 10-15 minutes for the water to heat before a hot shower. In the early years, traveling on the large mobile clinics to the Lake Eyasi region where we spent 5 days and it was pretty much like camping most of the time, we would take “bucket showers,” where you would have a five-gallon bucket and a cup with which to shower. In the mornings, the village women would boil large pots of water for us to use for our showers and then it was a matter of mixing the hot and cold water in your bucket to get just the right temperature. I remember thinking then that it was the height of luxury to even have hot water in those situations.

When the kuni boilers came into existence at FAME, they were like a Godsend as we now had hot water, most often in the morning, but it would often last throughout the day depending on how many people were utilizing it. When the Raynes House is full, as is often the case when the residents are here, it will often not last long enough for everyone to shower in the morning, unfortunately. Stepping into the shower when you’re expecting a nice hot, or even warm, shower can be more than disappointing to find out that is the not the case. Of course, the kuni boilers are wood fired, meaning that not only do they have to be lit, but they also be loaded with wood and, even though they burn quite efficiently, it still requires that they are loaded with wood which is done by our Maasai askari, or guards, who are patrolling all night to keep us safe, but also stoke and light our kuni boilers in the morning.

Meanwhile, back to the power situation at FAME, as it no longer relies simply on solar power. Once the hospital and operating rooms were built, there was always a need for a backup situation as the power demands for these services became greater and greater, and, finally, with the addition of radiology and a CT scanner, the demands far exceeded what could be supplied even with a generator. It was finally the time for FAME to become part of the power grid here, but even that may not be what it seems to those of us in the western world, as power here is not as reliable as it is back home where you may lose it once in great while when a heavy storm comes through. Here, there are constant brown-outs, some which are scheduled, but most which are not. I can’t tell you how many times I have traveled to Arusha, planning to charge my computer and phone when I arrived, only to discover that the power was out here and it was a lost cause. At FAME, thankfully, we now have a generator that will kick on, typically, within six or so seconds from when the power goes out and this is not all too uncommon. Finding a generator large enough to run the necessary equipment here was not easy task as you can imagine, nor was laying the necessary power lines to carry it, but thankfully FAME has had the assistance of a master craftsman for a number of years to help with this planning, Nancy Allard, a rare combination of a an architect trained in Switzerland, and an ICU nurse trained in the US, who came to FAME, like all of us, while on Safari, and decided to move here for a number of years. Though she’s now back in the US working as a nurse, she continues to work on projects for FAME and is responsible for much of the growth that has occurred there. If it had not been for Nancy’s help, the Raynes House would not be what it is for us today.

As is usually the case, I set aside several days at the end of our scheduled clinic to see follow up patients and to wrap things up if there were still things that needed to be dealt with. We had asked the mother with the young baby with infantile spasms to return today to see us, and, somewhat embarrassingly, none of us realized initially that we had seen them several weeks ago and proceeded to take a completely new history until we finally realized our mistake. We had placed the child on high dose steroids, and though it was unlikely that we would see any reduction in the child’s seizures given the amount of time that they had been occurring, we had still felt it worth an attempt. As expected, she had not noticed any change in the frequency, and so, we discontinued them and started the child on valproate gradually titrating to a therapeutic dose. Ultimately, though, the child was severely impaired and delayed and it would be very unlikely that they would improve in function which is what we tried to explain in the most compassionate, but realistic manner possible.

We also evaluated a young Maasai man who we had seen in the past, who doesn’t necessarily have a neurological issue, but came to us last March with a very unique problem that we are still not 100% clear of what it is, but our experts at CHOP have weighed in and feel that it is very likely just an indolent osteomyelitis of the skull rather than anything else more exotic (though, I must say, this is certainly not something you see every day). He has essentially had a progressive course that has deformed his skull and has caused not only numerous eruptions of his scalp to occur, but has also had problems with his vision due to misalignment of his eyes from his skull deformities, which is what initially brought him to see us in the first place. He has been placed on a number of antibiotic courses in the past including intravenous antibiotics, but nothing that has likely been long enough to fully suppress the ongoing infection. Hopefully, we will be able to get on top of this sometime in the near future, but it’s quite difficult given the many limitations posed by what is available.

Tuesday was our last official day in clinic for this trip and I had decided to spend Wednesday working on completing charts and would leave Karatu on Thursday morning to head for Arusha. It was my last day to work with everyone who had been so amazingly helpful in making the clinic run so smoothly and I was grateful that, despite the absence of the residents, we were still able to see in the neighborhood of 140 neurology patients that we had either contacted to come for follow up visits or who had been referred from the other doctors at FAME to come see us. There were also those who just happened to come at the right time with a neurological problem and were directed to us by reception. I am certain that there were also some “word of mouth” referrals that had heard about our presence from others who had seen us, which was certainly fine as long as they had a neurological problem for us to evaluate.

I had missed working with Dr. Anne, who had unfortunately broken her ankle just prior to our arrival and had been laid up at home with her leg elevated for the entire month, but I know that she will be back working with us again in the future. There are always silver linings, though, and this one turned out to be in the form of Dr. Adam, someone who I had not had the chance to work with in the past as he had just come following our rather sudden departure in March with the COVID crisis looming. Adam, who was an incredibly quick learner and a remarkably capable physician, found neurology fascinating and will very likely become our second “FAME Neurologist,” someone who will have the necessary skills to follow and manage our patients there, but also the ability to evaluate and diagnose the more common neurological illnesses that we see. He and Dr. Anne will also be able to communicate their assessments of the more complex neurological patients so that we can assist remotely in those diagnoses as well.

I said goodbye to both Abdulhamid and Revo, my two incredibly capable brand new graduates who have worked with me on several occasions now and will hopefully work with me again in the future. I know that would be working at FAME the following day, though not seeing patients, and so I would not have to bid farewell to anyone else this day.