After having spent two full days at O’Hare Airport and, with all of the stress concerning whether we were actually ever going to be able to fly or not, we were on our way to Doha to connect up with the residents for our final flight to Kilimanjaro. Our initial thirteen hour flight seemed to go much quicker than we both had thought it would be, but perhaps that had more to do with the circumstances than the actual time that transpired. We actually bumped into the residents after our arrival, something that would never have happened during normal times given the size and congestion that is typically seen there. At least we were now all in one place and it was merely the matter of one more flight until we reached our final destination, though for Margo and me, it was a two day delay in our plans that had included a visit to a local lodge near Arusha National Park and two days of relaxation. We’d have to find another opportunity to get away so as not to lose the money we had, but we had time to figure that one out.

The delay in Chicago had also now meant that I’d be spending my 65^th birthday for the most part in the air which, even though I do not normally make a big deal out of the day, often not even making others aware, was certainly not what we had intended when making our plans for the two days at the lodge. Thankfully, I have access to the business class lounge in Doha given the amount that I fly on Qatar Airways, and that evening before I next flight, we enjoyed a wonderful meal of the freshest sushi, a huge buffet, and a dessert bar, from which I chose a lemon merengue tart that turned out to be scrumptious and just what the doctor had ordered though by the end, I was quite full. The lounge also offered showers for both of us and comfortable chairs for us to relax in during the nearly eight hour layover we had there.

We met up with the residents again at the gate (they had been in another club that Alex had access to with his Amex card so I didn’t leave them out in the cold entirely) and discovered at boarding that they had switched to a smaller aircraft given the limited number of passengers that were traveling. This meant that all of our seats had been changed, though at this point, that was of little concern as we were all exhausted, and particularly Margo and me, and just getting to Tanzania was the primary objective. The flight was actually busier than I had thought it would be, but regardless of that, we all still had decent seating and, after landing in Dar es Salaam for those passengers that were disembarking there, the plane was virtually empty with almost no passengers left on board. We arrived to Kilimanjaro International Airport (or KIA) in the morning and smoothly moved through immigration as we had all purchased our visas online in advance of our travel and, despite the lack of an empty full visa page in my passport, we promptly moved through to find our baggage, all of which had arrived safely, not always a normal occurrence when flying this route and especially considering the change in aircraft that occurred.

Now that six of us had all arrived together with all of our luggage, it would likely be an exercise in frustration to fit everyone into a single vehicle, even considering the size of Turtle, so Leonard had also arranged for a second vehicle to transport us all to Arusha, where we would regroup and relax for a few hours prior to departing for FAME. Pendo had also wanted to prepare a nice meal for us and spent the better part of the morning and afternoon cooking in the kitchen to present us with a meal fit for royalty and was very much appreciated given the amount of time we had all been traveling. We finally departed for FAME at 4pm with plans to arrive around sunset anticipating an uneventful journey that I have taken dozens and dozens of times now over the last ten years plus that I have been coming here.

I’ve described this drive through the Rift Valley so many times, but I can never imagine it getting old, especially to someone like me who is an armchair physical anthropologist. Arusha is the largest city in Northern Tanzania and has been growing rapidly even since my first coming here in 2009. It is a huge sprawling city of numerous neighborhoods and a central part of the city where there are now numerous multi-story buildings where previously there had been few. There is always traffic despite the fact that the vast majority of people here do not own vehicles and walk or take the dala dala (their local transports that are little minivans with 20 seats in them) everywhere. Following the Rwandan genocide of 1993, the United Nations had a huge presence in Arusha as part of the International Criminal Tribunal for Rwanda that provided many jobs beginning in 1994 and all were western wages. This facility closed in 2015 and, along with it, those jobs went away, many of which had been held for nearly two decades by residents who had now depended on that income. The city has continued to grow and now one can avoid the traffic with a western-style bypass that takes one around through the less congested outskirts, though at a very slow 50 kph (32 mph) pace rather than the 65+ mph we’re used to in the States.

So, we traveled the bypass from Leonard and Pendo’s to meet up with the main highway heading west towards Karatu and, eventually, the Serengeti, before it reaches the modern city of Mwanza, on the shores of Lake Victoria hundreds of kilometers in the distance. Through the many towns in the Maasai region where their bomas abound and large herds of livestock are seen at close intervals from the road, typically being shepherded by the youngest of children who do much of the work. It is wet season here meaning that everything is the most pleasant green and lush as opposed to the brown and dusty landscape of the dry season. We finally reach the little village of Makuyuni that signals our turn off the highway and is the first fuel station we have seen since leaving the environs of Arusha. Continuing straight and we would reach Tarangire National Park, home of the elephants in Tanzania, a wonderful park centered around the Tarangire River. It is important to remember, though, that animals here roam the country at will and the parks were created where the animals are most dense for reasons of water and food. The herds can move from park to park during the seasons and the in the Serengeti, the great migration is a year-long event where the wildebeest move in a large circle from Kenya to the Southern Serengeti and then back again in their search for the grasses that sustain them. Calving occurs in Kenya during our winter months and then they move to the south.

Our turn at Makuyuni allows us to continue west in the direct of Lake Manyara, the famed location of Hemingway’s The Green Hills of Africa chronically his visit there in the 1930s hunting rhino with his wife. Unfortunately, the rhino of Manyara have long ago disappeared from overhunting and are now found only in Ngorongoro Crater and the Serengeti. These are the rare black rhino as opposed to the larger and far more numerous Southern white rhino that inhabit the more southern countries of Africa. The Northern white rhino is now essentially extinct as they are represented by only two females living under protection in Kenya with no hope for survival of the subspecies due to overhunting for many years. Their story is a tragic one, but the black rhinos of Tanzania have made a wonderful comeback after years of protection here by the government.

Making our way towards the town of Mto wa Mbu (mosquito river), we descend slightly into the Great Rift Valley where Lake Manyara sits and is a huge expanse of water now protected as a national park. It has a wonderful array of wildlife though is one of the smaller of the northern safari circuit parks. Only thirty minutes from Karatu, though, it is one of my favorite parks to visit and drive as it is virtually impossible to get lost or disoriented with the lake on one side and the steep cliffs of the rift on the other. Mto wa Mbu is a true frontier town that sits in the Rift Valley and is the intersection of several cultures. Heading north from here and you will take one of the most amazing drives towards Lake Natron and the district of Loliondo that lays close to the Kenya border. But we continue to travel west and begin to climb the massive escarpment leading out of the valley in the direction of Karatu, our final destination on this leg of our journey.

Up and up we climb to the village of Manyara that lays intermediate on a plateau atop the escarpment and before we make the final push up to the village of Rhotia. There are several high end lodges and camps that sit along this amazing geologic feature, a two-thousand foot cliff that overlooks the entire Rift Valley in this region, far north towards Ol’Doinyo Lengai, or Mountain of God, that is sacred to the Maasai, and far south to the far end of Lake Manyara. It is a remarkable view that never fails to amaze me no matter how many times I’ve seen it. The hills are incredibly green as we approach Rhotia and the Rhotia Valley with its lush vegetation and large areas of planted fields where an incredible amount of produce is raised. From Rhotia, it is another steep drop and then a final short rise into Karatu.

The sun is near the horizon and directly in our eyes as I drive though this dusty town once again, my home for two months out of the year for the last eleven years and a place that has welcomed each of my residents for the last seven. It is yet another chapter in our wonderful saga here in Tanzania and at FAME where we have now treated well over three thousand patients and counting and have trained many, many of the doctors and nurses at FAME how to recognize and manage neurologic disease in a region where there are no neurologists. And on our side, we have many, many residents and students who have now had the opportunity to experience the many cultures of Tanzania while practicing medicine in a low resoufdrce setting, but most importantly being exposed to these amazingly resilient people who have welcomed us with open arms and nothing but love and respect. FAME, as well as our neurology project here, has enabled us to greatly improve the general and neurological health of the residents of this district in a sustainable manner that will continue for many years to come, inshallah.