Friday, March 12 – Day 2 of Neurology Clinic…


March is the wet season here in East Africa, meaning everything is very green and the weather can be iffy at times. It has been nothing but bright sunshine, though, since our arrival several days ago and we’re hoping that this trend will continue. When it does begin to rain, it can be very treacherous getting around on the roads whether you are driving or walking due to the extreme muddiness and slipperiness. Early on, while driving to one of our mobile clinics, the Land Rover that I was driving managed to slide off the heavily crowned and muddy road into a drainage ditch, leaving us completely stranded for the better part of the afternoon and required that we be pulled to safety by one of FAME’s Land Rovers that had been unable to get very close to us for fear of their becoming stuck as well. Each wheel had to be individually jacked up, dug out and backfilled with stones and debris before moving on to the next and, finally, when the vehicle was raised up, it was jerked and pulled free. We finally made it back onto the road, but then there was the problem of not slipping off again and, much to my chagrin, no one else there was capable of driving a stick as for the first time in my life I would have been more than happy to have handed over the driving duties to someone else.

It has been absolutely gorgeous for us so far with total sunshine, not a cloud in the sky and incredibly comfortable temperatures hovering around 80° F during the daytime. The nights have been equally comfortable, though it would be nice if it cooled off just a bit more for sleeping. We’re almost exactly a mile high here at FAME while atop the crater rim, it reaches over 8000 feet and can become quite cold at night, but mostly in our summer months of July and August.

Normally, our daily routine here is a bit different as we would typically all be attending morning report at 8:00 am, but with the pandemic and social distancing, it has been decided that the smallest number necessary would be present for the meeting. The conference room used to be packed with doctors, nurses, and volunteers, all sitting around the perimeter of the room and at the large conference table in the middle, but now the attendance is appropriately sparse for everyone’s protection. What was an incredible daily meeting to discuss inpatients and interesting out patients here at FAME, is now a very abbreviated and sparse session that is more to pass on information to the oncoming coverage team. Over the last year, there have been essentially no volunteers, other than me, that have come to FAME due to the travel restrictions caused by the pandemic. Teaching sessions, often run by whichever volunteers happen to be here at the time, have also been put on hold to limit the number of people present at all gatherings, though a number of us have continued to make these available from the States using Zoom.

Ultimately, the mission of FAME is to create a completely self-sufficient hospital and health center that will be run by all Tanzanians and require no outside support other than financial. Another of those silver linings of the pandemic is that FAME has successfully proven their mission as there has been essentially no outside clinical support from volunteers over the last year and, despite this, FAME has not only weathered the COVID storm successfully, but it has also served in a leadership role for other government health centers and hospitals in the Karatu district. Amidst the turmoil and stress of the pandemic that has changed our lives forever, there have been many triumphs, even here in rural Tanzania.

Without morning report, we don’t have to be at clinic until 8:30 am which is a welcome half an hour in the morning to finish breakfast or to exercise (residents only 😉). Usually, neurology has been a completely separate clinic space where patients check in and vitals are taken, but with the new screening process for COVID symptoms, all patients are seen first for screening and vitals in the same area and are then directed to where we are seeing patients in our open air clinic. The pace we’ll maintain at clinic for the month will be dramatically slower than our normal mob scene that we encounter every day during our normal clinics. We most commonly hand out numbers to patients and those over our quota will be seen the following day first, but it is typically impossible for us to see all of the patients that show up each day. By the end of the clinic, we are typically caught up and have been able to see everyone.

Part of the Neuro Team ready for work – (from left to right) Dr. Anne, Jess Fan, Revo, Alex and Jess Saunders

As expected, there were several patients waiting to be seen by us on our arrival this morning and even though the numbers were small, they remained steady throughout the day. Most were follow-up patients who had been called by Kitashu or Angel the night before to come to clinic for visits, though several were new patients who had either heard that we were here or had been referred to us by the other clinicians at FAME. As we have found in the patient data that we’ve kept over the last years, it is our epilepsy patients who have had the greatest likelihood of returning to clinic for follow up visits which is most likely based on the impact we’ve had on their health and quality of life. Many of the patients who we see here have never been evaluated or treated for their epilepsy and the impact of having their epilepsy controlled for the first time is truly life changing in so many ways.

Having finished our clinic at a respectable time, it was home to the Raynes House and a quiet evening enjoying some gin and tonics and eventually dinner. Darkness falls quickly after sunset and given the incredibly low amount of light pollution, the stars come out quite early for some serious star gazing and an incredible milky way that looks like a wide, twinkling, diamond-studded belt stretched completely across the sky. The constellations and planets are all easily visible to the naked eye while slow moving satellites intermittently show themselves as they progress on their appointed trajectories and shooting stars appear randomly throughout the night. We’re south of the equator so we are seeing all of the southern constellations, though I must admit that I’ve never been much of an astronomer beyond the big dipper and the North Star. I remember fondly each of the nights on our original safari back in 2009 when we overlapped with another group at the camps who had one of those fancy star spotting scopes that would identify each star and constellation and being totally enthralled with the technology. Now, with a simple app on my iPhone, it’s easy to identify each and every celestial body in the night sky and given the incredible weather we’ve had, the nights have been clear and inviting.

Tomorrow, we have a half-day of work as it is one of two of the resident’s “wellness” afternoons for the month. Though I’ve argued that the entire month is made up of wellness days, I’ve been asked to include these as part of the resident’s work schedule. We also have plans for dinner at Gibb’s Farm tomorrow night which has become a tradition for each group coming to FAME.

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