Thursday, September 16 – Akash returns from Dar (finally), the Tarangire group arrives and a night at the Golden Sparrow…

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Revo and Emily with a patient

As I had mentioned previously, Akash had been in Dar es Salaam since last Sunday due the fact that he needed to renew his J-1 visa prior to being allowed to re-enter the United States. Normally, this would have been a formality, but because of the pandemic it required that a number of things worked in our favor. Thankfully, they all did and Akash had received his passport and renewed visa yesterday and had then taken a flight to Kilimanjaro, but it arrived too late for him to travel to Karatu, thus requiring him to overnight in the KIA Lodge. “KIA” is the name for Kilimanjaro International Airport and the lodge is not your ordinary plain vanilla airport hotel. The KIA Lodge has wonderful room and a very nice outdoor lounge where you can always find groups of climbers who had just conquered Mt. Kilimanjaro and were now waiting for their long flights home the following day to whichever continent they had originated from.

Dr. Anne and Cat evaluating a patient

Knowing that we had clinic starting today at 8:30 AM, I had asked Prosper to have Akash picked up early from the KIA Lodge (6 AM) so that he could make it in time to see the pediatric cases that we had told to come back after he had returned from Dar. Today, we also had a number of patients (probably around 12) who had been brought to see us from near Tarangire National Park and this included a number of children, many of who had epilepsy. The morning began as expected and we had no word from Akash or where he might possibly be. It was not until near noon that Akash finally appeared, several hours later than expected. When I asked him where he had been, he simply explained to me that he was late because breakfast wasn’t served until 6:30 at the Lodge and he hadn’t wanted to miss it. Needless to say, I was a bit bent out of shape over the issue and had even considered causing him bodily harm, but then quickly realized that he was still our only pediatric neurologist and whatever pleasure I would have gotten from doing so would have paled in comparison to not having his around to see the pediatric patients. In the end, Akash quickly got to work seeing the children and all was forgotten once we had finished our day of patients.

Leeyan and Denise working together

We again had our educational lecture on Thursday morning which was given by Dr. Kerry once again as she and Dr. Sean would be departing this weekend and we would have other chances to lecture. This time she covered how to deal with traumatic head injuries focusing primarily on conditions such as subdural hematomas and how to manage them. She included several case presentations as examples which is something that we’ve always tried to do here as it is more often a very effective way to relay information that will be retained.

Working together on a patient

In addition to our regular patients who were coming to see us today (i.e. those from the Karatu region or follow up patients who we had called to come in), we were expecting a Maasai group from near the Tarangire park gate who were coming. They had been expected yesterday, but the van bringing them apparently had broken down delaying their arrival by one day. We have been seeing patients from this area now for several years and they are brought by a Maasai elder who we have just referred to as their “chief,” though he is really more their leader or elder. He has always brought patients in to see us with real neurological issues, such as seizures or migraine, rather then patients with joint pain or muscle aches and this was always very much appreciated as those are the patients who we are most interested in seeing here.

Denise and Dr. Leeyan evaluating a patient

It was last September, when I was here on my own working with Revo and Abdulhamid as my “residents,” that the two Down Syndrome boys, Tajiri and Amani, were first brought in to see us and I had spoken to Kitashu about trying to figure out a way to send them to vocational school so they might be able to contribute to their own support going forward. Kitashu did most of the leg work and we were able to find a suitable training center in Usa River that the two boys visited with their “chief” and Kitashu  and determined how much it would cost for the several years of vocational training for the two of them. Through the generosity of those who responded to my GoFundMe page, https://gofund.me/9d3e6a7b, I was able to raise enough money to send the two boys for several years and have hoped that I might be able to continue assisting other such neurologically impaired patients with their vocational rehab in the future.

Leeyan and Denise with a patient and mother

Last March, we were able to visit the two boys and their families in their village after a game drive in Tarangire. Their “chief” met us outside the park gate on his motorcycle, which was quite a sight to see as he is probably 6’ 3” tall , quite broad shouldered and dressed in shukas with his knife and Maasai club that are carried by all grown male Maasai, and we followed him on tiny trails between homes until we arrived at his home. There, both of the boys met us with their parents and despite the language barrier, exchanged pleasantries as well as a few gifts they had for me. Both boys came today as they were home on school break and I was able to review the “report cards” from school which were all good news as both of the boys were doing quite well in their vocational training. It is so unfortunate here for any children with disabilities as there really are no similar programs to what we have at home with things such as IEP (independent educational plan) or a 504 plan, both of which enable children with disabilities to receive appropriate accommodations that even the playing field for those children without disabilities. As I care for many patients with Down syndrome, or trisomy-21, at home, I am quite familiar with what is typically provided for them such as being able to remain in school until they are 21-years-old rather than just when they finish 12th grade. At least for Tajiri and Amani, we’ve figured out a way to enable each of them to contribute to their own future by learning a trade.

One of our younger patients

In addition to coming to see us today, it also enabled Kitashu to take both of the boys down to the “Double D,” or government dispensary in town so that they both could receive the Johnson and Johnson vaccine, which was now a requirement for them to return to the vocational rehab center. As I may have mentioned previously, Tanzania finally requested vaccine for the country and received one million doses, for a country of sixty-million, last month. Though nearly all of FAME’s staff have now been vaccinated as well as many others in the tourism industry, there has been a significant amount of vaccine hesitancy here in Tanzania, similar to what we’ve seen in the US, and all of it misguided. One funny side note to their visit was that after they had gotten their vaccinations and were waiting around for the others from Tarangire to be finished with their appointments, they had gone down to the Lilac Café to wait. The next day, when having a going away breakfast for Sean and Kerry and being handed my bill, there were charges for some sodas and snacks that I hadn’t recalled ordering and wasn’t inclined to pay. Though broken English and Swahili, it eventually dawned on me that it was for the two boys from the day before and I gladly paid it, knowing that they had all the right intentions.

Matilda deciding to bail on Cat

Sean and Kerry would be departing on Saturday, with Kerry leaving early to go to the Serengeti for two nights, so we all decided that it be appropriate for us to go out and enjoy ourselves for the evening. The options for this type of entertainment in Karatu are very limited and, in fact, there is really only one that would meet our needs. The Golden Sparrow is an eating establishment that also has an indoor disco with a DJ attached to it and has been the site of celebrations during past trips to FAME. I will have to admit, though, that the words, “what happens at the Sparrow, stays at the Sparrow,” have been muttered before, though every evening we’ve had here in the past has been quite civil with everyone making to clinic in the morning. The Golden Sparrow is relatively new on the Karatu scene, and is the successor to the club, “Carnivore,” where they served wonderful grilled chicken, chips (French fries) and drinks. Carnivore had dirt floors and plastic tables with a tiny inside bar and dance floor and though it had plenty of character, was nothing like the newer Sparrow that was opened by the same owner.

Denise getting ready for a run with her headlamp

The night was attended by all except for Akash, who was home finishing work on a paper he was submitting, and Emily, who decided to stay at home and keep him company. The rest of us, which included Dr. Anne, Revo, Leeyan, and Kitashu, all enjoyed dancing the night away to loud music, none of which I knew, and being with friends and colleagues who had shared in the work we’re doing here. There is a wonderful connection that occurs no matter one’s background or age or culture, when you’re working for a common goal that is to help those who are in need and to make the world a better place for all. Those who have participated in this type of work in the past will clearly understand, and those who have not should consider doing so when they have the opportunity.

Cat presenting Revo with his very own copy of the Penn Neuro JAR Guide. He was incredibly touched.

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