Friday, September 17 – A few difficult cases, stopping by Teddy’s duka and a visit with Daniel Tewa…

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The FAME team of doctors with Dr. Kerry and Dr. Sean

There was no educational lecture this morning so that meant a half hour more of sleep for most everyone. I’m usually the earliest one up in the morning as I like to get some things done, but Emily has also been up very early (though at least she’s in bed early as opposed to me) so there’s always been hot water ready to go for my tea. The mornings here are usually quite gorgeous, but the weather pattern has been dense clouds and very cool in the morning, perhaps another sign of the ongoing climate change that so many in Washington have chosen to ignore despite all the science to the contrary. Thankfully, for the moment, though, the skies have typically cleared by noon and the afternoons have been quite pleasant and occasionally warm. This is not the coldest month of the year here for that is in July, but it can still be very brisk in the highlands where we are located, and even colder on the rim of the crater several thousand feet above us.

Our lunch table behind the cantina – rice, beans, mchicha, pilipili, and banana. A definite favorite

Kelley Humbert and Paul Novello, two colleagues from Penn, would be arriving tomorrow to join us and we were having some issues with their travel. Kelley had been here in October 2016 as a resident and is now a neurohospitalist at Penn, while Paul, also a neurohospitalist, had never been to Africa. They had left Philadelphia yesterday on Qatar Airways and because we would be heading to Ngorongoro Crater on Sunday and they wanted to join us, the connections were through Dar es Salaam on a Precision Air flight. That leg kept getting bumped later and later on Saturday such that it meant they would arrive to Kilimanjaro too late to make the drive to Karatu – night driving is incredibly dangerous here due to both animals wondering into the road and crazy commercial drivers who pass when it’s unsafe.

A difficult discussion

Kelley spoke with our travel agent prior to leaving Philadelphia to inquire about just not using the last leg of their flight and booking on a different airline arriving in Kilimanjaro earlier. Unfortunately, they were told that doing that would void their return flights. They arrived into Doha at around 5 pm today and, thankfully, the airport had excellent WiFi so we could stay in touch about their trip. I had to make an executive decision, though, and booked them flights from Dar to Arusha that would depart shortly after they arrived there and would get them to Karatu early in the day meaning they would come to the Crater with us. I would have to speak with them once they arrived in Dar and that would be tomorrow morning.

Dr. Anne and Emily delivering difficult news to a family

Meanwhile, we did have a clinic to run today and had plans to visit my good friend, Daniel Tewa, in the late afternoon for coffee. More about Daniel later. The two patients that stood out during today’s clinic were both difficult, but in very different way. The first patient was a young woman who had been involved in a very bad motor vehicle accident earlier in the year, not only suffering multiple traumatic fractures of her limbs, but also a very serious head injury that left her non-communicative and bedridden. Her family had brought her to us to see what we had to offer in the form of rehabilitation or anything that could help her get better. Unfortunately, her injuries were devastating and irreversible, but it was unclear whether her family had ever been told that or not. Emily had done her best to obtain a detailed history from the family, though in the end, it really didn’t change what we had to tell them. Ultimately, it required a discussion that was very difficult and involved both Emily and Anne that took not only quite a bit of time, but also their energy as it was very draining. The patient did have a very large sacral decubitus ulcer (bed sore) that was originally concerning, though in the end, it turned out that it was being dressed at home by one of FAME’s nurses so we were reassured that it was clean. How long the patient would survive in this condition was something that no one could really tell, but in the end, she would probably succumb to a systemic infection or something similar and there was very little that could be done to prevent it.

Dr. Anne and Emily speaking with the family of the neurologically devastated young woman

The second patient that stood out to me appeared at the very end of the day and was actually someone who arrived after I had told Kitashu that we were finished with patients. It’s essential that we have a time after which we stop seeing patients, otherwise, we would be stuck in clinic all evening long as patients would continue straggling in to see us and it would never end. Most of the patients we see are from the Karatu region and though it is certainly not the most convenient to return the next morning if we ask them to do so, sometimes that is necessary given our volume. This patient was brought over to us and I agree that we could see her before realizing that she had a bag full of records and prior imaging.

Revo, Cat, Anne and Emily all contributing to our final patient with a bag of records and radiology studies

Her complaints were varied and numerous and very little of her story made a lot of sense to us outside of her having fairly simple radicular symptoms in the lower extremity that didn’t require our involvement necessarily. What made matters even more difficult was that she had undergone a multitude of testing at a number of different sites and though she had the results of all of the testing, it didn’t make much sense to us. It seemed that she had been evaluated at some point for demyelinating disease, or multiple sclerosis, which really doesn’t exist much here given that we are on the equator and when we reviewed her MRI scan of the brain that had been read as possible MS, it was much more consistent with small vessel ischemic disease, a common problem, especially in those with hypertension, a condition from which she also suffered. In the end, all that we really had to offer her was to treat her hypertension better, take a baby aspirin and put her on a statin medication to keep her lipids low. Anne did her best to explain everything to her in detail, though she continued to want more explanations of everything until even Anne, the most thoughtful and concerned clinician I know, had become completely exasperated.

Teddy in her new shop sorting through clothing
Dr. Sean tying his bow tie with Akash’s help

As we had planned a visit to Teddy’s late this afternoon prior to heading to Daniel Tewa’s home, everyone abandoned Anne and her patient so we could change and get Turtle for the drive. Anne was coming with us, of course, to help at Teddy’s as it always helpful to have her along since Teddy’s English, is about as good as my Swahili, meaning that we both need a translator, hence Anne’s participation in the venture. By the time we had returned to the pick-up Anne, she had finally finished with her patient and was ready to head out. Teddy, had also moved her shop since the last time I was here which meant that we had arranged to meet her at Happy Days with her boda boda (motorcycle) driver so she could then show us the way. Kerry, who had a number of clothes made, would be leaving town in the morning which meant that her orders were the priority for this visit, while Sean, who would also be leaving tomorrow, did have a bowtie made that he would pick up. All of the other clothes could wait if necessary.

Philip, Akash, Denise and Emily watching an Indian soap opera in Swahili. Talk about lost in translation
Sean checking out his bow tie in the mirror

At Teddy’s shop, Kerry immediately went to work modeling her clothes for us (they were all great and fit perfectly which was amazing how given the little time she had been given to create them) and Sean modeled his bowtie, which, I will have to admit, was just a bit much with his scrub shirt and in the middle of East Africa. The effect was there, though, and everyone was tickled with her work and looking forward to our subsequent visit for everyone else’s clothes to be presented. I had met Teddy through a previous long-term volunteer here and she has continued to do wonderful work for all the residents and others who have wanted pieces made from the colorful and bold kitenge cloth that is worn here. Her new shop (and home) is also very nice as it is not only her workshop for making clothing, but also a neighborhood duka (shop) where the local residents come to buy sundries, many of them stopping by while we were there. It is so important that we support the local merchants like Teddy while we are here, though most of her work is for the local population and I am certain that we are the only outsiders that visit her.

Dr. Sean over the top with his bow tie
Teddy at work

Once finished with our fitting session, we hightailed over to Daniel Tewa’s home for the daylight was quickly waning and I wanted to make sure we had plenty of time to spend with him. I have spoken of Daniel many times in this blog, but he is an incredibly special person not only to me, but to his Iraqw community. I had first visited Daniel in 2009 when I was here on safari with my two children and we had chosen to do some volunteering at the end of our trip. Not knowing where we would be volunteering in advance, Thomson Safari had paired us with the village of Ayalebe here in Karatu and we spent three days painting the local primary school during which time Daniel joined us. This was also the time I was introduced to FAME by our guide, Leonard, forever changing my life and cementing life-long friendships not only with Leonard, and eventually his family, but also with Daniel and his family.

Daniel Tewa and me on my very first visit back in 2010

When I had decided to come back a year later to work at FAME, I contacted Daniel and he not only remembered me, but also immediately asked me how Daniel and Anna, my two children, were doing. When I visited him for dinner that very first trip back to Karatu in 2010, he told me that of all the hundreds of foreigners (for he gives cultural visits for the tour companies at his home) who had visited him during their safaris, I was the only one who had reached back out to him and the only one who had come to his home for dinner. He told me of how incredibly honored he was to have me visit his family and home, but it was I who was the one that most honored. Since that time, Daniel and I have become attached by that special bond of friendship and family and despite the fact that we see each other only twice a year when I am here, we are both keenly aware of each other’s existence in the universe. Each time that I am here, Daniel has had the entire group of residents and others with us over to his family’s home for dinner and it has always been one of the most remarkable and memorable experiences for each of them.

Entering Daniel Tewa’s Iraqw house

Daniel is a truly unique individual. He is someone who grew up during the time of Tanzania’s independence and has seen the country grow into what it is today. Having only a seventh grade education, he is one of the most informed people that I know, always telling us more about U.S. politics and history than most of us know and being the one to inform us of current events back home when we visit him as we do not pay attention to any new back home when we are here, either intentionally or unintentionally. He has twelve children, most of whom have been to college and are working in various parts of the country as accountants, court advocates, or in tourism. He continues to farm his property that is on the Gibb’s Farm road here in Karatu as well as land that he has near Haydom, several hours away. He is an authority on everything Iraqw and Tanzanian and every time we visit, I learn something new about him and this amazing country. As we all sat outside in the fading sunlight of this remarkable land, he tells us stories about our homes that most of us had never heard and stories about Tanzania. He serves us African coffee that is boiled with milk and water and is to die for. I had decided that it probably wasn’t totally appropriate for us to have dinner indoor given the pandemic, so we were just visiting for coffee today, but the experience was the same.

Daniel and his house in March 2020 demonstrating throwing spears under a rainbow

One of the highlights of going to Daniel’s home is a visit to the Iraqw house that he built in 1992 and continues to be visited by students and scholars of Tanzania history. After the Maasai had come to this region several hundred years ago, they began to cause trouble with the Iraqw over their cattle, which the Maasai believe were all given to them by God. I have heard this story from enough individuals of many of the tribes here over my years of visiting that I do believe it to be at least reasonably accurate. The Iraqw home was built underground so that it would protect the family and their animals, all of which would be in the house at night for protection. You could hear whether anyone was walking on top of the house at night and then protect against an attack.

Daniel Tewa’s goats including the little young one bouncing on the right

Before the Maasai had come to this region of East Africa, the Iraqw had lived in a Bantu style of house that is now quite common here. When Tanganyika, and then Tanzania, became an independent country in 1961, and then 1964, respectively, with its union with Zanzibar, there were over 120 individual tribes, all of which had their own villages and cultures. Julius Nyerere, the father of the country and their first president, quickly realized that it would be impossible to build a country of such distinct cultures in regard to the infrastructures, so he required that villages become multi-cultural and outlawed such unique features as the Iraqw house. Daniel’s home was built as a historical reminder and he and his family live in a Bantu style home currently. The Iraqw and the Maasai eventually signed a peace treaty, but that was not until 1986. If you search the blog for “Tewa,” you will find numerous photos and references to prior visits with Daniel and his family. For today, everyone was thrilled to sit outside in the gorgeous Tanzanian evening light with the sun setting in the distance, sipping Daniel’s African coffee and hearing stories of the past, present and future.

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