Today had been planned for a half-day in clinic, which was good given the issues with getting Paul and Kelley here on time. For the last several years, we have inserted two “wellness” afternoons for the residents during their time here that would essentially mimic the procedure back used at home, though the wellness days are normally to take care of personal matters such as doctor’s appointments and the such, none of which occurs here. I have never argued with the request, of course, as it keeps the moral up for the residents, who are typically working six days a week and could use a break. My only argument to this plan has been that the entire month working here is really just like one big continuous wellness day given what we are doing here and the pleasure that comes from it. Regardless, I was instructed to insert tow half days for the residents which means it’s a half day for me as well.

There is no morning report on Saturday and it was Sean and Kerry’s last morning with us, so we all elected to go to the Lilac Café for breakfast and coffee. The Lilac Café opened around the same time as the inpatient hospital did as it became readily apparent that there needed to be a kitchen not only to serve the inpatients, but also to provide meals to the families who were here to visit their loved ones. Thankfully, it also serves as a place for a good meal, coffee, or even a cappuccino when one is needed. It has also served as home base for the medical students who have come us as a good portion of their work is data entry which can easily be accomplished with a good cappuccino and a cookie. Our breakfast there was incredibly relaxing and Anne, Revo, Leeyan and Kitashu eventually joined us, though none but Anne were tempted by the available options on the menu. I suspect that they all ate at home prior to coming.

During our breakfast, I heard from Kelley and Paul who had arrived on time in Dar es Salaam on schedule and now it was a matter of figuring out what the airline was going to do to help us. I had purchased tickets with FlightLink, a local Tanzanian airline, to fly them to Arusha with an arrival time of noon, rather than the 8:30 PM that their original Precision Air flight had slowly morphed into which would have meant that they wouldn’t be here in the morning to leave for the Crater, something Kelley had never done, nor had Paul. They had arrived too late to have even conceivably made a morning flight that the airline had later suggested, so I was on the phone all morning with Penn’s travel agency to see what we could do.

After multiple calls to the agency, who were very helpful, and numerous calls by them to Qatar, it had finally been determined that if they did not board the final leg of their originating flights, then their return trip home would be forfeited with no hope for a refund. Meanwhile, during these conversations, the two of them had boarded the FlightLink flight to Arusha which meant that they were absolutely not going to board the Precision Air flight they had originally been booked on. Qatar chose to take absolutely no responsibility for the repeatedly delayed code share flight with Precision, a flight whose time was no longer acceptable to them. To make matters worse, Qatar suddenly offered an earlier flight on Precision that had not been offered earlier, but since they were already in the air, that was an impossibility.

We were told by Qatar that the only option we had was to cancel their remaining flights and then rebook the return flights, but this had to be done prior to their previously booked, and massively delayed, flight took off, otherwise everything would forfeited and the property of Qatar Airways. The cost to rebook would be around $400 for each passenger. It was complete highway robbery in my mind and we were being held hostage to their technicalities without any chance for recourse or someone with common sense looking at the situation. World Travel was totally sympathetic, but Qatar Airways was completely unwilling to listen to reason. So, in the end, I made an executive decision to cancel their existing flights and rebook the returns for the additional fee, all while they were in the air, as there appeared to be no other choice in the matter. World Travel did offer to have their Qatar rep pursue the issue on our behalf, but I think it is very doubtful that anything will change after the fact. The important thing from my standpoint, is that the two of them arrive to FAME safely and the fact that they’ll be able to make the trip to Ngorongoro Crater was certainly an additional factor as we had already paid for that with the Conservation Authority who manages the Crater.

Meanwhile, we had to finish up our morning clinic to be free in the afternoon and perhaps the most interesting patient that we had wasn’t here at all, but his MRI was. The young boy who we had seen last week with back pain and unilateral leg weakness had undergone an MRI of the thoracic spine that was quite abnormal, but not in any typical manner that one would normally see. Unfortunately, Kerry had left this morning for the Serengeti as she would have been the perfect person to have reviewed the scan given the fact that she is a pediatric neurosurgeon. Thankfully, Sean was still here to review the study and we were all in agreement that there was a significant posterior extramedullary, intradural process that appeared to represent either flow voids representing spinal arteriovenous fistulas or a spinal subdural hematoma. Never the less, what we saw was compressing his spinal cord and undoubtedly causing his pain and neurologic deficits.

Now, the question was what to do about it. There is no place in Northern Tanzania that could deal with this type of a problem as he was going to need advanced imaging such as a spinal angiogram or spinal MRA, both studies that would require the proper center to administer them and then the surgeon to fully evaluate him clinically along with the studies. Quite atypical of the normal situation here, though, the boy’s family did have the resources to take him wherever the best center would be in Africa, Europe or Canada. Due to their insurance, they could not travel to the US to be evaluated or have surgery. We made the necessary inquires regarding various centers around the world and made the necessary recommendations to his family, who will hopefully be able to take him to a center that will be able to deal with his problem.

Clinic was finished by lunchtime (typically 1-2 PM here) and we all made our way home for the afternoon. Kelley and Paul had landed in Arusha by now and were making the trek to Karatu, typically about 2 hours, which was better than the three hours needed to make it all the way to Kilimanjaro. I choose to stay at the house, while most of the others decided to make the hike again to Gibb’s Farm as Akash had not done it before and Denise wanted to check if they had her sunglasses she thought she may have left the last visit. While at Gibb’s, they did take the opportunity for cold drinks and Akash was introduced to Stony Tangawizi, a strong ginger flavored soft drink made here in Tanzania by the Coca Cola Company. Meanwhile, Kelley and Paul arrive to FAME after their lengthy flights and detour in Dar. They were no worse for the wear, but were certainly exhausted. I sat and caught them up on recent events here at FAME and how things were going and what the plans were for the following day going to Ngorongoro. I had planned to pick up the residents (other than Emily who had stayed behind) at the carver’s shop or our new coffee supplier and was going to take Paul and Kelley, but seeing how exhausted they were, suggested that they both take naps and we’d wake them up for dinner later in the evening.

We drove up the Gibb’s Farm Road, back to Philippo’s farm to meet the others who had been shopping there and next door at the wood carver’s where Denise was determined to get a large painting that she liked. I had asked Philippo to save us some honey the next time that he was harvesting some, and he promptly brought out five small jars of the golden brown liquid that was like treasure to us. I quickly bought all five jars, figuring that we could work out who would be taking some of this amazing product later. Others bought more coffee and there was a huge crowd of Tanzanian guests visiting to sample his coffee. Denise did manage to get her painting for a relative steal. I drove everyone home after their hike and shopping spree and we hung out at the house until it was eventually time to wake up Paul and Kelley and to head out for dinner.

We ended up returning to the Golden Sparrow, but this time our mission was only for dinner and no dancing as we would be leaving early in the morning and needed to get home to make our safari lunches of peanut butter and jelly sandwiches for the following day. Though its precursor, Carnivore, had served only chicken and chips, the Sparrow has a full menu with many other items. Cat, as a pescatarian, had ordered fish and Akash, a devout vegetarian, had ordered lots of carbohydrates and a few vegetables, while the rest of us chose various versions of chicken with sides of chips (fries) or ugali and vegetables. Every restaurant here takes around 45 minutes to an hour to bring your food, so it was not at all unexpected that we enjoyed a drink before dinner was even close to having been served. We all traveled home with the same thought in mind as we’d be heading to the Crater early tomorrow morning with the anticipation of seeing the incredible sights of animals at the bottom of a caldera that is over ten miles in diameter and 2000 feet deep.