Our day in the Crater and visit to the Crater Lodge had been incredibly memorable and now it was time to get back down to work. Mobile clinic has been a staple of our month of neurology here at FAME over the last ten plus years and began initially at the suggestion of Paula Gremley, an expat who had lived in Tanzania for over sixteen years when we first met, and had partnered with FAME during the early days. After one of our larger mobile clinics to the Lake Eyasi region where we spent a week in the bush, she had suggested that we travel to the Mbulumbulu region nearby Karatu to visit some smaller villages and provide neurology care for individuals who, even though travel to FAME was possible, were not aware that treatments possibly existed for their conditions. We had traveled originally as a very small group – me, Paula, a clinical officer and a nurse as well as Paula’s associate, Amiri, who did the driving. We visited several villages during each of my visits and continued doing so long after the Lake Eyasi clinics ended, thus maintaining the tradition of FAME’s work in communities remote from Karatu.

These clinics have become an integral part of our work here and have typically occurred during the third week of our visit as this seemed to work the best in regard to the timing of visits and the ability to have some of our patients return at the end of our time here before we left. During the pandemic, though, we were unable to have the clinics due to safety concerns and so, it had been well over a year since we had traveled away from FAME other than to Rift Valley Children’s Village. Though we hadn’t originally planned to do any mobile clinics this visit, the opportunity presented itself for us to travel to the region of Mang’ola for one or two days to provide neurologic care in this community. When we had last traveled there in March 2020, we had seen our highest daily volume and it seemed to make sense for us to travel back to both the town of Barazani and the village of Mbuga Nyekundu, both near Lake Eyasi.

Lake Eyasi has to be one of the more remote regions that I have visited, or at least it has the feeling of being so. In the early days of FAME, we used to travel to the village of Gitamilanda which was much further along the shore of the lake and where the Hadzabe, the last hunter gatherers of Tanzania, lived alongside the Datoga. In comparison to Gitamilanda, Mang’ola and Barazani seem like a metropolis, but in reality, this is also a very remote region with little in the way of resources. The drive from Karatu is a tough 1-1/2 hours along one of the bumpiest and “wash-boarded” roads you could ever imagine. The trick to driving these roads is to do so at a fairly high speed to make the bumps less noticeable, or perhaps it’s just to get there quicker and suffer less. Regardless, it is a torturous drive and I suspect much better for the driver than for the passengers, considering we had two vehicles packed full with passengers.

I drove the entire neuro crew in Turtle since there now eight of us including myself, meaning that we had a single empty seat in the middle back that was vacant. We rented another vehicle and driver from Kudu Lodge for the support staff that included Dr. Anne, Dr. Revo, and Dr. Leeyan, all our interpreters, and then Joel, our nurse, Kitashu, our coordinator, and Prosper, our volunteer coordinator who would take photos for FAME. We brought with us all the medications that we might need to prescribe to the patients we would be seeing and all of the tools that we’d need for our work. We had picked up box lunches in town for everyone and had plenty of water to last for the day or a possible breakdown along the way. We drove in tandem with Turtle following as I wanted to make sure I remember the way, but this also meant that we would have to eat the dust of the other vehicle and given the dry gravel roads we were driving on, there was plenty of dust to spare.

We had planned to leave at 7 AM, but by the time we picked everyone up in town, got the lunch boxes and other necessary supplies, it was more like 7:30 before we got onto the road. We had a bit of tarmac until the turn-off for Mang’ola and then it was gravel and washboards for the remainder of the drive until we reached our destination. Despite the condition of the road, the drive is absolutely gorgeous as it travels through spectacular countryside. We travel through numerous ravines that look as though they are completely washed out every year due to the torrential rains that must come down during the wet season. There are places where we are driving over long stretches of rock and others where you would have to avoid a complete lane having been washed out. Needless to say, you had to be on your toes every moment of the drive as you never knew what was coming next or whether a herd of cattle might be crossing the road around the next turn. Challenging is an understatement.

As we came over the last hill, Lake Eyasi lay before us looking like a mirage in the middle of a vast desert, but, in fact, it is one of the very large lakes that populate the Great Rift Valley that runs diagonally through all of East Africa. It is the same Great Rift Valley that became the cradle of mankind several million years ago and populated the remainder of our planet with our species. We drove through the dusty streets of Barazani heading towards our destination which was the local dispensary where we had visited previously. Local dispensaries are the small government health clinics that provide the vast majority of care in Tanzania and are typically manned by a clinical officer (the equivalent of a nurse practitioner) who provides all of the necessary medical care that doesn’t require a trip to a major facility. They will even do minor surgical procedures in the local dispensaries and certainly all of the deliveries that do not require C-section.

The clinic had already anticipated our arrival though it still required that we organized the rooms with the necessary equipment for us to see the patients here. In the past, we have worked in rooms with only beds, labor and delivery rooms, desks in the middle of an open area in the forest and the likewise, but here we actually had decent rooms that in short order were equipped with at least a desk and several chairs or a bench to accommodate the patient and the caregivers. I had opened all of the windows to get some type of ventilation, but the large metal doors kept slamming in the breeze with a bang so I quickly whittled several door stops from the local foliage to keep the doors open. Necessity is the mother of invention they say.

Once everyone was settled in, we began seeing patients and there were a moderate number there as we’d been here several times before and the local population were aware of our coming today. Dr. Annie gave her standard talk to the patients who had gathered regarding the types of illnesses that we treated and that we were not here to treat general medical conditions or joint pain. This is often an issue for us as many patients come because of the flat fee that includes a month, or sometimes more, or medication. This screening is essential as we are not here to replace or compete with the local medical officer by doing general medical work and have always made sure to maintain that boundary. The day was a steady smattering of both new and return patients as well as patients with various neurologic conditions. One patient we saw had, in addition to her neurologic issues, which were minor, very significant medical issues with marked edema and hypertension. I believe that her neurologic treatment would have consisted of amitriptyline, though without knowing what her cardiac status was, we did not feel comfortable prescribing this her without an EKG or labs. We eventually recommended that she come to FAME for a medical evaluation and laboratory tests to confirm that she could tolerate the medication.

We had finished seeing all of the patients within a reasonable amount of time meaning that we might be able to do a bit of site seeing prior to our departure from Mang’ola. Since the town is on the shore of Lake Eyasi, though, there had to be a beach somewhere close and the others offered to take us there. I had no idea of what to expect, but it certainly seemed like it would be something fun to do, or at least a great exploration. I had been to the lakeshore of Eyasi far southeast of Barazani a number of years ago on one of our visits, but the lake in that region was mostly dry at the time and we were able to walk far out into the lake on the mud flats. As we had come into town earlier in the day, the lake was clearly quite full and I was sure there must be a reasonable beach for us to find. We had the two vehicles and I had no idea where we were going, but we wound in and out of homes along the way, driving much further than I had anticipated, at times the road becoming much narrower than our vehicle, until after long last we could see the water.

As we approached, there were tents that made me thing people were camping here, but, in fact, we had come upon an encampment of fisherman and their families who were clearly living on the beach during the fishing season. There were rather primitive boats pulled up onto shore and the lines for nets strewn across the beach. We drove out onto a spit of land where there were cattle and goats grazing and parked our vehicles at a high point on the land a bit away from the water, but close enough for us to keep our eyes on them. Everyone clambered out to enjoy the sand and the water and to watch the fisherman working their nets. What we later came to realize was that the nets were strung far out into the lake with glass globes as floats that you could barely see as it was directly looking into a very strong sun reflecting off of the water. It was a gorgeous scene, though, and there was absolutely no sense that we were intruding in any way. There were children running around who were appropriately shy upon our arrival, but eventually warmed up to us as I had no trouble at all entertaining them with my camera, which they thoroughly enjoyed and managed to take a few photos that were halfway decent.

We all watched as the fisherman slowly dragged their nets onto shore, using old burlap sacks as slings around their bottoms while they creeped backwards in unison, tugging on the ropes. It was a long and arduous task to slowly haul in their nets, obviously heavily laden with the tiny sardines that are brought in and dried in the sun, then serving as a staple protein for many. At one point, Kitashu apparently asked one of the fisherman if he could take some of us out on the lake in one the boats, which he agreed to do and promptly found enough volunteers for at least two boats full even though it was clear that the boats were not completely watertight, thus leaking water and requiring them to be continuously bailed during their voyages. Someone did comment on the fact that everyone was voluntarily, and excitedly at that, getting into a boat that was knowingly sinking and somehow this didn’t seem like a very smart idea. Regardless of the poor seaworthiness of the boat, everyone did seem to have a wonderful time, though, paddling out onto the lake without the fear of sinking, or, if they did, they didn’t mention it nor did they seem to mind. There were enough fearless thrill seekers for two complete boat rides out onto the lake and, had the boat actually sunk along the way, I’m sure they probably could have swum or walked to shore without difficulty.

At one point, we began helping the fisherman drag in their nets, but this didn’t last for long as it was clear that it was going to take some time to get it close into shore and, with a long drive home, the daylight was quickly waning. We did have enough time, though, for Denise to try out one of their butt slings and in doing so, she got some necessary instruction from one of the younger fisherman along the way. I joked that I thought being hooked up to the same line hauling in the fish meant that they were now married, but, that didn’t seem to be the case and we were allowed to leave with Denise and without a fight thankfully. Though we were clearly outnumbered by the many fisherman and their families, I am certain that it would have been an even battle in the end.

Our visit to the beach had been a truly unexpected and lovely experience, but that is so often how things happen here. It is perhaps this spontaneity and near expectation of the unexpected that makes everything so exciting on our visits. This is certainly the case when out on safari as you never know what you might along the way such as our caracal experience in the crater and our visit with Philippo whom I had never met before despite having traveled the Gibb’s road dozens and dozens of time before. Each day here brings a new adventure.

We left the town of Barazani with great memories and the knowledge that we had left part of ourselves with the patients and the fisherman of this remote and dusty town. We would be heading back to another village in Mang’ola tomorrow and who knew what our next wonderful adventure would be along the way. The road home was long and dusty and bumpier than you could ever imagine, but no one complained for this is Africa and the experiences will last a lifetime.