With the long and dusty drives to Mang’ola now behind us, it was time for our shorter and more sedate drives to Rift Valley Children’s Village near the village of Oldeani and in the middle of a very rich agricultural region growing coffee and large fields of other crops. With the shorter drive, we were able to leave much later, giving us time to attend morning report, or for others to escape to the Lilac for coffee and breakfast. I have been visiting RVCV since my very first visit to FAME to work with the clinic. Early on, FAME had been providing semi-monthly medical clinics to RVCV to care not only for the children who live there, but also for the local villagers and area that surrounded them. Over the last years, though, our neurology clinic every six months is all that remains of the mobile clinics to RVCV. All toll, I have visited there on dozens of occasions considering this is my 24th visit to FAME and we attend there on at least two days every visit.
Rift Valley Children’s Village is an incredibly unique institution that first opened in 2004 when India Howell and her associate, Peter Mmassey, decided to adopt 17 orphaned children and create a home for them. From that humble beginning, the village has now grown to a home for over 100 children who have all been adopted by India and Peter, spending their lives in the comfort of their family rather than having the fear of adoption hanging over them. Along the way, India and Peter have not only raised those children who have called RVCV their home and family, but have also created mechanisms to better the community concerning health, education and economy. The Tanzanian Children’s Fund now also oversees a dispensary at the village with a clinical officer (Africanus, who first came to FAME and worked with our neuro group several years ago, before working with FAME formally and then moving to RVCV), funding for the local schools to assist with hiring extra teachers at both the primary and secondary levels, and an economic project, the Rift Valley Women’s Group, training women from the local village to manufacture and market local crafts and enabling them to support their families.
I have known and worked with several of the older “children” that have grown up at RVCV and they have all be totally remarkable. A number of them have gone on to the university to study medical fields. Selina, who had worked with our neurology team for several years as a translator eventually found work as a nurse at FAME and when we arrive this visit, she had just had a baby. I am reminded on every visit to RVCV just what an amazing place it is and how incredibly well-adjusted the children are which is no surprise given the amount of love they receive from the family they now have. There are multiple houses for the children, each one for a particular age group and sex and each with its own house mother who cooks and cares for the children that she supervises. There is a pre-school within the village and the primary school is adjacent to the village while the secondary school is a further distance away. The test scores of the children of these schools far exceeds the national average meaning that far more children advance to secondary school and university when it is time.
When we arrive at the village, there are always patients sitting outside on benches waiting for us and all have been checked in by Africanus with their charts split into pediatric and adult cases. Our patient list includes not only Mama India’s children from the Village, but also local children and adults from the surrounding area who have come to see us for their neurological problems. Many of the patients we have seen before, some for years, and they have returned religiously to receive their medications, many of who have epilepsy and have been well-controlled. In between our visits, Africanus has been managing their care with occasional emails to me about specific patients and perhaps medication adjustments. The patients from the Oldeani ward who receive their care from the dispensary all get their medications for free so compliance is less of an issue here.
Rift Valley Children’s Village and the Tanzanian Children’s Fund are the main reason that FAME is where it is in Karatu, only 45 minutes away when the roads are good, as India suggested the location to Frank and Susan with one of the main reasons so that FAME could provide the medical care to her children and the surrounding community. From their beginnings, FAME and RVCV have remained inexorably linked and continue to be for the health of their communities.
The drive to “Rifty” is an incredibly lovely one that courses through expansive cultivated fields and homes of the farmers, often on the hillside, that are mud huts with thatched roofs adorning a small solar panel to charge their phones. Our road drops down into the ravines on several occasions, a steep decline on rocks and ruts as well as the large angled gutters to divert the rain water and keep it from completely destroying our path. It is the dry season now so there are no worries about travel, but in the wet season, this road becomes a slick and muddy mess that is always a challenge.
My first driving in Tanzania was on this road when I was traveling in a small truck with other FAME workers who had just learned to drive. Two of them were unable to make a sharp first gear turn at the bottom of a ravine and then keep the car moving steeply uphill without stalling it. Eventually, I offered to get it up the hill and they all gladly accepted so I drove the rest of the way to the village. When we were ready to head home, I again offered to drive if they wanted me to and, much to my delight, they accepted my offer. I have been driving here ever since and do consider it a badge of honor as it is not common and I am always complimented on my driving by the Tanzanians. Those who know me well will understand this.
I believe I heard a huge sigh of relief from everyone in my car (the FAME staff rode in a RVCV Land Rover that had come to pick them up) as we pulled into the children’s village for our visit as despite how gorgeous the drive is, it is still tremendously bumpy. We piled out of the vehicles and everyone was introduced to Africanus and the RVCV staff who would be assisting us for the day. It is incredibly orderly here unlike most of our other mobile clinics as Africanus has already triaged all of the patients and pulled charts on those who had seen us in the past. Having past history on patients is essential, especially in those who have been on medications in the past and it’s necessary to know which ones may have worked and which ones hadn’t. Unfortunately, we do not have the FAME EMR here to retrieve records which was a significant problem with one of our patients today as you will see.
We saw many epilepsy patients today and the vast majority were well controlled on their medications. We can’t check labs here, but for those patients needing labs, they can get them at FAME as part of this visit and RVCV supplies all of the transportation to and from FAME for any patients needing to go there. There are typically cars going to Karatu several times a day to pick up supplies and transport patients. One of the patients that came in today to see us was a 12-year-old boy with Duchenne’s muscular dystrophy who we had followed in the past. He was severely quadriparetic now and had to be carried by his mother to get into his wheelchair at this point. He was still swallowing and breathing fine, but who knew how long that would last. His mother and he were incredibly stoic and clearly knew the score since he had two older siblings who had died of the disease previously. We had tried using steroids on him in the past, but to little avail and they were no longer appropriate given the extent of his disease and his deficits. This condition is no more treatable in the US than it is here, but somehow there just seems to be a stronger sense of helplessness here, perhaps borne out of the general lack of medical care here or perhaps due to the difficulty of obtaining aggressive rehabilitation. We would continue following the young man and attempt to make his life easier, though his fate is obviously sealed and he does not have much time left.
The interesting patient we saw today was a bit more of mystery for us, or at least she was until we were finally able to access her FAME records later after we returned home. She was brought in by her daughter who had helped to supply the necessary background information, but apparently this was not at all accurate and made little sense to what she looked like clinically. She had a hemiparesis also involving her facie that had been progressing since it began months ago. The patient had apparently been seen initially at FAME, received a CAT scan and was then transferred to another facility. Then the daughter said she was told that it was a bleed that was outside of the brain, but inside the skull which certainly sounded like a subdural hematoma that may have been expanding. There was still something that was not right about the history or her examination and it was eventually decided that she would come to FAME to see us after the weekend to see us after we had a chance to fully review her records and hopefully look at the CT scan she had had and get a repeat one if that was felt necessary.
We finished up our work at the Village having seen a good number of patients and made our way back to FAME. I always drive an alternate route on the way home that takes us through difficult fields and bypasses some of the bigger bumps. It does travel down and then up some very steep hillsides though that are taken quite slowly (first gear all the way uphill), but the views are again spectacular and he weather was truly gorgeous. As we’d be back to the village again tomorrow we were able to leave our box of medications there in the pharmacy and we a list of the additional medications needed to restock that would be obtained from FAME. It was an early evening at home to relax.