For those of you who are not Class B movie historians (if you are, I am sorry), the movie If It’s Tuesday, This Must Be Belgium was a romantic comedy that starred Suzanne Pleshette and covered a group of American tourists traveling around Europe on a busy schedule. If you happen to have missed it, there are no worries as the title is surely enough to imagine the entire gist of the movie sans the love affairs.

Meanwhile, the significance of the time of year remains as we are all poised to begin another adventure to East Africa to provide neurological care to the population of Northern Tanzania and neurologic education to those caregivers at FAME who will continue to care for the patients we see in between our every six month visits. With the work that we have done to date and the help that we have received from FAME, we have developed a first class system for the delivery of neurological care, or any specialty for that matter, where there are no specialists and, more importantly, do it in a sustainable fashion. But it is undeniably clear that none of these successes would have been possible without the incredible infrastructure that is FAME and without the hard work of all those individuals on the ground in Tanzania. For that we will be forever grateful.

Our neurology program, bringing residents, medical students and additional neurology faculty to FAME has also continued to grow as would be expected over the last decade plus that we have been traveling to the Karatu region, and it is out of this growth that we have found other opportunities to improve the neurologic health of the population of Tanzania. As I have mentioned in the past, we have accumulated data on our patients into a database whose sole purpose was to provide the necessary internal information, such as medications and supplies, where patients were traveling from to see us, what types of neurologic illnesses we were treating and in which tribes, so that we could continue to provide the most efficient and cost effective care possible. What developed, though, was an incredible treasure trove of data that would apply not only to our beloved specialty of neurology, but also to many other specialties that had not yet developed a presence in the rural regions we were serving. Thus, began our “database project” that has now involved a number of researchers at the main government teaching hospital in Dar es Salaam, Muhimbili University, as well as those caregivers at FAME who have been working with us over the last years. We were poised to begin our work in earnest in 2020 when the pandemic hit which has merely delayed the project.

And it is through this relationship with Muhimbili University of Health and Allied Sciences (MUHAS) and Dr. Bruno Sunguya that I visited the medical school last October, only to discover that there were two neurology fellows there who were eagerly waiting for my arrival and were like sponges for as much information as I could humanly supply. Even though I had only been able to spend less than a week with them before heading home, it was incredibly productive and has now developed into what I hope to be a longer term relationship between Muhimbili, University of Pennsylvania and FAME. Next fall, I am hopeful that the two new neurology fellows will come spend the month with us at FAME, working side by side with our residents and the FAME clinicians. Inshallah.

So, it is on the background of these new developments in global health involving FAME, Penn and Muhimbili University, that we embark once again to the now enlightened, “Dark Continent,” a term that I use only from the standpoint of its historical background. Where we are traveling and living for the next month will be not only the furthest from dark, but will be a journey of exploration and enlightenment, both individually and as a group, both personally and professionally. It is truly difficult to put into words just how meaningful this experience can be for those who participate, and I say that not just from the standpoint of what I wish it to be, but rather from the direct feedback of those 40+ residents who have accompanied me to visit FAME over the past decade. Practicing in a low-resource setting, such as that in East Africa, provides an education of its own, from the cultural differences in which we live and work here, to the decisions that we make with our patients and the unintended consequences that can occur if one is not careful. It is nothing short of an intense professional course condensed into a single month.

With the restrictions placed by the pandemic on who could travel and who could not, we had to forego keeping a spot for a medical student this trip, though that opened up extra room in addition to the four residents. Whitley Aamodt, who had traveled to FAME in the fall of 2017. and who has now completed her movement disorder fellowship (think Parkinson’s disease for you non-neurologists) elected to come for a second visit now that she will be staying on as a faculty member at Penn. Meredith Spindler, another movement disorder faculty member at Penn, will also be joining us as she has been considering this return to Tanzania for several years, having spent some time during residency at Bugondo Medical School in Mwanza on Lake Victoria.

The residents who will be arriving a day later than us, allowing me time to get Turtle in order for our travels, include Savannah Quigley, Alex Pfister, Natalie Ullman and Peter Schwab. Natalie is our Children’s Hospital of Philadelphia representative and a very necessary addition to the team, while Peter has been to FAME previously as a medical student accompanying us. In fact, Peter was the very first medical student to come with us, having paved the way for this possibility.

Our flights from Philadelphia have been uneventful thus far considering my two previous trips. In March 2021, I was stuck in O’Hare Airport for two days with a passport that didn’t have a full empty page, eventually receiving permission to fly from immigration, and my last visit in September, having arrived to the Philadelphia Airport with a COVID test that had been too early after they changed the requirements from 72 hours prior to departure to 72 hours prior to arrival. Dr. Frank’s expression of “TIA,” which has an entirely different meaning than what most neurologists think and instead meaning “this is Africa,” pretty much sums it all up and apparently extends outwards to include one’s travel to and from. These types of plans with so many moving parts requires a combination of skill, luck, ingenuity, and the realization that we will eventually get to where we are going. But if all else fails, we must be confident that there is someone, or something, looking down upon us that is ultimately directing this great journey that is life. I am often reminded of a saying that I read in one of the mountaineering survival sagas that I am so found of: Good judgement comes from experience, and experience comes from bad judgement. A good example of this was having our tire fall off the Land Rover last March while driving in Tarangire National Park – the result of tightening the lug nuts with the vehicle on the ground after having had a flat tire. I will never make that mistake again.

We will be landing at Kilimanjaro International Airport in several hours and even thought this is my 25^th trip to Tanzania, I can still recall the excitement of my first, something that I know each of the residents who are on their first trip will also have the chance to experience. Kilimanjaro International Airport, or KIA, is a tiny speck of an airport that caters to only two carriers arriving each day from off the continent, while a host of African carriers arrive throughout the day from such sites as Dar es Salaam, Nairobi, Johannesburg, Kigali, and such. Arriving on a widebody jet from off the continent such as we are today is a site to see as the airport suddenly becomes a sea of activity with lines forming everywhere for purchasing visas, moving through immigration and then through customs, and now, during the pandemic, having a rapid test done at the airport despite that fact that we have all tested negative just to board our originating flights. Thankfully, obtaining a visa has now become a streamlined process on the internet, though I will have to admit the TIA adage definitely applies here as it became a bit of group effort as the website was determined to take some credit cards and not others in a hap hazard fashion that left us relying on Venmo to send funds back and forth. This is Africa.

The drive from Kilimanjaro to Arusha is an incredibly colorful one, traveling first along the foothills of Mt. Kilimanjaro that dominates the landscape at nearly 20,000 feet, though it is most often in the clouds and unseen, and then to the slopes of Mt. Meru that dominates the skyline around Arusha. At 15,000 feet, it is higher than anything in the continental United States. All the while, we’ll be traveling through the small towns of the Arusha district that saddle the highway, each with its own hustle and bustle of the daily life that goes on here. We’ll soon arrive to Leonard and Pendo’s home in Arusha, my Tanzanian family, who have feed and housed countless residents while in transit to FAME. Leonard was my safari guide in 2009 when I first came with my children and it is he who is responsible for introducing me to FAME and everything that has followed. Our lives have become hopelessly intertwined for more than a dozen years and through them I have learned much of the Tanzanian ways while watching their two oldest children grow to become simply amazing young men.