Saturdays tend to be the quieter day of our work week, though we still had to see the last third of our patients from Food for His Children to be seen today and, along with the regular patients to be seen, it would make for a busy day for us. We can regulate the number of patients that we see in a day as the majority of patients are coming from Karatu and having them come back the following day typically isn’t a huge chore for anyone. For those patients coming from a distance, though, returning another day can be a hardship and therefore we try to do our very best to see them that day, but if we can’t, they will usually stay in town overnight with relatives as everyone seems to be related in East Africa and a place to stay is never an issue for that reason.

Alex went up to the hospital this morning to see the patient in the ward who we had been consulted on and unfortunately, he had died overnight. He had looked extremely bad the night before with a significant change in his exam that had worried us about worsening increased intracranial pressure and even possible herniation so it did not come as a complete shock perhaps. Be that as it may, I don’t think Alex had necessarily expected to have found that news on her arrival to the ward and gathering a detailed breakdown of what had happened is not always as simple as one might think given the complexities of these patients. The most important thing, though, is for everyone to regroup and process the information with the hope that we would all learn something from it. Ultimately, it is unclear that we could have done differently in this case other than to have put him on anti-seizure medication when he arrived, but it’s not even entirely that was his problem at the end.

There is no morning report on Saturday as the staffing at FAME  is much more streamlined on this weekend day, allowing everyone a much needed additional 30 minutes of sleep (except for Alex, of course) . We had been out last night at Gibb’s Farm for dinner and, though it hadn’t been a late night, it had been late enough and all of us took a few extra minutes to get ready for clinic. Once clinic was up and patients were being seen, I had an errand to run as Turtle’s engine temperature gauge hadn’t been working properly and I had wanted it repaired prior to heading to Ngorongoro Crater tomorrow or for our week-long mobile clinic the following week. Driving around East Africa without a working temperature gauge is not a smart thing to do given the fact there is no Automobile Club here to rescue you or even service stations once you leave the tarmac, which encompasses the majority of roads here throughout the region.

I have a mechanic here in Karatu who has worked on my vehicles over the years and who I was introduced to by FAME. He has literally come to my rescue on numerous occasions during my visits here – such as completely rebuilding the clutch plates in a Land Rover the day before we needed to leave for Arusha or driving all the way out to Mbulumbulu to install an alternator in our completely incapacitated vehicle as the sun was going down. Soja has been available to me at a moment’s notice, always managing to do the necessary repairs despite our always needing the vehicle back right away for some new expedition, whether it be to mobile clinic, for a game drive, or just to take our group to dinner at one of the local lodges. Today was no exception as he tested and replaced the temperature sensor, topped off the engine oil, checked the other fluids and made sure that Turtle was in tiptop shape for tomorrow’s game drive to the Crater – and all for 50,000 TSh, or about $21.

Once repaired, it was back to check on everyone in clinic at FAME and to make sure that things were running smoothly, which they were. As our waiting room continued to expand throughout the morning and it became increasingly clear that it was going to be another blockbuster day for us, one of our patients promptly decided that it was time for them to have a convulsion on one of the benches. As one can probably imagine, advertising throughout the community that we will be holding a neurology clinic, when you cast your net so widely it will be very likely that you will land at least one patient with an active seizure disorder. As I learned many, many years ago in training, the first rule of epilepsy is that epileptics seize and that the second rule is that if you don’t take your anticonvulsants, they won’t work. So, putting a bunch of epilepsy patients into the same confined space, there is at least one who will have a seizure waiting to see you whether they are taking their medication or not. Once the commotion was over with patient now postictal and stable, everything settled down with everyone getting back to the work at hand – more and more neurology patients.

Natalie evaluated three young children (a set of 9-year-old fraternal twins and a 3-year-old sibling), all of whom were clearly affected with the same syndrome manifesting as cognitive delay and functional impairment. One of the twins was paraplegic and the other had a spastic hemiparesis. The 3-year-old also had a spastic hemiparesis and had been born prematurely. They all had a similar syndromic facial features with almond eyes and macroglossia. The mother had normal older children and a normal younger baby. We explained to the mother that the children most likely had a genetic syndrome affecting the three children, though she informed us that the reason for their problems was that she had had a fight with her in-laws prior to the birth of the twins, but had eventually made up with them after the first of her 3-year-old which was why the younger baby was not affected. Other than providing recommendations for therapy, there was little else for us to do here as there is no access to genetic testing here, which is not surprising as it would not change our management.

Though we had plans to head out early for dinner again tonight, our clinic ran longer than expected and we had to depart later than anticipated. We were heading down to the African Galleria and its new Ol Mesara restaurant that was designed and build just prior to the pandemic, but has really only been open over the last year due to the decrease in tourist traffic. The food is simply amazing and everything is wonderfully cooked in traditional Tanzanian style with just a little bit of flair to make it that much more interesting. Though all the food was to die for, I think it was the cheese samosas that were everyone’s favorite for the night. The drinks, though obviously not traditional, were equally delicious and very creative. The night was finished off with the entire staff dancing around our table singing “jambo bwana,” then happy birthday while banging just about every item from the kitchen you could imagine in a wonderful cacophony even though my birthday had been several days prior. I guess there’s no harm in celebrating one’s birthday over a week.

It was another lovely night out and as we drove home in the dark, plans were made for our game drive to Ngorongoro Crater the following day and the necessary preparations. We filled Turtle with diesel fuel and picked up two cases of bottle water for the day. At home, the residents worked on preparing our lunches for the day out – peanut butter sandwiches with either jelly or banana, hard boiled eggs, sliced cheese and whatever else we could dig up from the kitchen. We would be leaving at 6 am in the morning as the gate to the NCA opens at 6:30 am and it’s always best to get to the crater floor as early as possible.