Our neurology mobile clinics have been a part of FAME since first traveling to the Mbulumbulu region in 2011 with Paula Gremely, who had then been in Tanzania for many years providing access to health services through her own non-profit and who had partnered with FAME to provide services on their larger monthly clinic visits to the Lake Eyasi region. It had been Paula (pronounced “Paw-oo-la” as Swahili pronounces every vowel) who had first suggested traveling to some of the smaller villages in the Karatu district to provide our neurology services with advance notice to the villagers. FAME had been providing a weeklong monthly clinic for all services to the Hadza and the Datoga, two tribes in the Lake Eyasi region, as part of a grant from Malaria No More, and I had traveled on several of these which were very successful (and very often, exciting), though after our first visit to Kambi ya Simba (“Lion’s Camp”), it became quite clear that there was a role for these smaller, dedicated neurology clinics.
The very first clinic was in a single Land Cruiser and consisted of me, Paula, Amira (Paula’s associate and driver), a clinical officer, Patricia (our nurse) and myself. We brought all the necessary medications and held our clinic outdoors as there was no health dispensary that was available to us for space. This first clinic was a great success and we managed to see a number of patients who were unaware that there was any treatment for their condition. I have always said that most often it is not a matter of the patients at these clinics being unable to get to FAME, but rather that they may be completely unaware of the fact that their condition is treatable so they don’t bother traveling to FAME. It is not uncommon at all for us to see an epilepsy patient at one of the mobile clinics who has had seizures for many years and had never seen anyone for their episodes or been on a medication.
So, for one of the four weeks we spend at FAME, we dedicate it to our mobile clinics, traveling to different villages throughout the Karatu district to provide neurology assessments for the residents of those villages. Just to be clear, though, these villages have government dispensaries that are typically staffed by a clinical officer, or, in the very least, a nurse, who provide routine medical services for the residents. Our role is solely to provide neurologic services and we’re very careful not to cross that line or step on anyone’s toes by our presence. We are guests when we visit these locations and will only come as long as we are invited. The district medical officer has become well aware and very supportive of these clinics over the years, though there have been times when our efforts have been misinterpreted by village elders as somehow being a money making activity and we have been asked to pay for each patient we see. We have explained to those villages that this is not the case and have simply left it at that as there are many other locations where the clinics have been appreciated and we’ve had fantastic partnerships with those villages.
This is obviously our mobile clinic week or I would not have prefaced this entry as I have. Since Meredith and Whitley were only here for two weeks and I wanted them to experience these clinics, I moved the week from our normal third week, to happen in the second week. Our team has increased in size from the single small Land Cruiser to now involving two vehicles and a host of other participants. Our group of seven, of course, with four clinicians/translators who would partner with each of the residents along with Kitashu, who would be the main organizer of the expedition, Christopher, our nurse, and a driver for the extra vehicle that would be required to help transport our team. We bring along a large container with all of the medications that are needed for the day and include not only our neurology meds, but also medications for blood pressure, in case they’re needed, antibiotics, antidepressants, antipsychotics, and whatever else we can think of. We also bring all of our old records from these clinics as we are not computerized, instructions for back exercises and whatever other paperwork we can think of that might help during the day. Oh yes, we also have to bring lunch with us and, for the last several years, have been in search of the best and equally affordable lunch box to bring with us. Today’s lunches would be coming from the Golden Sparrow, which we haven’t used in the past, and I, for one, was very enthusiastic to see what they would put in our lunch.
We were planning to visit Mang’ola, which is about a 75 minute drive from Karatu when the packed dirt and gravel road is in good condition and it is not raining as there are multiple gulley crossings that completely flood in a heavy rain. Given the distance to the clinic, it was decided that we would leave at 7 am, a not quite ungodly time to get two car loads of travelers together, but close, as there is typically much for us to do in preparation when we arrive. We have been traveling to the Barazani dispensary in Mang’ola for the last three or four years and it has been a very successful clinic both in the number of patients seen as well as the types of cases that we see. The dispensary is well-established and the clinical officer there, Dr. Damien, has been there for the entire time we’ve been visiting and has been incredibly happy to have us there seeing his patients.
We walked through the building to see what rooms we could use, and though we had originally chosen to use only three exam rooms given the number of patients, it wasn’t long before the “waiting room” completely filled up with patients and we quickly maneuvered to create four rooms so that things would move more smoothly. Thankfully, we had brought four translators to work with everyone and it was quickly off to the races for the residents. Whitley and Meredith did most of the staffing for the day and I supervised, which means I sat and tried to work on my blog as much as possible. In addition to our regular crew, Shama, our infectious disease volunteer at FAME, has come along to join us and see what the mobile clinics were like. One of the patients we were asked to see today was a young girl with a reported heart problem and since both Shama and Natalie were there, it seemed like as good of time as any to tackle the problem.
As is typical here, what is billed never seems to be case, and the plot thickened as her mother told the story. When she was much younger, she had reportedly contracted TB, though the therapy her mother described didn’t seem to be adequate if that was indeed what she had been treated for. The child was clearly small for her age and had been born prematurely, but her mother also gave the history that she had a heart condition but did not specify exactly how that had been determined or whether she had ever received a specific treatment for it. So, we essentially had a very young child who needed a very thorough cardiac and infectious work ups that were clearly not going to occur at the Barazani dispensary and the fact that needed to come to FAME to have a number of lab studies as well as an echocardiogram was clearly evident. Her mother did not have the necessary bus fare to get to Karatu (5000 TSh, or slightly more than $2 each way for each mother and child) so it was given to her by Kitashu (from me, of course) and she would come on a specific day when all of us would be there to direct her care. Where was the neurological problem, you might ask? There wasn’t one, but as it had been Dr. Damien who had asked us to look at the child, it was perfectly appropriate for us to facilitate the medical services that this young child would need.
There were quite a few patients for us to see here, but the patient that really stuck out for me was a young 25-year-old gentleman that Peter was seeing who had been suffering with epilepsy since he was 12 years old and who was having several generalized tonic-clonic seizures a month. And throughout this entire time, he had never seen a doctor and had never been put on any anti-seizure medication. During the visit, the patient had one of his typical seizures with his typical semiology of a focal onset and then secondary generalization. The seizure lasted for over a minute during which time he was rolled on his side and his head was protected. He had clearly bit his tongue as he spit up some blood and was then post-ictal for probably 15-20 minutes during which he was initially a bit combative and then confused. All in all, though it was unfortunate that he had the seizure, it was incredibly helpful to us to have witnessed the onset of the event as it confirmed his seizure type and on which of the anti-seizure medications he would be started. He was placed on carbamazepine, a very common and inexpensive medication here and one used primarily for focal onset epilepsies.
It was not until all was said and done and the patient had left clinic after receiving his medication and epilepsy education that Peter informed me that the patient and his father had traveled 5 hours on a boda boda (motorcycle) to come to our clinic after having heard that we would be there from one of our announcements. Though there is little question that the work we have all done here at FAME and in the surrounding communities have made the difference for countless individuals over the last twelve years, it is still stories like these that impact me the most. Knowing that had we not made the effort to continually return to Mang’ola and the Barazani dispensary, this young man would never have been brought here and would still be suffering from an entirely treatable condition with little hope in his life.
Our day had been steadily busy and it was now time for us to pack things up and begin the drive home. We had seen a total of 40 patients between the four residents with Whitley, Meredith and me staffing (supervising) them. Dr. Damien met with Kitashu and me for a few minutes before our departure to discuss our future clinics with them and we were thankful for being invited back to a dispensary where we could make an impact on the health of the community. Tomorrow, we would be visiting a different dispensary in Mang’ola, but would also drop off some medications that we hadn’t brought with us and were necessary for patients. We bid everyone in Barazani goodbye and began our journey back to Karatu, arriving home around sunset. Tomorrow, we would be making the same journey to another village nearby.